1. HEALTH, WELLBEING & PLACE
East Herts Rural & Urban Conference, October 2016
Bethan Clemence
Hertfordshire Public Health

2. The Public Health Mandate
Health Improvement
Commissioned services e.g. School Nurses, Health Visitors, Stop Smoking Service, Sexual Health
Interventions (projects) tackling local health needs e.g. Hertfordshire Year of Walking/Cycling
Health Protection
Commissioned services/interventions e.g drugs & alcohol
Addressing threats and hazards to human health
Prevention
Reducing Health Inequalities
Health protection means we address threats and hazards to human health including
infectious diseases, chemicals and poisons, radiation, emergency response and
environmental health hazards.
Public Health is not GP surgeries, hospitals and acute care.

4. Health inequalities slide
There is an eleven year gap in life expectancy between the healthiest and the least healthy areas in Hertfordshire, and there are a number of reasons why this is the case:
Too many people in our county spend the end of their lives in avoidable disability caused by non-communicable disease as a result of the common risk factors of smoking, obesity, poor diet, physical inactivity and alcohol consumption;
Too many people in our county die early of avoidable disease;
Smoking remains our biggest cause of avoidable death;
Being obese or overweight is reducing the healthy life expectancy of too many of our young people and adults;
Preventable mental ill-health, and the burden of mental ill-health across the lifecourse is too high;
We need to do more to ensure our children have a healthy start in life and grow up healthy;
Avoidable ill-health and the risk factors for these are hindering efforts to reduce poverty and increase prosperity.
The Public Health ambition for Hertfordshire is to see:
Citizens who enjoy life and are healthy
Safe and active communities that get on well
A strong economy where businesses thrive
A high quality environment
People who are able to achieve their potential

5. Health is primarily determined by factors beyond just healthcare
The importance of public health
Our health is determined by our genetics, lifestyle, the health care we receive and our wider
economic, physical and social environment. Although estimates vary, the wider environment (by this we mean everything outside at health care and genetics) has the largest impact.
In simple terms this means addressing the complex causes of health inequalities at the community level by improving the places – the physical, built, natural and social environments - in which we live, work, learn and play
Unique role of local authorities – can tackle and influence over 70% of determinants
Spatial planning can influence the built environment, environmental quality, access to services (and provision of services) access to employment and education (and the provision of); through design, it can influence community safety issues, people’s behaviours around diet and exercise

6. Place Fundamental to good health, social capital and prosperity
Preventative role of place in promoting good health is as important as access to clinical care
Health and wellbeing is just one of the many angles that planners need to consider when planning for long term growth. Our health and wellbeing is determined by our general socioeconomic, cultural and environment conditions. In return, healthy individuals and communities can generate greater social capital and prosperity for a local area, with less recourse to health and social care. Spatial planning in this context has a fundamental role to play and, if we get it right, can be a big player in the ‘prevention’ agenda.
In a recently published Select Committtee report, MPs have called for health to become a key consideration in planning decisions, going as far as to suggest that health and wellbeing should be seen as a material consideration in planning applications and the planning process in its own right. Responding to the report, the District Councils Network said the planning system could have a positive impact on public health, in "enabling and encouraging physical activity, tackling obesity and boosting mental health".
Spatial planning has a clear and strong influence on healthy choices made by individuals, and evidence suggests that there are a number of issues that impact on physical and mental wellbeing.

7. Place Shaping - Reuniting Planning and Health
Foundations of town planning based on the need for good public health (housing, sanitation, communicable disease)
Public health priorities have changed since (although not completely e.g. housing)
Obesity
Heart disease
Physical inactivity
Diabetes
Mental Health
Ageing
Spatial planning is not an intervention in itself, but an enabler
Good spatial planning helps improve the ‘liveability’ of areas (Barton 2009)
Increasing access to planned green space has a positive influence on physical activity levels (Croucher et al 2007), particularly for those from lower socio-economic groups (Mitchell & Popham 2008).
Not just bricks and mortar and green spaces
Access to employment and education
Influence healthy behaviours
Health protection – air quality; road safety
Tackling social isolation; connecting/improving existing

8. National Planning Practice Guidance and health (March 2014) - What is a healthy community?
A healthy community is a good place to grow up and grow old in. It is one which supports healthy behaviours and supports reductions in health inequalities. It should enhance the physical and mental health of the community and, where appropriate, encourage:
Active healthy lifestyles that are made easy through the pattern of development, good urban design, good access to local services and facilities; green open space and safe places for active play and food growing, and is accessible by walking and cycling and public transport.
The creation of healthy living environments for people of all ages which supports social interaction. It meets the needs of children and young people to grow and develop, as well as being adaptable to the needs of an increasingly elderly population and those with dementia and other sensory or mobility impairments.

9. Public Health Considerations in Planning
Mix of land use
Street layout, connectivity and active travel
Access to public and other services
Safety and security
Open and green space
Affordable and energy efficient housing
Food access
Air quality and noise
Access to education and employment

10. What can Town & Parish Councils do?
Influence development through Neighbourhood Plans, using a strong evidence base of local health & wellbeing ‘needs’
Include non-strategic policies such as design standards
Identify health and wellbeing projects that meet local needs e.g. open space deficiencies addressing weight and physical inactivity, community space provision to tackle social isolation
Use S106/CIL funding for specific health & wellbeing projects that address an identified health need and facilitate growth
Need to identify from the outset what the problem is and what the solution is – this needs to be articulated through the neighbourhood plan process and agreed by community consultation– acts as a hook to refer back to.
e.g. identified high prevalence of depression – identified project to deliver a sensory garden or outdoor gym – seek this provision through S106 or fund through CIL topslice
e.g. identified ageing population, want to prevent falls and social isolation – identified allotment project – seek provision of community space through S106
New development: provision of green space/infrastructure to be delivered in an early phase so that it is established prior to occupancy. Encouraging healthy behaviours
Prioritise the pedestrian (swiftly followed by the cyclist) in new development. Encouraging healthy behaviours
Locate new schools and care homes away from busy roads and areas of poor air quality. Health protection.
Focus on urban agriculture and provision of allotments. Healthy lifestyle – opportunities for physical activity, diet and mental wellbeing

11. Work in partnership. Common goals with district and county – can’t achieve without working together

12. Resources Hertfordshire Joint Strategic Needs Assessment (JSNA)
Hertfordshire Health and Planning Guidance (available early 2017)
Town and Country Planning Association – Reuniting Planning and Health work programme
Public Health England briefing and evidence reviews

13. JSNA

16. THANKYOU