Top-Down vs Bottom-Up Indicators on What Makes a Healthy Place
In the paper The Messy Challenge of Environmental Justice in the UK: Evolution, Status and Prospects (2019) Gordon Mitchell discusses the differences of environmental justice perspectives, approaches, and practices between the USA and UK/Europe. They argue that in the USA environmental justice has primarily been led and culturally shaped by grassroots community groups. This has resulted in the narratives of environmental justice being a socio-political issue given the acute geographic localisation of injustices. Whereas in Europe the narrative has been shaped by NGO action from the 1970s on the problems of carbon emissions being the problem of climate change, framing it more closely to a broader socio-economic issue. A bottom-up versus top-down approach.
So what about Health?
The Health and Care Act (2022), and its predecessor the Health and Social Care Act (2012), do not provide an active working definition of health. It is often assumed in these cases that any understanding of health is through the WHOs definition: Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The Ministry for Housing, Communities, and Local Government also does not offer a working definition of health in its overarching guidance document the National Planning Policy Framework (NPPF).
A lack of working definitions leads to interpretations, and as people such as Alastair Parvin write, British planning law is a culture of interpretations rather than rules, showing this is by design. Based on people's own attitudes, learnings, and epistemological framings they can make interpretations in many different ways.
This means that Local Plan policies can be designed using “legitimate evidence” and be problematic as depending on the subjective framing of authors and publishers the work can be biassed, misinformed, ignorant, or at worse, malicious. Therefore, well-meaning references to health around initiatives of access to natural space, good housing, local services, etc. the policy interpretation can exacerbate existing inequities when they fail to address the social, cultural, and political/governance issues that underpin them.
What did our research show?
In the case of our HIA we noticed that when reviewing the document September 2023 Rapid Health Impact Assessment for The Green Quarter by planning consultancy Lichfields, which used the GLA advised HUDU template, that a generalised access to food spaces would be seen as a positive health indicator. However, what makes food a healthy benefit for local people can mean many different things. For example, the Green Quarter HIA refers to the diverse demographics of Southall but the guidance for determining the health impacts of food spaces through new real estate don’t reflect this. Meaning that the provision of another large scale supermarket may tick a box and present a positive benefit to the needs of the community on paper but not meet the nutritional needs of all cultures, resulting in the need to travel further to access goods or go without, unhealthy in many ways.
When comparing the indicators from the HUDU template to ours we saw many comparisons. However the metrics were different. Our more bottom-up approach also brought in a wider range of issues that demonstrated what helps sustain a healthy place from a community point of view. For example, in our HIA we created an indicator asking for the assessing in the numbers of school aged children in and around a construction site. This was done under experiencing the impact of construction noise at critical times family-oriented times, such as when children are at home trying to do homework or for dinner time. Disturbances to this can cause multiple systemic issues to family life and increase stress on everyone involved. The indicator asked to a use of ONS or local authority data to understand the potential scale of impact, and therefore augment actions to reduce impacts. The solutions on which could be a range of things depending on the situation, for example, this could mean traffic management at specific times; noisy construction avoided between hours such as 3-6pm; a special after-school homework place for children and families otherwise impacted by the noise.
Another indicator/metric difference was on social infrastructure. The mere mention of providing social infrastructure in a planning document receives a positive mark however that can mean many different things. In the case of our HIA we talked about this meaning more secular social spaces, and a focus on childcare provision given the challenges many families and communities are facing over costs and lack of services. Inadequate provisions for childcare can reduce people’s capacity for employment in full- or part-time work or even shift-work, meaning the aforementioned positive benefit of employment as a health indicator being meaningless to some. Inadequate provisions for childcare can also mean children spend less time with their families or are forced to live irregular patterns, which goes against the majority of research and guidance that children need stability and routine in early years to develop good mental health. Disturbances and insecurity at young ages can lead to developing emotional, and thus behavioural, problems impacting school and social lives. The rest speaks for itself.
Conclusion
Whilst we mostly may be on the same page around issues, the approaches, framings, and details are different. This is what gets lost on a technocratic approach that becomes revealed when doing things bottom-up. The main issues remain however the methods evolve.