UPSTREAM

Looking upstream: the main barriers and opportunities

to healthier urban development according to the UK's main delivery agencies

Gabriel Scally

Public HealthDaniel Black + Associates | db+a

Presentation at Building Health in to the Urban Environment: Evidence and Opportunities

Royal Society of Medicine, Thursday 13th December 2018

Daniel Black

Director | db+a

Project Director | UPSTREAM

Black, D., Scally, G., Orme, J., Hunt, A., Pilkington, P., Lawrence, R., and Ebi, K. (2018) Moving Health Upstream in Urban Development: Reflections

on the Operationalisation of a Trans-disciplinary Case Study, Global Challenges, Wiley.

No “knowledge broker certificate”

(Robeson et al, 2008)

“often endorsed uncritically”

(Kislov et al, 2017)

Human

and

planetary

health

outcomes

Planning,

architecture,

engineering,

urban design

Controls

Land

Finance

Delivery

Public Health &

Sustainability

Specialists

National policy-making

Planning

Permission

Governance

City

Private

?

Black, D., Scally, G., Hunt, A., and Orme, J (2018) We must look further upstream to enable planetary health-literate

urban development. The Lancet Planetary Health. Vol 2, No.4, e145-e146, April2018. Elsevier.

1

Health outcomes not fully felt or understood

for another 70 years?

Business? Or academic?

(Observer Partner)

• City Council

• District Council

• Volume House-Builder

• Development Corporation

• Real Estate Developer & Asset

Manager

• New Investment Social Enterprise

• Regeneration Joint Venture

(contractor-social housing

provider)

• Combined Authority

ORGANISATION TYPES

CASE STUDY PARTNERS

Interviewees, Organisations and Positions

Sector OrganisationNumber of

intervieweesPosition within company

Private

• Volume House-Builder

• Developer/Asset manager

• Regeneration JV

• Investor Social Enterprise

6 Senior Executives

2 Sustainability / Health Specialist

Public

• City Council

• District Council

• Development Corporation

5 Senior Executives

2 Sustainability / Health Specialist

METHODOLOGY

‘Elite’ Interviews + Academic-Practitioner Partnership

‘Elite’ interviewing with thematic ‘probes’

Transcriptions

479 pages

codified

ACADEMIC

SPHERE

Final Analysis

Field Notes

69 pages, cross-checked

against transcriptions

PRACTITIONER

SPHERE

Reflexivity

Synthesis and

thematic analysis

2nd Round: 5 areas of deeper enquiry / testing valuation

1st Round: 13 thematic areas / wide ranging

1. Understanding of health

2. Valuation

3. Barriers and opportunities:

i. Land

ii. Partnership

iii. Finance

iv. Governance

v. Public Realm

vi. Politics

vii. Capacity

viii. Risk

ix. Knotty Problems

Key thematic areas identified

We must “balance between complexity and

the reduction of that complexity”

(El-Sayed, 2017)

Industry understanding of health

UNDERSTANDING OF URBAN-HEALTH

‣ Interviewees aware of most of the evidence (e.g. air pollution, green space, physical inactivity)

‣ Some areas of surprise e.g.: ‣ Noise from road traffic > child conduct disorder

‣ Air pollution > dementia

“Almost surprised it’s not more.

Bears out my assumptions.”

“All expected”

“Broadly not surprising”

“Most are obvious, but

dementia surprising”

Industry response to valuation

VALUATION

‣ Health not adequately accounted for

‣ Supportive of use of economic valuation, depending

on assumptions/detail

‣ Exact monetary value less important than ability to

compare, prioritise, get a sense of scale

‣ “Who bears additional costs?” (e.g. Consumers?

State? Landowners? Tech giants?)

‣ Multiple uses suggested (e.g. Treasury, RICS,

planning evidence, etc.)

‣ “Difficult to do”…yet private sector leading the way?

‣ Agreed mechanisms needed?

“…this looks like a really useful checklist…

…actual costs are less important…”

Industry thoughts on…

Barriers & Opportunities

LAND

• Control of land (public sector?)

• Land disposal (e.g. NHS Property?)

• Land value capture widely supported…but “dangerous”

PARTNERSHIP

• Critical to balance the various strengths of stakeholders

• Concern on both sides about value that is taken out;

planning requirements “never enough”

“I think it’s very dangerous when

you try and intervene in things like

(land value capture)”

“I think land value capture

is really key…

there’s a cost and where’s

that money coming from?”

“You’ve got to understand

what you’re putting in to

the pot, and be able to

value that.

If it’s only 10% of the

partnership, then you only

get 10% of the control.”

GOVERNANCE

• Clear demand for greater devolution

• Policy alignment with delivery critical (e.g. PPG3)

• Law (e.g. Social Value Act, EIA) - “limp”?

FINANCE

• Financial short termism likely significant, but…

• … length of financial interest not a panacea

• Pension funds or niche ‘enlightened’ investors?

• ‘Localisation’ of investment?

“not to long ago there was more

about maximising stakeholder

value…

…but it’s definitely shareholder

value today…”

“…making a profit, but not profiteering…”

“Planning Policy Guidance 3

(PPG3) set minimum densities…

…now if you visit those

developments, they’re a complete

nightmare…”

PUBLIC REALM

• Maintenance

“…we don’t retain an ownership in a development…

…our business is about developing and selling houses and moving on…”

POLITICS

• Short-termism

• Prioritisation

“…elections every 5 years drives a lot of

extremely short-term decision-making...”

“If health, air quality and noise are high up

your agenda, then you’ll deliver it.”

REFERENCES

• R.J. Lawrence (2015) Mind the Gap: Bridging the divide between knowledge, policy and practice. In H. Barton, S. Thompson, S. Burgess

& M. Grant (eds.) The Routledge Handbook of Planning for Health and Well-Being, pp. 74-84, New York, London: Routledge.

• H. Frumkin (2017) ‘Welcome & Meeting Overview: What is Planetary Health and Why Now?’ [PowerPoint Presentation - Planetary

Health Alliance Inaugural Meeting. Saturday, April 29th.]

• Williams, K. (2014) Urban Form and infrastructure: a morphological review, Future of cities: working paper. Foresight, Government

Office for Science. [WWW]

• Rao, M., Barten, F., Blackshaw, N., Lapitan, J., Galea, G., Jacoby, E., Samarth, A. and Bucley, E., 2011. Urban planning, development

and non-communicable diseases. Planning Practice and Research 26 (4), 373-391.

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scientific responses, and the way forward. Current Opinion in Environmental Sustainability. Vol.4, Issue 4, pp.465-472. Elsevier.

• Stern, N. (2007) The Stern Review: The Economics of Climate Change. Cabinet Office - HM Treasury. ISBN: 9780521700801.

• Hoyler, M., Lizieri, C. M., Pain, K., Taylor, P., Vinciguerra, S., Derudder, B. and Pelckmans, D.(2014) European cities in advanced

producer services and real estate capital flows: a dynamic perspective. In: Pain, K. and Van Hamme, G. (eds.) Changing Urban and

Regional Relations in a Globalizing World: Europe as a Global Macro-Region. Edward Elgar, Cheltenham, pp. 115-137. ISBN

9781782544647

• Kemm J. (2012) Health Impact Assessment: Past Achievement, Current Understanding, and Future Progress. Oxford University Press.

ISBN 0191629502, 9780191629501

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England.

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• Black, D., Scally, G., Orme, J., Hunt, A., Pilkington, P., Lawrence, R., and Ebi, K. (2018) Moving Health Upstream in Urban

Development: Reflections on the Operationalisation of a Trans-disciplinary Case Study, Global Challenges, Wiley.

• Black, D., Scally, G., Hunt, A., and Orme, J (2018) We must look further upstream to enable planetary health-literate urban development.

The Lancet Planetary Health. Vol 2, No.4, e145-e146, April2018. Elsevier.

• El-Sayed, Abdulrahman M & Galea, S. Systems Science and Population Health. (Oxford University Press, 2017)

• Kislov R, Wilson P, Boaden R (2016) The ‘dark side’ of knowledge brokering. Journal of Health Service Research and Policy. Sage.

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Association. 2008;29:79–82.