The healthy garden city

The healthy garden city

By Bob Pinkett, Partner – Transport

With the connections between place, mobility, health and wellbeing now increasingly present in our policy conversations are we finally catching up with the Garden City pioneers?

In “Garden Cities of To-Morrow” Sir Ebenezer Howard identifies a key objective of the Garden City as “To find for our industrial population work at wages of higher purchasing power, and to secure healthier surroundings and more regular employment.”

Even without the archaic language of Howard’s 1902 manifesto – and a whole range of political, economic and social sub texts – the message was clear. Born out of the Victorian era’s increased understanding and support for improving the health of the nation the role of the ‘better place’ becomes central, in particular in connection with working conditions and quality of life.

Town planning has a long history of making public health a core factor in spatial choices and improving urban design. In fact, much current planning practice is derived from public health professionals designing cities for healthier lives, from the original Garden Cities to the current rethinking of urban living across the world. The Town and Country Planning Association, which was founded by Howard, continues to make the case for greater integration to achieve healthy outcomes in planning and urban design.

Having reviewed a few recent policies and initiatives, I think we are at the moment when the integration of health, wellbeing, place and mobility is finally becoming mainstream, as Howard advocated. However, before we celebrate there are also some fundamental matters to address – taking and sharing responsibility, winning community support, securing long term funding.

The consultation on the draft London Mayor’s Transport Strategy, for example, places considerable weight on delivering ‘Healthy Streets’ as a necessary precursor to growth. Our review welcomed the policy direction to support health and transport integration, but we did suggest it could miss the target by focussing primarily on physical activity. Increased cycling and walking activity will undoubtedly help the health agenda, for example by reducing obesity, improving heart conditions and reducing respiratory diseases from improved air quality as people switch from cars. My hope is that general wellbeing, mental health and quality of life of Londoners will also be improved through the advent of ‘Healthy Streets’, as what London leads with is often adopted across a wide range of urban environments, including the emerging garden communities.

To secure Government funding there is greater recognition of the need to value health benefits, and recent advice to transport planners (in WebTAG) sets out a better method to estimate the health benefits of walking and cycling interventions. In our 2016 CIHT report, we emphasised the need for improved project appraisal approaches to identify and measure health benefits better, making them a key factor in infrastructure spending decisions, so we welcome the recognition of our recommendations by the DfT. In particular, we encourage both transport planners and town planners to work with colleagues in Public Health and the NHS more, as they are years ahead of us in effectively measuring the physical and mental health impacts of interventions. 

Similarly, measuring the benefits beyond the basic qualitative health impacts usually identified in Environmental Impact Assessments is now being challenged as new quantitative approaches emerge from health professionals and academics. We are still a long way from properly valuing wider wellbeing and mental health benefits, often characterised as ‘hard to do’, but in the context of greener and friendlier garden city spaces it becomes even more essential for making the case beyond the economic benefits.

This positive movement to greater integration comes in the context of continued local authority austerity pressures impacting on infrastructure, transport and social care expenditure, while the government is planning a major NHS and social care review, which will inevitably impact on spatial planning choices. In the NHS, the focus on Sustainability and Transformation Plans (STP) encourages greater integration and coordination through partnerships, but in the resulting restructuring we have seen potential negative impacts on access to healthcare, as services are concentrated in fewer, larger (and often less conveniently located) facilities. NHS organisations across England were asked to jointly develop plans for the future of health services in their area, working with local authorities and other partners – this is welcomed, but in our reviews very few STPs are taking access, mobility and travel impacts seriously.

Looking back over 100 years, Howard advocated placing healthcare at the centre of his garden cities, with local doctors seen as essential – yet this proven localism could potentially be unpicked with the STP led changes in healthcare planning.  The NHS commitment, as part of its Healthy New Towns project, to work with ten major developments (two of which PBA is involved with at Ebbsfleet and Barton Park) to integrate health and care services into their masterplanning process, is a more positive sign of joined up thinking, and clearly in line with Howard’s thinking. 

As with ‘sustainable’, and ‘smart’ ultimately, we need to guard against health and wellbeing as becoming increasingly meaningless adjectives in the ‘big policy toolkit’. If health (and particularly mental health) is just another tick box in the garden city formula we also may miss a chance to fundamentally reassess, for the current age, the links between place, mobility, health and wellbeing – links that the Garden City pioneers understood well.

“Ere long, I trust we shall meet in Garden City.” Sir Ebenezer Howard