Systemic Thinking
The planning documentation seeking consent to redevelop the Gasworks in 2008 appears to have been influenced by the 2003 UK Government paper ‘Tackling health inequalities - a programme for action’. Whilst the 2003 report uses meritable actions for reducing health inequalities they fail to address the systemic conditions in which the recommendations sit as well as their abilities to unintentionally exacerbate determinants of health if not they’re not addressed at source.
Increasing opportunities for employment has typically been seen as pathways to reducing health inequalities as it relates to the ability to purchase good quality foods, access to services, and the chances to access a quality of home that would infer better health opportunities. However, as many have pointed out, if the economic system in which the employment opportunities sit are from extractive methods this can have an impact on a range of systemic factors that influence long term health.
If labour rights are diminished in the name of powering the economy this can result in unfair working conditions such as zero-hour contracts, shift-work, and a hostile and fragile employment status, all of which impact health in a number of ways.
Additionally within the extractive economics framing is the capacity for business and economic practices to impact wider determinants of health such as climate change and political instability. Another example of an extractive economic practice can be whether systems contribute to community wealth building or not. Katz et al from the Drexel University Lindy Institute for Urban Innovation have demonstrated at length in Towards a New System of Community Wealth how without addressing community wealth building from the ground up, a slow erosion of social infrastructure and capital takes place where local tax bases diminish whilst conditions for quality of life also decrease.
A row of closed shops in the UK
This is one example of good intentions not accurately reflecting the conditions in which they sit. Another example can be housing, and to keep it simple, whilst ‘Tackling health inequalities - a programme for action’ may state that “good” housing is a pathway to good health there are issues to navigate such as the number of volatile organic compounds found in modern building tools, the quality and quantity of tenure for those that rent is crucial, and whether the types of homes being made reflect the cultural realities of modern life - such as multi-generational households. Without these issues being addressed more accurately the promise of a direction of good health can in fact lead to a different set of health problems.
This brings to light the need for the inclusion of a Determinants of Health framework to guide the conditions under which indicators and metrics within an assessment sit. Sir Michael Marmot has worked to establish the Social Determinants of Health in modern British lexicon however it’s time we go one-step further and ensure that commercial and political determinants are also considered - side note: we take issue with the term “social” as this implies there is an inherent societal, or personal, attribute that causes factors such as unemployment (e.g. lazy) and treating them as issues at a local level, whereas we would refer to them as “socialised” determinants of health as they are the conditions set by political and commercial actions, such as the investment in employment opportunities and training by governmental and industry actors.
Lastly, it’s worth bringing to light the timescales involved in such projects. A document from 2008 refers to another document in 2003 (itself most likely produced over 2001-02) and influenced an activity taking place in 2018. It can be argued that in 2003 (white) society was less aware of social determinants of health and systems thinking theory and practice and therefore it wasn’t debated as extensively. However, by the mid-2010s the breadth of knowledge and insight produced in these fields is undeniable. By these points in time, and certainly in response to the 2008-era Global Financial Crisis, the social awareness and practice of systems design were mainstream. Meaning that we have a time-based problem.
Conclusion
We ask a simple question that surely planning processes should have mechanisms in place to be reflected in a more real time, socially relevant manner? Why couldn’t a process such as an HIA be completed with up-to-date theory and practice be submitted within 12 months of an application?