The history of planning
More than 15 centuries ago when he wrote that “by far the greatest and most admirable form of wisdom is that needed to plan and beautify cities and human communities”, Socrates recognised the inherent role our living environment has on our health, something that we are still grappling with today.
The 1875 Public Health Act was the first step towards improvements in housing as it gave local authorities the ability to ban ‘back-to-back’ housing. During the industrial revolution, as towns and cities grew, and new houses were needed to satisfy the increased demand for homes. This led to homes being developed at a rapid pace with quality often being sacrificed.[1] Cheap back-to-back housing, for example, posed grave risks such as overcrowding and ‘squalor’ (inadequate cleanliness). In Manchester, it was approximated that the death rate of people living in these houses was 40% higher than people living in houses that were not built ‘back-to-back’. Moreover, tuberculosis was 50% more prevalent in people living in back-to-back housing.[2]
By the turn of the century, there was increasing concern about the health impacts of poor housing conditions. The 1909 Housing, Town Planning, etc. Act made the building of back-to-back housing illegal, marking a big step towards improved quality of housing for the public going forward. Former Prime Minister, David Lloyd George, also set about making Britain ‘fitter’ amid concerns about housing conditions for people who lived in rented accommodation. This was especially important after the First World War when 80% of households were renting their homes almost exclusively from private landlords. [3]
After the end of the war, the 1919 Housing, Town Planning, & etc. Act, or Addison Act after Dr Christopher Addison, the Minister for Health, signified a further step towards a welfare state when building new homes for people in employment became the responsibility of local authorities. Although only 200,000 of the 500,000 new council homes it aimed to deliver were built, it marked another major improvement in the quality of housing because it was the first time houses were built with amenities such as electricity, running water and indoor toilets.[4]
The later 1930 Housing Act sought to ensure councils eradicated any ‘slum’ housing that still remained and to provide those living in these homes with new accommodation. By 1939 more than a million council houses had been built in the UK.
During the Second World War, planning gained newfound importance when the publication of the Beveridge report set out squalor as one of the five ‘giants’ for society to eradicate.[5] Promises to improve the state of housing, which in some cities was in short supply due to German air raids, played a major role in enabling the Labour government to become elected in 1945.[6] Aneurin Bevan, the then Health and Housing Minister, sought to do this by improving building standards. Bevan was particularly adamant about expanding the clearance of slums to more parts of the country.[7] Additionally, the former Health and Housing Minister advocated for old unconverted houses to be renovated with additions such as bathrooms or kitchen units to bring them up to date.
The 1947 Town and Country Planning Act passed under the Clement Atlee’s Labour Government contained the building blocks of modern-day planning as we know it today.[8] The act stipulated that developments need to be granted permission and could no longer be done solely on the basis of ownership of land. Local authorities now held the most influence over decisions on planning permission applications.
The growing recognition of the link between health and housing was formalised when the Ministry of Housing and Local Government became the Ministry of Local Government and Planning in 1951 after the roles of the Ministry of Health was merged with the Ministry of Town and Country Planning.
In an attempt to eradicate any remaining ‘back-to-back’ housing in nearby cities, new towns such as Milton Keynes were built from scratch. In the 60’s, the then Director of Public Health (DPH) for Buckinghamshire, John Reid, was closely involved in the planning of Milton Keynes which saw thousands of people being relocated from the old, dirty and overcrowded slums found in industrial towns and cities of the day.[9] Two of this new town’s goals was to provide residents with freedom of choice and ease of movement with a pledge that locals would be able to easily walk to an activity centre within minutes. The town featured plenty of greenery as well as numerous walking and cycling routes.[10] This emphasis on both the provision of decent housing and access to active travel in order to benefit residents demonstrates the potential of planning to support the health of its communities.
In addition to determining the feasibility of active travel, planning also plays a predominant role in the availability and proximity of unhealthy food, especially near schools. In a report by the Royal Society of Public Health, the ease of access to fast food shops nearby schools were noted, particularly in London.[11] It was estimated that on average there are six take aways within a few minutes walking distance from schools, a figure that is even higher in more deprived areas. The report concluded that in cities the time between a child leaving school and arriving home has a major impact on what they are consuming and how active they are. To address this issue, in Gateshead, the DPH has worked closely with the planning department to introduce policy that has reduced the number of fast-food outlets to help tackle the high levels of childhood obesity in the area.
Planning healthier spaces to live and work not only benefits our physical health, people who spend at least two hours a week in nature are more likely to have better health and psychological wellbeing than people who do not, according to just one of a number of studies demonstrating the positive impact of the environment on people’s mental health.[12]
Alongside green spaces, green belts also have an important history in planning. Green belts refer to an intervention used to prevent ‘urban sprawl’ in ring-fenced areas with the intention of keeping these regions open and undeveloped indefinitely.[13] The Greater London Regional Planning Committee was the first to put forward the suggestion of a green belt around London in 1935.[14] The 1947 Town and Country Planning Act granted local authorities the power to make green belt propositions in their developmental plans. Moreover, Duncan Sandys, the former Minister of Housing showed his support for green belts in the 1950s by advocating for English local authorities to protect the land surrounding cities with this intervention.[15]
Around the time when green belts started to emerge, interest in national parks also grew. However, the origins of national parks can be traced back to the 19th century. Towards the end of the 19th century a campaign to enable public access to the countryside began but the ‘freedom to roam’ bill that was initiated in the 1880s was rejected. [16] Amid growing industrialisation and urbanisation, public interest in accessing the countryside rose. This created tensions between landowners and those calling for the countryside to be opened up to all.
By 1949 the Government passed the National Parks and Access to the Countryside Act through Parliament. Shortly after the bill passed, the first group of national parks in Britain were designated in the 50s. Similar acts in Scotland were introduced in the early 2000s.
Now the UK boasts a total of 15 national parks.[17] Free to access and use, they are an important part of our infrastructure and enjoyed by millions for both their physical and mental health benefits.
As is the case with many areas of public health, despite the improvements to planning law and commitment to improve our local spaces, there is still an unacceptable gap in outcomes for people who live in more deprived areas. Green spaces are less common, overcrowding more likely and active transport options less accessible – all conditions which lead to poorer mental and physical health.
It is clear that planning is a vital component of public health efforts to provide places where families can not only find shelter but also lead healthy lives. The history of planning demonstrates marked improvements in sanitation and reducing the prevalence of disease particularly with respect to housing. However, it is crucial that we continue to build upon these milestones to better ensure the health of the population. It is especially important that children are able to live in environments that are set up to promote healthier outcomes, particularly in the most deprived areas to prevent a new cycle of ill health for the next generation.
Today, DsPH work closely with planning departments to support developments that make houses fit for purpose, active travel more feasible, green spaces more accessible and local recreational facilities healthier. As the collective voice for DsPH, ADPH have repeatedly called for health to be placed at the heart of planning decisions and work in partnership with organisations such as Association of Directors of Environment, Economy, Planning and Transport as well as the Town and Country Planning Association to advocate for healthier places across the UK to improve people’s lives for the better.
[1] https://schoolshistory.org.uk/topics/british-history/modern-britain/liberal-reforms/housing-town-planning-act-1909/
[2] http://etheses.dur.ac.uk/5687/1/5687_3103.PDF
[3] https://www.theguardian.com/business/2014/may/24/history-british-housing-decade
[4] https://www.bbc.co.uk/bitesize/guides/z9924qt/revision/5
[5] https://navigator.health.org.uk/theme/beveridge-report
[6] https://fet.uwe.ac.uk/conweb/house_ages/council_housing/section5.htm
[7] https://api.parliament.uk/historic-hansard/commons/1949/mar/16/housing-bill
[8] https://historicengland.org.uk/whats-new/debate/recent/town-and-country-planning-act-70th-anniversary/rise-and-fall-of-1947-planning-system/
[9] https://pubmed.ncbi.nlm.nih.gov/37002671/
[10] https://www.miltonkeynes.co.uk/news/people/back-in-time-to-1992-when-the-creation-of-the-new-city-of-milton-keynes-was-declared-complete-3662858
[11] https://www.rsph.org.uk/static/uploaded/5194975e-89a1-4dff-9e8aa68da4836231.pdf
[12] https://www.oxfordhealth.nhs.uk/news/green-spaces-do-wonders-for-your-mental-health/
[13] https://commonslibrary.parliament.uk/research-briefings/sn00934/
[14] https://www.rtpi.org.uk/media/1242/what_is_the_green_belt-briefing-note.pdf
[15] https://www.oldsite.cpre.org.uk/magazine/opinion/item/4157-green-belt-an-idea-for-the-ages
[16] https://www.nationalparks.uk/the-history-of-national-parks/
[17] https://www.newforestnpa.gov.uk/about-us/uk-national-parks/#:~:text=There%20are%2015%20National%20Parks,the%20benefit%20of%20the%20nation.