Editorial viewpoint: promoting health through spatial planning for ‘health net gain’

Abstract

The Ottawa Charter for Health Promotion recognised that health is created within the settings of everyday life, from homes and workplaces to our wider natural and built environments. The planning, design, and management of these environments significantly influences health and wellbeing (Chang, Petrokofsky, and Green 2022), and environmental changes present opportunities to create health-promoting settings, address health-damaging risks and reduce health inequalities. Environmental and health policies share principle-based approaches and objectives of protection and improvement. An ‘environmental net gain’ principle has been introduced in English spatial planning policy that requires new developments to deliver gains in biodiversity, using a metric based on characteristics of place. A mitigation hierarchy prioritises avoidance and minimisation of damage, which has obvious parallels with health protection hierarchies addressing threats such as air pollution and flooding. Gains necessitate measurable improvements, extending the comparison from specific risks, exposures and harms to broader concepts of health and opportunities to improve it. Realising sought-for gains requires long-term local commitments as well as strategic coordination. Planning obligations and covenants aim to secure biodiversity gains; here there are parallels with the provision of healthier environments and health promotion. The idea of a net gain principle for health in spatial planning raises many considerations, not least its role in addressing inequity and health inequalities and the place of health promotion integral to the realisation of health gains forecast by developers. This is an area of emerging interest and research (Stewart-Evans, Koksal, and Chang 2022; Koksal 2022) requiring the integrated multi-disciplinary approaches that underpin health promotion. Whilst reform of the planning system presents opportunities and challenges, considered input from public health practitioners remains fundamental to creating and realising opportunities to create health through our built and natural environments, places and settings.