Leveraging Health: The Urban Planner’s Dilemma THESIS SUBMITTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE UNIVERSITY OF LIVERPOOL FOR THE DEGREE OF DOCTOR IN PHILOSOPHY BY PETER FAWCETT APRIL 2019 DEPARTMENT OF GEOGRAPHY AND PLANNING SCHOOL OF ENVIRONMENTAL SCIENCES UNIVERSITY OF LIVERPOOL Table of Contents Abstract ................................................................................................................. vi Acknowledgements ............................................................................................. vii Part I Introduction and background .................................................................... 1 1. Human health: a “new” agenda for urban planning ................................. 2 1.1 Introduction ................................................................................................... 2 1.2 Health in the planning project ........................................................................ 6 1.2.1 The birth of modern urban planning ....................................................... 6 1.2.2 Integration and fragmentation .............................................................. 11 1.2.3 Shifting perspectives and healthy cities ................................................ 15 1.2.4 Cities at the crossroads ........................................................................ 19 1.3 Project details ............................................................................................. 24 1.3.1 Genesis of the research ....................................................................... 24 1.3.2 Problem statement ............................................................................... 26 1.3.3 Research aims and objectives.............................................................. 29 1.4 Structure of the thesis ................................................................................. 31 Part II Healthy urban planning: theoretical and empirical perspectives ......... 32 A review of the literature ........................................................................................ 33 Section One The concept and determinants of health .......................................... 35 2. The determinants of health....................................................................... 36 2.1 Introduction ................................................................................................. 36 2.2 The wider determinants of health ................................................................ 37 2.2.1 Public policy-making ............................................................................ 37 2.2.2 Healthcare............................................................................................ 39 2.2.3 Social context ....................................................................................... 41 2.2.4 Health behaviour .................................................................................. 46 2.3 Spatial dimensions of health ....................................................................... 48 2.3.1 The settlement as a health setting ........................................................ 48 2.3.2 The built environment and health ......................................................... 52 2.4 Chapter Summary ....................................................................................... 58 3. The meaning of health .............................................................................. 59 3.1 Introduction ................................................................................................. 59 3.2 A conceptual and lexical quandary .............................................................. 60 3.2.1 Lexical ambiguity.................................................................................. 60 3.2.2 The (contested) concept of health ........................................................ 62 3.3 Locating the meaning of health ................................................................... 69 i 3.3.1 Health as the absence of disease ........................................................ 71 3.3.2 Health as wellbeing .............................................................................. 74 3.3.3 Health as a resource ............................................................................ 78 3.4 Considerations for urban planners .............................................................. 83 3.4.1 Definitional considerations ................................................................... 84 3.4.2 Ethical considerations .......................................................................... 87 3.5 Chapter summary ........................................................................................ 92 Section Two Concepts, challenges, and the practice of healthy urban planning... 93 4. Healthy urban planning ............................................................................ 94 4.1 Introduction ................................................................................................. 94 4.2 Concepts and principles .............................................................................. 95 4.2.1 Urban planning ..................................................................................... 95 4.2.2 Healthy urban planning ........................................................................ 97 4.2.3 The healthy city .................................................................................. 100 4.2.4 Sustainable development ................................................................... 103 4.3 Planning for health .................................................................................... 106 4.3.1 The links between urban planning and health .................................... 106 4.3.2 Health in all policies ........................................................................... 109 4.3.3 Urban planning health objectives ....................................................... 114 4.4 Theory to practice: the evidence around urban planning and health .......... 116 4.4.1 Consideration of health within urban planning .................................... 116 4.4.2 The health effect of urban planning .................................................... 124 4.5 Chapter summary ...................................................................................... 130 5. Barriers and opportunities to health urban planning ........................... 131 5.1 Introduction ............................................................................................... 131 5.2 Urban planning: linear and rational or fluid and dynamic? ......................... 132 5.3 Complex and ‘wicked’ planning problems .................................................. 135 5.4 Collaborative working and partnership ...................................................... 139 5.4.1 The planning game ............................................................................ 139 5.4.2 The theory of collaborative planning ................................................... 142 5.4.3 Collaborative working for HUP ........................................................... 145 5.5 Political considerations .............................................................................. 152 5.5.1 Planning and politics .......................................................................... 153 5.5.2 Political implications for healthy urban planning ................................. 157 5.6 Chapter summary ...................................................................................... 162 Conclusions from and research issues suggested by the literature review ........... 163 Part III Research paradigm, methodology and methods ................................. 170 ii 6. The research strategy ............................................................................. 171 6.1 Introduction ............................................................................................... 171 6.2 Research questions .................................................................................. 174 6.3 Research paradigm ................................................................................... 176 6.3.1 The epistemology of social constructionism ....................................... 177 6.3.2 The theoretical perspective of postmodernism ................................... 181 6.3.3 A case study methodology ................................................................. 183 6.4 Research design ....................................................................................... 189 6.4.1 Designing a qualitative case study ..................................................... 189 6.4.2 Case selection criteria ........................................................................ 192 6.4.3 Phase One data collection ................................................................. 194 6.4.4 Phase Two data collection ................................................................. 198 6.5 Data analysis and interpretation ................................................................ 207 6.5.1 Content analysis and thematic coding ................................................ 207 6.6 Reflexivity and ethics ................................................................................ 211 6.6.1 Reflexivity .......................................................................................... 211 6.6.2 Ethics ................................................................................................