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15.06.2023 - Ausgabe: 3/2023

Joint planning towards a healthy city

By Thomas Preuß and Christa Böhme (German Institute of Urban Affairs (Difu), Berlin)
© M Einero/ peopleimages.com/ stock.adobe.com

Healthy, equal, resilient and thus liveable municipalities are characterised by the fact that health concerns such as rest, recreation, well-being, physical activity, stress management and relaxation have a high priority in urban planning. For municipalities, this means a major transformation task, because many urban areas are still characterised by multiple pressures on the population in terms of the environmental situation as well as the health and social situation. In many cities, the health opportunities of the inhabitants are distributed unequally depending on where these inhabitants live, because in addition to the social situation, there are sometimes significant differences in the burden of noise, polluted air and heat, as well as in the availability of green spaces. This is reason enough to give health issues a high priority in spatial and environmental planning.


Municipal planning for better health

The fact that noise action plans, green and open space policies as well as urban land use planning and urban development planning offer a variety of starting points for taking health concerns into account comprehensively and at an early stage is shown in the new UBA brochure "Gemeinsam planen für eine gesunde Stadt - Empfehlungen für die Praxis" (Planning together for a healthy city - recommendations for practice), which was produced by the German Institute of Urban Affairs in cooperation with LK Argus and the Bochum University of Applied Sciences. Based on the requirements for a healthy city, the publication provides recommendations on how aspects of preventive health care and health protection can be more strongly anchored in municipal environmental, green and urban planning offices. In doing so, the potentials of the mentioned planning are described and explained, and specific options for action are shown by means of municipal examples of practice. In addition to the technical and content-related interfaces on the topic of health, great attention is paid to the cooperative interaction of the various offices. The municipal health offices have an important function in this context, as they are involved in the above-mentioned health-related planning in addition to tasks such as prevention, health promotion, health protection and child and youth health. This participation is also firmly anchored in the laws on the public health service of some federal states.


Health concerns in spatial and environmental planning

Land-use planning offers a variety of starting points for the integration of health concerns, e.g. in the designation of green spaces and recreational areas as well as fresh air corridors, through the specification of compatible building densities (e.g. distance areas, storey heights) and through the allocation of disturbing and non-disturbing uses. By assessing noise pollution, air pollution and odours when drawing up development plans and by closely comparing the development plans with the contents of other health-relevant and sectoral plans, health concerns can be integrated into the planning at an early stage. Urban planning competitions in the run-up to the preparation of development plans can also take up health concerns as important criteria. 


Urban (sub)development planning provides a special potential for integrating topics and actors. For example, in integrated urban development plans, the topic of health can be dealt with as a cross-sectional or guiding theme at city-wide level. In this way, various sectoral plans with health-relevant interfaces can be bundled: both with regard to structural "conditions" and with a view to health-related "behaviour", especially of vulnerable population groups. Care should be taken to ensure that the health department as a planning actor and other stakeholders such as sports and small garden associations, urban gardening initiatives, day-care centres and schools are actively involved with their approaches to better health in the city.  Finally, this can also create the basis for the development of social space-related health projects, which can be funded by health insurance companies, e.g. on the basis of the Prevention Act.

Formal or informal green and open space planning considers all functions of green and open spaces as well as their interactions. It is thus an integrated sectoral planning with a great potential to also develop the health-related functions of green and open spaces such as exercise and sports, recreation and encounters. At the same time, the balancing functions of urban green spaces can be expanded in order to reduce climatic stress, air pollution and noise. In this way, the "quiet areas" designated in the noise action planning can be adopted in the planning representations of green-related plans and vegetation-technical measures or measures of engineering biology for noise reduction can be defined. Analyses of green spaces in social areas can contribute to the prioritisation of socially disadvantaged sub-areas that are undersupplied with green spaces as future focal points for spatial action.

Noise action planning, on the other hand, aims directly at central health concerns with the task of "noise reduction and noise prevention". After all, the aim is to reduce health risks (including cardiovascular diseases, psychological impairments, stress, sleep disorders) and the number of people affected by noise (noise remediation) by means of noise-reducing measures. The primary focus must be on motorised road traffic and railways. One way to do this is to designate quiet areas as public leisure and recreation areas that are to be protected from an increase in noise (noise prevention). These must also be designated in inner-city locations in the residential environment, especially for the population with multiple stresses or vulnerabilities. In order to create remedies against noise in the urban development stock, lower trigger or target values for measures in the noise action plans should be applied than have been applied so far. In future, these should be more closely oriented to the recommendations of the WHO guidelines for environmental noise. In addition, noise action planning should be more closely interlinked with other health-relevant planning such as green and open space planning, traffic development planning, air pollution control planning and urban planning.

More health in the city therefore means much more than the consideration of the protected goods of humans/human health in the environmental assessment for urban land use planning or landscape planning. In the interest of city residents, attention to pollution control should not be limited to compliance with existing limits, guideline or orientation values.


Important adjusting screw: actively planning health offices 

In the design of the above-mentioned sectoral plans, the health authorities should actively participate in the spatial sectoral plans to a much greater extent than they did before. This concerns both content-related contributions and procedural aspects. 

In terms of content, for example, health targets and small-scale health and social data from health and social reporting, among others, must be included in the inventory analyses of spatial planning at an early stage. Furthermore, the specific spatial health needs of vulnerable groups or institutions should be included in all procedural phases of the above-mentioned planning. Finally, from a health perspective, special attention should be paid to areas with multiple burdens, as it is here where measures to reduce health burdens and improve health-relevant resources (e.g. green spaces) in the residential environment are urgently needed.

In terms of procedural measures, the health offices could strengthen health concerns in the planning process with qualified statements in the context of spatial planning, through active participation in interdepartmental exchange formats, with active participation in informal participation procedures in urban and district-related planning, with networking at the neighbourhood or social area level or also by introducing questions of health-promoting urban and neighbourhood development in municipal health conferences.

With their "Health Sector Plan", health authorities can position themselves as players at the same level as planners within the municipal administration. Such a plan addresses health concerns with close reference to the urban environment and a data-based inventory of the health and socio-spatial situation as well as spatial planning goals for health. Based on these data, specific spatial health measures are presented in close coordination with other offices and other health-relevant actors. The "Health Sector Plan" also shows the content-related interfaces to other health-relevant planning. This allows important aspects such as noise reduction, air pollution control, heat prevention, climate adaptation, transport, green and open space and urban development to be incorporated into health planning.


More health in the city: key conclusions

To ensure that health is given a higher priority in spatial planning in the municipalities, the following measures are required from the relevant stakeholders:


  • common understanding of what more health means for the city,
  • common language in relation to health concerns and spatial planning in urban spaces,
  • common goals that guide health concerns in spatial planning,
  • defined professional responsibilities, tasks and interfaces with regard to health concerns in spatial planning,
  • joint goal and solution-oriented work with the available planning, instruments and options for action,
  • exchange of knowledge and data on the health and social situation as well as the environmental situation in the city as a whole and in the urban sub-areas,
  • interdepartmental cooperation in existing or newly established structures,
  • training for administrative staff and the opportunity for professional exchange both within the municipality and beyond.


The creation of a health city is possible

The creation of a healthy city in many different facets is already possible today. In many places the multi-actor and cross-sectoral scope is already being used for this purpose. However, good framework conditions must be created for active and comprehensive administrative action for health in the municipalities. In addition to sufficient technical and personnel resources in the municipal administration, this includes improved education and training at the interface of health, environment and planning, as well as anchoring participation in planning as a task of the health offices in all state laws on the public health service.


Publication reference:

Böhme, Christa, Elke Bojarra-Becker, Thomas Franke, Eckhart Heinrichs, Heike Köckler, Thomas Preuß und Michael Schreiber (2023): Gemeinsam planen für eine gesunde Stadt – Empfehlungen für die Praxis. Umweltbundesamt (Hrsg.), Dessau-Roßlau. 


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