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The Complexity of Assessing Health Impacts
Whether you’re an enthusiast or a critic of the planning system, there is no denying its pivotal role in shaping our environment on a local up to global level. It’s an open secret that every new development – regardless of scale – sustains some impact on popular news topics such as the economy, public health, and climate change. It is also clear that these issues are intrinsically inter-related.
As such, it is important that we fully understand such impacts in order to maximise the benefits they can bring to the population, whilst simultaneously focusing on minimising any potential harm. This is the purpose of Health Impact Assessments (HIAs) – an assessment that has rapidly grown in demand over the last decade, particularly since the pandemic, due to a rising concern regarding local and national health inequality.
Broadly speaking, HIAs measure the impact of a new development against a number of key health determinants, disaggregated into a number of health indicators (see Figure 1). These indicators vary considerably, from income and air quality, to sense of belonging and housing conditions.

Figure 1: Health Determinants and Health Indicators

Health is a complex, intricate topic and therefore presents a number of challenges when it comes to assessing the impacts of a new development against the indicators outlined in guidance. Healthier – our new HIA framework – takes account of these challenges and applies a large array of varied data to articulate what the definitive impacts of new developments are. A couple of prevalent challenges are summarised below.

Exogenous vs Endogenous

First, health is influenced by many exogenous and endogenous factors. Exogenous factors relate to the external factors that could impact an individual’s health, such as air quality; the availability of employment opportunities; and the quality of housing. For the most part, they are factors that are outside of an individual’s control. In contrast, endogenous factors are those that an individual has far greater control over, and are often characterised as behavioural decisions. Consequently, new developments, (theoretically) have a much lower impact on influencing endogenous factors as, ultimately, they rely on human decisions.
By way of example, Lichfields recently assessed the health impact of a mixed-use residential scheme – comprising of new housing and a foodstore in the North East.
In this case study, the provision of new housing was assessed to naturally have a beneficial impact on the quality of local housing as it is likely to unlock a host of associated positive health-related impacts (see associated blog). It was also important to assess the impact of the foodstore on key health indicators such as nutrition and diet. However, the true scale of this impact was less clear. Whilst the new foodstore will increase the accessibility of healthy and affordable food, the extent of the impact is ultimately reliant on the decision-making of the local population to choose such items. As such, to maximise the benefit that this aspect of the development will have on the local population, it could require a number of ‘supporting’ interventions that goes past the responsibility of the developer (such as improved food education).

 

Long Term and Short Term

A common oversight on some HIAs is to only consider the short-term implications of new developments on health. Typically, this provides an unweighted bias towards adverse impacts, as these impacts often have a stronger appearance in the short term. Alternatively, many beneficial impacts instead have a lag period where the true extent of the impact is not clear until years later.
One such scenario was presented when Lichfields assessed the health impact of a new school in Yorkshire. The proposed development was anticipated to generate adverse impacts during construction with respect to noise, by virtue of its proximity to nearby houses. Such impact could generate poorer mental wellbeing in the short term – due to disturbance – but, resort back to normal post-construction phase. In contrast, the impact of an enhanced education offer may only become clear in the long term. Indeed, a good quality education enhances crucial cognitive and social skills, which in the long run supports the potential for better paid employment opportunities – an indirect, but strong determinant for positive health outcomes – as well as well-reasoned decision-making.

 

How can Healthier help?

At its core, Healthier is designed to help ensure that all new developments will have a net benefit on the health of the local population. As a result, it supports the planning application in meeting validation requirements, as well as certifies that the scheme is beneficial.
Our framework combines the multitude of guidance methodologies for assessing health across the UK into one comprehensive, but flexible format to streamline the process for clients. Underpinned by a host of publicly available datasets, Healthier models key health determinants and weights them appropriately to reflect their true impact on health outcomes. This comprehensive approach ensures each assessment is robust to meet the rigours of planning and public scrutiny. Reports are then tailored to meet the specific requirements of local planning authorities and can be applied across any sector and for any scale of development.
Please contact Isaac Vango or Helen Ashby-Ridgway if you require any help with health-based assessments or would like a further discussion on what we can offer to you.
 

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The High Street isn’t dead, long live the High Street #4 - Repurposing for Alfresco Summer Dining
The reopening of ‘non-essential’ shops on 15 June has provided the ability for the core of many town centres (shops) to reopen, albeit with social distancing measures in place.
While shops are a key component of all town centres and high streets and will undoubtedly continue to play a central role in their future landscape, a major component of town centre vibrancy and character are the food and beverage uses.
Restaurants and bars are meeting places and hubs for social activity: places where friendships are forged; couples fall in love; and business dealings are done. They have a strong emotional attachment for many of us – walking into your favourite restaurant or pub is like coming home.
There has been huge growth in food and beverage uses in recent years. This growth has been positive for our town centres – encouraging longer dwell times and making our high streets more liveable.
The impact of Covid-19 has been immediate and devastating for many aspects of commercial life. For town centres, high streets and destinations centred around eating and drink, entertainment and hospitality, the effects have been felt hardest. This threatens the very essence of place and what makes our town centres and high streets so special.
So, with this culture and way of life having been under threat, what is the route map out of the crisis and reversion to normality from 4th July? Is the longer-term repurposing of our high streets to support active travel unavoidable? And will this (weather permitting!) usher in a new wave of alfresco dining?

Active Travel & Temporary Measures to Improve the Public Realm

Coronavirus has brought the need to make town centres and high streets easily and safely accessible into sharp focus. For those with mobility issues or young children this has been known for some time. Where, in ‘normal’ times, you’d shuffle along a high street dodging and weaving as you go, the need for more space is now greater. Space which is often in short supply given the competing demands on high street spaces.
Following a review of social distancing measures, the Prime Minister has set out that, where it is not possible to stay two metres apart, guidance will allow people to keep a social distance of ‘one metre plus’. This means “staying one metre apart, plus mitigations which reduce the risk of transmission”.
Providing sufficient space for social distancing is a huge challenge for food and beverage operators. The relaxation of the ‘2m rule’ is a welcome and crucial change for pubs, bars and restaurants which revolve around close contact socialising and are often constrained by small unit sizes.
As explored in Steven Butterworth’s blog, Transport for London (TfL) and boroughs authorities are rapidly reallocating road space in London to accommodate significant increases in active travel modes through the Streetspace initiative. The Mayor’s Healthy Street policies and initiatives are in effect being accelerated to accommodate pandemic-based travel demands.
The Government’s guidance to support social distancing through the creation of Safer Public Spaces includes a number of ‘typical temporary interventions’ for high streets and town centres. These include:
  1. Widening footways;
  2. Introducing cycleways;
  3. Reducing traffic speeds;
  4. Provision of seating areas for the disabled and elderly; and
  5. Pedestrianisation.
     
For many town centres, these interventions are aspirational longer-term strategies in their own right. They have potential to make our town centres safer, more attractive and vibrant post-pandemic if they gain traction, public support and become embedded in the public realm. Many of the interventions are also key tenants of town centre planning and transport policy, site specific guidance and Area Action Plans. 
TfL and many local authorities have acted swiftly. In London, TfL has widened the pavement widths in Brixton to provide more space for pedestrians and Hackney Council has closed Broadway Market to traffic to creating more space for pedestrians and cyclists. A campaign to make changes at Broadway Market permanent has already been set up.     
Brixton

Source: @EdDavie via Twitter

Broadway Market

Source: @Hackneycyclist via Twitter

In the short to medium term, the focus on promoting active travel and discouraging the use of public transport for all but essential journeys, may mean that we end up living our lives (and spending our money) more locally. For now, initiatives like this provide a boost in confidence that our local high streets are safe and open for business by creating the space needed to visit whilst respecting social distancing.

Optimising Outdoor Space: Alfresco Dining

Social distancing measures mean that restaurants and bars will need to operate at significantly reduced capacity (which will undermine viability for many) unless they are able to compensate for social distancing through the provision of additional seating areas beyond their demise or expansion of their customer base through takeaway services.
For one year (until 23 March 2021) temporary permitted development rights allow restaurants and cafes (Use Class A3) and drinking establishments (Use Class A4) to provide takeaway food (subject to notification). This swift action has allowed many businesses to take advantage of the new PDR and keep some income flowing throughout lockdown.
Depending on the location and design of outdoor seating areas planning permission and/or a licence may be required. This takes time, has risks and is often only permitted for temporary periods (usually one year).   
With this in mind, MHCLG has called on local authorities to accelerate licence approvals for the sale of takeaway food and drink outside of premises and refrain from taking enforcement action “which would result in unnecessarily restricting outdoor stalls during this period”. Local authorities are also called on to explore opportunities for setting up more outdoor markets and identify whether “closing certain streets to traffic could better support temporary markets and outdoor eating”.
The emerging Business and Planning Bill will further ease the burden on operators by streamlining the licensing process for businesses wishing to put tables and chairs outside of cafes, bars and restaurants and by allowing some operators to continue using outdoor seating areas without needing to re-apply for planning permission. The proposed temporary pavement licences process will simplify, speed up and reduce the costs of the consent route for outdoor seating (no more than £100), making it easier for people to safely drink and dine outside. Temporary changes to licensing laws will also allow many more licensed premises, such as pubs and restaurants, to sell alcohol for consumption off the premises – making social distancing easier.
In addition, proposed planning freedoms announced on 25 June “mean that proposals for outdoor markets, pop-up car boot sales or summer fairs will not need a planning application which will transform the way people shop and socialise”. Whilst the press release refers to these specific uses, the benefits are far broader – allowing use of land within the curtilage of a building for a wide range of activities and for an associated moveable structure to be erected.
In London, Soho Estates is campaigning for Westminster City Council to allow the temporary pedestrianisation of parts of Soho so restaurants are able to offer outdoor seating (outside their land ownership on the public highway). The Soho Summer Street Festival aims to reinvigorate much of Soho and lead the recovery of Soho as the cultural and vibrant heart of London.
For smaller asset manager or individual businesses, there is an urgent need for joined up thinking and for local authorities and/or Business Improvement District to support businesses by taking the lead in making our streets and public realm more alfresco friendly. 
Internationally, many cities around the world have reclaimed streets (mostly from cars) to facilitate the expansion of restaurant and bars.  
Copenhagen

Source: @colvilleandersn via Twitter

New York

Source: @ReynosoBrooklyn via Twitter

There are also innovative off the shelf solutions capable of being rolled out, such as the below modular ‘Parklet’ in Hammersmith and Fulham:
Hammersmith and Fulham

Source: @PaulWellman_ via Twitter

Takeaways

With the repurposing of road space, facilitation of active travel and reduced risk of enforcement action being taken, easing of lockdown will give rise to one of the biggest experiments in our town centres.
As we get use to this new way of life, some of these measures may become a permanent fixture, making town centres and high streets more accessible, liveable and pleasant spaces to spend time in. 
Lichfields is well placed to help navigate this transition through assisting with pavement licence applications, securing temporary worthwhile uses, and repurposing town centre sites to help breathe new life into high streets.
The 4th of July is set to become England’s ‘independence’ celebration too. Bring on the summer.

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