Integrating health into urban planning practice
Submitting InstitutionUniversity of the West of England, Bristol
Unit of AssessmentArchitecture, Built Environment and Planning
Summary Impact TypeSocietal
Research Subject Area(s)
Built Environment and Design: Urban and Regional Planning
Summary of the impact
The populations of over 250 European and near Eastern cities are
benefitting from closer integration of health and planning. As a result of
research undertaken at the World Health Organisation Collaborating
Centre for Healthy Urban Environments (WHO CC), built
environment professionals have integrated concerns about public health
into their decision-making and, correspondingly, public health
professionals have engaged with how urban places affect health. Based on a
long-term programme of empirical study, this has happened through our
development, and subsequent operationalisation, of the concept of `Healthy
Urban Planning'. The adoption of our models, assessment tools and
appraisal methods, has fostered a new emphasis on urban development and
planning at neighbourhood level; the implementation of which has resulted
in more active lives, more inclusive communities and environments that
1993-2000: The importance of the neighbourhood as an urban unit of
scale and its vital contribution in meeting national sustainability
targets was defined by the preliminary research (Fudge) (R1).
Effective methods for broad-based appraisal of development plans emerged
from further research and were communicated widely (Barton) (R2).
These practical neighbourhood-scale tools were then evaluated and refined.
Building on these foundations, further research revealed correlations both
within and outside neighbourhoods, between propensity to walk, distance,
and type of amenity (Farthing and Winter). It concluded
that community physical activity levels and social inclusion were
dependent on access to local, everyday destinations and facilities.
2000-2008: Land use standards for local accessibility were
established (Barton) and through research with a network of
European cities, culminated in the development of the critical concept of
`Healthy Urban Planning' (HUP) (R2, 3, 4). The conclusion of this work was
the identification of 12 key objectives for HUP (R5). These objectives
translate key World Health Organization (WHO) health priorities such as
less obesity, better food access, fewer respiratory problems, better
mental health and a reduction in health inequalities, into spatial
criteria including access to local green space, access to local jobs, and
development of mixed, inclusive communities. Our research repeatedly
concluded that knowledge translation from the public health discipline to
planning is fundamental for creating healthier places. Through studying
the methodologies employed by cities active in HUP, an overarching
conceptual model for sustainability and health in the built environment
was developed and empirically tested. This was conceptualised as the
`Health Map' (R3,4), a now much used visual conceptual tool, with people's
health at the centre and global sustainability on the perimeter, clearly
indicating the required specific spatial planning and urban design
interventions. From 2000 onwards a sustained longitudinal research
programme was implemented. This included a time-series of annual analyses
of the implementation of HUP in 70-100 cities in the WHO European Healthy
Cities programme (R6).
2008-2013: Under the EPSRC's Sustainable Urban Environments
Programme, the WHO CC investigated local neighbourhood
accessibility and found significantly different walkability access
outcomes arising from different urban form archetypes (Barton and Grant).
Parallel analysis of population data supported setting design standards
for distance thresholds for walking access to local facilities. This,
together with a pilot study, supported refinement of a threshold technique
for participatory impact appraisal of development proposals. The `Health
Map' was then strengthened through evidence studies of spatial elements
that present risks and challenges to health in urban environments (Barton
and Grant) (R6). In particular, findings based on trials with a
range of disciplinary stakeholders lead to modifications and design
optimisation. As part of designation as the NICE Collaborating Centre for
Spatial Planning and Health, seven aspects of health in spatial planning
across different national planning systems at a trans-disciplinary policy
and capacity level were studied in depth (Carmichael, Gray and Pilkington)
(R7). Through systematic analysis of studies from European countries this
identified both systemic facilitators and blocks. It identified that the
separate structural and paradigmatic spaces occupied by public health and
built environment professions are a key blockage to developing healthier
settlements. Crucially, the research described the conditions under which
the wider determinants of health can be supported in spatial and urban
planning, leading to more effective, impact-focused activity (R 8,9).
Key research staff: Hugh Barton, 1973-2012, Professor of
Health and Sustainability; Laurence Carmichael, 2002-present,
Senior Lecturer; Stuart Farthing,1973-2011, Principal Lecturer; Colin
Fudge, 1995-2008, Executive Dean and Chair of EU Expert Group on the
Urban Environment; Marcus Grant, 1997-present, Associate Professor
for Healthy Urban Environments; Selena Gray 2002-present,
Professor of Public Health (in UoA3, Allied Health Professions
submission); Paul Pilkington, 2006-present, Senior Lecturer (in
UoA22, Social Work and Social Policy submission); John Winter,
1970-2003, Associate Dean.
References to the research
R1. Fudge, C and Rowe, J (2001) Ecological modernisation as a framework
for sustainable development: a case study in Sweden. Environment and
Planning A, 33, pp.1527-1546.
R4. Barton, H and Grant, M (2006) A health map for the local human
habitat. The Journal for the Royal Society for the Promotion of Health,
126(6). pp. 252-253.
Developed from the model by Dahlgren and Whitehead, 1991. "The main
determinants of health" . Accessible from: Dahlgren G, and Whitehead M
(2007) European strategies for tackling social inequities in health:
Levelling up Part 2. Copenhagen: WHO Regional Office for Europe.
R6. Barton, H and Grant, M (2012) Urban planning for healthy cities: A
review of the progress of the European Healthy Cities Programme. Journal
of Urban Health, 90(1), pp.129-141.
R7. Carmichael, L, Barton, H, Gray, S, Lease, H and Pilkington, P (2012)
Integration of health into urban spatial planning through impact
assessment: identifying governance and policy barriers and facilitators. Environmental
Impact Assessment Review, 32 (1), pp.187-194.
R9. Grant M. and Barton H. (2012) No weighting for healthy sustainable
local planning: evaluation of a participatory appraisal tool for
rationality and inclusivity. Journal of Environmental Planning and
Management, pp.1-23. http://dx.doi.org/10.1080/09640568.2012.717887
• Barton H (Co-I) Sustainability of land use and transport in outer
neighbourhoods (SOLUTIONS), EPSRC, 2004 -2009, Total project funding
£1,749,921, UWE project funding £409,560. UWE undertook all neighbourhood
scale work. Others in the consortium were Cambridge University, Leeds
University, Newcastle University and University College London.
• Barton H (Co-I) OUTCAST, 2003-2004, EPSRC, UWE Project funding:
£33,665 Scoping study on research into the sustainability of outer city
• Barton H and S Gray, Systematic Reviews to establish the degree to
which English planning processes incorporate health and well-being
effectively into plan-making, plan and project appraisal, monitoring and
review, National Institute of Health and Clinical Excellence (NICE),
• Grant M, Risks and challenges to health in urban environments,
WHO, Bonn Office, 2008-2009, £10,000, An international evidence review for
WHO and EU Commission policy.
• Grant M and Barton H, Annual Programmes of Work, as expert
advisors in the WHO Collaborating Centre for Healthy Urban Environments,
World Health Organisation, European Office, 2003-2013, Approx. £80,000.
• Grant M, Research and programme development for healthy urban
planning, South West Strategic Health Authority and the Department
of Health, 2008-2012, £163,000.
Details of the impact
The research findings and practical tools and approaches developed by the
research team have been adopted and incorporated into planning and health
activities in local, regional and national settings in many parts of the
world. `Their work has changed the nature of political and professional
debate about how cities incorporate health issues into their spatial and
transport planning' (S1).
Promoting and supporting healthy urban planning in cities in the
WHO European region
In recognition of the critical importance of the HUP work undertaken by
the research team at UWE, WHO designated it as an official Collaborating
Centre (originally in 1995). The designation is renewed regularly, and was
most recently assigned in 2011. The UWE Centre is the only one in Europe
to be based within an environment-oriented (rather than health) Faculty.
The research team in the WHO CC is the main source of
advice on HUP to the European network of more than 100 officially
designated WHO Healthy Cities and over 500 cities that are members of the
25 separate WHO national networks. With reference to the impact of the WHO
CC research and its implementation, `[t]his has included
initiatives in several cities that now better link public health outcomes
and public health practices within strategic planning projects such as:
Milan, Italy concerning inclusion in deprived neighbourhoods; Kuopio,
Finland assessing local areas through active travel; Bursa, Turkey
integrating green infrastructure; and, here in Belfast through using forms
of Health Impact Assessment in city development' (S2).
Annually the WHO Collaborating Centre undertakes a systematic collection
and analysis of data from all of the participating cities. This complex
data set is used to ascertain and monitor the development of HUP and thus
guide the support provided to cities. Findings from the analysis of phases
4 and 5, 2005-2013, show that HUP knowledge and action has developed both
quantitively and qualitively in cities across the WHO European region,
which includes Russia, the ex-USSR states, Turkey and Israel. A smaller
sub-group of European cities (those with the most capacity for and
commitment to HUP) is provided with additional support by the WHO
CC. `Through their work in supporting this group we have seen
some truly inspirational examples of implementation through influencing
planning policy and processes in our cities to better address public
health issues' (S1).
Spreading understanding about the spatial determinants of health
The `Health Map' (see right) is a research-based conceptual tool,
developed from what had been a narrower health-only approach (R4), to
enhance understanding of the wider determinants of health in human
settlements. The global reach and utilisation of the health map is a
robust indicator of the impact of the overall research programme. It has
been translated into 32 languages and has been used as a key conceptual
tool in a wide range of settings from the European Environment Agency's
`The European Environment — state and outlook 2010' (S3) to the Australian
Government's Institute of Health and Welfare (in 2011) (S4). Functional
utilisation ranges from spreading understanding of the complex
explanations of the effects of the built environment on health, to
practical use in scoping impacts as a prelude to policy review or
Environmental Impact Assessments.
UK policy development and guidance
Because of its expertise, the WHO CC team was commissioned
by the UK's National Institute for Health and Care Excellence (NICE) to
assist in the production of national policy guidance (2009-11) and a
briefing for local authorities (2013). A series of six evidence reviews
under the theme `Spatial Planning for Health' has been produced and
disseminated (S5). In March 2013, at the invitation of Public Health
England, the research team organised an invited expert seminar initiating
development of its `Healthy Places' work-stream.
Developing cross-sectoral leadership for healthier places
The WHO CC's research showed that the separate structural
and paradigmatic spaces inhabited by public health and built environment
were a key blockage in developing healthier settlements. At the invitation
of Regional Government bodies in the South West of England the centre
conducted three high-level study tours (in 2008, 2009 and 2012) to
`healthy planning' exemplary developments (e.g. in Germany and the
Netherlands). These visits acted as learning sets for senior public health
officers from health and planning, and gave the WHO CC team
the opportunity to disseminate its research and knowledge in context.
Post-tour evaluations found the events were influential in developing new
partnerships, policies, perspectives and projects at leadership level. For
example, in Bristol, planning applications are now routinely screened for
their potential impact on health, and in South Gloucestershire two major
new town extensions have been subject to Health Impact Appraisal.
Commercial partnership: incorporating health in commercial development
Honed in the aforementioned EPSRC project (SOLUTIONS), the WHO CC
team developed `Spectrum Appraisal'. This is a commercially available
built environment appraisal tool that supports collaborative
decision-making and synergistic outcomes for health and sustainability.
Since 2012 it has been made available in a commercial partnership with
Daniel Black and Associates (S6). Through UK application, Spectrum
Appraisal has changed proposed plans and policies. Examples include
Merthyr Tydfil Borough Council and Bristol City Council housing
strategies, South Gloucestershire's Filton New Neighbourhood and the
award-winning ICON housing development in Somerset. In each case the
benefit of use of the tool has been to develop mutual understanding and
better solutions from disparate stakeholder groups, including
cross-departmental groups of council officers and civil society, resulting
in developments that support more active lives and better social cohesion.
Rethinking professional education
Research Councils UK included WHO CC's educational
implementation of the integration model for health and the built
environment as one of the 100 ground-breaking pieces of research from all
fields in their `Big Ideas for the Future' report published in 2011 (S7).
The report is a compilation of `UK research that will have a profound
effect on our future'. This WHO CC innovation has led to
change in the national training programme for public health consultants
and a shift in policy for the national professional accreditation bodies.
Sources to corroborate the impact
S1. Director, Division of Policy and Governance for Health and
Well-being, World Health Organization, Regional Office for Europe,
Copenhagen - Available through UWE. [1 on REF Portal]
S2. Chief Executive, WHO Healthy Cities Secretariat Belfast -
Available through UWE. 
S3. European Environment Agency (EEA) (2010) The European Environment,
State and Outlook 2010: Synthesis, EEA, Copenhagen, doi:10.2800/45773,
Fig 5.1, Page 92.
S4. Australian Institute of Health and Welfare (2011) Health and the
Environment: A Compilation of Evidence, Cat. no. PHE 136. Canberra: AIHW.
Fig. 1.1, p.1. - Available through UWE.
S5. National Institute for Health and Care Excellence (NICE) (2011)
Spatial Planning for Health: Programme of Evidence Review Work, Link
S6. Spectrum Appraisal Partnership, with Daniel Black and Associates. http://www.db-associates.co.uk/services.html
(accessed 05/11/2013) - Page available through UWE.
S7. Research Councils UK (2011) Big Ideas for the Future, p.39. - Available through UWE.