How Health Impact Assessment can lead the way to healthier communities.
It has long been accepted that our living environments are a key determinant of our overall health and wellbeing. The onset of the COVID-19 pandemic has brought into sharp focus the need to build and maintain healthy communities. Similarly, there is a growing awareness of the issues which act as barriers to healthy communities, such as poverty, isolation, education, employment, many of which are also considered as risk factors for COVID-19.
Source: Healthy People 2020, Office of Disease Prevention and Health Promotion, US Department of Health Servicest
In development planning, a Health Impact Assessment or HIA is the only widely recognised tool for identifying and mitigating these barriers and for identifying community health improvements. In what will likely be defined in due course as the ‘Post Covid’ era, the HIA process offers a ready-made means of ensuring new developments are designed and equipped to maximise community health and minimise vulnerability to health threats such as pandemics. New development, through HIA, can and does contribute to each of the social determinants of health. These are set out in Figure 1.
Unfortunately however, the use of HIA in UK planning remains inconsistent and far from universal. There has been a lack of universally accepted guidance or agreement about precisely how and when to carry out HIAs, leading to variations in the way they are used and prepared. Local Planning Authorities may – or may not – require HIAs with planning applications. This can lead to situations where developments in one area are subject to a HIA, but not in another. In a recent journal article (October 2020) for the Institute of Environmental Management and Assessment1, it is noted that;
The planning system has a fundamental role to play in managing and enhancing the spaces and places within which we live and yet, the consideration of health within planning has to date been, at best, variable. Nevertheless, there is now a ground swell of support… for increased consideration of health and wellbeing within the planning system. In a sign of that support, in October 2020, Public Health England published new HIA guidance with t he specific aim to “increase coverage of HIA in the planning process”.2
Given the impact of the COVID-19 pandemic, it is more important than ever that there is a clear understanding between stakeholders of how, why and when to use HIAs. This is crucial to engendering trust in the HIA process, so that all stakeholders can know what is to be assessed and measured, and that the results can be relied upon. HIA stakeholders can be categorised under three headings, Developers; Public Authorities and Community. These are set out in more detail in Figure 2. Improving understanding and awareness of the HIA process among these stakeholders will help to gain their support. This opens the way to identifying areas of improvement to development quality which ultimately means added value.
From Pegasus Group’s own experience of working with stakeholders, we would stress the need for clear communication between and within the stakeholder groups. For example, between health and planning authorities. Recently updated HIA guidance in Essex, states that for each planning application requiring an HIA, the type of HIA required should be agreed between the planning authority and the local Public Health authority.
In our experience, this does not always happen, or happens retrospectively. This can result in a request for a HIA only being made after an application has been submitted or prepared. We also find that validation checklists often do not state a requirement for HIAs, yet the local health authority may request an HIA when consulted on an application, post submission. This adds unplanned costs to the applicant and also means that the HIA inevitably has to be rushed.
Analysis by the Town and Country Planning Association found that just 30% of Validation Checklists specified HIAs to be included with planning applications3. Where there is no stated requirement in the checklist, this is inevitably out of step with the aims of the local public health institutions and strategies which all recognise the role of development planning in creating healthy places. We have also experienced examples where a local plan has a policy for HIAs, yet the validation checklist does not specify them, because the checklist has not been updated to reflect the new plan.
As such, we suggest that planning authorities make sure their validation checklists are in step with local plans and the requirements of health authorities, while also ensuring that departments and officers have a clear understanding of their HIA policy and how it is applied for different development types.
Once it is understood when a HIA is required and what it should measure, it is also important that the assessment itself is relatively straightforward to carry out. This is necessary in order to align with the overall aim of the 2020 Planning White Paper, which aims to make the planning system simpler, faster and more predictable in decision making on development projects. To achieve this, the processes that make up the planning system – of which HIAs are a part – must themselves be simpler, faster and more predictable.
For this to happen, we suggest that stakeholders, and in particular Health Authorities, work together to determine accessible metrics in key areas of HIA. For example, there is currently no agreed means for determining capacity in GP Surgeries. Consultants such as Pegasus Group can produce metrics such as the ratio of GPs to residents. However, data on GP numbers can be patchy. Where this ratio can be produced, there is not universal agreement that it represents an accurate measure of GP capacity. A similar situation exists when assessing dentist capacity.
In summary, to improve the adoption of HIAs in planning, we have three recommendations.
- Universal inclusion of HIAs in all planning authority’s Validation Checklists, with appropriate thresholds set for what level (rapid, desktop, detailed) of HIA is needed and for which development types and sizes.
- Ensure there is a clear understanding among planning officers of HIAs and what should be assessed in them, agreed with local Public Health teams and accompanied with clear supplementary planning guidance, also developed with Public Health teams. New PHE Guidance for HIA (October 2020) can be useful in this respect and be referenced, rather than there being a need for separate guidance in every area.
- A drive by Health Authorities to establish universal, accessible metrics for measuring key aspects of health service impact (in particular GP capacity and dentist capacity), and for measuring key HIA outputs and outcomes such as those relating to active lifestyles, environmental improvements, sustainable transport.
For more information about the contents of this briefing note, please contact our Economics Team below:
Richard Cook – Director – Planning: 0161 393 4535 or Richard.Cook@pegasusgroup.co.uk
Andrew Poulton – Principal Economic Analyst: 0203 897 1121 or Andrew.Poulton@pegasusgroup.co.uk
Emily Hall – Senior Economic Analyst: 0161 507 0410 or Emily.Hall@pegasusgroup.co.uk
Download the briefing note here.
Foot notes:
1 IEMA, Impact Assessment Outlook Journal, Volume 8: October 2020.
2 Public Health England, Health Impact Assessment in Spatial Planning: A guide for local authority public health and planning teams. October 2020.
3 Public Health England, Health Impact Assessment in Spatial Planning: A guide for local authority public health and planning teams, p9. October 2020.