Client: Office for Health Improvement & Disparities, UK
Although there are a number of existing frameworks that help to address place-based determinants of health, they are siloed and do not enable a holistic approach to place-based assessment. These frameworks are difficult to find, access and use consistently, and most have been developed from evidence that is not applicable to the English context.
Why the Healthy Places Framework?
A Healthy Places Framework for England would fill the gap, providing a systematic consideration of the features within the environment that constitute a healthy place.
We conducted thorough research and stakeholder consultation to build the foundations for the framework. The project consisted of:
- A systematic scoping review of the literature outlining existing healthy place frameworks and identifying framework components.
- A systematic appraisal of existing healthy places frameworks being used nationally to appraise their implementation and impact.
- Gathering stakeholder input from local authorities, healthy planning experts, and framework designers to identify needs.
- Establishing best practice recommendations, rationale, and an evaluation plan for a new Healthy Places Framework for England.
- Developing the prototype Healthy Places Framework.
Research: Systematic Scoping Review
Our systematic scoping review looked at the range, diversity, composition and design of healthy places frameworks. The search discovered 61 relevant healthy planning frameworks accompanied by a usable tool.
Data extraction showed that while there are a variety of existing frameworks, they generally focus on individual urban determinants, and rarely consider specific health outcomes. A framework that approaches both specific health outcomes from a holistic point of view could be a useful addition to better involve health professionals and value planning changes.
Frameworks that measure or evaluate the baseline and inform the design process are widely available, however are generally complex to use. There are few frameworks focused on community or citizen use.
Frameworks are also generally poorly signposted and lack user-friendly design. Very few (8%) included an impact or implementation evaluation, and many offer limited updating mechanisms, indicating that the long-term relevance is rarely considered.
Research: Systematic Appraisal
The systematic appraisal evaluated the design, use, usability and impact of six relevant UK Healthy Place frameworks. Data and interviews with those involved in the frameworks were analysed using the thematic analysis method to draw out best practice recommendations.
In terms of design, clear and simple recommendations, an easy-to-use tool, and multimedia guidance were shown to be crucial to success.
Recommendations were shown to have strong uptake when they were developed with extensive stakeholder input, aligned with policy priorities, and were feasible for those implementing them.
There was a clear data gap in terms of evaluations, and complexity gathering data on outcomes, however most frameworks had led to an increased awareness and conversation on healthy planning.