Five takeaways from Health in All Policies 2019

Prevention is better than cure’ is a truth universally acknowledged and one that has recently taken centre stage in UK health policymaking. The extent to which we can prevent poor health depends on influencing the wider determinants of health and wellbeing, neatly summarised here…

Social determinants of health

Many of these determinants are within the control of local authorities, underlining the case for a ‘Health in All Policies’ (HiAP) approach which:

‘systematically and explicitly takes into account the health implications of the decisions we make; targets the key social determinants of health; looks for synergies between health and other core objectives and work we do with partners; and tries to avoid causing harm with the aim of improving the health of the population and reducing inequity.’

The recent HiAP 2019 conference at the Royal Society of Medicine sought to identify those synergies. I spoke at HiAP 2019 about the connections between transport and health and the opportunities for collaboration between the two sectors. You can read my presentation here.

Here are five things I took away from the day:

1. Give up power

Throughout the conference was a recognition that, to achieve HiAP, health – and other professionals – need to be willing to give up some power and, where possible, some funding. That might include, for example, the health sector giving up some power to enable other sectors – such as transport, housing, playwork – to tackle the wider determinants of health. It might also include professionals recognising that the amenities, services and places we design must work for the people and communities that we want to see using them. That means co-design, listening and acting on what communities say they need rather than what we think they should have.

2. Social participation is vital for good health

Dr Piroska Ostlin of the World Health Organisation talked about social participation as a key means for, and goal of, health equity. If we ask and act on what communities say they need (which itself is social participation) they are more likely to get out of the house and use it once it is delivered– whether that’s an attractive, well-cared for green space in the neighbourhood or a new bus service. Good public transport, walking and cycling have a vital role in linking people to each other and to opportunities to participate.

3. Place-based, not service-based

In line with HiAP, health policy is increasingly looking to intervene at the level of place rather than individual health services. How can we design our places and provide the amenities required to promote health and wellbeing? This plays directly into our Year of Action on Healthy Streets – an approach that seeks to put people and their health at the heart of the way we design individual streets. At HiAP 2019 I learnt about other models and frameworks that can help us think about how whole places can be designed with health in mind including the TCPA’s 6 elements of healthy places and Scotland’s Place Standard, pictured below. How people travel and move around a place is a central consideration in both frameworks.

Scotland's Place Standard

4. These places are already putting HiAP…

Wales: The Well-being of Future Generations (Wales) Act requires public bodies to think about the long-term impact of their decisions, to work better with people, communities and each other, and to prevent persistent problems such as poverty, health inequalities and climate change.

Norway: Government departments and politicians have a mandatory obligation to take account of health in all policy decisions.

New Zealand: The forthcoming 2019 Budget will place wellbeing, kindness and compassion at its heart. For the first time, alongside GDP, it will measure performance against five key priorities aimed at improving New Zealanders’ quality of life including: supporting mental health; improving child wellbeing; and creating opportunities. Any Minister wanting to spend money must prove it will improve inter-generational wellbeing.

5. Watch out for these…

A raft of new publications and resources are due in summer:

  • The Department for Health and Social Care’s Green Paper on prevention.
  • Public Health England’s Joint Strategic Framework for Health Inequalities (working title). A live, modular resource, the Framework is intended to provide a structure and vision for people working at local level on place-based action to tackle health inequalities.
  • The Health Foundation’s HiAP case studies collection.

For more on the connections between transport and health as well as tools to foster collaboration take a look at our Health and Wellbeing Hub.

Rebecca Fuller

Oh, Vienna! Lessons from the world’s most liveable city

jacek-dylag-579742-unsplash

As part of our ‘Healthy Streets for All’ year of action, we were delighted to sponsor this year’s Healthy Streets conference which took place at the Guildhall in London. The day amply illustrated the ever growing ranks of cities seeking to put people, their health and wellbeing at the centre of their urban planning. In a day packed with inspiring city case studies, the one that particularly stood out for me was Vienna – named the world’s most liveable city nine years in a row. Maria Vassilakou, Vienna’s Vice Mayor and Deputy Governor painted a compelling picture of how this came about. Here’s what we can learn from Vienna’s approach – note also how it meets all ten Healthy Streets Indicators, flagged up in bold.

Children are the key to a healthy city

Vienna’s urban planning takes the needs of children as its starting point. The city’s leaders believe that if a city is good for children, it is good for everyone (Everyone feels welcome). A city that welcomes children means that families, and young professionals thinking about starting a family, are not driven out to the suburbs but are encouraged instead to stay and build their lives in the heart of Vienna. Doing so not only creates a vibrant, multi-generational environment, it also cuts the congestion and pollution associated with commuting (Easy to cross, Clean air, Not too noisy).

Places that are designed around children are pleasant places to be. Designing for the needs of a child means plenty of safe space for walking and cycling, restricting car traffic and providing opportunities for play and exploration (People choose to walk and cycle, People feel safe, Things to see and do).

Some 50% of Vienna is green space and they intend to retain this (Shade and shelter). City streets are dotted with trees and interspersed with splashy water features which are great fun for kids and offer interest, animation and a calming environment for everyone else. The idea is for people to feel relaxed, slow down and take time to enjoy city spaces which offer them something to experience (Things to see and do, People feel relaxed).

Affordability and fairness

Vienna, home of grand palaces, high culture and an impressive musical, artistic and intellectual legacy (Mozart, Beethoven, Klimt and Freud all called it home) is not necessarily the place you would expect to prize affordability and access for all. But you don’t get to become the world’s most liveable city by excluding people. Vienna’s vision is for a city where everyone can afford to have a good life (Everyone feels welcome).

An annual public transport ticket is 365 Euros, just 1 Euro a day to travel throughout the city! Imagine that. This, together with a welcoming urban realm, helps to explain why 73% of trips in the city are by public transport, cycling and walking. They aim to increase that to 80% by 2025 (People choose to walk and cycle).

The city also offers annual grants to communities to transform under-used spaces into temporary ‘neighbourhood oases’. Crucially, these must be available to everyone ‘without consumption’ – places that can be enjoyed without buying anything (Places to stop and rest).

The party where everyone’s invited

As Maria put it in her presentation, ‘People will go where the party is…let your city be the party’. Vienna is all about creating excitement and interest (Things to see and do). Giving children space to play. Creating public spaces that allow for temporary uses. Building an environment where everyone feels welcome. As UTG lead Board member for health, Jon Lamonte put it in his presentation about Greater Manchester’s emerging ‘Streets for All’ programme, we need to ‘make streets an invitation’. An invitation to play, to enjoy, to stay.

Rebecca Fuller