Standard urban planning and design practice no longer matches the multi-disciplinary theories that intersect at wellbeing. A fresh policy and design approach is required.[i]
This note describes the Integrated Planning Guide (IPG or the guide) for a healthy, sustainable and resilient future, including adaptation for a pandemic setting, and provides a case study of how it was used with a large-scale urban planning project.  The guide provides a holistic, integrated approach to heath as part of impact assessments.

The quality of the physical and social environment in which we live has a significant impact on the health and wellbeing of individuals, whānau and communities. As such all decisions that impact on place or community have a health element. Everyone, whether they realise it or not, is part of the health workforce.

To create active and resilient communities we need to build a culture where health is integrated into decisions made in all sectors of society—health here being interpreted as both physical outcomes and wider wellbeing outcomes. The COVID-19 pandemic demonstrated how well sectors can collaborate and what can be achieved when a health-first approach is taken. Health is wealth – both in physical and monetary terms.  Despite the evidence and known benefits, gaps are still evident where planning and policy could be improved to impact positively on health.  The IPG was developed as a tool to try to bridge these gaps.

The guide takes for granted the fact that all planning processes affect health for good or bad — it aims to provide a tool to assist planners and policy makers to make decisions that do more good than harm. The guide adopts a co-benefits approach, asking what other gains can be leveraged off the particular project they are dealing with.  Rather than considering just health, it also brings together the interlinked ideas of resilience and environmental sustainability. The guide is designed to help:
  • plan in ways that build stronger, more sustainable social, environmental and economic outcomes,
  • use a determinants of health approach,
  • promote the health of all using an equity lens, and
  • consolidate a shared vision for stronger, healthier and more resilient communities.

​This integrated planning involves a holistic approach, considering a range of wellbeing impacts and taking account of them alongside other considerations such as equity, and the wellbeing and pae ora of Māori. Effective integrated planning in this way ideally requires all key stakeholders to be active collaborating partners in the planning process so that resource investment and planning are collectively working together towards common goals by fully assessing impacts on health.

Guide Development

The IPG was initially developed in 2011 as a collaboration between the Canterbury District Health Board (DHB), Christchurch City Council (CCC), Environment Canterbury and Greater Christchurch Partnership with a recovery planning focus following the 2010/2011 earthquake sequence in Canterbury.  The guide builds on a CCC/Canterbury DHB publication ‘Health Promotion and Sustainability through environmental design (HPSTED)’ and retains 14 themes linking place with community health and wellbeing.  Although initially developed reflecting the local principles of the Greater Christchurch Urban Development Strategy, the IPG is nested within the national (Living Standards) and international (Sustainable Development Goals) frameworks. The current version of the IPG, 3.0 published in 2019, removes the direct focus on recovery and positions integrated planning as ‘business as usual’.
 
The IPG enables positive and negative factors affecting health and wellbeing for all population groups to be considered early in the development of a plan or policy through lists of questions prompting analysis across a range of dimensions of health to provide a basis for developing and evaluating planning proposals or projects. 
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The resulting plan or policy should be enhanced by having considered wider impacts and should have positive impacts on population health and wellbeing.  The process also provides additional benefits such as helping build cross-sector relationships and strategic environmental assessment, learning each other’s language and priorities, and providing an opportunity to share resources and skills across organisations.

Using the Guide 

The use of the IPG is flexible depending on the scale and scope of the plan/policy. It can be used as a roadmap, or brainstorming tool and offers a more streamlined approach than other, more intensive, integrated assessment methodologies.

The first section of the guide discusses why assessors should focus on a holistic view of health and wellbeing, and why an integrated approach is needed to improve outcomes.  It also touches on integrating Māori perspectives and contains a description of Te Pae Mahutonga, a model for health promotion planning. While many groups suffer inequities, our responsibility to te Tiriti o Waitangi means specifically integrating Māori knowledge, values and perspectives into planning and decision . The Wai 2575 report notes that the achievement of equitable health outcomes for Māori is the responsibility of all sectors, not just the health sector.  We interpret this to mean that the impact of any project, plan or policy on issues of equity must be considered and achieving equity should be prioritised. The principles of te Tiriti o Waitangi and the practice of engagement and partnership with Māori need to be progressed. 

The main section of the guide goes through each of the 14 themes or building blocks of health (Figure 1), and outlines some key points and questions to consider. These questions are not an exhaustive list, but are rather a starting point for innovative planning, identifying co-benefits and reducing the risk of unintended consequences.
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Users are encouraged to consider the links between the different dimensions and themes together rather than in isolation. The intention of integrated planning is to promote all of the themes in a holistic manner. Because of the range of themes, the guide encourages seeking out information to answer the questions, engaging with others and the community.  For a large scale assessment it could prompt the need for a comprehensive report and community engagement. For smaller assessments it might just be a matter of checking in with stakeholders.
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Figure 1. Themes or building blocks of health and wellbeing in the Integrated Planning Guide

To promote sustainable decision making, some questions act as prompts for strengthening engagement processes through recognising and communicating the needs and interests of all participants, including decision makers.

In response to user feedback, the latest edition also features some suggested performance measure examples and targets, and provides links to existing indicator sets like the Canterbury Wellbeing Index and Ngā Tūtohu Aotearoa, as starting points.

Ideally the guide should be used early enough in policy and planning to help shape a proposal. It can be especially useful at the outset of an assessment during brainstorming or storyboarding to scope the proposal and establish criteria for evaluation or monitoring.  It can also be used as a tool to inform planning (preparatory and feasibility) and to help identify alternatives.  While a workshop or group discussion is preferred to gain stakeholder perspectives, the IPG can also be used as a desktop exercise.
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The current and previous versions of the guide have been used to inform different levels of assessment including: integrated assessment for recovery plans; master plans for Sydenham, Lyttelton, Ferry Road; a framework for earthquake recovery planning for Kaikōura; design of the Christchurch Metro-sports facility project; and to inform evaluations under s32 of the RMA 1991. 

Adapting to pandemic recovery 

The emergence of COVID-19 and the measures to reduce its impact created opportunities to collectively respond and recover in a way that responds to other health concerns and keeps people well in the future.  

Working together with Christchurch City Council and Environment Canterbury, Canterbury DHB identified three key priorities to be taken into account while planning in the recovery from the pandemic: health and equity; addressing climate sustainability; and incorporating wider social goals.
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Rather than develop a new resource, a four-page supplement was created to sit alongside the IPG as a tool to support health-promoting policy and decision-making in a response or recovery phase and to help prepare for future disruptions.  The supplement includes all the same categories/building blocks as the main guide, with 3-5 additional questions.  The web version also includes links to good practice examples from cities around the world.

Case study: Our Space 2018-2048 

Our Space 2018-2048 Greater Christchurch Settlement Pattern Update Whakahāngai O Te Hōrapa Nohoanga outlines land use and development proposals to ensure there is sufficient capacity for housing and business growth across Greater Christchurch to 2048. It was developed by the Greater Christchurch Partnership primarily to meet the requirements of the National Policy Statement on Urban Development Capacity 2016.  The strategy includes what the population will look like, where they will live, and how they will they get around.

As part of the formal consultation process agreed by the GCP Committee, a cross-sector stakeholder review workshop was held following the release of the strategy document for public consultation.  The workshop, facilitated by Community and Public Health, Canterbury DHB, was structured around an assessment of Our Space against the 14 themes of the IPG.

A total of 25 invited participants attended from a broad range of sectors including NGOs, developers, housing, business owners, transport, disability, and environment groups. Planners from the cross-organisation project group were also involved to answer questions and listen to feedback.  Participants were divided into small groups to consider two or three IPG themes as a lens to explore ways to strengthen the strategy.

Feedback from the workshop identified[i]:
  • Equity or how the plan could reduce current inequities was not explicitly addressed.
  • There was concern that driving development to the urban fringes could exacerbate existing inequities.
  • Food security was not mentioned despite planning for future development on versatile soils.
  • In terms of natural capital, the feedback was that mitigating hazards was driving the planning process rather than the need to protect and promote the natural environment or biodiversity.
  • There was support for the need for more variety in housing types as proposed and how this could link with the suggested 10-minute neighbourhood concept – although there was a disconnect as to how this plan enabled these to be achieved.
  • The importance of a plan to be relevant to the health of all communities was emphasised, especially as cultural diversity increases in the region.
  • Although climate change was identified as a risk to wellbeing, the draft lacked detail.  Following the hearings this element was made more explicit.

Conclusion

Agencies in Canterbury have a long history of working together with a health focus to improve outcomes of projects, plans and policies, especially through formal joint Health in All Policies partnerships and work plans.  COVID-19 has highlighted what should have always been the key appraisal questions for officials to answer: Does this project make this community stronger, its people and environment healthier, and this place better?  The IPG is a tool that can be used to help answer these questions.

Note

The IPG and the pandemic supplement can be downloaded here.
Further information on the Health in All Policies approach in Canterbury, including examples of health impact and integrated assessments, is available at https://www.cph.co.nz/your-health/health-in-all-policies/ .

[1] Barton, H., Thompson, S., Burgess, S., & Grant, M. (Eds.). 2015. The Routledge Handbook of Planning for Health and Well-Being. Abingdon and New York: Routledge.
 
[1] 2019. Officer’s Report Draft Our Space 2018-2048 Greater Christchurch Settlement Pattern Update Whakahāngai O Te Hōrapa Nohoanga. Available at: https://www.greaterchristchurch.org.nz/assets/Documents/greaterchristchurch/Our-Space-consultation/Officers-Report-for-Our-Space.pdf