Tag Archives: obesity

Tackling Obesity – Through Planning and the Built Environment

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With obesity rates at crisis point across the UK, Dr Tim Townshend, Director of Planning and Urban Design within the School of Architecture, Planning and Landscape, discusses the part that our built environment has to play. Part of the Newcastle University Institute for Social Renewal‘s Ideas for an Incoming Government series, Dr Townshend argues that central government and local authorities need to take action now to promote healthy living in our communities.

Tackling obesity

What is the problem?

Rates of obesity have reached crisis point, with accompanying health problems (type 2 diabetes, coronary heart disease etc.). In 2007 the Foresight Report ‘Tackling Obesities: Future Choices’ suggested there was enough expert evidence to implicate built environment in the obesity crisis. The places where we live, work, go to school and spend our leisure time can either provide, or constrain, opportunities for physical activity and access to both healthy and unhealthy food. However, the planning system in England is ill equipped to act on this evidence.

This needs action now. Even if the influence of the built environment is small at the individual level, given its impact is over whole communities and that it generally survives several generations unchanged, it is highly significant in aggregate. The change in policy initially needs to address the National Planning Policy Framework (NPPF). The NPPF calls for the planning system to promote ‘healthy communities’, but it is vague in its focus and how this might be achieved.

Obesity is not the only health crisis to face the country – however, it is one in which intervention in the built environment could make a significant difference and interventions to tackle obesity have the potential to deliver broader health and well-being benefits. For example, there is evidence that providing adequate good quality open spaces will encourage physical activity – we also know that physical activity and greenery/green space are also linked to improved mental health and well-being. Moreover obesity is also a problem that has a distinct socioeconomic profile – poorer communities are more adversely affected by obesity and related health/well-being issues than their better off neighbours – and therefore addressing this issue can help tackle health inequalities through the planning system.

The Solution

Action by Central Government/ Department of Communities and Local Government (DCLG)

The NPPF:

  • The NPPF (or its replacement) needs to be strengthened – it should state that planning policies must deliver (not merely promote) environments that support healthy lifestyle choices.
  • The NPPF should be clear that policies that deliver healthier environments should be enshrined in core polices of the Local Development Framework (LDF) – i.e. not just Supplementary Planning Documents (SPD) so they carry enough weight to be acted upon.
  • The viability clause – paragraph 173 – must be rewritten. The elements which support healthy lifestyles, good quality public realm, greenspace, bespoke cycle provision are expensive – however ‘viability’ should not be used as an acceptable reason to remove elements of design in the planning process which are proven to be linked to healthy behaviours and outcomes.

More broadly non-planning actions DCLG should consider include:

  • Including directives that aim to improve health and wellbeing in other built environment guidelines – such as UK Building Regulations
  • Introducing a ‘healthy lifestyle’ kitemark or rating system (like that used for energy efficiency) for new buildings, particularly housing.

Action by Local Authorities

Local authorities should have planning policies that:

  • Deliver healthier lifestyles and greater well-being through the built environment incorporated in their Local Development Framework – to ensure enough weight is attached to these policies. Supplementary Planning Documents may be used to support and/or enhance core policies.
  • Enable ‘active travel’ (walking/cycling) to be ‘designed in’ as part of everyday life for communities wherever possible
  • Ensure adequate greenspace – in its full variety of forms (pocket parks; parks; sports pitches; garden allotments; wildlife areas etc) – is provided, particularly when new housing is developed
  • Restrict the proliferation of fast food outlets – in particular prohibit new outlets in the proximity of schools and children’s centres

More broadly:

  • Ensure the new public health responsibilities in local authorities (Public Health Boards etc.) are fully linked into to planning practice – for example through robust review processes.

The evidence

There is a vast body of evidence, it’s not all in a form that can be used by planning – however the Government Office for Science Foresight Report provides a useful summary:

FORESIGHT 2007. Tackling Obesities: Future Choices – Project report. London: Government Office for Science.

Also see:

LAKE, A. & TOWNSHEND, T. 2006. Obesogenic environments: exploring the built and food environments. The Journal of the Royal Society for the Promotion of Health, 126, 262-267.

TOWNSHEND, T. G. & LAKE, A. A. 2009. Exploring obesogenic urban form, Theory, policy and practice, Health and Place, 15, 909-916.

Townshend T.G. (2014) Walkable Neighbourhoods: principles, measures and health impacts, in Burton E., & Cooper, R Well-being and the Environment, Oxford, Wiley-Blackwell

TOWNSHEND, T.G., GALLO, R. & LAKE, A.A. (May 2015) Obesogenic Built Environment: Concepts and Complexities in BARTON, H., GRANT, M., THOMPSON, S., & BURGESS, S. (Eds) The Routledge Handbook of Planning for Health and Well-being, Abingdon, Routledge.

Freeing public service to perform

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Dr Toby Lowe from the Centre for Knowledge, Innovation, Technology and Enterprise (Newcastle University Business School) presents his Idea for an Incoming Government: make public services more effective. He urges us to move away from a ‘Payment by Results’ approach, and suggests alternatives that would cope better with the messiness of the problems we face in our society.

What is the problem?

Governments have attempted to make public services more accountable for producing desirable social outcomes. From reducing reoffending to helping the long-term unemployed to find work  increasing numbers of programmes are commissioned using a ‘Payment by Results’ approach (PbR).

The rationale behind seems compelling – we should only pay for work undertaken that is effective in solving the problems that society has identified. Unfortunately, the evidence suggests that PbR creates a paradox – programmes commissioned on this basis produce worse results, particularly for those with the most complex needs.

There are two reasons why this is the case:

Firstly, real life is complex and messy. But PbR programmes need life to be simple and measurable. They require that desired ‘outcomes’ can be easily measured – because payments are triggered by these measures. Unfortunately, the complex social issues which social interventions most often deal with are frequently those that are most difficult to measure. Take, for example, tackling obesity. Body Mass Index (BMI) is the measure that is most frequently used to measure obesity.  It is used a measure of obesity because it is easy to measure: it is a simple measure of weight in proportion to height. Anyone with a BMI of more than 25 is overweight. Anyone with a BMI of more than 30 is obese.

Unfortunately, real obesity is much more complicated than that. BMI doesn’t effectively measure obesity for children, individuals with different body shapes, with different exercise regimes, and with certain medical conditions.  According to BMI measures, this woman, Anita Albrecht, who is a personal trainer, is very overweight, and is only one BMI point short of being clinically obese.

Anita Albrecht

So what happens if you use what is measurable as mechanisms to pay by results? You end up wasting time and money targeting obesity programmes on people like Anita – because that’s what simple targets, which are abstracted from the intrinsic messiness and complexity of life make people do.

The second reason that PbR makes it more difficult to create good outcomes is that they work on very simple cause and effect logic: if you are going to pay a person or organisation for producing a result, then you need to know that it was that person or that organisation which did it. How else do you know who to pay?

Unfortunately, the messiness of real life gets in the way once more. Real outcomes are emergent properties of complex systems. Look at the complex system which lies behind obesity as an issue:

Causes of obesity

This is the reality of what causes obesity. If you pay an organisation to undertake obesity activity, they can only influence a small part of this system.  Whether people actually end up obese or not is the result of the interaction of a hundred other factors.

If you pay people or organisations on the basis of whether they achieve particular results, you are asking them to be accountable for things they don’t control. As a result, they learn to manage what they can control – which is the production of data. This is the evidence about what people do:  They reclassify what counts as success (for example, counting trolleys as beds in hospitals in order to meet waiting time targets). They only work on clients who they know will provide the desired results, and they ignore the more difficult clients. They ‘teach to the test’ – only doing things which relate to what is measured, ignoring people’s needs that don’t fit into the simple measurement framework. And if all else fails, they simply make up data.

They do this because Payment by Results is nothing of the sort. Payment by Results should really be called ‘Payment for Data Production’. It changes the purpose of people’s job from helping those in need to producing the data which gets them paid.

All this is an enormous waste of resources. We end up paying huge fees to organisations who can play the data production game well, rather than those who are good at helping people. We waste resources paying organisations not to help those most in need.

The solution

The evidence is clear. If you want to achieve good outcomes, don’t pay by results. Evidence shows that these alternative approaches are successful:

1) Use systems thinking and invest in relationships. Design systems around people’s needs. Invest in organisations that build relationships with clients, and so who understand their needs authentically. Commission locally, so that the organisations have a connection with the people they serve.

2) Promote horizontal accountability. Make practitioners accountable to one another for the quality of their work. Create mechanisms for peer-based critical reflection, such as Learning Communities.

3) Create positive error cultures. Create cultures in which people talk honestly about uncertainty and mistakes – because this is how people learn and improve.