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Investment decisions about land use, transport, housing, economic development, facilities and green infrastructure, which together determine the future shape of the human habitat, are quite literally building unhealthy and unsustainable conditions into our environment. Hugh Barton, FRSA argues for a new approach.

At the global level overlapping crises of climate, deforestation, desertification, sea-level rise, loss of biodiversity, plastic pollution et al, threaten habitat sustainability. Within urbanised regions there are profound problems of housing, congestion, air pollution and environmental inequity, exacerbating health inequalities and increasing pressure on health and social care services. There is widespread recognition of these problems and promises of action. But the rhetoric is not matched by action.

Consider the vexed issue of housing. The availability of housing at prices that are affordable and in locations that are convenient is a policy priority, yet the situation grows only worse. A fundamental principle of good planning is that new development should be located – and integrated into the urban fabric – so as to make walking, cycling and public transport trips attractive and convenient, with facilities and jobs accessible. But suburban housing in Britain is characterised by the obverse, with car-dependence, high emissions, low levels of daily physical activity and overweight children the result. Essentially, new housing, approved through the local plan process, is located where the investors happen to be able to purchase land, rather than where it would be best for people and the environment long-term.

At the same time we fail to build enough homes to satisfy demand. Land and housing prices escalate and poorer households find their income consumed by housing costs. Public sector housing is undermined by land price and the right to buy, which means is it a wasting asset. Co-housing, co-operative and self-build projects, plentiful in concept, find it difficult to gain a toe-hold in a land market dominated by big house-builders. Development land is owned by the few, not the many.

We can extend these arguments into related fields: transport, retailing, business development, green-space, energy generation…Take the case of business parks. Locations have been chosen by developers and supported through the planning system to maximise vehicle accessibility, with flat land available at a price that allows large car parks, not subject to the same charging regimes as town centres. This is despite the fact that government guidance (the National Planning Policy Framework), and every local plan state we should promote development that reduces reliance on the private car and supports healthy active travel. Town centres are starved of the oxygen of new local employment, while land is used profligately for low-density offices and their car parks.

The essential problem is that within the widely prevailing neo-liberal economic philosophy, the perceived needs of economic growth take precedence over healthy urban environments. Prevention is sidelined and starved of funds even though illness and caring services struggle to cope. Ironic that the climate emergency (identified by the World Health Organisation as the biggest health threat of all) now has garnered government backing for Zero-carbon by 2050. The carbon-intensive settlement pattern still being promoted is bad for people and bad for the planet.

The characteristics of a healthy urban environment are clean air and pure water, contact with nature, a wide choice of good quality affordable housing, safe and convenient active travel networks, a full range of accessible local facilities, varied and safe opportunities for outside play and convivial meeting places free from excessive noise. Overriding all of these are spatial patterns that gives excellent access to a wide range of jobs, higher-level facilities and wider social networks without necessary recourse to car and van. Quite a challenge!

We need to rediscover the motivation of the pioneers of modern planning. The entrepreneurial planners and social reformers a century ago, reacting to the unsanitary and inhumane conditions prevailing in the industrial cities of Europe and America, saw health as central. Promoting a healthy environment was not viewed in opposition to economic development but as a pre-requisite for it, increasing creativity and productivity.

These early planning ideals were blown away in the latter part of the 20th century. The segregation of professional and institutional responsibilities, the pressures of technological change (particularly motorisation), and the triumph of neo-liberal economics, have meant that holistic principles were submerged. Silo decision-making predominates. Health planning has become all about providing services for those who are ill, while tacitly ignoring the many societal factors, including environmental conditions that are tending to make them ill. Income inequality has grown, and health inequality has followed suit, reinforced by social exclusion in housing, transport and access to facilities. The worldwide obesity epidemic is at least partially due to an environment that prejudices healthy physical activity. Parallel rises in social isolation, mental illness, stress-related cardiac morbidity and respiratory diseases – usually dealt with in separate clinical silos – are similarly related when considered from a spatial planning perspective.

We now face a rising economic burden as a result of non-communicable diseases, longer periods of poor health and inequality and this is partly due to unhealthy environments. So, how do we re-orientate policy?

All the evidence suggests that modest tinkering and gesture politics will fail. Planning and property rights are intimately connected. Private ownership rights need to be balanced with community rights. The latter were respected historically, as shown by our heritage of Commons and rights of way. A key lesson from ‘best practice’ European cities – in Denmark, Sweden, the Netherlands and Germany – is that urban authorities need to be liberated to buy land in interests of the whole community, in the best locations, with simplified compulsory purchase. One of the early new towns, Letchworth, built this shared value into its constitution. The British new towns exemplify the benefits, where infrastructure can be supported by the profits from development, and overall the town can make a profit (for the Treasury).

Far from being an economic problem, civic ownership of land can give an economic boost. Agricultural land and derelict or underused sites can be bought at something rather above existing use value (to give the owner compensation) but way below the eventual value. Then the uplift of land values with urban development pays for the physical and social infrastructure, the affordable housing, and the pedestrian-friendly, green, low-carbon environment.  

Town planning is not an accidental, incidental activity. Nor was it invented just to facilitate market development and protect our heritage. Planning is for people, for our convenience, delight, health and wellbeing. Its ends are essentially social, its means are the physical settlements we live in. If we conceive of village, town or city as being the local human habitat (within a global eco-system), then we have some hope of making rational decisions. Conversely if we visualise the built environment more as a battleground for competing market and institutional forces, with the planning system being simply the rules of engagement, then we will lose the war.

The only way to create sustainable, healthy cities is to co-operate, forging alliances, searching for practical solutions that blend social, environmental and economic aspirations. In a situation where climate change and the obesity epidemic threaten health on an unprecedented scale, healthy planning is a moral obligation. 


Hugh Barton is Emeritus Professor of planning, health and sustainability at the WHO Collaborating Centre for healthy urban environments at the University of the West of England, Bristol.  This article draws on Hugh Barton’s recent book City of Well-being: A radical guide to planning.

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