Land use planning and health and well-being☆
Introduction
The focus of this paper is on land use planning for healthy human settlements. It is widely recognised that the spatial planning of human urban activity is affecting quality of life, health and well-being (EEA, 2009, WHO, 2009, RTPI, 2009, NICE, 2008). The paper gives a brief introduction to the issue and provides a framework for analysis, before summarising the evidence in relation to a wide range of topics. It concentrates in particular on the crucial relationship between spatial variables and physical activity, mental well-being and inequality.
First to give some definitions: settlements in this context include cities, towns and villages. The tentacles of large settlements spread out far beyond urban areas, into hinterlands and networks, linking places together through commuter residence and work, retail, educational and leisure activities. So there is no clear functional distinction between urban and rural settlements within a town or city region.
Land use planning is conventionally called ‘town and country planning’ in Britain, following the 1947 Act, but since 2004 is officially termed ‘spatial planning’, implying a more integrated, inter-agency process. In literature the term ‘built environment’ is often used to mean the human-made environment that may be subject to planning. It does not refer only to buildings and hard infrastructure but to all the physical elements that go to make up settlements, including greenspace.
Health is defined broadly, in line with the World Health Organization (WHO), as ‘not only the absence of disease but a state of complete physical, mental and social well-being. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political belief or economic or social condition’ (WHO, 1946). Health in this sense is linked to every aspect of life – the social, the economic and the environmental – and can be seen as consonant with the anthropogenic version of sustainable development evident in the UN Brundtland definition. Just as equity (intra-generational as well as inter-generational) is a key aspect of sustainable development, so concern for health inequalities is central to public health policy.
Section snippets
Health and land use planning
Health and land use planning are historically linked. Modern planning originated in the nineteenth century expressly in order to combat unhealthy conditions—the unsanitary, over-crowded and inhumane conditions of the burgeoning industrial cities. It was recognised then, and still is, that there is an umbilical link between environmental conditions and human health. This link has been articulated in the modern era as permeating the human condition. The environment is seen as one of the key
Community and mental well-being
Community is defined here in terms of social networks of mutual support. Social networks are critical to mental and emotional well-being (Halpern, 1995). Many people have social networks which are numerous, varied and geographically widespread, with a basis in a range of shared interests. Some are virtual. But the networks of vulnerable groups are often very local. These groups include elderly people, infirm or disabled people, young parents (especially single parents) and their children, some
Local economy and income issues
Employment and income are clearly related. Both are determinants of health and both impact on social status, which is also a key determinant of wellness (Marmot, 2004). It is generally accepted that mortality and mental illness increase when unemployment rises (Cave et al., 2004). Individuals who are long-term unemployed are much more likely to suffer depression and physical illness than those in satisfying work, because of both relative poverty and lack of purpose in life. Poverty itself
Activities, space and networks
Spatial planning influences activities through decisions on infrastructure, land and buildings (the ‘built environment’), while the activities themselves are pursued by individuals, households, firms and institutions. The focus here is on equity and social inclusion.
Spatial planning is deeply implicated in social exclusion and health inequalities. Land use decisions, particularly in relation to housing, transport and economic development, are key determinants of where people live, and therefore
The local bioregion
The relationship between environmental pollution and health was, as noted earlier, one original reason for developing a land use planning system. Basic life support depends on the quality of the air, the availability and quality of water, and lack of contamination of soils when they are used to grow food. This section focuses on air pollution as the most significant environmental health risk in the UK.
The risks associated with poor air quality come mainly from transport and to a lesser extent
Global ecology
The interdependence of humans and nature becomes obvious when we consider climate change. Global warming and sea level rise are the biggest risks to health in the world – and possibly to the UK specifically, as the Inter-Governmental Panel on Climate Change (2007), the World Health Assembly (WHA, 2008) and Costelloe et al. (2009) have shown. The main threats to health come from regional weather changes, which affect heat stress, flooding, water security and food production, and from sea level
Overview: a wicked problem
This brief review points up a vital realisation: the relationship between health and land use, especially urban land use, is hugely complex. The various aspects of human social and economic activity, development patterns, planning and environmental policy and health and well-being interact in a myriad ways. Inevitably, many different agencies need to be involved in cooperating to create a healthy environment. This highlights the desperate need for a coherent, shared philosophy. Health (which we
Future directions and expected findings of future research
Below are some of the expected insights which research will be able to afford us in the future, chosen from instances where already one can see clear trends in findings and the conviction with which researchers are able and willing to put them across. It is interesting to note the relative speed with which the research community acts once a new agenda – such as climate change or the obesity epidemic – takes hold. In the field of physical activity and urban form, for example, the main research
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While the Government Office for Science commissioned this review, the views are those of the author(s), are independent of Government, and do not constitute Government policy.