The way we plan our cities and locate services is often overlooked as an important issue to health of the population. Planning policy in local authorities, for instance, is responsible for the siting of supermarkets; the placement of road bypasses; and the introduction of controlled parking zones. The content of planning guidance can determine whether a local authority allows a project or development to go ahead or not. In some cases if a project puts people or the natural environment at risk, it can ensure that relevant mitigation measures are carried out by the developer in the short, medium and long term. Local authorities can order an environmental impact assessment (EIA) to be carried out (as well as those required by law - see later in chapter) which provides more in-depth information about the locality and resulting effects of the development. It is become increasingly more popular for these EIAs to include more information about the impact on the health of local people, but there is still a distinct shortage of health data. Proper planning law in the UK has no doubt prevented many potential dangerous developments from coming into fruition and has tightened controls on existing developments, but there is still an overarching conflict between the health interests of the local populations and the financial gains of 'big business' and developers.

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With the introduction of the new Greater London Authority the Mayor has taken over responsibility for strategic planning in London from the Secretary of State. The main responsibilities of the Mayor are to:

The detailed content of the SDS is a matter for the Mayor to decide, within the context of the Mayor's general duties to promote economic development, social development and the improvement of the environment. The draft SDS takes account of European, national and regional planning policies. It includes the Mayor's general policies for the development and use of land in London that are to be reflected in UDPs. It should incorporates the spatial elements of the Mayor's other strategies. The strategy sets priorities and provide direction for the future development of London, and must be integrated with the Mayor's other strategies.

The Government has issued a circular (see below) givingsome general guidance about what matters should be considered by the SDS and on the Mayor's planning role in general, but the strategy will be expected to address all issues of strategic importance to the capital including:

The Mayor has consulted widely on the draft SDS. The strategy is also subject to an Examination in Public (EiP) where important points of the strategy are debated in front of an independent chair and panel, who will report back to the Mayor. The Mayor must take the report into account before publishing the SDS.

The boroughs continue to be responsible for dealing with all planning applications in their areas, and retain their day-to-day development control responsibilities. The Mayor is a statutory consultee for planning applications with potential strategic importance. He is able to comment on and support these applications or, if the Mayor considers it necessary on strategic planning grounds, direct the borough to refuse planning permission. The Mayor is not able to direct approval of applications. The Secretary of State has defined the types of planning applications that must be notified to the Mayor by the boroughs as planning authorities. The applications are limited to a small number that are likely to raise issues of genuine strategic importance. Categories will be subject to periodic review and are set down in an Order made by the Secretary of State (see below). In broad terms they cover applications for:

The Secretary of State sets national planning policy within which the SDS must be framed. He is able to make representations on, and in the last resort direct amendment to, the SDS to protect national or broader regional interests. The Secretary of State also sets out the criteria for planning applications to be referred to the Mayor. He continues to be able to call in applications of more than local importance for his own decision and to intervene in UDPs, although he will look to the Mayor to ensure that London's strategic planning interests are taken into account in borough decisions. (Greater London Authority Website)

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The new Environmental Impact Assessment Regulations which became law in 1999. They increase the number and type of developments that need to be assessed for their impact on their surroundings, giving more impetus to the important control and mitigation of large and small scale developments.

EIA formally began in 1988 with the UK's implementation of the EC Directive 85/337/EEC through the Town and Country Planning (Assessment of Environmental Effects) Regulations and some 17 other Regulations but the concept of impact assessment has originated in the US from the 1960s. To date there have been well over 3000 submitted in the UK. 21% have been for waste management, 14% for roads with extractionprojects, energy and retails the next most common categories (Wood and Bellanger, 1999)

Although the regulations state that the following is required:

'A description of the aspects of the environment likely to be significantly affected by the development, including, in particular, population, fauna, flora, soil, water, air, climatic factors, material assets, including the architectural and archaeological heritage, landscape and the inter-relationship between the above factors', Statutory Instruments 1999 No. 293 The Town and Country Planning (Environmental Impact Assessment) (England and Wales) Regulations 1999.

There are few references to the protection of human health and subsequentlywhat mechanisms or procedures developers should undertake or local authorities could investigate to ensure minimal short, medium or long term impacts.

National health policy shows similarities to national planning policy in that it stresses the need for health impact assessment but at this stage offers little, if any, rigid guidelines as to how to undertake health impact or which health agencies should play a role in the process. A variety of work is being done within London and by the LHO to further develop health impact assessment projects and to devise a toolkit for use by health professionals involved in planning decisions.

There are a variety of approaches, many of which have been reviewed (Mcintyre and Petticrew, 1999) to health impact in the UK and across the world that offer incomplete but nevertheless useful negotiating tools for the examination of relevant impacts. The existing HIA evidence base is currently small, with many studies using 'matrix style' examination of the respective impacts, and published results hard to find in the 'grey' literature. The Health Development Agency (HDA) has created an online comprehensive database of HIAs to be utilised by others working in the field so that lessons can be learnt.

Some developers have in-house expertise to conduct EIAs but most rely on consultants who offer a range of expertise or have specialities in one or two areas. There are a host of consultancies across the UK with an increasing number with world-wide interests. There are over 600 consultancies involved in over 50,000 contracts with total annual turnover somewhere in the region of £650 million in 1995/6 which may approach £1 billion in 2000. There is a small but growing number of HIA consultants but currently most HIAs are conducted by the statutory sector, generally led by NHS departments of public health but sometimes local authorities.

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The number of out-of-town shopping centres has grown considerably in the last 10 years in boroughs such as Westminster, Brent, Camden, Newham and Hackney. The use of cars as the preferred mode of transport is well-known to create non-sustainable travel patterns and hence contributes to air pollution and further traffic congestion. This demand is not yet being reduced in the UK despite relevant planning guidance. Those without private cars are at a distinct disadvantage in being able to use out-of-town centres. Although there are fewer out-of-town shopping centres in London compared with the UK as a whole, those that are present are known to have a huge impact upon existing retail centres, local shops and ultimately communities as a whole creating a loss of important local identity. One of LPAC's targets is to prevent any further loss of local shopping facilities.

Planning policy can influence where basic essential services such GP surgeries, post offices, food shops or banks are located. Modern sustainable thinking believes in providing access to services for all and it is well-documented that people who are isolated in urban areas are at greater risk of health inequality. Also, how people travel to these basic services is also important in reducing the demand for travel by private car - cycling and walking being the most sustainable forms of travel. With improvements in local authority geographical information systems (GIS) more useful information will be available about the siting of services and access to those services be those in health inequality.

Green Belt and Metropolitan Open Land accessible for public recreation, which encompasses country parks, commons and golf courses, can influence how we exercise according to our surroundings. No Government guidance exists on how much land should be given up for such recreational purposes.

Open space also plays a major role in influencing our movements and how we feel about our surroundings. The total amount of publicly accessible open space in Greater London is 14823 hectares with LB Richmond having almost 14% of the total share as a result of the number of Royal Parks in this borough.

Planning policy can determine how buildings are built to provide vital access to people who are disabled and ensure a greater level of equity for all. New buildings must provide suitable access to the disabled. The extent of accessibility of local authority buildings, health centres and GPS services varies considerably across the capital. The number of buildings open to the public has decreased but the number of accessible buildings as whole has increased from 3% to 7%. Mobility difficulties are best expressed in the lack of accessible transport modes for disabled people in London.

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Early attempts to require local authorities to develop a register of contaminated land failed, mostly because the identification of such areas would incur compensation obligations. The DETR planning Policy Guidance "planning and Pollution Control" clearly states that "the principle of sustainable development means that where practicable, brownfield sites, including those affected by contamination should be recycled into new uses". The new Environment Act 1995 requires local authorities to identify and deal with contaminated land, especially where there is an obvious health risk. The London Waste Regulation Authority (now part of the Environment Agency) licensed sites for landfill from 1976. Approximately 430 sites are recorded on their register but does include gas works , sewage treatment works, chemical works and scrap yards which can all lead to ground contamination. What information does exists within local authorities is kept on an adhoc basis.

Derelict land is classified as land that cannot be developed for an alternative use without a significant degree of treatment. London's out regions have large areas of derelict land. According to a survey of boroughs in London by LPAC in 1993, there is a total of 1387 hectares. Although there are no direct health consequences this land can be given over to recreational usage and thereby encourage greater exercise amongst the population.

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Date	Title	Format	View
2 Dec 2003	Area of Publicly Accessible Open Space (hectares) based on the Hierarchy of Open Spaces, London Boroughs, 1994 & 1998
2 Dec 2003	Number of Public Buildings Open to the Public, London Boroughs, 1993-1998

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Health development agency

• British Medical Association(1998) Health & environmental impact assessment: an integrated approach. Earthscan Publications LTD.
• London Planning Advisory Committee (2000) State of the Environment. Report for London Update 1999. LPAC.
• London Planning Advisory Committee (2000)LPAC'S Endowment to the Mayor and to the Boroughs.
• Mcintyre L and Petticrew M (1999) Methods of Impact Assessment: a literature review. MRC Social & Public Health Sciences Unit, Occasional Paper.
• Statutory Instrument 2000 No 1491 The Town and Country Planning (London Spatial Development Strategy) Regulations 200. London: The Stationery Office ISBN 0 11 099358 6
• Statutory Instrument 2000 No 1493 The Town and Country Planning (Mayor of London) Order 2000 published by The Stationery Office ISBN 0 11 099360 8
• Strategic Planning in London - GOL Circular 1/2000. London:The Stationery Office ISBN 0 11 753550 8
• Wood G and Bellanger C (1999) Directory of Environmental Statements July 1988 - April 1998. Working Paper No. 179. Impacts Assessment Unit, School of Planning, Oxford Brookes University.
• London Health Commission. Health impactassessment of the Mayor's Draft London Plan. London: LHC, 2002.
• Mindell J, Joffe M, Health impact assessment in relation to other forms of impact assessment. Journal of Public Health Medicine, 2003; 25(2): 107-112

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