Mission possible: “We must build healthy New Towns and shift behaviours”

 

The potential for health to be embedded into the planning of new towns and regeneration programmes in existing places is influenced by skills, funding, learning and knowledge sharing opportunities. This echoes the conclusion of a Health and Social Care Committee inquiry into prevention of ill health and designing healthy places. 

 

It is essential that the right systems, people and funding are in place for the long term and ensuring the prevention agenda is not crowded out. While there is now investment to counter the effect of past levels of reduced local government resourcing, we question whether we have the right systems in place to sensitively address what the Chief Medical Officer’s annual report on health in cities referred to as unique qualities within our built environments which are inherently more complex and multi-dimensional.

 

 

Designing for health from project inception is vital for promoting healthy behaviours and delivering neighbourhood health in new towns. The COM-B model offers a valuable lens to understand and address the barriers practitioners face in embedding health into planning and design. 

 

Commonly used in behaviour change programme, the COM-B model identifies behaviour as the result of capability (physical and psychological), opportunity (physical and social), motivation (automatic and reflective).

 

Changes to the built environment can boost capability and opportunity by making healthy choices easier and more appealing. For example, walking and cycling infrastructure increases physical opportunities for active travel. Seeing others walking or cycling boosts social opportunity by normalising the behaviour. Best practice examples include Waterbeach Neighbourhood Development and the Gateshead Exemplar Neighbourhood. 

 

Motivation (both emotional and rational) can also be enhanced through better design. Adding green space to walking routes or making journeys to local facilities more enjoyable encourages positive emotional engagement with walking and cycling. Through great design, local government can create communities that are beneficial for mental and physical health 

 

 

Inclusive design is also important in actively enabling everyone to participate in community life. The Social Model of Disability reminds us that individuals are made disabled by barriers constructed by society, a narrative also shared by Sir Michael Marmot and the social determinants of health model. 

 

Collaboration is critical for the health of our towns and cities. Policy can fall short of being truly inclusive, creating environments that exclude vulnerable people from active travel and public space. 

 

Community co-design within planning, particularly with vulnerable and under-represented groups, allows professionals to better understand the real-world experiences of residents, and creates a greater level of accountability for how planning and design policies are implemented. A leading example is Lambeth Council’s Accessibility Working Group where facilitated discussion with the Disabled community has helped address common accessibility barriers. 

 

As a result, the council has delivered more inclusive streets and parks, enabling more residents to access the health, wellbeing, and economic benefits of active travel.

 

In terms of capability, many professionals lack clear, consolidated guidance on how to deliver health outcomes through planning. A fragmented policy environment and the multiplicity of practical, step-by-step tools can limit both confidence and capacity to act. There is a clear need for more streamlined policy requirements and accessible support materials that clarify what “designing for health” actually involves, such as through design codes. As a result, the council has delivered more inclusive streets and parks, enabling more residents to access the health, wellbeing, and economic benefits of active travel.

 

 

In terms of capability, many professionals lack clear, consolidated guidance on how to deliver health outcomes through planning. A fragmented policy environment and the multiplicity of practical, step-by-step tools can limit both confidence and capacity to act. There is a clear need for more streamlined policy requirements and accessible support materials that clarify what “designing for health” actually involves, such as through design codes. 

 

Physical opportunity is also a key constraint. Tight budgets and rigid funding mechanisms can prevent the inclusion of health-enhancing features in schemes. Reforming these funding models to allow more flexible, place-based spending across sectors, particularly health, planning, and transport, would help unlock innovation. For example see Oxfordshire’s Healthy Place Shaping programme. 

 

Social opportunity remains limited too, as many practitioners simply may not have sufficient exposure to current best practice. Increasing regional and national opportunities to share knowledge, showcase demonstrator projects, and build communities of practice could help embed health more deeply into professional culture. Networks such as the Health and Wellbeing in Planning Network, TCPA’s New Communities Group and the ADPH Planning and Health Collaborative Group can be useful forums for sharing lessons and secure opportunities for collaborative cross-sector working in building lasting healthy new towns and regeneration. 

 

Finally, motivation, both emotional and rational, is critical. Practitioners are far more likely to embrace a health-centred approach when presented with compelling evidence that it delivers value for money, long-term savings and tangible social benefit. Working with academic institutions to build stronger evaluation frameworks, improve business case modelling, and wider promotion of successful outcomes will all play a vital role in shifting professional mindsets and encouraging consistent, health-focused design.

 

Just as we aim to shift behaviours in communities, we must also support behaviour change in the professionals shaping the places where people live their lives. This systemic shift represents both a challenge and a significant opportunity. Responding to the Health Mission will require the use of limited resources to invest in a different educational pathway. 

 

We call for a collaboration mission: A collaborative spirit between planners, engineers, designers, behaviour change specialists and health practitioners to create a built environment with health at its core. 

 

Shifting behaviours to embrace different perspectives through early engagement with communities, obtaining advice from health stakeholders and embedding inclusive design from the outset. We can make more of an impact together by pooling our collective expertise, experience, skills and tools.   

 

Michael Chang is a healthy planning specialist who has worked extensively with and in the health system on healthy places and a PhD candidate at the University of Bristol. Lauren James is an engagement and behaviour change consultant specialising in Active Travel. The views expressed are personal and do not represent their employers and affiliated organisations.