The way cities are designed and managed has big impacts on our health. While Australia is considered a world leader in research on health and cities, nationally our planning policies remain underdeveloped relative to our knowledge base. To remedy this, healthy planning advocates need to better understand how urban planning systems can be influenced.
Several recent, mostly positive, experiences in the New South Wales (NSW) planning system provide insights into this process. Each represents a milestone for land-use planning in this state given extensive reforms have been on and off the table for the past decade.
The connections between city planning and health are many and varied. Key aspects include environmental sustainability, pollution risks and liveable places. Being liveable means having access to healthy food, nearby employment and services, and opportunities for active lifestyles.
These issues are increasingly important given projected population growth pressures on urban infrastructure. Other areas facing similar pressures, in Australia and overseas, might wish to take note of what has happened in NSW.
Since 2014 we have used political science to investigate attempts in NSW to include health in legislative reform, strategic city planning and major urban infrastructure assessments. As well as scrutinising relevant policies and associated documentation, we have interviewed more than 50 stakeholders. This has provided insights into how and why recent developments came about.
How has NSW brought health into planning?
Healthy planning has always had champions in NSW, but really hit its stride during a major legislative reform exercise that began in 2011. This came to a head in November 2017, when the state parliament passed amendments to the Environmental Planning and Assessment Act 1979.
This legislation now lists two objects of direct importance for health:
- protection of the health and safety of occupants of buildings
- promotion of good design and amenity of the built environment.
Also in 2017, the NSW Office of the Government Architect produced a policy of “design-led planning”. Known as “Better Placed”, this policy positions health as a top priority. It embeds health within design processes, methods and outcomes for different levels of planning from cities and towns to places and buildings.
In our view, Better Placed is an exemplary policy in demonstrating the importance of urban planning for health.
In another positive development, the Greater Sydney Commission recently released Metropolitan and District Plans that position health as a core objective (number 7). The plans consistently refer to health across the central themes of liveability, productivity and sustainability.
To their credit, the NSW government and the commission have developed plans concurrently with transport and infrastructure and released them together. The evidence suggests this integration should have public health benefits. The emphasis across the commission, transport and infrastructure plans on creating a liveable and accessible city increases our confidence in this outcome.
Three key factors in making health a priority
Our research suggests three crucial factors in elevating the status of health in planning.
1. A core group of non-government, government and academic representatives has led health advocacy for over a decade. The group’s messages and activities intentionally focused on collaboration across agencies in the public interest.
This advocacy has grown in sophistication since the early days of making submissions about “health” issues that risked being treated as peripheral to the main game of planning (infrastructure, for instance).
Within government, NSW Health (both state and local departments) has developed an increasingly effective response to urban planning opportunities for promoting and protecting health.
2. The previous minister for planning (Rob Stokes), the Office of the Government Architect and the Greater Sydney Commission have each provided vital policy mechanisms for including health. This illustrates the importance of particular agents in the right place at the right time.
The minister was essential in establishing the commission. This effectively created a respectful distance between strategic planning and the “economics trumps all” planning agenda seen in some policy environments.
The “design-led planning” emphasis came about when Stokes was planning minister. The starring role given to health in Better Placed gives healthy planning advocates, for the time being, unprecedented opportunity to influence strategies and plans.
3. Delivery now requires close attention, as these positive shifts alone have limited power. For instance, the commission’s plans emphasise collaborative infrastructure delivery to create an equitable city. Infrastructure has profound health impacts, costs and benefits.
Shifting infrastructure funding to benefit the city’s West will be the core fault line for delivering on promises of equitable infrastructure provision. However, infrastructure project funding and appraisal are crying out for reform. Better indicators, transparent analyses to inform options, improved governance arrangements and greater accountability have all been identified as required reforms.
The NSW planning system has begun to recognise the importance of urban planning for health. These developments present a tremendous opportunity to influence how healthy public policy can be delivered for the benefit of the whole city.
Patrick Harris, Senior Research Fellow, Menzies Centre for Health Policy, University of Sydney; Elizabeth Harris, Senior Research Fellow, UNSW; Emily Riley, Research Assistant, University of Sydney; Jennifer Kent, Research Fellow, University of Sydney, and Peter Sainsbury, Adjunct Associate Professor, South Western Sydney Local Health District