Marcus Grant is told there is no evidence that design and layout improve the health of neighbourhoods. He and others, however, believe it cannot be otherwise . . .

An absurd notion keeps me absorbed at the boundary where city-planning meets public health. As an urban planner, I am acutely aware that the design and layout of neighbourhoods, where ‘people live, love, work and play’, is strongly associated with outcomes for health and health equity. Apparently there is no evidence for ‘place’ to support healthier lifestyles. However, I can’t find any evidence saying that business-as-usual produces healthy places either.

I hear the constant refrain to reduce NHS and Social Care costs, but am always told that there are more pressing public health issues than healthy city development. However, from the mid-1990s, the connection between place and urban health, evidence or no, was embedded in the WHO European Healthy Cities Network. With the government again gearing-up for more house building, public health specialists would do well to draw on WHO’s Healthy Cities experience.

It goes beyond just healthy urban planning: the Health Cities approach is about spreading governance of population level health across a whole town or city. The top tier comprises about 100 cities, all displaying the highest political commitment to action on population health and health equity. Cities sign-up to five-year phases. The focus of the current phase is leadership and governance for health in all policies. Cities benefit through the political spotlight thrown onto their five-year programme of activity, and through access to expert and peer support. The next tier comprises about 1,000 cities, which belong to their relevant WHO Healthy City National Network, and benefit from national events, networking and access to WHO resources.

“the Health Cities approach is about spreading governance of population level health across a whole town or city”

Through analysis healthy urban planning, cities fall into one of three approaches.

  • Initially a city may undertake a few isolated projects. Using public health evidence and advocacy help to win the investment, success is an emergent collaboration between public health and urban planners.
  • Next is the creation of a ‘standing dialogue’ between public health and city planning, which allows more strategic projects to be tackled. Examples include a cross-city cycle highway connecting disadvantaged communities to the city centre.
  • The final step, and maturity, of the healthy urban planning approach is when the use of a ‘health lens’ starts to be embedded into the culture of how a city ‘does’ urban policy. A number of tools and policies emerge, backed up by strong relationships, with health influence extending into area such as strategic planning, urban regeneration, climate mitigation or transport investment. This is a whole systems approach.

Marshalling the evidence base and the arguments requires careful attention. Public health specialists wanting to create healthier cities need political backing and a network of peers. The WHO Health Cities network exists to provide that support. If, flying in the face of evidence, you believe in the absurdity of healthier cities, consider joining-up.

As published in Public Health Today “Getting the green light; The sustainability issue” Spring 2016, p11