Johnson must ‘build build build’ cities less welcoming to disease

The writer is a barrister specialising in planning and public law

On the Morland estate in Hackney, east London, children have spent lockdown staring at a brand new playground. For Rachel Faulkner-Gurstein, a resident and mother of two, the lack of access is frustrating. “Kids learn through play — it’s key to good health.”

Ms Faulkner-Gurstein and her neighbours spent years transforming what had been an unloved piece of land, consulting, fundraising and lobbying local officials. Work finished just as the UK went into lockdown.

As Michael Marmot, professor of epidemiology and public health at University College London, observed: “Covid-19 exposes the inequalities in society and amplifies them.” Nowhere is this starker than in relation to the built environment.

It might seem obvious that overcrowded, damp, precarious accommodation is bad for health, yet the link revealed in Office for National Statistics data between higher Covid-19 mortality and poor housing is shocking. Those living in cramped homes, often in multigenerational families and disproportionately from Bame backgrounds, have experienced higher levels of coronavirus hospitalisation and mortality. As John Gray, housing chief in east London’s Newham, one of the worst affected local authorities, puts it: “This is a housing disease.”

And it’s not just housing. One in eight Britons has no access to a garden. Time spent in gardens relates to exercise, which directly influences the risk of obesity, diabetes and heart disease, which increase Covid-19 death risk. Even a view of green space has been found to have measurable health benefits.

Lessons from combating TB have taught us that even with a vaccine, addressing the environmental factors that drive disease is central to its control. Instead of threatening open spaces with development or privatisation, they should be protected.

In response to Covid-19, the UK government has announced a radical planning shake-up. But exactly what gets built and its quality will affect the link between the built environment and worsening health inequalities.

Expanding permitted development rights that remove the need for planning permission will allow empty shops, offices and industrial sites to be converted to housing. We need more homes but in the right places — with the physical and social infrastructure to support healthy communities.

It is easy to see why developers like PD — and why local planning officers and many others don’t. There’s no need to consult local authorities or residents. Such projects are often more profitable; they don’t require a contribution to affordable housing or community infrastructure like schools, playgrounds or public transport — the very things that make for healthier places.

Since 2015, more than 60,000 flats have been created this way, predominantly from offices. According to the Royal Institution of Chartered Surveyors, 70 per cent of PD flats are below minimum space standards. The latest changes risk creating invisible slums, made up of thousands of tiny, inadequate homes. 

The next stage of pandemic response should focus on the built environment because most factors that influence people’s health lie outside healthcare. By investing in good quality social housing and parks, we tackle disease before people reach the healthcare system.

All new plans and planning applications should be required to explain how they help tackle health inequalities, with evaluations that measure impacts over time. Citizens must be involved. We must invest in genuinely affordable housing, built to decent standards.

The pandemic could drive urban renewal. Morland residents cannot wait to enjoy the playground they created. Ms Faulkner-Gurstein says “communities want something different and want to be listened to”. As the government promises to “build build build” its way out of the recession, it would do well to remember that.

Dr Tolullah Oni, clinical senior research associate with the Cambridge university MRC epidemiology unit, also contributed to this article

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