UK Healthy Cities Network- Stephen Woods / Jennie Cawood, RTPI CPD June 2013


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  • The UK Healthy Cities Network is part of a global movement for urban health that is led and supported by the World Health Organization (WHO). Its vision is to develop a creative, supportive and motivating network for UK cities and towns that are tackling health inequalities and striving to put health improvement and health equity at the core of all local policies. Established with funding from the Department of Health for England, the UK Network is one of 30 national Healthy Cities networks across Europe, and we are proud that it is one of 20 accredited by WHO as a member of the Network of European Healthy Cities Networks. It is co-ordinated by the Healthy Settings Unit at the University of Central Lancashire and overseen by a high-level steering group representing all four countries within the UK.
  • Committed to tackling the wider determinants of health and addressing the needs of vulnerable and disadvantaged groups, Healthy Cities prioritises equity, solidarity, sustainability, empowerment, intersectoral collaboration, community development and participatory governance. Concerned to translate rhetoric into tangible action, it recognises that success requires experimentation, learning, adaptation and change.
  • Within England, the changes heralded by the Health & Social Care Act 2012 provide an important context for the Network’s future development. As Local Government prepares to take on the responsibility for Public Health, the Network is uniquely placed to support sector-led improvement by local authorities in promoting health and tackling inequalities through action on the wider determinants of health – drawing on the long history of Healthy Cities and the rich experience of member authorities in advocating and implementing ‘health through local government’. Furthermore, the life course approach and the five core domains of the Public Health Outcomes Framework resonate with the Network’s aims and activities.
  • Healthy Cities is a global movement that engages local authorities and their partners in health development through a process of political commitment, institutional change, capacity-building, partnership-based planning and innovative projects. Within Europe, there are around 90 cities that are designated as members of the WHO European Healthy Cities Network – including 14 in the UK:
    In addition, there are approximately 30 national Healthy Cities networks involving more than 1400 cities and towns as members.
  • SW
    ‘25’ the number of additional Cities, Towns, Boroughs and Local Authorities who have expressed an interest in becoming Network members. Throughout 2012 we have continued to support cities and towns from across the UK who have expressed an interest in applying to become members by offering one-to-one guidance, attending regional and thematic meeting and supporting discussions at a local and county level. We are currently exploring the potential for a County Council level membership option with Cumbria, Lancashire and Derbyshire and are working with those areas to establish how this might work at an operational level.
  • That might sound as if I’m stating the obvious – but it’s important to reflect on what it means. Not surprisingly, the term Network has many definitions, but perhaps the most resonant is:
    “An interconnected system of things or people.”
    Delving further, the dictionary defines Network as:
    “Something resembling an openwork fabric or structure in form or concept, especially: a system of lines or channels that cross or interconnect; a complex, interconnected group or system; or an extended group of people with similar interests or concerns who interact and remain in informal contact for mutual assistance or support.”
    Benefits in summary – full list on the website
  • Not just about planning in a traditional sense – all local policies
  • The focus on planning and health is important and timely. Historically, the town and country planning system developed at least partly in response to the unhealthy environments and unsanitary conditions that existed in the early 19th century – and planning and public health were understood to be closely interwoven. Whilst the relationship between planning and health drifted somewhat during the 20th century, there has in recent years been increased recognition of the need to bring them back together. There’s an accumulating evidence base that shows how important the physical, social and economic environments are in determining our health and quality of life. It’s also clear that many of the issues for which spatial planners are responsible interact with human health and have the potential to improve physical and mental wellbeing and help reduce health inequalities. Viewed in this way, planners are public health strategists and practitioners.
    Optimising population health outcomes requires effective multi-disciplinary and intersectoral health-promoting strategies, which give access to safe, clean and sustainable environments, ensure good housing and living conditions, and support social inclusion.
    Before moving into the main programme, I want to highlight a few key ways in which planners can make a difference and impact positively on health and wellbeing:
    Firstly, the form of the built environment and patterns land use impact levels of physical activity – and thus levels of obesity and patterns of non-communicable diseases – through whether (or not) people want to, are able to and/or choose to walk and cycle.
    Secondly, planning decisions influence access to healthy, sustainable and locally-produced food and to fast-food outlets – likewise having the potential to impact levels of obesity and patterns of non-communicable diseases.
    Thirdly, research has shown that access to nature and green space is important for physical and mental health and development – highlighting the centrality of the planning role.
    Fourthly, the design of our cities, towns and neighbourhoods influence levels of social interaction, which in turn affects social capital, community cohesion and wellbeing.
    And lastly, planning as a discipline and profession provides an obvious ‘bridge’ between public health, sustainable development and equity agendas – for example, through contributing to community resilience to climate change.
    With the health reforms taking shape and the transition of the public health function to local government, the time is right to debate how public health and planners can work together across county and district tiers, to bring about sustainable health improvement.
  • From reuniting health with planning – healthier homes, healthier communities
  • WHO – European activity has included the production of key document –
    There are a number of complementary and competing frameworks for developing Age-Friendly Cities. The WHO team will map and analyse them for consideration by AF-SN member cities.
    The main frameworks are;
    The draft WHO European Strategy and Action Plan for Healthy Ageing (2012-2016)
    the Guide to WHO Global Age-Friendly Cities (2007) developed via the
    the Vancouver Protocol and forming the basis for
    the planning cycle for WHO Global Network of Age-Friendly Cities (2009).
    Two Products of the Phase IV AF-SN are Demystifying the Myths of Ageing (WHO, 2008) and Healthy Ageing Profiles: Guidance for producing local health profiles of older people (WHO, 2008).
  • Valuing older people – asset based approach
    Intergenerational element
  • The old-age support ratio is an important indicator of the pressures that demographics pose for pension systems. It measures how many people there are of working age (16-64) relative to the number of retirement age (65+). At the moment, there are just over four people of working age for every one of pension age on average.
  • The N8 Research Partnership is a partnership of the 8 research intensive universities in the North of England - Durham, Lancaster, Leeds, Liverpool, Manchester, Newcastle, Sheffield and York.
    The N8 Research Partnership aims to maximise the impact of this research base by identifying and co-ordinating powerful research teams and collaborations across the North of England. To support the collaborations, N8 Research Partnership creates teams with a critical mass of world class academics. These teams form a network of virtual centres of science and innovation excellence.
    Population - Population change, 2011-2036
    LLTI - Projected population with limiting long-term illness, 2011 and 2036
    NGH - Projected population with not good health, 2011 and 2036
    Labour Force - Projected labour force, 2011 and 2036
    Households - Projected households, 2011 and 2036
  • The rate of increase of the population with limiting long term illness and in not good health will be
    greater than the population as a whole because the age structure will shift towards the ages at which people
    have experience more illness Population ageing reflects improvement in survival and longevity
    but at the expense of more time spent in illness and more people ill, unless illness onset can be delayed by
    improved health behaviours (less smoking, moderate drinking, better diets, more exercise )
  • UK Healthy Cities Network- Stephen Woods / Jennie Cawood, RTPI CPD June 2013

    2. 2. The Healthy Cities Movement Initiated by WHO in the mid-1980s as a small-scale project that aimed ‘to put health on the agenda of decision-makers in the cities of Europe’, Healthy Cities quickly fired the imagination of politicians, professionals and citizens worldwide. It is now a global movement for public health and sustainable development with over 25 years’ experience of incubating new ideas and developing creative solutions to old and new challenges.
    3. 3. Wider determinants of Health - Equity  wider determinants of health  vulnerable and disadvantaged groups  equity, solidarity, sustainability, empowerment, intersectoral collaboration,  community development and participatory governance.  Change agent
    4. 4. Primary Goal The primary goal of WHO Healthy Cities is to put health high on the social, economic and political agenda of local government. •Its aims are to:    enhance learning and build capacity through sharing ideas, experience and best practice widen participation in the Healthy Cities movement and support member towns and cities to develop and test innovative approaches to emerging public health issues become a strong collective voice for health, wellbeing, equity and sustainable development – informing and influencing local, regional, country and national policy.
    5. 5. UK Healthy Cities Network Membership Belfast* East Staffordshire Portsmouth Brighton and Hove* Glasgow* Preston* Bristol Lancaster Sandwell Cardiff* Leeds Sheffield* Carlisle* Liverpool* Stoke-on-Trent* Chorley Manchester* Sunderland* Cumbria Newcastle* Swansea* Norwich Wakefield Nottingham Warrington Derry* *Denotes cities with WHO designated status
    6. 6. Membership New Towns/Cities/LA’s/DC’s/Boroughs expressing interest in membership • Birmingham • Leyland • Blackburn with Darwen • Newport • Calderdale • Perth • Chelmsford • Plymouth • Coventry • Salford 4 • Grimsby • Southampton • Westminster • Kirklees • Tamworth • Redbridge • Knowsley • Wrexham • Kensington & Chelsea • Lancaster • West Lancashire • Hammersmith & Fulham • Derbyshire
    7. 7. What is a Network / Benefits? “An interconnected system of things or people.” “Something resembling an openwork fabric or structure in form or concept, especially: a system of lines or channels that cross or interconnect; a complex, interconnected group or system; or an extended group of people with similar interests or concerns who interact and remain in informal contact for mutual assistance or support.” Being part of a values-based movement Being part of an active and dynamic network
    8. 8. Phase V of the WHO European Healthy Cities Network runs from 2009-2013 Overarching theme - Health and Health Equity in All Local Policies Caring and supportive environments. Healthy living. Healthy urban environment and design. A healthy city offers a physical and built environment that supports health, recreation and well-being, safety, social interaction, easy mobility, a sense of pride and cultural identity and that is accessible to the needs of all its citizens.
    9. 9. “significantly improve the health and wellbeing of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality.” Working together: adding value through partnerships Health 2020 – a common purpose and a shared responsibility Phase VI - City Health profiles, integrated planning for health and sustainable development - remain at the heart of the work – creating community resilience
    10. 10. “Healthy urban environment and design” Important issues: •Healthy urban planning. •Housing and regeneration. •Healthy transport. •Climate change and public health emergencies. •Safety and security. •Exposure to noise and pollution. •Healthy urban design. •Creativity and liveability.
    11. 11. “Where people live affects their health and chances of leading flourishing lives. Communities and neighbourhoods that ensure access to basic goods, that are socially cohesive, that are designed to promote good physical and psychological wellbeing, and that are protective of the natural environment are essential for health equity.” Closing the gap in a generation, WHO (2008) “The planning system can play an important role in facilitating social interaction and creating healthy, inclusive communities.” National Planning Policy Framework, DCLG (March 2012)
    12. 12. SPATIAL PLANNING, HEALTH AND INEQUALITIES – THE EVIDENCE ‘Evidence shows that a disproportionate burden of ill-health associated with the built environment is borne by poorer people living in low quality built environments. This includes adverse conditions related to transport including lack of access, pollutions, and injury; deteriorating features such as vandalism and litter leading to insecurity, isolation and obesity; poor housing and lack of good green spaces. Land use, transport and development policies determining urban form are key to tackling these inequalities and securing healthy built environments for all. ‘ Caroline Bird, Research Fellow Planning and Architecture, WHO Collaborating Centre for Healthy Urban Environments, UWE
    13. 13. “Healthy urban environment and design – city links” ● the National Planning Policy Framework (NPPF) and local plans; ● neighbourhood planning and community involvement; and ● housing growth, quality and affordability. ● health and wellbeing boards; ● Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs); ● clinical commissioning groups (CCGs); and ● the Public Health Outcomes Framework.
    14. 14. National Planning Policy Framework ‘The planning system can play an important role in facilitating social interaction and creating healthy, inclusive Communities’ NPPF Published March 2012 Purpose of planning – ‘contribute to the achievement of sustainable development’
    15. 15. ‘contribute to the achievement of sustainable development’  Making it easier for job to be created in cities, towns and villages  Replacing poor design with better design  Improving the conditions in which people live, work, travel and take leisure  Widening the choice of high quality homes Social / Economic / Environmental objectives Health cuts across all these Section on promoting healthy communities ……. role in facilitating social interaction and creating healthy inclusive communities
    16. 16. Measures aimed at reducing health inequalities  Improving access to healthy food and reducing obesity  Encouraging physical activity,  improving mental health and wellbeing,  and improving air quality to reduce incidence of respiratory diseases Other hooks:Promoting sustainable transport Choice of high quality housing Good design
    17. 17. Health and Health Equity in All Local Policies ‘health in all policies is not confined to the public health community or to the national level. It is relevant and has a tremendous potential for positive health outcomes at the local level, strengthening the public health leadership role of municipal governments. Health in all policies is a horizontal approach that seeks to engage all sectors of society in integrating health and well-being considerations as central values in their strategies and plans’
    18. 18. Ageing Populations the challenges - an example guide to global age friendly cities 2007 demystifyng the myths of ageing WHO Strategy and Action Plan for Healthy Ageing in Europe 2012 - 16
    20. 20. DEMOGRAPHICS – POPULATION CHANGES/CHALLENGES • At aggregate level across the North, the population will continue to grow throughout the period 2011- 2036, but will also age considerably. • The numbers of people with Limiting Long Term Illnesses (LLTI) will rise • The labour force (as currently defined) will fall • The Old Age Support Ratio (OSR) will increase.
    21. 21. DEMOGRAPHICS – POPULATION CHANGES – THE NEED TO RESPOND Area Lancashire Preston Population 2011 Population 2036 Population 75+ 2011 1,521,651 1,706,457 132,644 143,063 169,394 12,472 Population 75+ 2036 Population 90+ Male 2011 Population 90+ Male 2036 Population 90+ Female 2011 Population 90+ Female 2036 225,180 4,237 20,419 9,769 19,924 22,248 683 3,238 576 1,191 Source N8 Research Partnership
    22. 22. DEMOGRAPHICS – POPULATION CHANGES – LOCAL  INFORMATION Area   Lancashire Dementia  65+ 2011 Dementia  Health Not  Health Not  Health Not  Health Not  65+ 2036 good 75+  good 75+  good 90+  good 90+  2011 2036 2011 2036 19,642 35,095 29,761 53,145 3,628 11,064 Preston 1,756 3,405 3,947 6,894 522 1,385 Area   LLTI 75+ 2011 LLTI 75+ 2036 LLTI 90+ 2011 LLTI 90+ 2036 Lancashire 74,840 133,099 9,748 28,978 Preston 10,182 17,992 1,587 4,188 LLTI –  Projected  population with  limiting long-term  illness, 2011 and  2036 
    23. 23. PLANNING FOR HEALTH COLLABORATION  – TCPA – RTPI – UWE – HUDU – RIBA Showcasing the “Reuniting Health &  Planning”  document and sharing  case  studies and  scoping the  Health &  Wellbeing Check list  to support local  authorities planning policy  frameworks.   Debating the new Public Health Outcomes  framework , which makes direct and  indirect links to planning across the 4  domains. This gives a mandate for  public health & planners to work more  closely for health outcomes and the  new responsibility for LA on public  health..    
    24. 24. PLANNING FOR HEALTH COLLABORATION  – TCPA – RTPI – UWE – HUDU – RIBA   • Exploring key insights  and relationships  for health & wellbeing outcomes via   sustainable buildings & health  and sustainable urban habitats  [ connecting with  nature local ecology] • Health Impact Assessments as tool for maximising health benefits in  planning  decisions  and health policy; and a lever for corporate social responsibility . • Bristol Protocol as a tool for both planners and public health to prioritise  planning applications that require a “health Lens” • Key topics for planning & PH – Community Use of  derelict  land; Allotments /  Community Food Growing schemes. Regulatory responsibilities; HIA, Shisha; take  aways; accessibility etc. • Influencing design – work with developers • Development of National Guidance around planning for Health