The importance of Health Impact Assessment in Planning.

What are Health Impact Assessments?

The World Health Organisation (WHO) defines Health Impact Assessment (HIA) as a practical approach to judge the health effects of a policy, programme or project on a population, particularly on vulnerable or disadvantaged groups (WHO, 2022)¹. Furthermore, the WHO highlights the fact that health and wellbeing is influenced by a range of determinants including social, environmental, economic, and behavioural. This is depicted via a model of ‘human ecology of a settlement’, first published in researched by Barton and Grant (2006²) (Figure 1).

Pegasus Group has built up extensive experience of Health Impact Assessment (HIA) over recent years. This note gives an overview of the growing importance of HIAs in terms of development planning, a high level summary of the practicalities of undertaking a HIA, and a summary of our experience, and an invitation to contact us for more information as to how we might be able to help you.

There is an opportunity for development planning and place-making to be at the heart of the movement to address health inequalities by taking the time to think about the inter-combination effects of each of the determinants involved. Inequalities that have been allowed to remain and even worsen, and society accepting those inequalities as the norm, can be challenged and the trajectory changed. HIA is one such tool that can help us rethink the norm, avoid contributing to any existing health inequalities, and instead enhance health and wellbeing for all future users and wider population.

Policy relating to Health

In respect of UK development planning, the consideration of the potential effects of development proposals on health and wellbeing is guided by a number of published policies, guides and tools. This includes the National Planning Policy Framework (NPPF, 2021³), and ‘Health Impact Assessment in Spatial Planning: a guide for local authority public health and planning teams’ (Public Health England, 2020⁴).

In addition, the Levelling Up White Paper, published in February 2022⁵, identified health as a ‘Focus Area’ within the ‘Levelling Up Missions’. The target relating to health is that “By 2030, the gap in Healthy Life Expectancy (HLE) between local areas where it is highest and lowest will have narrowed, and by 2035 HLE will rise by five years” (Mission Seven). From a health perspective, the Levelling Up White Paper highlights that:

• At the national scale, life expectancy for both males and females between 2017 and 2019 was highest in England (63.2 and 63.5 years respectively) and lowest in Scotland (61.7 and 61.9 years respectively).
• At the local scale, people in the top decile (least deprived) areas of the UK can expect to live around a decade longer than people in the bottom decile (most deprived) areas of the UK.

Based on statistics presented in the ‘Due North: Inquiry on Health Equity for the North’ published by Public Health England in September 2014⁶, such trends in UK health inequality have been identified for decades. The report notes that the north of England has persistently had poorer health than the rest of England and the gap has continued to widen over four decades under five governments (Hacking et al, 2011⁷). It is stated that, since 1965, this equates to 1.5million excess premature deaths in north compared to the rest of the country (Whitehead and Doran, 2011⁸).

Practicalities of undertaking HIA

In development planning practice, we are guided by the NPPF (2021)⁹ which highlights the promotion of healthy and safe communities and recognises that planning policies and decisions should aim to achieve healthy, inclusive and safe places for all. As a result of health and wellbeing having been given focus in national scale planning policy, the issue has been afforded increased attention and specific requirements being identified in Local Plans. This means that, in recent years, councils across the UK are more commonly including the consideration of HIA on their validation checklists, something that is supported by the guidance published by Public Health England which suggests that HIA is a tool to identify and optimise health and wellbeing impacts of planning (PHE, 2020).

HIA tools have been developed in the context of the range of policy-based guidance on the topic and are commonly considered to be appropriate frameworks that embody ‘best practice’ in the application of HIA. These include the London Health Urban Development Unit (HUDU) Rapid Health Impact Assessment Tool¹⁰  and Wales Health Impact Assessment Support Unit (WHIASU) guidance tools¹¹.  These tools include for consideration of issues across each of the determinants of health and wellbeing advised by WHO, namely social, environmental, economic, and behavioural factors.

The depth of detail in respect of a HIA is dependent on the scale and nature of the proposed development for which it is to be applied. Some authorities are very prescriptive in their requirements for a HIA, and publish tools and templates for use, which are often at least informed by, if not a replica of, either the London HUDU tool or the WHIASU guidance. Where such prescriptive expectations are not made, councils who require HIA to be undertaken defer to the use of commonly used best practice tools, those typically being the London HUDU tool or the WHIASU guidance.

In some instances, and more commonly now than ever before, there is a need to undertake consultation with the council and specific consultees in respect of the HIA and issues identified during the assessment process. The need for engagement is considered from the outset and factored into the programme as required. The aim is for engagement to be undertaken as early as practicably possible to enable feedback to be considered within design evolution, as well as consideration to be given to potential requests for financial contributions, where relevant.

Our experience 

The Economics team at Pegasus Group has delivered an extensive number of HIAs over the last five years. Since the start of 2021, this has amounted to over 60 HIAs delivered for clients. Assessments undertaken to date have spanned a range of developments, including residential, commercial, renewable energy proposals, and public sector-led development including prisons.

Case Study 1: Overstone Green, Daventry

A HIA was undertaken in relation to an outline planning application for major residential and commercial development, including 1,600 dwellings and almost 20 acres of commercial land, north east of Northampton on behalf of L & Q Estates and Davidsons Developments. The scheme will secure and deliver balance of the Northampton North Sustainable Urban Extension (SUE) as allocated under Policy N3 in the adopted West Northamptonshire Joint Core Strategy. The deliverable was designed-up by our in-house design team to aid communication for all interested parties. Link to further information regarding the scheme and Pegasus Group’s role in the project can be found on Pegasus Group’s website here: Overstone Green. – Pegasus Group.

Case Study 2: Kirklees Cultural Heart

An application seeking full planning permission and associated applications for Listed Building Consents was submitted in autumn 2022 for this ambitious project referred to as ‘Kirklees Cultural Heart’, which is the flagship element of Kirklees Council’s wider Huddersfield Blueprint – a ten-year plan to create a thriving town centre. The application includes a substantial new public park, a new multi-purpose 2,200-capacity live entertainment and events venue and multi storey car park, an art gallery, the repurposing of the current library building to house a dedicated museum and the refurbishment of the historic Queensgate Market building to become a vibrant food hall and new library. A HIA was undertaken considering the effect of each element of the proposals. Further information relating to the proposals and Pegasus Group’s involvement can be found here: Plans submitted for £210m Kirklees Town Centre regeneration. – Pegasus Group.

¹ World Health Organisation (2022). Health Impact Assessment. Available at: Health impact assessment (who.int).

² Barton, H. and Grant, M. (2006). A health map for the local human habitat. Journal of the Royal Society for the Promotion of Health, 126.

³ Ministry of Housing, Communities and Local Government (July 2021). National Planning Policy Framework (NPPF). Available at: National Planning Policy Framework (publishing.service.gov.uk).

⁴ Public Health England (October 2020). Health Impact Assessment in Spatial Planning: a guide for local authority public health and planning teams. Available at: Health Impact Assessment in spatial planning (publishing.service.gov.uk).

⁵ Levelling Up White Paper, HM Government, February 2022. Available at: Levelling Up the United Kingdom White Paper (publishing.service.gov.uk).

⁶ Due North: Inquiry on Health Equity for the North, Public Health England, September 2014. Available at: Due-North-Report-of-the-Inquiry-on-Health-Equity-in-the-North-final.pdf (cles.org.uk).

⁷ Hacking, JM., Muller, S., Buchan, IE. (2011). Trends in mortality from 1965 to 2008 across the English north-south divide: comparative observational study. British Medical Journal (2011) 342: d508-d508.

⁸ Whitehead, M., Doran, T. (2011). The north-south health divide. British Medical Journal (2011) 342: d584-d584.

⁹ The NPPF is due to be updated imminently, as suggested by the then Secretary of State for Levelling Up, Housing and Communities, Michael Gove, in July 2022. Changes or additions to the focus on health and wellbeing effects of population will be reviewed in due course.

¹⁰ NHS London Health Urban Development Unit (October 2019). HUDU Planning for Health: Rapid Health Impact Assessment Tool, Fourth Edition. Available at: HUDU Rapid HIA Tool October 2019 (healthyurbandevelopment.nhs.uk).

¹¹ Wales Health Impact Assessment Support Unit (WHIASU) (2022). Resources. Available at: Resources – Wales Health Impact Assessment Support Unit (phwwhocc.co.uk).

For further details on how Pegasus Group can help in assessing the demand for care accommodation and its economic impact, please contact: