A plan for health - will NPF4 help to create healthy food environments?

Planning has a fundamental impact on our daily lives. It influences the places and spaces we live in, visit and use every day – where we live, work, and go to school. These places also influence our health outcomes. When you think of your local place, what springs to mind? Is it an area with lots of local shops selling healthy food, plentiful fruit and vegetable provision, with access to green space, or is it an area with derelict shops, fast food chains, with limited or no access to green space? Unfortunately, the latter is not uncommon in Scotland’s communities and is even more likely to be the reality in deprived areas. Planning systems contribute to what our local areas look like and offer us and for too long the system has prioritised economic growth and business need over population health.

What is the planning system and why does it matter?

Currently, the places where we live are a major driver of poor health outcomes in Scotland. They drive inequality and are a significant contributory factor towards worsening rates of overweight and obesity. Evidence shows that it is those living in the most deprived communities who are the most likely to be exposed to social and environmental factors that negatively impact on their health. Research has found that essential food items can cost up to three times as much in rural and deprived areasⁱ, and the clustering of fast food outlets also disproportionately affects deprived areasⁱⁱ. Further, the poorest fifth of UK households would need to spend 40% of their disposable income on food to meet the Eatwell Guide healthy diet, compared to just 7% for the richest quintileⁱⁱⁱ.

This translates into poorer health outcomes and a growing burden of inequalities. Overall, two-thirds of adults in Scotland have overweight and obesity^iv and 91% report feeling that fast food is too easily available^v. This is clearly patterned by deprivation, with those in the most deprived quintile significantly more likely to have overweight and obesity than those in the least deprived quintile. The trend for females is particularly stark, with 40% of those in the most deprived quintile overweight or obese, compared to only 18% in the least deprived quintile. For children, this pattern by deprivation is replicated – 24% of children in the most deprived quintile are at risk of obesity, compared to only 9% in the least deprived ^vi.

So, what can be done about it?

Health and NPF4

Health and wellbeing features for the first time in NPF4 with a specific policy for it (policy 14). This is welcome as it acknowledges the central role the planning system has on health outcomes. Improving the health and wellbeing of the people in Scotland is one of the outcomes for planning outlined in NPF4 and the commitment for development proposals not to be supported where significant adverse health effects are likely to occur is also welcome. Other important policy developments within NPF4, including 20-minute neighbourhoods and retail policies (policy 25), will also impact on health and wellbeing outcomes. The impact of the latter two policies will be dependent on how they are implemented and how well they align with other policies within NPF4. However, despite the inclusion of a specific policy and an outcome focused on health and wellbeing, NPF4 is generally very weak on health and in its current form will do little to create and promote healthy food environments. Food and the food environment are rarely mentioned in the document and when they are, little or no connection is made to health.

Central to the issue is that planning authorities are unable to control planning applications and decisions on the basis of health. Health is not a material planning consideration, nor is it considered to be a core principle of the planning system. This is problematic and something that urgently needs to change, and it remains unclear how or indeed if NPF4 will enable this to happen. Controlling planning applications on the basis of health can and has been done in England, with good examples from several local authorities where health has been used as the basis for refusing a planning application^vii. Such powers need to be extended to Scotland.

At its heart, the stated aim of NPF4 is about tackling climate change and delivering a plan to move towards achieving net-zero emissions by 2045. This is of course a welcome aim but it shouldn’t be the sole focus. There needs to be a shift in the discourse to view tackling climate emissions and tackling health inequalities as complementary and part of the same end goal.  We know many of the changes we need for planetary health will also deliver improved population health outcomes.

What needs to happen in the planning system? OAS asks for NPF4

We do not believe that draft NPF4 is a plan for health or that it will deliver the change required for the planning system to improve the food environment. Food and the planning system are intrinsically linked and NPF4 currently fails to take account of this.

Food is a fundamental need for public health and is a significant driver of health outcomes. If we are to ensure a healthy, resilient population, we need to ensure that NPF4 plays its role in enabling access to healthy, nutritious food in a variety of ways, including:

• easily accessible retail and out of home premises at a density that reflects the needs of the local population, for example incentivising healthy food retailers to enter low-income areas;
• enabling and supporting the supply and sale of healthy nutritious fresh food;
• and preventing and discouraging oversupply of foods high in fat, sugar and salt, for example through preventing positioning of unhealthy food outlets where children gather.

Fundamentally, health needs to be a core principle of the planning system and to be included as a material planning consideration. This should include explicit reference to food and the food environment, recognising that food is a core influencing factor of health and wellbeing. NPF4 and the planning system more generally must acknowledge and explicitly reference the clear link between food and the environment, diet, and overweight and obesity and other health outcomes.

References

ⁱ https://www.smf.co.uk/wp-content/uploads/2018/10/What-are-the-barriers-to-eating-healthy-in-the-UK.pdf

ⁱⁱ Macdonald, L, Olsen J. R, Shortt, N. K and Ellaway, A (2018) Do ‘environmental bads’ such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate more in deprived areas in Glasgow City, Scotland?’ Health and Place 51, 224 – 231 

ⁱⁱⁱ Food Foundation (2021) The Broken Plate. The State of the Nation’s Food System https://foodfoundation.org.uk/sites/default/files/2021-10/FF-Broken-Plate-2021.pdf

^iv Scottish Government (2019) Scottish Health Survey – volume 1: main report

^v https://www.obesityactionscotland.org/

^vi Scottish Government (2020) Diet and Healthy Weight Monitoring Report Data tables. Table 2

^vii Scottish Government (2018) Research Project: To Explore the Relationship Between the Food Environment and the Planning System