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The role of planning in preventing needless mortality

20 March 2014

Inge Hartkoorn

The majority of illnesses which lead to early mortality worldwide are preventable – they should not be occurring, or at least not occurring at their present rate. For me, this was the key, sobering message with which I left this year’s International Conference on Urban Health (ICUH) held in Manchester. I attended the conference as part of the RTPI’s work on our Planning Horizons Urbanisation and Health paper, which will be launched in October this year. Globally, planning can play a major role in prevention – so why is this role still relatively neglected?

The top preventable ‘killers’ include cardiovascular diseases (accounting for 3 in every 10 deaths), respiratory infections, chronic obstructive lung disease, diarrhoea and HIV/AIDS. Tobacco use remains a major contributor, accounting for 1 in 10 adult deaths worldwide. These deaths are caused by modifiable risk factors which we can influence.

Public health, by definition, is the focus for how we might tackle these challenges, since it refers to “all organised measures (whether public or private) to prevent disease, promote health and prolong life among the population as a whole”. These measures extend beyond the realm of formal medicine and health, to include the factors which shape our environment, behaviour and living conditions. And planning plays a particularly important role in this, as it can directly influence these factors which impact our health outcomes –particularly in terms of prevention.

From a behavioural perspective, preventative lifestyle changes can be influenced through a combination of public education, pricing, taxation and various incentives and disincentives. In the main, the science, knowledge and means already exists to reduce the prevalence of these illnesses. It seems obvious then that prevention should be much more of a priority on the political agenda, as well as for public health workers, planners and decision-makers – just because preventing these illnesses would relieve the burden of ill health from a part of the population, but also for the simple economic reason that in most cases prevention is cheaper than treatment.

Interventions do not necessarily have to be costly. Modest investments can make a big impact, and a country’s income level does not have to be a major barrier to introducing effective preventative approaches. Barriers to achieving effective prevention, such as a lack of knowledge on health and health risks, cultural pressures and a lack of choice (particularly related to fresh food, adequate sanitation and the provision of basic services and infrastructure) therefore need to be addressed.

To do so, we need to take WHO’s advice on-board and encourage high levels of commitment, good planning and community mobilisation to focus on a small range of critical actions. These can produce quick results in reducing major behavioural risk factors.

Beyond behavioural factors, there are of course the conditions in which people are born, grow, live, work and age, also known as the social
determinants of health
(see the diagram below). These are complex and harder to influence because they are shaped by the distribution of money, power and resources in society. Underlying these are inequalities and social injustice; social justice is, in this context, literally a matter of life and death. In the words of Michael Marmot, one of the many impressive keynote speakers at the conference, the persistence of such inequalities “affects the way people live, their consequent chance of illness and their risk of premature death” (as the chart at the end of this post illustrates). To tackle this, individual and community empowerment are critical as the starting point to improving material, psychosocial, behavioural and political conditions. If the biggest cause of premature mortality is socialisation, then people can start living more flourishing lives if they are given a voice and more control of their lives.


Planners and others need to embrace the opportunities for preventative measures, and learn from successful methods from around the globe. Think of how planning can influence and stimulate active travel through walking and cycling, and promote urban design that encourages exercise, how it can promote more green spaces and age-friendly communities, how it can influence high street composition to tackle ‘toxic high streets’, how it can facilitate the reduction of air pollution, and so on. These were all examples that were touched on at the conference.

But perhaps the biggest challenge in achieving healthier places is realigning public health and the planning profession. The two are currently largely disconnected and are driven by different forms of evidence. We need to find ways to reunite the two, and to work together in responding to current and future health challenges in response to the social determinants of health. (Our Planning Horizons paper will also consider how planners can inform often increasingly complex and fragmented formal healthcare systems as well). Only when public health and planning work together effectively can we be more successful in creating places where people not only have the highest life expectancy possible, but also, as illustrated in the chart below, there are reduced inequalities in disability-free life expectancy as well.


You can read more about the RTPI’s Urbanisation and Health paper here.

A leaflet produced by the RTPI on the Worldwide Value of Planning can be found here.

About Inge Hartkoorn

Inge Hartkoorn is Research Assistant for the RTPI’s Urbanisation and Health Planning Horizons Centenary paper, which focusses on public health and planning, and the role that they can play in promoting urban health and well-being. Her interests include community empowerment, active transportation, ageing and the role that planning can play in accommodating for the needs that resonate from them. She also manages the Planning Education and Research Network (PERN) e-bulletin. In conjunction with her work at the RTPI, she works for the Deltametropolis Association, an association dedicated to the sustainable development of the Randstad city-region in the Netherlands. You can follow Inge on Twitter: @ichy84