Exploring the potential for planning support systems to bridge the research-translation gap between public health and urban planning

The intersection of planning support science and spatial analytics, combined with health research, is offering new possibilities for data-driven approaches to urban planning and for the translation of health evidence to equip designers and planners with multidisciplinary, science-based information to make better, evidence-informed decisions that positively influence the design and planning of urban areas [50, 51].This paper examined the potential role and previous applications of planning support systems (PSS) and software to provide a science-based health impact assessment to communities’ planning and design through the integration and application of empirical health evidence.

Despite their promise, and potential, PSS have not become widely used in planning practice. Lessons are needed on how to effectively develop and apply PSS. This lack of experience hampers the further improvement and evolution of PSS technologies and their application [52]. As such, the paper also presents. a health-impact PSS (the “Urban Health Check”) that was trialled with a state government land development agency, planning consultants and community members on a real-world redevelopment situation with the specific aim of evaluating the usefulness and benefits of integrating a health impact PSS into the planning process in providing. planning professionals and policymakers with information to understand how different neighbourhood design approaches might impact community health and well-being and thus ‘bridge the gap’ between urban planning and public health. This is important knowledge to fill an important gap in PSS research, and to inform the future evolution and development of health impact PSS.

Current health impact PSS

Our review identified two studies that had developed and deployed health-impact focused PSS: (1) The National Public Health Assessment Model (N-PHAM) [39] and (2) the Walkability Planning Support System [41]. The health impact components of both PSS were driven/underpinned by rigorous empirical analyses and modelling to identify coefficients describing the strength of association between multiple built environmental features and health outcomes of interest. Thirteen planning support system (PSS) products that have evolved from prototypes to fully developed professional software packages or products were identified addressing land use transportation planning and environmental impact analyses. Of these, only three incorporated a health impact analysis component. We identified one off-the-shelf proprietary software product—CommunityViz Scenario 360 [36] that would allow users to build a health impact analysis. This dynamic plug-in for ESRI’s ArcGIS enables the programming of custom models that link the spatial features to outcomes of interest (i.e., health behaviours). As proprietary products, both Envision tomorrow and Urban Footprint use their US-based models and background land use data to calculate health indicators, limiting their applicability. The models underpinning the Urban Footprint and Envision Tomorrow were developed from the same The National Public Health Assessment Model of Schoner et al., (2018) [39]. As a plug-in to ESRI’s ArcGIS software, CommunityViz provides more flexibility as it also offers the possibility for the user to define formulas for customised health and spatial indicators in different study sites and locations and scales.

Similar to the attempts of Boulange et al. [41], we have demonstrated that empirical models of the relationship between the built environment and health-related outcomes can be accommodated within CommunityViz to create a bespoke, interactive, analytical tool to test scenarios of changes in the built environment. This moves beyond conventional research translation approaches from the public health field through its ability to introduce an academic evidence-base to the world of practitioners and decision-makers who rarely use evidence (or PSS) in practice [13, 33] and to provide decision-makers with the opportunity to trial different scenarios of planned or potential interventions and to assess them against health-oriented indicators. Because the Urban Health Check PSS was built on a customisable system (CommunityViz), the proposed methodology can be applied to construct further PSS applicable to other projects and contexts and locations.

Assessing the value of the urban health check PSS

Previous reviews into the use of PSS in the planning profession have concluded that PSS research still has to prove its added value to planning practice [28] through empirical research that moves away from experimental case studies towards real-world planning problems [30,31,32,33]. Moreover, PSS performance measures have shifted from a focus on their technical functionalities to their performance concerning their usefulness for assisting specific planning tasks [25]. This shift is highly relevant in thinking about the use of health impact PSS for the translation and application of health evidence into planning practices and design outcomes. [41]

Traditionally PSS have been developed by academic researchers for planning professionals [49]. More recently, Russo et al. [33] have emphasised the need for a co-design approach to the development of PPS that includes the participation of the planning professionals in the PSS design team to address the common problem of mismatch between PSS functionality with end-user expectations [31, 53]. Similarly, Biderman and Swiatek [51] stress the need for and added value of collaboration between politics and knowledge institutes (i.e., ‘evidence-based public policymaking in partnership with research institutes and universities’, p. 267). In the same vein, Luque-Martın and Pfeffer [54] promote ‘bridging academia and practice’ together and advocate that ‘academics and practitioners should join efforts in testing and researching the development and application of the different PSS components as an effective way to realise the desired outcomes of planning practices’. Indeed, Dias et al. [55] describe the use of interactive PSS in participatory planning processes as a promising way to bridge the gap between architects and urban designers’ creative design process and the more analytical process of planners. The Urban Health Check PSS was developed in collaboration with our industry partner to ensure it matched the planning tasks required. The spatial and health indicators were chosen to address the project’s specific design principles and community concerns, thus ensuring their relevance and fit for purpose.

The development of PSS has traditionally been focused on supporting individual decision making [20]. However, more recent approaches have seen the application of these to support group decision making as part of dynamic workshops or processes in land use planning, to engage a range of key actors and stakeholders interactively and to stimulate cooperation and improve knowledge exchange among decision-makers [20]. PSS have previously been identified as useful for planning practice by helping the public to express their needs, promoting interpersonal dialogue and debate and producing information in a form that can be understood and used by the ‘non-specialists’ [56]. However, community members engaging with our Urban Health Check PSS were reluctant to engage “hands on” with the PSS, preferring to let the facilitator sketch their ideas in the system. This might reflect the unfamiliar nature of GIS and PSS for non-professional and those competent in GIS skills.

Whilst the results of our focus groups indicated a positive response to the outputs of health impact PSS, there remains a number of obstacles to acceptance and use of PSS (in general) that could hamper the uptake and use of health impact PSS. Previous work by Vonk and Geertman [52] has identified the main bottlenecks concerning user acceptance were a lack of awareness concerning the existence and potential of PSS in planning practice, a lack of experience in using PSS and knowledge of and competency using spatial data and geographical information systems, and a general lack of intention to use PSS by the actors in the planning community. As a plug-in to ESRI’s ArcGIS, community viz. users need a degree of competency and experience using ArcGIS to create the spatial inputs and program the underling models and formulas for a PSS. The Urban Footprint and Envision Tomorrow platforms also require a level of familiarity with spatial data and GIS-based skills for the application and interpretation of the available tools and analyses – which may hamper their widespread uptake and use to date.

Further studies and evaluations, such as the one we present here, are needed to generate a better understanding of the factors influencing PSS’s actual usefulness in practice. This will enable effective solutions to the current implementation gap of PSS to be identified [18, 23, 30, 58] and improve the evolution of dedicated health impact PSS for healthy cities—helping to bridge the current research-practice gap between public health and urban planning.

Using an evaluation framework adopted from Pelzer [27, 48] that addresses the issues of usability and usefulness, we assessed the success of the Urban Health Check PSS in assisting with two distinct planning tasks identified by our industry partner and its ability to communicate health impacts of planning and design scenarios. Evaluation results indicated the PPS helped in four key areas:

(1)

Visualisation: the tool allowed stakeholders to see how the neighbourhood would change in response to a proposed plan.

(2)

Understanding: the tool helped stakeholders understand how the plan could benefit the community and demonstrate the complexity of balancing several desirable outcomes within a concept plan.

(3)

Health impact: the health indicators improved staff understanding of planning and design decisions that positively impact health outcomes and allowed for the communication and illustration of the broader health-related benefits to the community.

(4)

Engagement: the tool made it easier for community members to provide direct feedback and see the immediate implications of amendments to a proposed plan.

Limitations of health impact PSS

The walkability PSS by Boulange et al., and our Urban Health check PSS were limited to estimating a single health (behaviour) outcome—the likelihood of walking for transport. The N-PHAM and Urban Footprint and Envision Tomorrow models included a number of different health behaviours, including walking, cycling, walking to school as well as BMI, blood pressure, diabetes and a measure of poor population health [34]. The predictive health modes underpinning the N-PHAM, Urban Footprint and Envision Tomorrow PSS and the walkability PSS were derived from large-scale population health and travel surveys and multivariate regression analyses that accounted for all of the modelled built environment variables simultaneously as well as applicable covariates including gender and age. The Urban Footprint and Envision Tomorrow models also stratify the results by gender—reflecting important and known associations of age with the health outcomes of interest.

The linear modelling approaches used in all identify PSS for the health impact indicator has limitations because it does not consider the dynamic environment in which walking is undertaken. Alternative statistical models should be tested to simulate better the complex pathways through which neighbourhoods’ design influences walking.

The health impact PSS software and studies identified have limitations associated with the underlying health impact models. A limited set of built environmental variables have been included. Whilst different across the various software and tools, the models typically included macro-level Urban Design and built environmental features associated with walking, cycling and physical activity outcomes such as landuse mix, access to public transport, retail and other daily use destinations, schools, green space, amount of green space, dwelling mix and residential densities.

In our case study of the Urban Health Check and the walkability PSS model developed by Boulange et al. (ref) did not make interventions to the street network. It is unclear from whether the N-PHAM model that underpins the Urban Footprint and Envision Tomorrow modules allow and account for changes to the street connectivity. Given, connectivity is an important design feature associated with walking outcomes, the ability to modify the street network whilst allowing real time dynamic updates warrant further investigations in future health impact PSS. Other micro-level design factors are also important in influencing walking behaviours, for example, the presence of footpaths, trees and shade or traffic volumes, but these have not been tested and included in the statistical models to date. Moreover, other variables such as safety conditions are important factors determining walkability outcomes and have important impacts on the health behaviours modelled in the identified PSS. However, the health identified health impact PSS have not included safety factors in their underlying models.

The health outcomes included in the identified PSS have focussed on physical health behaviours—such as walking, cycling and physical activity, and physical health outcomes, such as blood pressure. None of the health impact PSS identified included estimates for mental health or social health outcomes—such as sense of community, that have been extensively studied with built environments. Future health impact PSS could look to include such outcomes. Given the limited resources, economic estimates can help make public health policy decisions by quantifying the costs and benefits of different alternatives [59]. The Urban Footprint and Envission Tomorrow software include fiscal modules monetising the health impacts of design scenarios that will further assist in land use and transportation decisions and research translation. PSS also present an opportunity to explicitly communicate information about the potential health impacts of urban planning policies using spatial indicators that reflect local planning policies and are essential for research translation [12,13,14]. Moreover, the identified health impact PSS tools and software were developed for, and applied in, a limited number of ocations in Canada, the US and Australia. More work is needed to apply these health impact PSS to a variety of spatial contexts, locations and scales of the built environment.

Lastly, the health impact PSS software and studies identified here, as well as our pilot Urban Health Check, assess simulated alternative urban design scenarios or futures. However, the actual built form that eventuates may be markedly different. Despite this, health impact PSS have an important role to play in ensuring health is considered in the design and planning phases. More studies, that can evaluate and demonstrate the benefits of health impact PSS in educating policy makers and planners of the importance and impact of their decisions on the health of the communities they are planning for is an essential first step to ensure policies and plans include the design features needed for optimal on-ground outcomes to be achieved.

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