Addressing health inequalities, or the “social gradient” in health whereby those living in the most deprived neighbourhoods die earlier and spend more time in ill health than those living in the least deprived neighbourhoods, requires action from planners, health and environmental professionals.

Kent has already produced an action plan to address health inequalities between 2012 and 2015. Kent’s Health Inequalities Action Plan is centred on the needs and priorities identified in Kent’s Joint Strategic Needs Assessment which in turn informs the Strategies, Business Plans and Local Delivery Frameworks across the Local Authority. The Health Inequalities Action Plan has been composed under the six Marmot Policy Objectives. Under each objective a set of priorities have been identified from the JSNA and partners have agreed actions that support them.

“Local planning authorities should use [the business evidence base] to assess… locations of deprivation which may benefit from planned remedial action.”

NPPF, 2012

The benefits of addressing health inequalities are wide ranging and would help to address the following points:

  • Physical wellbeing: The Marmot Review, 2010 reports that poorer communities suffer a higher prevalence of cardio-respiratory disease and the lowest social grade visit green spaces infrequently, which is likely to be due to both the low availability and bad quality of green space in deprived areas.
  • Mental wellbeing: people in the lowest 20 per cent of household income are almost three times more at risk of having mental illness compared with other households; and being unemployed puts a person at a similarly increased risk of developing a common mental disorder (MNWIA, 2011).
  • Climate Change Risk Exposure: Low-income groups will be more exposed to extreme weather risks, flooding and homelessness, even though they are responsible for fewer carbon emissions, and will lack insurance and other material resources to cope (Sustainable Development Commission, 2010).
  • Legislation: The Health and Social Care Act 2012 contains the first ever specific legal duties on health inequalities.
  • Shift of public health responsibilities: local authorities should take on the major responsibility of improving the health and life chances of the local populations they serve (Local Government Association, 2011).

“Life expectancy is better than the national average but there is a considerable gap in life expectancy between the most and least deprived areas. Although the population of Kent as a whole is less deprived than the national average, there are considerable pockets of deprivation in areas of Dartford, Dover, Gravesham, Shepway, Swale and Thanet, and these are on a par with the most deprived communities nationwide.”

The Kent Health Profile 2013

Relevant tools

  • Health Inequalities and Wellbeing Impact Assessment (HIWIA) and Screening Toolkit – this screening tool builds on the Mental Wellbeing Impact Assessment because national research shows that negative impact of stress, inequity and control contributes to poor outcomes in people’s health and wellbeing. It is to be used as a ‘stand alone’ process for making an initial assessment of a proposal.
  • Strategic Health Asset Planning and Evaluation (SHAPE) is a web-enabled, evidence-based application which informs and supports the strategic planning of services and physical assets across a whole health economy.
  • Mental Well-being Impact Assessment: A Toolkit for Well-being helps support national, regional and local services and systems across health, local government, the voluntary, community and private sector to embed mental well-being into their work.
  • Natural England Accessible Natural Green Space Standard (ANGSt) – is a powerful tool in assessing current levels of accessible natural greenspace and planning for better provision.
  • Health contacts
  • Planning contacts

Advice: Local evidence

Advice: Wider sources

  • The Marmot Review, 2010 is a comprehensive review of health inequalities in the UK, which concludes with six policy objectives to improve health inequalities and a framework on indicators.
  • Review of Social Determinants and the Health Divide in the WHO European Region – the WHO Regional Office for Europe commissioned this review of social determinants of health and the health divide to identify actions needed to address health inequities within and between countries across the 53 Member States of the European Region.
  • Plugging health into planning: evidence and practice – includes a section on reducing health inequalities.
  • Community green: using local spaces to tackle inequality and improve health – Community green uniquely investigates the inter-relationship between urban green space, inequality, ethnicity, health and wellbeing.
  • The National Institute for Health and Clinical Excellence (NICE) review on spatial planning and health details which elements help to integrate health into planning.
  • The Town and Country Planning Association (TCPA) guide on Spatial Planning for Health sets out details of the JSNA and its role in spatial planning, and includes examples from Brent, Northamptonshire, Sandwell and Wakefield.
  • Integrating Health into the Core Strategy by the NHS London Healthy Urban Development Unit (HUDU) covers requirements to address health inequalities.
  • Natural solutions for tackling health inequalities – sets out the potential contribution of the natural environment to reducing health inequalities in England.

Evidence of impact

  • The Marmot Review, 2010 is a comprehensive review of health inequalities in the UK, which concludes with six policy objectives to improve health inequalities and a framework on indicators.
  • The Joseph Roundtree Foundation’s website contains a wealth of information on poverty and inequalities in the UK. Their report on Climate Change, Justice and Vulnerability (2011) presents evidence on the distribution of the effects of flooding and heatwaves on people’s well-being.

Case studies

  • Newham’s 2010 JSNA identifies nine priorities for health. Recognition of the links with spatial planning policy has helped to inform and develop a core policy on healthy neighbourhoods in the London Borough of Newham’s core strategy submission draft (Local Government Group, 2011). Newham also has a core policy called Healthy Neighbourhoods. Its objectives are to “promote healthy lifestyles, reduce health inequalities, and create healthier neighbourhoods.”
  • Sandwell – Sandwell Healthy Urban Development Unit (SHUDU) – have been pulling together projects from across a variety of different sectors, such as community agriculture, access to healthy food and work to track potential environmental hazards and the impact on health inequalities.
  • Oxford City Council consulted in mid-2011 on a major urban extension (Barton Park) that adds about 1000 homes to the edge of an existing estate. Councillors were concerned that the design should promote good health. As well as generating new information for planners, this project has fostered better links between health and planning (Local Government Group, 2011).
  • Stoke-on-Trent – spatial planning and reducing health inequalities –Stoke-on-Trent have been working to integrate health into planning is part of a wider approach to reducing health inequalities across the city.

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