Tipping the Scales: Case Studies on the Use of Planning Powers To
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Tipping the scales Case studies on the use of planning powers to restrict hot food takeaways Foreword England has one of the highest rates of I was fascinated to read of one multi-faceted unhealthy weight of other western countries. approach to changing a whole population’s The prevalence of obesity in England has norms about diet. In 1972, the population more than doubled in the last twenty five of North Karelia in Finland had the highest years. And if we go on as we are, the rate of rate of heart attacks in the world. They also obese people is expected to double in the had a diet enormously high in fat and salt, next 40 years. Although the recent increase based on meat and high fat dairy products, in the prevalence of obesity has been seen with almost no vegetables or fruit. Following in virtually every country in the world, the rate decades of work with community groups, of increase in England has been particularly food producers, dairy farmers and local high. This is bad news for our residents, their media, the mortality rate of coronary heart children, our health and care services and disease in the middle-aged male population our economy because being very overweight in North Karelia has reduced by a whopping dramatically increases the risk of many long- 73 per cent. What seems to have happened term, life-threatening medical conditions. is that, through the efforts of public health specialists and the grassroots allies they Obesity is a complex problem that requires made in farming communities, the whole ‘food action from individuals and society across environment’ has changed and obesity is multiple sectors. One important action which no longer the norm as it has become in our the Foresight report identified was the need country1. Of course, rates of death from heart to modify the environment so that it supports disease have decreased elsewhere, including being active and does not promote sedentary the UK, during this period, in large part behaviour or provide easy access to energy- due to reductions in smoking and effective dense food. Indeed, the Foresight report on treatment. But North Karelia is an outstanding Obesity showed that to successfully address example of how a multi-faceted approach this problem we need to address it in a can make a difference. holistic manner on many levels, considering such issues as individual behaviour and food Raising awareness, generating public debate, consumption. (REF). working with our communities, schools and businesses and using our local government We know that many councils have begun to functions can all help to make the food take such a holistic approach to addressing environment a healthier one for our children the challenge of obesity. This is where those and young people. One of the important councils that have introduced restrictions on messages from Karelia, which is echoed in the proliferation of fast food takeaways are the case studies below, is that to create this seeking to make a contribution. healthier environment we must work at many levels with many sectors and partners and with communities. 1 To read how this community changed its eating habits, see: www.theatlantic.com/health/archive/2015/04/finlands- radical-heart-health-transformation/389766/ 2 Tipping the scales The Local Government Association (LGA) Using the planning system is only one and the councils it represents do not want weapon in our armoury. For those councils to make life unnecessarily difficult for that choose to use it, I hope the key restaurant and catering business. We need messages and case studies below will a flourishing eating-out sector in our towns give some useful pointers. and cities: it is good for both the day- and night-time economies for balanced and busy town centres – and people enjoy it! That is why all the councils which have introduced restrictions on takeaways through their planning policies are also working with businesses to help them make a healthier offer to their customers. Talking to businesses is already beginning to pay dividends, with some businesses improving their offer with advice from environmental health and public health staff and some competing for awards Councillor Izzi Seccombe for healthier food. Chair, LGA Community Wellbeing Portfolio Tipping the scales 3 Contents Introduction 5 Key messages 7 Case studies Gateshead Council 12 Salford Council 14 Sandwell Council 17 St Helens Council 20 Tower Hamlets Council 23 Waltham Forest Council 25 Bolton Council 28 Annexe A – Supplementary planning documents and local evidence 30 Further Information 32 4 Tipping the scales Introduction Obesity is one of the most important public University to support councils in designing health issues currently being addressed by a whole-system approach to reducing this country. It is a cause of chronic disease obesity2. NHS England is also developing leading to early death. Two-thirds of English a programme of support to councils in adults, more than one fifth of four to five-year- developing healthy towns and communities3. old children and more than a third of 10 to 11 year olds are obese or overweight. There is a These initiatives recognise that local growing body of evidence on the ‘obesogenic authorities, through a wide range of their environment’ that makes it harder for people functions, are well placed to take action to to attain and remain at a healthy weight combat obesity. A multi-faceted approach and hardest of all for people in the most to tackling this issue appears in all local deprived areas in this country. This has been authorities’ health and wellbeing strategies. recognised in national policy and by local A number of important publications have authorities and the bodies representing and already drawn attention to the potential for advising them (DH 2011, Foresight 2007, local government to use its powers in a LGA 2013, PHE 2015). variety of ways to combat obesity and try to dilute some of the effects of the obesogenic A study by McKinsey and Company in 2014 environment. The planning system is one area estimated that obesity was a greater burden in which local government can act. on the UK’s economy than armed violence, war and terrorism, costing the country nearly The National Planning Policy Framework £47 billion a year. The report found that (March 2012) makes it clear that the planning obesity has the second-largest economic system can play an important role in creating impact on the UK behind smoking, generating healthy, inclusive communities For some years, an annual loss equivalent to 3 per cent of a number of local authorities have been using GDP. The country spends about £6 billion their planning powers to try to restrict the a year on the medical costs of conditions growth of hot food takeaways near schools 4 related to being overweight or obese and and in town centres . There are now over 20 a further £10 billion on diabetes. Together councils which have introduced restrictions obesity and diabetes cost as much as the on fast food outlets (Ross 2013), these outlets UK’s combined budget for the police and fire tend to sell food that is high in fat and salt, and services, law courts and prisons. If current low in fibre, fruit and vegetables. trends are not reversed, the cost of obesity There is evidence that there are elevated and overweight conditions could increase levels of obesity in communities with high from between £6 billion and £8 billion in 2 http://www.local.gov.uk/documents/10180/6101750/Whol 2015 to between £10 billion and £12 billion e+systems+approach+to+obesity+-+invitation+to+particip in 2030 (McKinsey, 2014). ate+in+national+programme/45319246-4a78-4686-82a5- 3e2657a547df The need for action at all levels of government 3 https://www.england.nhs.uk/2015/07/01/healthy-new-towns/ 4 ‘Hot food takeaways’ is the term used in planning legislation and society has been recognised by the to describe the A5 use class in relation to retail outlets “for newly-announced partnership between Public the sale of hot food consumption intended for consumption off the premises”. Here, this term is used interchangeably with Health England, the LGA, the Association of ‘fast food outlets’, ‘takeaways’ etc. The planning restrictions Directors of Public Health and Leeds Beckett described in the case studies below apply exclusively to the A5 use class. Tipping the scales 5 concentrations of fast food outlets (Zenk 2009) in particular. Below we describe how a number and further evidence that such concentrations of councils have used their planning powers are highest in areas of greatest deprivation and, as far as possible, what the impacts (PHE 2014a). There is also evidence that the have been. We provide detail in six case type of food on sale nearest to schools may studies with additional examples in boxes to influence the diet of schoolchildren. (Engler- illustrate the range of councils which have Stringer, 2014; Smith, 2013) taken action through planning. Public health and planning specialists have begun to draw This document contains case studies of conclusions from their experience about the seven local authorities which have developed best approach. Some of the lessons learned policies and supplementary planning and key messages from local authorities which documents with this objective. It complements have gone down the planning route to tackling a previous publication by Public Health obesity are outlined below. England (PHE), the Chartered Institute of Environmental Health (CIEH) and the LGA Local authorities do not claim that their which describes the policy, the evidence and planning decisions have an immediate and the legislative background (PHE, 2014). direct impact on obesity, but as one public health specialist put it, at the very least The planning system alone cannot solve the their work may help to make ‘a chink in the problem of obesity whose causes are many obesogenic environment’.