Conclusions

The overarching question this research sought to answer is:

Why do we fail to plan for and produce healthy environments in Australia and how can this change?

To appropriately address this question, additional research objectives were developed. The conclusions presented in this thesis in response to those additional research objectives are as follows:

Conduct literature review to define healthy planning, healthy urban design and active living initiatives, and to identify who is responsible for their delivery.

Given the wide scope and complexity of matters such terms encompass (for instance, refer to Section 2.1 on definitions of health and Section 2.2 on definitions of urban planning and urban design), a single and definitive definition does not exist and is unlikely to be forthcoming.

Nevertheless, definitions are available in the literature (at least for healthy planning, active living initiatives are less commonly examined or defined). The definitions emerging from the literature review and informing the scope of this research are as follows:

• Healthy planning: for the purposes of this research healthy planning is defined as the management of natural and built environments to meet the health and well-being needs of current and future communities, including through improvements to economic, social and environmental conditions and striving towards more equitable distribution of these health improvements across populations. This definition is partly adapted from the definition of Jennifer Kent et al. (2012, p. 385) (see Section 2.3) and was adopted given its applicability across settings and the multitude of ways that changes to the built environment can impact community health. Yet for the purposes of this study, the scope

is limited to physical activity, one of three key domains through which Kent and Thompson (2014) identify that the built environment influences community health.

• Healthy urban design: Given the overlap between definitions of urban planning and urban design outlined in Section 2.2, as the relevant literature often uses the terms interchangeably (for instance, see Clifton, Smith, & Harrell, 2007; Kent et al., 2012) and as the definition of healthy planning adopted above is relatively general, for the purposes of this study the same definition of healthy urban design is adopted as that for healthy planning, as above.

• Active living initiatives: active living initiatives are those initiatives that encourage a way of life which integrates organised or informal physical activity into people’s daily routines and aim to meet the health and well-being needs of current and future communities. It is noted that the academic literature does not commonly use the term

‘active living initiatives’ and that difficulty in finding an agreed upon definition of such also arises. However, the term is used in urban planning and health policy (ACT Government, 2016; NSW Government, 2013) and is adopted for the study given the research scope (relating to those urban planning measures aimed at increasing physical activity) and the need to consider behaviour change programs that increasingly accompany urban planning initiatives (see, for instance Buckenara, 2015; Kent & Ampt, 2012).

Within the complexity surrounding the built environment and health and the systems of governance that influence them, there is not one single agency responsible for the delivery of projects attempting to address health through changes to the built form, or even for coordinating the delivery of such projects. The reality is a messy picture with blurred boundaries of responsibility and multiple, interrelated actors often with differing interests.

In Australia, in terms of governance, the federal level plays a limited, ad hoc role. The state level is generally responsible for undertaking both urban planning and health, however states can (and to a large extent do) devolve urban planning responsibilities to regional or LG levels.

There are examples of regional urban planning bodies (Crommelin et al., 2017), but consistently and historically urban planning powers in particular have been given to LG. However, these

roles are changing and increasingly LG is considered to have a role to play in addressing global concerns, such as climate change and rising NCD rates, which were previously more commonly the domain of centralised governments. In addition, LG in Australia is the closest level of government to the community and is responsible for the management of the majority of public places used in day-to-day life. As healthy planning ranges in scale from the arrangement of city-wide systems and processes to micro-scale interventions (Australian Local Government Association et al., 2009; National Heart Foundation of Australia (Victorian Division), 2004), LG is likely to have a role (sometimes in partnership with other levels of governance or other stakeholders) in the majority of healthy planning and active living initiatives, particularly as they relate to increasing physical activity levels through active transport. Therefore, while no one stakeholder is solely responsible for the delivery of healthy planning and active living initiatives, and though much focus has centred on the state level in Australian healthy planning, the responsibility commonly falls to LG.

Undertake surveys and interviews with healthy planning practitioners and advocates to determine the barriers to uptake and implementation of healthy planning and active living initiatives.

The surveys were undertaken with Australian practitioners working in LG and involved in healthy planning. The interviews were undertaken with Australian healthy planning advocates, operating at a LG level however with roles external to LG. Findings from these surveys and interviews indicate that an inconsistent policy setting across state and LG levels fails to provide an adequate mandate for the uptake and implementation of healthy planning and active living initiatives. Yet even where an adequate policy setting is evident, politicised decisions still have greater influence over project uptake and delivery. Concerns over the applicability of research, guidance and evidence to an Australian setting (whether real or perceived) also act as barriers to implementation. Projects addressing community health through encouragement of increased physical activity levels are seen to be popular politically, yet details of such are generally avoided, which reduces the likelihood of policies or advocacy work then being implemented on-the-ground.

The weak policy setting and political decision-making (and political concerns) present as barriers, but also provide the opportunity for policy entrepreneurs (such as

advocates/champions) to have notable influence in the field. Yet the barriers to implementation are structural. Even though individuals can overcome these barriers and facilitate project implementation (see below) in one-off instances, structural impediments such as the lack of legislative backing, a continued reliance on advocates and a lack of funding will likely remain elsewhere.

Undertake surveys and interviews with healthy planning practitioners and advocates to determine factors that enable the uptake and implementation of healthy planning and active living initiatives.

The surveys undertaken with Australian LG practitioners and interviews undertaken with Australian healthy planning advocates identified various factors that encourage uptake and implementation of healthy planning and active living initiatives. Key considerations that can act as enablers to project uptake and implementation include the presence of policy entrepreneurs (or champions, advocates), internal operations of the LG, partnership formation, a supportive policy setting (though see above), the use of framing techniques (including the recognition and good news that projects can facilitate), the creation of a mandate for LG, resourcing and funding, the discussion of co-benefits and previous project success.

Policy entrepreneurs commonly adopted two, seemingly conflicting approaches to framing healthy planning and active living initiatives:

• Health by stealth – that is the avoidance of mentioning the health benefits of projects, focusing instead on other benefits; or

• Showing health to be a central consideration to LG functioning.

Identify ways in which enablers could be better utilised to encourage the planning and production of health-promoting environments, particularly with regard to relevant barriers.

The above findings might inform the way advocates and practitioners approach the promotion of healthy planning and active living initiatives. Identifying project-specific enablers might allow for opportunities to be better recognised, and barriers to be better addressed in the

short-term. In the longer term, if health by stealth were adopted as an approach by advocates it is likely that a contextually-specific aspect of Australia would have to inform the approach, given societal (and in some cases practitioner) hesitancy over the applicability of active transport research and guidance developed elsewhere and implanted to an Australian setting. The proximity of the majority of Australians to the coast could be a starting point to this discussion.

Although health would not be an explicit consideration (or not appear to be), the health of communities could be improved given such changes that promote active living would be positioned as having contextual applicability, and as Australian communities demonstrate certain characteristics that present a comparative advantage in providing health-promoting (or walkable and bikeable) settings.

Alternatively, in showing community health to be a central consideration of LG functioning, particularly through LG’s potential to influence physical activity levels, the importance of actual projects themselves in encouraging future project uptake and implementation is highlighted.

Although paradoxical, this finding encourages continued advocacy efforts to deliver healthy planning on-the-ground at the LG level as a way to address the current reliance of the healthy planning field on the efforts of champions and on ad hoc implementation.