Assessing the impacts on health of an urban development strategy: a case study of the greater Christchurch urban development strategy.

• Author: Stevenson, Anna

Abstract

This paper discusses a strategic policy-level health impact assessment (HIA) on the Greater Christchurch Urban Development Strategy (UDS). The need for a strategy is based on a number of premises, including an expected 120,000 increase in the population in the greater Christchurch region by 2041, bringing the total population to around 500,000. This is one of the first HIAs in New Zealand that assesses the link between urban design, health determinants and health outcomes at a high level of strategic planning. The HIA considered six key health determinants: air and water quality, housing, transport and social connectedness. A second work stream focused on developing an engagement process with local Maori around the UDS. Social connectedness, air quality and the Maori work stream are covered in this paper. This trial of the HIA process was constrained by time and resource limitations, but nevertheless was considered to be an extremely valuable process by participants. The development of a common language between unengaged stakeholders was seen as key to future collaboration. The final report was accepted by the UDS steering group, with population health outcomes having become a key focus. The authors recommend the incorporation of health impact assessment principles and processes into local government policy cycles.

INTRODUCTION

The major influences on the health of people in the community lie outside of the health sector. While clinical practitioners manage illness, other sectors influence where people live their lives--their social, cultural and economic environments. It is in these arenas that the determinants of health and wellbeing are found. Addressing these wider societal influences requires that many sectors, such as transport and Treasury, work collaboratively with the health sector. Policy-level health impact assessment is a relatively new tool that provides a method for engaging intersectoral activity towards a common focus--health and wellbeing.

This paper discusses a strategic policy-level health impact assessment (HIA) of the Greater Christchurch Urban Development Strategy (UDS) (Stevenson et al. 2006). This is one of the first HIAs in New Zealand that assesses the link between urban design, health determinants and health outcomes at a high level of strategic planning. The paper describes the HIA process and summarises its results, the potential impact of the UDS on two of the health determinants (social connectedness and air quality) and the engagement process with local Maori. Discussion focuses on the recommendations made, the critical success factors and some possible barriers to performing policy-level HIAs in New Zealand.

UDS BACKGROUND

The UDS is a collaborative community-based project that is preparing a strategic plan to manage the impact of urban development and population growth within greater Christchurch. The need for a strategy is based on a number of premises, including the following.

* By 2041 approximately 120,000 more people will have moved to the greater Christchurch area, bringing the total population to around 500,000.

* This population will be ageing. By 2021, 20% of the population will be aged 65 and over.

* By 2021 traffic growth is expected to increase by 40-50%.

* The population increase will generate demand for more infrastructure, with its associated costs.

The purpose of the UDS is to ensure that the projected population increase is planned for and managed so that changes to the community improve the overall quality of life rather than detract from it.

Representatives from Selwyn and Waimakariri District Councils and Christchurch City Council, Environment Canterbury and Transit New Zealand meet regularly with a cross section of local leaders from business, the community and government as the Greater Christchurch Urban Development Strategy Forum. The Forum is guiding the process of developing the Strategy. The Forum recognises that:

To get the future we desire for our families and ourselves, we must manage the impact development has on our quality of life: Decisions made today will affect our lives, our children, grandchildren and all future generations. (Urban Forum 2005a). UDS Consultation Document on Options for Growth

In April 2005, a consultation document on four possible options for growth and development in the greater Christchurch region was released to the public for their consideration (Urban Forum 2005b). The area covered by the UDS is shown on the map in Figure 1.

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The options document provided a brief summary of key issues and presented three options for managing growth: concentration, consolidation and dispersal, as well as the business as usual option. Comparisons between each of the options were made. People were asked to comment on a feedback form and select their preferred option.

Option A or "concentration" pictured 60% new housing in urban renewal with 40% occurring in new subdivisions. Development would focus on central Christchurch and inner suburbs, as well as Rangiora, Kaiapoi and Rolleston. Option B or "consolidation" pictured 40% of new housing as urban renewal with 60% in new subdivisions, while Option C or "dispersal" looked at development nearly all in greenfield locations outside Christchurch and in the rural towns. Business as usual meant no change from current development practice.

UDS Consultation Findings

Of the more than 3,250 feedback forms received on the UDS (a record response for councils), 62% chose option A, to concentrate development within Christchurch city and other larger towns in Waimakariri and Selwyn districts (see Table 1). Another 22% wanted Option B, which balances future urban growth between existing built areas with some expansion into adjacent areas. Few wanted Option C (2%), or Business as usual (3%), which allow for more dispersed development. About 12% did not answer or liked none of the above options, although their written comments made it clear that the vast majority of these preferred Option A, a mixture of A and B, or something more sustainable than A. This means near to 95% wanted something other than business as usual; in other words, a more concentrated urban form.

What was very noticeable from the UDS consultation process was that respondents shared the same concerns no matter where they lived. Most recognised the need to protect the water supply, valuable soils, community character and open spaces, and to provide well-planned communities linked by good transport systems. Around 50 of the more lengthy submissions of individuals and groups were presented directly to the Forum.

In addition to the UDS work, two other consultation processes were reviewed: the local government community outcomes for 2006-2009 (2) and Environment Canterbury's 50-year visioning report. (3) Environment Canterbury's report demonstrated that (as with the UDS consultation) respondents felt the greatest improvement on current levels should be the availability of good health care for all, people to feel safe at all times, having healthy ground water systems, for the air to be in a healthy condition, and for everyone to have access to an acceptable standard of housing.

WHY DO A HEALTH IMPACT ASSESSMENT ON AN URBAN DEVELOPMENT STRATEGY?

HIA is a policy tool that provides guidance through a formal process to assess how a particular policy may affect specific health determinants (Public Health Advisory Committee 2004). The direct impact of the policy on health status is assessed, as well as the indirect effect of the policy on health outcomes through its impact on health determinants such as access to health services, transport options and housing quality. The UDS was an appropriate strategic planning process for an HIA because it will influence multiple critical health determinants.

HIA processes explicitly test whether social inequalities are likely to occur. Patterns of inequality are well recognised within Canterbury and across New Zealand (Crampton et al. 2004), with patterns in health status affected by socioeconomic status, ethnicity, gender and geographical residence (Ministry of Health 2002). Indeed, "The challenge for urban development ... is to achieve improvement for the whole society, while enhancing the position of the poorest" (McCarthy 2002).

When this project began, the influence of the health sector on the UDS decision making and their engagement with the Urban Forum were minimal. Policy-level HIA was seen as a potential tool for developing intersectoral collaboration around a common concern (health and wellbeing) and providing meaningful input to the UDS team. The public consultation had already established a clear option preference, so the HIA process focused on comparing this option with "business as usual" and making recommendations to ensure that health concerns would be explicitly addressed in the final Strategy.

HIA METHODOLOGY

The project was initiated through a conversation by two attendees at HIA training (4) in April 2005, one a public health medicine registrar (Anna Stevenson, lead author of this paper) from Community and Public Health (CPH), the public health division of Canterbury District Health Board, the other a senior professional in environmental health from Christchurch City Council (CCC). Buy-in was achieved by these two players engaging key stakeholders from CCC, such as the UDS project leader and the general manager of CPH. After initial screening by a small group from each agency to establish connections between the UDS and population health, both organisations...