Targets for measuring health and wellbeing are critical to success of levelling up

The UK government’s Levelling Up white paper and the Levelling Up and Regeneration Bill set out aims on achieving “healthy life expectancy” and “improving wellbeing,” but lack detail on how it will meet those targets.

A new clause put forward in the House of Lords by Simon Stevens, Philip Hunt, George Young and Don Foster, and supported by the Better Planning Coalition, seeks to tackle this by placing a duty on local planning authorities to include policies in their development plans that contribute to health and wellbeing. Specifically, planning authorities would be required to give special regard to: increasing access to high quality green infrastructure; access to good quality, affordable homes; opportunities to participate in everyday physical activity; providing services and amenities people need close to where they live.

The UK Health Alliance on Climate Change has previously written about how the Levelling Up Bill can support the design of the built environment for better health, biodiversity, and climate outcomes. Many of these are addressed through the requirements of the proposed amendment, which has the potential to bring multiple co-benefits for general health and wellbeing, reduce health inequalities, and protect the environment.

Rapid and large scale urbanisation has coincided with a massive loss in natural spaces and biodiversity. The design of urban environments and transport systems that favour private motorised transport have also made it more difficult, or less likely for people to participate in more active modes of travel such as walking and cycling. In the UK, inequalities in access to green space for exercise and recreation, combined with higher levels of air pollution in the most socioeconomically deprived areas, threaten the physical and mental health of millions of adults and children.

There is increasing evidence that the built environment affects both physical and mental health. Lower levels of physical activity, for example, increase the risk of obesity, diabetes, cardiovascular, and mental diseases. There are more than 850,000 people in the UK with dementia and this is expected to double by 2040. The government’s 10 year plan for dementia reports that about 40% of dementias are preventable, for example through increased physical activity, healthy lifestyles, and diet.

There is ample evidence of widening health inequalities due to poor access to high quality spaces by low socioeconomic groups. Currently, there are 28 000 to 36 000 deaths annually in the UK linked to air pollution. Areas of deprivation have a significantly higher exposure to toxic air that increases the risk of childhood and adult asthma, cardiovascular diseases, dementia, cancer and hospital admissions.

Access to good quality green space benefits the health system. A 2020 review of green space by Public Health England concluded that £2.1 billion per year could be saved in health costs if everyone in England had good access to green space. Fields in Trust estimate that reduced GP visits as a result of access to parks and green spaces would save the NHS around £111 million per year.

Currently, access to good quality urban green space is relatively poor, and at best moderate in most major cities in England. Yet, there are huge economic and health benefits to incorporating green space in urban infrastructure. In Birmingham, the annual net benefit of parks and green space is estimated at nearly £600 million, which includes £192 million in health benefits.

Green spaces that are high quality, safe, and have more complex biodiversity are known to have a positive impact on health and wellbeing. Prioritisation of equitable access to green spaces through sustainable design and protection and development of high-quality natural places have the potential to bring about immediate and long term physical and mental health co-benefits, while also improving air quality and creating space for nature in the built environment.

Creating neighbourhoods that enable people to reach the services and amenities they need within a 20 minute walk or cycle from their home, combined with good quality natural spaces, would help foster an environment for people to be outdoors and for active travel to thrive. This would have a positive impact on physical and mental health while also reducing air pollution. Low traffic neighbourhoods with priority given to pavements and cycle lanes over private motorised vehicles would also help to reduce the risk of road injuries and fatalities.

While access to green space is poor in many low socioeconomic areas, so too is access to good quality, affordable housing. More than two million families in England and Wales live in energy-inefficient houses and are at risk of fuel poverty. This comes with devastating health implications. During the Winter of 2020-21, there were around 63 000 excess deaths linked to extreme cold in England and Wales. A further 3,200 excess deaths were reported during the extreme heat periods between June to August 2022. It is estimated that through appropriate insulation and adequate ventilation of houses, 836 000 life-years could be gained in England and Wales by 2050.

The levelling up agenda aims to ensure that “geography is not destiny.” Health is crucial to achieving this aim. The physical environment that we live in plays a significant factor in the quality of our lives.

Urban planning that includes ample natural spaces and inclusive streets, will establish environments that promote physical activity, health and wellbeing, while also helping to reduce air pollution.

The amendment to the bill that requires planners to include policies on health and wellbeing seizes the opportunity to deliver on government commitments to boost active travel, help to achieve the ambition of everyone living within 15 minutes of green or blue space, and to provide homes that meet local health needs. Crucially, it also gives planners a mandate to deliver, and targets for the government to report on.

This article was first published on BMJ: https://www.bmj.com/content/382/bmj.p1600