From evidence into action - Using the planning system to promote healthy weight environments

Obesity is a modern day public health challenge that cannot be met by a traditional biomedical science approach alone. Tackling obesity levels requires action by national and local government, health and social care, non-governmental agencies, communities and individuals – a whole system approach.

Traditionally public discussion and campaigns targeted individual level behaviour change and treatment. This does not address the environment in which we live, that influences the decisions and actions that we make; things such as what we eat, whether we exercise, how we travel to work, how we interact within the community and if we have access to and use open spaces.

Local authorities, with planning, transport, environmental health and public health responsibilities, are in a unique position to improve the quality of the environment by actively promoting walking and cycling, enabling easier access to healthier food and drink options and supporting a diverse and healthy high street retail offer. By doing so, local authorities can help promote a healthy weight and reduce inequalities associated with obesity prevalence.

A healthy weight environment can support people with healthier food and drink options and opportunities to increase their physical activity through the way a place is designed and the variety of uses provided. To further encourage and support local authorities Public Health England has published guidance to provide strategic information on the use of the planning system to promote local healthy weight environments, in particular to focus on the healthier food and active environments. PHE has provided a template ‘Healthy Weight Environments Supplementary Planning document’ which can be used as a starting point for local public health teams to liaise with planning officers and other local authority teams, including environmental health, licensing, transport, and leisure. This guidance provides practical support to those local authorities looking to develop policies and approaches to promote a healthy weight environment. While this publication is set in the English context, its principles and approach can be replicated and adapted in other settings.

The drive to use the planning system to promote healthy weight environments has been highly influenced by the Government Office for Science’s Foresight report of 2007 Tackling Obesities: Future Choices [1], which recognised the role of the planning system in tackling obesity. This new guidance can be used in conjunction with the Association of Directors of Public Health (ADPH) and Public Health England (PHE) ‘What Good Healthy Weight for all ages Looks Like’ publication [2]. Many local authorities are already including healthy weight environment elements into local planning policy and practice. The Local Government Association (LGA) has published case studies of councils using planning to take a holistic approach to the challenge of obesity [3] including Gateshead Council’s innovative SPD approach which is featured as a PHE case study [4].

The use of planning policy and development management is a clear example of an intervention to tackle obesity which is not yet consistently applied across the country. Practice across the country has shown a diverse range of approaches in local plans and planning appeal decisions which has taken over 10 years to develop since the 2007 Foresight report, but is now becoming mainstream (See Fig. 1). PHE wants to support consistent whole system approaches, including the use of the planning system. This guidance is designed to help achieve this integrated approach.

Fig. 1.

Charting the use of planning for healthy weight environments.

Source: Public Health England.

This policy to implementation lag has to be seen in the context of an increasing obesity challenge (See Fig. 2) facing society. This context can be understood both in terms of prevalence in certain age groups such as children, and concentration of obesogenic environments in certain neighbourhoods which are helping to widen health inequalities.

Fig. 2.

key obesity data and trends.

Source: Statistics on Obesity, Physical Activity and Diet, England, May 2019 - NHS Digital, Government Statistical Service.

Is the reason down to the nature of local evidence provided or the knowledge of the individual local authority teams, planning inspectors or the wider planning regime?

This was recognised within the Childhood Obesity; a plan for action Chapter 2. The challenges it identified, included the proliferation of fast food outlets, less active travel, limited access to green spaces and physical activity; and these factors create an environment that makes it harder for children and their families to make healthy choices, particularly in some of our most deprived areas. The Childhood Obesity Plan confirmed that local authorities have a key role in tackling this challenge and pledged support;

• •to make sure that all local authorities are empowered and confident in finding what works for them, and
• •to develop resources that support local authorities who want to use their powers and provide up to date guidance and training for planning inspectors.

In response, PHE published its latest guidance (Using the planning system to promote healthy weight environments. Guidance and Supplementary Planning Document Template for Local Authority Public Health and Planning Teams).

It answers the following questions:

• •What is the current evidence base linking the built and natural environment and healthy weight? Specifically, can the local food environment influence diet and obesity?
• •How can the planning regime be used to promote healthy weight environments?

The publication identifies the background work necessary in order to comply with planning policy development, where the key is the use of local evidence and consultation. It specifically provides guidance on the use of the 400 ​m exclusion zone for hot food takeaways, specifically around educational settings to help tackle childhood obesity prevalence, features of the built environment and building design that promotes physical activity, use of green space, allotments and neighbourhood design.

There remain challenges to promoting a healthy food environment, for example the impact from the rise of industrial kitchens for food delivery and prevalence of online delivery services must be monitored. Multi-sectoral efforts must continue to influence the energy and compositional content of other food options with industry while supporting people to more active in their everyday lives. These challenges become even more acute as society grapples with the unintended long term impact on people’s behaviours from policy changes necessitated by the recent coronavirus pandemic. For example there have been legislative and policy changes to allow food businesses to temporarily operate as deliveries and takeaways [6] during the stay-at-home period. Those tasked with protecting and improving population health now and in the future should be prepared for the new normal.

In summary actions to promote a healthy weight environment must form part of a wider, long term systems approach to promoting a healthier weight in the local area, which can be supported by PHE guidance on whole systems approach to obesity [7]. Other examples of integrated place-based approaches include the NHS England Healthy New Towns [8] and the Childhood Obesity Trailblazers [9] programmes.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.