Lesson 1: Mapping your ecosystem

This section sets out the national, regional and local legislation, policy, and strategic context relating specifically to health. The purpose of laying this out is to help you navigate which existing areas of policy and legislation can help you in your advocacy as well as who along the way can be your ally, partner or comrade.

National Policy Context Health and Social Care Act

• The Health and Social Care Act 2012 (‘the Act’) states that the Secretary of State’s (‘SoS’) duty is to promote a comprehensive health service designed to secure the improvement of the physical and mental health of people in England and the prevention, diagnosis, and treatment of physical and mental health. The Act outlines the purpose of clinical commissioning as the function for the provision of services in accordance with the Act.

National Planning Policy Framework

• The National Planning Policy Framework (‘NPPF’) places a strong emphasis on sustainable development, and for planning to support national growth. Founded on separate economic, social, and environmental objectives, the NPPF seeks to work towards achieving each objective through plan-making and decision-taking, thereby achieving the overarching aim of sustainable development and pursue the United Nations’ (‘UN’) 17 Sustainable Development Goals (‘SDGs’) in the period to 2030. Paragraph 9 states that in order to accomplish these objectives:

“Planning policies and decisions should play an active role in guiding development towards sustainable solutions, but in doing so should take local circumstances into account, to reflect the character, needs and opportunities of each area.”

• Section 8 of the NPPF places significant emphasis on using planning policies and decisions on promoting healthy and safe communities. This includes through promoting social interaction, creating safe and accessible places to minimise crime and disorder, and enabling healthy lifestyles through the provision of community space, access to healthy food, and safe and accessible green infrastructure.

Planning Practice Guidance

• The Planning Practice Guidance (‘PPG’) highlights the need to consider the impact of the built and natural environment on health and well-being and to “undertake positive planning to create environments that support and encourage healthy lifestyles” (Reference ID: 53-001-20190722).

• The PPG sets out the Government’s vision of a ‘healthy place’ as a place that supports and promotes healthy behaviours, reduces health inequalities, and supports community engagement and social interaction. It emphasises the importance of meeting the needs of children and young people, the increasingly elderly population, and those with dementia and other sensory or mobility impairments (Reference ID: 53-003-20191101).

• HIAs are recognised as useful tools in the consideration of planning applications where there are expected to be significant impacts (Reference ID: 53-005-20190722).

• The PPG also focuses on how planning can play a crucial role in the creation of sustainable, inclusive, and healthy communities. This guidance is to be read alongside the National Model Design Code, which provides further detail on how design can promote social interaction, physical activity, and safe communities.

National Model Design Code

• The National Model Design Code (‘NMDC’) provides detailed guidance on the production of design codes, guides, and policies to promote successful (as well as a healthy) design. This places a greater emphasis on development supporting wider health outcomes, such as:

  • How the design of new development should enhance the health and wellbeing of local communities and create safe, inclusive, accessible and active environments;
    How landscape, green infrastructure and biodiversity should be approaches including the importance of streets being tree-lined; and

  • The environmental performance of place and buildings ensuring they contribute to net zero targets.

Health Impact Assessments in Spatial Planning

• PHE’s guide, Health Impact Assessments in Spatial Planning, describes the health and well-being outcomes that can be influenced or optimised as part of the plan-making and planning application process.
  

  • The guide sets out an evidence-based approach for preparing HIAs, which includes establishing the baseline for the project, identifying HIA health outcomes, identifying specific population groups that could be affected, assessing the potential impacts of wider determinants of health as part of the scheme, and identifying recommendations for implementation and monitoring that will support positive health outcomes. It sets out that the extent of assessment within HIAs should be proportionate to the significance of impact of a proposed development. This HIA follows the approach set out in this document.

Regional Policy Context London Plan

• In March 2021, the Mayor of London published the new London Plan, replacing the 2016 London Plan. The policies set out in the new London Plan comprise an “integrated economic, environmental, transport, and social framework for the development of London over the next 20-25 years”.

• Policies that are relevant to healthy communities and health infrastructure include, but are not limited to, the following:
  

• Policy GG3 – Creating a healthy city, states that planning and development must meet the following requirements in order to improve Londoners’ health and reduce health inequalities:

  • “Ensure that the wider determinants of health are addressed in an integrated and coordinated way, taking a systematic approach to improving the mental and physical health of all Londoners and reducing health inequalities”;

  • “Promote more active and healthy lifestyles for all Londoners and enable them to make healthy choices;

  • “Use the Healthy Streets Approach to prioritise health in all planning decisions”;

  • “Assess the potential impacts of development proposals on the health and wellbeing of communities, in order to mitigate any potential negative impacts and help reduce health inequalities, for example through the use of Health Impact Assessments”;

  • “Plan for improved access to green spaces and the provision of new green infrastructure”;

  • “Ensure that new buildings are well-insulated and sufficiently ventilated to avoid the health problems associated with damp, heat, and cold”; and
    “Seek to create a healthy food environment, increasing the availability of healthy food and restricting unhealthy options”.
    

Health Inequality Strategy

• London’s Health Inequality Strategy (‘HIS’) was published in September 2018 as a statutory requirement of the GLA. The Mayor’s vision for London is to be “a healthier, fairer city, with all Londoners having the best opportunities to live a long life in good health”. The HIS sets out the following key objectives for London which are:
  

  • Healthy children;

  • Healthy minds;

  • Healthy places;

  • Healthy communities; and

  • Healthy living.
    

• The HIS also outlines the Mayor’s Strategy for Social Integration, aimed at reducing social isolation, as well as physical and mental health issues.

Health Issues in Planning Best Practice Guidance

• There is an important link between how places are planned and developments delivered, and the health of the communities who live in them. The Best Practice Guidance (‘BPG’) provides information and tools as to how health can be integrated into development planning focusing on tackling health inequalities.

Knowing who you are connected to and what influence each of you have is an important step. For an HIA to travel beyond your internal purposes, it is helpful to locate your cheerleaders in political and decision making positions. 

• Are you connected to a local councillor? 

• Are you connected to your local GP practice and patient participation group (mobilising healthcare sector or data) 

• What is your relationship to Local Authority departments and decision makers? 

• Map out the stakeholders, decision makers and who you know, their backgrounds, skills and interests

• Are there existing HIAs, EIAs, IIAs that need critiquing and challenging? 

  • Do you know how your locality is being understood and assessed by your LA. 

• Are you currently experiencing a moment of change? e.g. demolition, development. Are you anticipating change related to land use, climate change? E.g. increased flood risk, heatwave? 

• Are there actionable outcomes to completing an HIA? 

As you are identifying the various actors in your neighbourhood ecosystem, you can also begin a Power Mapping exercise. 

Power mapping aims to identify those who hold power in a specific context and understand how they can be influenced to support a particular goal or initiative. 

It involves creating a diagram that maps out key individuals, groups, and their relationships based on their power and influence in relation to a specific issue or goal. 

The key elements are - 

Target: The person or group that can make the desired change happen. 

Allies: Those who support the cause and can be leveraged to influence the target. 

Opponents: Those who actively oppose the desired change. 

Secondary targets: Individuals or groups who have influence over the target and can be used to apply pressure.

Asset-Based Community Development (ABCD) is a community-led approach that focuses on identifying and mobilising the strengths and assets within a community to drive positive change, rather than focusing on problems and needs. It emphasises collaboration, citizen participation, and the utilisation of local resources to build stronger, more resilient communities. 

Taking an ABCD approach allows you to focus on the strengths within your community and build on existing knowledges, ideas, insights as well as skills. An asset can be anything from a social network to knowledge base.

Alongside mapping the key players in the system it’s ideal to map who you know, what they know, and what you can all do together.

Core Principles:

• Focus on Strengths:

  ABCD shifts the focus from what is lacking or wrong to what is strong and positive within the community. 

• Community-Led:

  It empowers residents to take ownership of their community's development, rather than relying on external agencies or experts. 

• Asset Mapping:

  This involves identifying and documenting the skills, talents, resources, and community assets (physical, social, and environmental) that already exist within the community. 

• Collaboration and Networking:

  ABCD encourages collaboration among residents, community groups, and organisations to leverage resources and build connections. 

• Citizen Participation:

  Residents are actively involved in identifying issues, developing solutions, and implementing projects. 

• Sustainable Development:

  By building on local assets, ABCD aims for long-term, sustainable change that is driven by the community itself. 

How it Works:

1. Identifying Assets:

   Community builders or facilitators work with residents to map out the community's assets, including individuals' skills, local businesses, community groups, and physical spaces. 

2. Connecting Assets:

   The next step is to connect these assets, facilitating relationships and collaborations between individuals, groups, and organisations. 

3. Mobilising Assets:

   Once assets are identified and connected, they are mobilised to address community needs and achieve desired outcomes. 

4. Citizen-Driven Development:

   Residents take the lead in identifying priorities, developing solutions, and implementing projects, with support from facilitators.