Evaluating the Health Impact of Redevelopment Schemes in a Post-pandemic World

PostCovidPlanning is very real

( Editor’s note: As so often, an individual #local issue has created a community identification and leadership and the resulting activism makes a significant contribution to planning overall.)                          January 5, 2021

By CLARE DELMAR – Mortlake (London) Brewery Community Group

( I thank WHO and UN Habitat advisor Marcus Grant for helping us all to understand that post-Covid planning is very real – we in Mortlake have a strong support base of academics and practitioners to guide our approach and activism. )

I wrote at the end of 2020 about the impact that Covid-19 has had on cities, referencing several individuals and organisations that have been researching and building evidence on what is fast becoming a hotbed of professional and academic activism:

Indeed, an enthusiastic community of practitioners dedicated to debating and advancing  #PostCovidCities  is emerging globally.

Our collective experience over the last year with Covid-19 has generated much agreement on the obvious links between health promotion, disease mitigation and urban design – such as the benefits of balconies in areas of high density, the importance of accessible green space – and the increasingly evidenced role of sunlight and vitamin D in supporting good health.

There is also lots of discussion and less consensus on the behavioural changes that the pandemic has generated and, in many cases, simply accelerated – and whether these are long-lasting or will, with time, revert to an earlier period of normal. Working from home is perhaps top of this list and underpins new visions of localism and placemaking, including the increasingly popular “15-minute City” concept.

I’m still curious about how to marry the design and the behavioural and wanted to investigate further how planners, developers, and policymakers are thinking about how to evaluate and integrate these changes into new designs and plans. I want to build a robust conversation with the public- and private-sector stakeholders in our very own redevelopment scheme here in Mortlake around design, behaviour and community health.

A starting point is the Health Impact Assessment (HIA) prepared by Reselton Properties for LBRuT in 2019 and revised in July 2020 for the Mayor of London:

The HIA shows multiple areas of health impact, including GP services along with air quality, available green space, and even healthy food accessibility. For each, it assigns an impact of “positive” or “negative”. All of the areas of impact are determined to be positive with one exception – primary care services. The developer plans to address this through funding from the Community infrastructure fund, Section 106. However, these funds will be competitively tapped for a number of community projects so we must be vigilant and interrogate the developer and the Mayor on exactly how Section 106 funds will be deployed to ensure our community health.

I spoke with the SW London CCG who commission all NHS services for Mortlake about this, and they confirmed that they requested funding for additional primary care services through the S106 provision. They also, however, stated their concern that there will be insufficient funding from this capped funding source once other community needs are competing for funds from the same pot.

On the broader questions about evaluating health impact, I spoke with Marcus Grant, advisor to the WHO Healthy Cities programme and UN-Habitat who editors a journal called Cities & Health about the Mortlake proposals and how we might leverage in a proposal that better supports population health. Our discussion inevitably led on to discussing how HIAs are produced and, more importantly, how those affected can evaluate them and start their won activities in the regard.

Marcus introduced me to a set of frameworks that have been developed to measure and assess the health impact of planning proposals, relevant now more than ever as both new planning proposals and questions about post-pandemic impact abound. As Marcus said

“There is an established community of support for healthier urban developments, by that I mean healthier for people and the planet. Over the years many tools have been developed, it will be important for you to connect in with those using these now and those who have had success in the past”.

Moreover, the Mother of all plans, the revised London plan, has only last week been released by the Mayor for review by the Secretary of State. This will guide any decision he makes on the Stag Brewery, so we will need to upskill ourselves in connecting through health into these formal planning mechanisms.

Here I briefly outline the three frameworks I discussed with Marcus who says

“These are avenues to explore for your community, they will help you understand the wider context of healthy urban development, and hopefully point you towards other sources of support’:

1. Health economic assessment tool (HEAT) for walking and for cycling.

This is an online tool to facilitate evidence-based decision-making that the World Health Organization has developed, in collaboration with experts, to estimate the value of reduced mortality that results from proposals that increase levels of regular walking or cycling. Used in reverse it could also calculate the cost of proposals that reduce these activities. HEAT calculates the answer to the question: if x people cycle or walk y distance on most days, what is the economic value of mortality rate improvements? A guidance book and summary address practitioners and experts, focusing on approaches to the economic valuation of positive health effects related to cycling and walking.

Applications may include:

• to plan a new piece of cycling or walking infrastructure: it models the impact of different levels of cycling or walking, and attaches a value to the estimated level when the new infrastructure is in place;
• to value the mortality benefits from current levels of cycling or walking, such as benefits from cycling or walking to a specific workplace, across a city or in a country;
• to provide input into more comprehensive cost–benefit analyses, or prospective health impact assessments: for instance, to estimate the mortality benefits from achieving national targets to increase cycling or walking, or to illustrate potential cost consequences of a decline in current levels of cycling or walking.

Cycling and/or walking infrastructure does not include just the obvious pedestrian crossing or cycle path that comes easily to mind. It can include any measure to support these activities, such as night-time lighting providing safer walking routes, or providing increases in requirements for secure cycle parking for each proposed dwelling.

1. ii) London Healthy Urban Development Unit

The London Healthy Urban Development Unit (HUDU) helps to create healthy sustainable communities and ensure that new developments are planned with health in mind. They offer support for groups wanting to explore the health impact of development proposals and lever in more health. Their website provides some useful tools.

Watch out for health!. This is a simple checklist for capturing and understanding the wider determinants of health of a proposal:

S106 and CIL planning contributions for health. HUDU has developed and maintains a model to calculate indicative health contributions arising from development proposals which is in widespread use across London (and by some NHS organisations outside London).The model can be used to assess both site specific impacts and the impacts of cumulative growth over time:.

• Reviewing a Health Impact Assessment (HIA)

Many developers and consultants submit HIA reports with development proposals but how are these assessed? Are they good, bad or ugly? Luckily there is a great tool that can be, and should be, used both by community organisations and those commissioning HIAs to assess quality. Ben Cave Associates has published a review package to enable a commissioner or reviewer of an HIA report to reach an opinion as to the quality of the completed report in a simple, quick and systematic manner.

Over the next several weeks I plan to use these frameworks to interrogate the Reselton proposals on their real impact on our community health. I encourage everyone in our community to think about how the proposed redevelopment of the Stag Brewery will impact their health and to share their thoughts and concerns with me.

Again out thanks to Marcus Grant for helping us all to understand that post-Covid planning is very real and we in Mortlake have a strong support base of academics and practitioners to guide our approach and activism.