Active Design and Spatial Planning Public Health Advisory Note Director of Public Health and Wellbeing, Dr Sakthi Karunanithi MBBS MD MPH FFPH

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Introduction

This Public Health Advisory Note explores how planning policy can make a positive contribution to increasing the rate of physical activity across Lancashire. It provides an overview of physical activity levels in Lancashire, examines national guidance and the 10 Active Design principles outlined by Sport Englandi. Based on this it provides recommendations regarding how Active Design principles can be incorporated into local planning policies.

Wider Determinants of Health

The health and wellbeing of individuals and communities is affected by a wide range of factors including the built and natural environment. Spatial planning can be used to influence these environments to make a positive contribution to addressing a number of public health issues such as air quality, physical inactivity, social isolation and obesity.

Within the National Planning Policy Framework (NPPF), guidance is provided on how health should be considered by the planning system. The NPPF states that planning policies should 'enable and support healthy lifestyles, especially where this would address identified local health and well-being needs – for example through the provision of safe and accessible green infrastructure, sports facilities, local shops, access to healthier food, allotments and layouts that encourage walking and cycling'.

Lancashire County Council's Director of Public Health, through the Health Equity, Welfare and Partnerships Service, is collaborating with Lancashire's local planning authorities (LPAs) to take account of local health issues and considerations, through the provision of local health data and advice.

Recommendations

A lack of physical activity in everyday routines, combined with other lifestyle factors, can lead to poor health outcomes at a population level. As with the issue of excess weight, physical inactivity is a complex problem and a multifaceted approach to addressing it is required. Active Design principles, developed by Sport England and supported by Public Health England, are intended to create environments that make the active choice the easy and attractive choice for people and communities.

Our recommendation is for the Active Design Principles to be reflected in the policies of Local and Neighbourhood Plans.

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Active Design

The design and masterplanning of development proposals will embrace the role they can play in supporting healthy lifestyles by facilitating participation in sport and physical activity. To do so they will, as far as is relevant to the specific development proposal, adhere to the following Active Design Principles:

1. Activity for all

Neighbourhoods, facilities and open spaces should be accessible to all users and should support sport and physical activity across all ages.

Enabling those who want to be active, whilst encouraging those who are inactive to become active.

2. Walkable communities

Homes, schools, shops, community facilities, workplaces, open spaces and sports facilities should be within easy reach of each other.

Creating the conditions for active travel between all locations.

3. Connected walking & cycling routes

All destinations should be connected by a direct, legible and integrated network of walking and cycling routes. Routes must be safe, well lit, overlooked, welcoming, well maintained, durable and clearly signposted. Active travel (walking and cycling) should be prioritised over other modes of transport.

Prioritising active travel through safe, integrated walking and cycling routes.

4. Co-location of community facilities

The co-location and concentration of retail, community and associated uses to support linked trips should be promoted. A mix of land uses and activities should be promoted that avoid the uniform zoning of large areas to single uses.

Creating multiple reasons to visit a destination, minimising the number and length of trips and increasing the awareness and convenience of opportunities to participate in sport and physical activity.

5. Network of Multifunctional Open Space

A network of multifunctional open space should be created across all communities (existing and proposed) to support a range of activities including sport, recreational and play and other landscape features including Sustainable Drainage Systems (SuDS), woodland, wildlife habitat and productive landscapes (allotments, orchards). Facilities for sport, recreation and play should be of an appropriate scale, positioned in prominent locations, co-located with other appropriate uses whilst ensuring appropriate relationships with neighbouring uses.

Providing multifunctional spaces opens up opportunities for sport and physical activity and has numerous wider benefits.

6. High Quality Streets and Spaces

Flexible and durable high quality streets and public spaces should be promoted, employing high quality durable materials, street furniture and signage.

Well-designed streets and spaces support and sustain a broader variety of users and community activities.

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The Public Health Wider Determinants team are offering to provide, upon request, up-to-date data and intelligence to assist districts in making the case for Active Design principles in their local plans. We are also willing to consider masterplan applications against the principles and produce comments and recommendations to assist the formulation of future plans a policies.

7. Appropriate Infrastructure

Supporting infrastructure to enable sport and physical activity to take place should be provided across all contexts including workplaces, sports facilities and public space, to facilitate all forms of activity.

Providing and facilitating access to facilities and other infrastructure to enable all members of society to take part in sport and physical activity.

8. Active Buildings The internal and external layout, design and use of buildings should promote opportunities for physical activity. Providing opportunities for activity inside and around buildings 9. Management, maintenance, monitoring & evaluation The management, long-term maintenance and viability of sports facilities and public spaces should be considered in their design. Monitoring and evaluation should be used to assess the success of Active Design initiatives and to inform future directions to maximise activity outcomes from design interventions. A high standard of management, maintenance, monitoring and evaluation is essential to ensure the long-term desired functionality of all spaces.

10. Activity Promotion & Local Champions Promoting the importance of participation in sport and physical activity as a means of improving health and wellbeing should be supported. Health promotion measures and local champions should be supported to inspire participation in sport and physical activity across neighbourhoods, workplaces and facilities. Physical measures need to be matched by community and stakeholder ambition, leadership and engagement. Planning applications will be assessed against how they embrace the role they can play in supporting healthy lifestyles by facilitating participation in sport and physical activity. The Local Planning Authority will use the Active Design Principles to aid this assessment. Where Design and Access Statements are required to support an application they should explain how the design of the proposal reflects the Active Design Principles. The Local Planning Authority may use planning conditions and/or planning obligations where necessary to address issues where developments could, but do not, embrace this role and do not adhere to the Active Design Principles.

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Physical Activity

Reduced physical activity in our population, along with poor diet and other lifestyle factors, is contributing to poor health outcomes across all ages.

All Our Health guidanceii states:

Physical inactivity is responsible for one in six UK deaths (equal to smoking) and is estimated to cost the UK £7.4 billion annually (including £0.9 billion to the NHS alone).

Unfortunately our population is around 20% less active than in the 1960s. If current trends continue, it will be 35% less active by 2030.

Many people don’t realise that physical activity has significant benefits for health, both physical and mental, and can help to prevent and manage over 20 chronic conditions and diseases, including some cancers, heart disease, type 2 diabetes and depression.

Physical Activity and Inactivity in Lancashire

The Chief Medical Officer’s report (2011)iii recommends that adults aged 19-64 years undertake 150 minutes of moderate intensity physical activity per week.

National and local estimates of physical activity and inactivity are established from the Sport England Active Lives Survey. The latest available figures are for 2016/17.

Adults

Figure 1 shows that Pendle and Rossendale are estimated to have a significantly lower proportion of physically active adults compared to England. Chorley has significantly higher proportions of physically active adults compared to England.

Figure 1: Percentage of physically active adults - current method 2017/2018

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Figure 2 show that Rossendale, Hyndburn and Burnley have a significantly higher proportion of inactive adults compared to the England average. Chorley, Lancaster and Ribble Valley have a significantly lower proportion of inactive adults compared to England.

Figure 2: Percentage of physically inactive adults - current method 2017/2018

Children

It is recommended that children aged 5-18 years should be engaging in at least 60 minutes of moderate to vigorous intensity physical activity every day. However, figures from the 2014/15 What about YOUth surveyiv indicate that just 15% of young people aged 15 in Lancashire-12 met the guidelines, similar to the England proportion (13.9%).

More district level data on physical activity, including related conditions such as diabetes and excess weight, can be found in the appendix of this document.

Mental Health

The NHS is currently encouraging physical activity as a way of promoting mental wellbeing, stating that "Depression is increasing in all age groups. People who are inactive have three times the rate of moderate to severe depression of active people. Being active is central to our mental health."v

The physical environment has a notable impact on mental health in a variety of ways. The Public Health England and UCL Institute of Health Equity document Local action on health inequalities: Improving access to green spacesvi, lists numerous benefits to being able to access good quality green space, including "improvements in mental health and wellbeing, such as depression, stress, dementia".

The Public Health England evidence paper Everybody active, every day: What works – the evidence discusses the importance of physical activity with regard to child mental development:

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A child active from an early age establishes good habits for life, and being active should begin in babyhood. Research suggests that campaigns to improve children’s health should be directed to whole families and for under-fives the focus is on active play rather than formal activity. Physical activity is a vital part of the physical and mental development of children, and helps them to achieve their potential and to be ‘school ready’.

Economy

Much has been written to explain how physical inactivity and the resulting poor health places an economic burden on the public purse. As stated in the Public Health England paper Everybody active, every day: An evidence-based approach to physical activityvii:

Around one in two women and a third of men in England are damaging their health through a lack of physical activity. This is unsustainable and costing the UK an estimated £7.4bn a year.

The same paper outlines a number of ways in which increased physical activity can actually stimulate economic growth:

Sport offers many entry-level jobs and opportunities for volunteering that can lead to full-time careers. Businesses with active workforces are more productive, have lower sickness rates and lower staff turnover. Pedestrians help keep local high streets alive.

Workplace

Many modern work places are often set up for sedentary, desk based work. Unfortunately sitting for prolonged periods slows the metabolism, affecting the body's ability to regulate blood sugar, blood pressure and break down body fat. The design and location of workplaces should also be a key consideration in addressing this.

NICE Guideline NG90 Physical activity and the environmentviii has a number of recommendations, such as:

Ensure different parts of campus sites (including those in hospitals and universities) are linked by accessible walking and cycling routes.

Ensure new workplaces are linked to walking and cycling networks. Where possible, these links should improve the existing walking and cycling infrastructure by creating new through routes (and not just links to the new facility).

Accessibility via public transport and facilities such as showers and bike storage are also good ways to encourage active travel.

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National Guidance

Government planning guidance, which is situated on the central government websiteix, contains a section on health and wellbeing (last updated July 2017) which states:

The range of issues that could be considered through the plan-making and decision-making processes, in respect of health include how:

development proposals can support strong, vibrant and healthy communities and help create healthy living environments which should, where possible, include making physical activity easy to do and create places and spaces to meet to support community engagement and social capital;

the local plan promotes health, social and cultural wellbeing and supports the reduction of health inequalities;

the local plan considers the local health and wellbeing strategy and other relevant health improvement strategies in the area;

the healthcare infrastructure implications of any relevant proposed local development have been considered;

opportunities for healthy lifestyles have been considered (e.g. planning for an environment that supports people of all ages in making healthy choices, helps to promote active travel and physical activity, and promotes access to healthier food, high quality open spaces, green infrastructure and opportunities for play, sport and recreation);

potential pollution and other environmental hazards, which might lead to an adverse impact on human health, are accounted for in the consideration of new development proposals; and

access to the whole community by all sections of the community, whether able-bodied or disabled, has been promoted.

There are numerous national guidance documents which align to elements of the Active Design Principles.

The National Institute of Clinical Excellence (NICE) states in their 2018 guidance document NICE Guidance Physical activity and the environment (NG90)x contains a number of recommendations that are relevant to planners:

Develop and use local strategies, policies and plans to encourage and enable people to be more physically active. Use information from sources such as the joint strategic needs assessment and local cycling and walking implementation plans. Follow established best practice to ensure everyone's needs are identified and addressed, including those of people with limited mobility.

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Take account of the views and needs of people who walk, cycle, drive or use public transport in the local area, particularly in relation to shared or contested space. (For example, space shared by pedestrians and cyclists, or cyclists and motorists.)

Take account of the views and needs of people with limited mobility who may be adversely affected by the design and maintenance of streets, footways and footpaths and urban and rural public open spaces.

Ensure planning permissions always prioritise the need for people (including people with limited mobility) to be physically active as a routine part of their daily life, for example ensuring access on foot to local services such as shops and public transport stops.

Ensure children, young people and their families and carers can be physically active, for example when playing and when travelling to school, college and early years settings.

In 2018 Public Health published Spatial Planning for Healthxi, An evidence resource for planning and designing healthier places. In the section on Neighbourhood Design, they recommend the following principles for building healthy neighbourhoods:

1. Enhance neighbourhood walkability: improved street connectivity, mixed land use and compact residential design

are considered to be important features of a walkable neighbourhood (Hajna et al., 2015xii)

there is evidence to suggest that walkable neighbourhoods can encourage active travel and thereby promote physical activity improving neighbourhood walkability, and access to recreational and non-recreational destination (such as grocery stores, schools and other amenities) can also impact positively upon social interaction among older adults (Beard & Petitot, 2010xiii; McCormack & Sheill, 2011xiv)

evidence suggests that investing in infrastructure to support walking can increase levels of physical activity among all age groups (Carlin et al., 2015xv; D’Hease et al., 2015xvi; Grasser et al., 2013xvii; Larouche et al., 2014xviii; Mueller et al., 2015xix; Wanner et al., 2012xx)

2. Build complete and compact neighbourhoods: compact neighbourhoods, i.e. neighbourhoods with higher street connectivity

(typically designed using finer grid patterns) with diverse land use mixes and greater residential densities are generally more conducive to non-motorised transport (Durand, 2001xxi; Gomez, 2015xxii; McCormack, 2011xxiii; WHO, 2007xxiv)

long distance trips for travel or recreation, steep inclines, and increased proximity to amenities have been identified as having a negative impact on walking and cycling (Fraser et al., 2011xxv)

provision of local amenities can improve mobility and social engagement among older adults (Laevsseur, 2015xxvi). Mixed land use developments that prioritise access to schools, recreational centres and social amenities can increase physical activity among children, adolescents and older adults

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3. Enhance connectivity with safe and efficient infrastructure: enhancing street connectivity via provision of walking and cycling

infrastructure and improving access to public transportation, can help reduce perceptions of long distance trips and provide alternative routes for active travel (Hajna et al., 2015xxvii)

public realm improvements such as provision of street lighting in residential areas can prevent road traffic collisions (RTCs) (Beyer & Ker, 2009xxviii), and increase pedestrian activity. General environmental improvements have the potential to reduce fear of crime (McCormack, 2011xxix)

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Active Design Principles

Sport England's Active Design Principles are supported by Public Health England and is part of their collaborative action to promote the principles set out in Public Health England’s ‘Everybody Active, Every Day’xxx, to create active environments that make physical activity the easiest and most practical option in everyday life. The principles and their reasoning are as follows:

Figure 5: Active Design Infographicxxxi

1. Activity for all

Neighbourhoods, facilities and open spaces should be accessible to all users and should support sport and physical activity across all ages.

Enabling those who want to be active, whilst encouraging those who are inactive to become active.

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2. Walkable communities

Homes, schools, shops, community facilities, workplaces, open spaces and sports facilities should be within easy reach of each other.

Creating the conditions for active travel between all locations.

3. Connected walking & cycling routes

All destinations should be connected by a direct, legible and integrated network of walking and cycling routes. Routes must be safe, well lit, overlooked, welcoming, well maintained, durable and clearly signposted. Active travel (walking and cycling) should be prioritised over other modes of transport.

Prioritising active travel through safe, integrated walking and cycling routes.

4. Co-location of community facilities

The co-location and concentration of retail, community and associated uses to support linked trips should be promoted. A mix of land uses and activities should be promoted that avoid the uniform zoning of large areas to single uses.

Creating multiple reasons to visit a destination, minimising the number and length of trips and increasing the awareness and convenience of opportunities to participate in sport and physical activity.

5. Network of Multifunctional Open Space

A network of multifunctional open space should be created across all communities (existing and proposed) to support a range of activities including sport, recreational and play and other landscape features including Sustainable Drainage Systems (SuDS), woodland, wildlife habitat and productive landscapes (allotments, orchards). Facilities for sport, recreation and play should be of an appropriate scale, positioned in prominent locations, co-located with other appropriate uses whilst ensuring appropriate relationships with neighbouring uses.

Providing multifunctional spaces opens up opportunities for sport and physical activity and has numerous wider benefits.

6. High Quality Streets and Spaces

Flexible and durable high quality streets and public spaces should be promoted, employing high quality durable materials, street furniture and signage.

Well-designed streets and spaces support and sustain a broader variety of users and community activities.

7. Appropriate Infrastructure

Supporting infrastructure to enable sport and physical activity to take place should be provided across all contexts including workplaces, sports facilities and public space, to facilitate all forms of activity.

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Providing and facilitating access to facilities and other infrastructure to enable all members of society to take part in sport and physical activity.

8. Active Buildings The internal and external layout, design and use of buildings should promote opportunities for physical activity. Providing opportunities for activity inside and around buildings 9. Management, maintenance, monitoring & evaluation The management, long-term maintenance and viability of sports facilities and public spaces should be considered in their design. Monitoring and evaluation should be used to assess the success of Active Design initiatives and to inform future directions to maximise activity outcomes from design interventions. A high standard of management, maintenance, monitoring and evaluation is essential to ensure the long-term desired functionality of all spaces. 10. Activity Promotion & Local Champions Promoting the importance of participation in sport and physical activity as a means of improving health and wellbeing should be supported. Health promotion measures and local champions should be supported to inspire participation in sport and physical activity across neighbourhoods, workplaces and facilities. Physical measures need to be matched by community and stakeholder ambition, leadership and engagement.

Evidence for intervention There is a wealth of high quality evidence in this area, much of the most relevant of which has been referenced in the National Guidance section. More generally, on the matter of increased physical activity contributing to better health outcomes for the population, the conclusions are very clear. As stated by Sport England in Active Design: Planning for health and wellbeing through sport and physical activity:

Since the 1960s people have become less and less active in their daily lives, largely as a result of technological changes and an increase in sedentary activities. There is a growing body of evidence of the benefits of physical activity, and the need to tackle inactivity as part of this.

Physical inactivity is responsible for 1 in 6 deaths in the UK. It has adverse effects on health, wellbeing and quality of life at all ages and across all sectors of society, but particularly affects vulnerable groups, such as those in lower social groups.

An important and often cited piece of research on the importance of physical activity is the 2012 paper: Effect of physical inactivity on major non-communicable diseases

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worldwide: an analysis of burden of disease and life expectancyxxxii which calculates population attributable fractions associated with physical inactivity for each of the major NCDs (non-communicable diseases), by country, to estimate how much disease could be averted and life expectancy increases, if physical inactivity were eliminated. The paper states that the Elimination of physical inactivity would remove between 6% and 10% of the major NCDs of CHD, type 2 diabetes, and breast and colon cancers, and increase life expectancy.

In 2013, the Glasgow Centre for Population health produced the built environment and health: an evidence reviewxxxiii which drew conclusions from a wide range of research studies, stating that:

…perceptions of the local area, social connections, accessibility and physical activity levels are all influenced by the quality and design of the built environment. These impacts are recognised as being largely interdependent and have been associated with both physical and mental health outcomes.

The review also presents the following key message on the subject of planning considerations:

Well-connected and attractive public places and streets can encourage more people to exercise and make active travel choices.

High-quality parks and recreational facilities are often unevenly distributed across towns and cities.

Places which enable people to carry out daily routines (e.g. shopping, banking, exercising, meeting people) within walking distance of their homes are likely to have higher levels of walking and cycling.

Land use decisions can be considered in terms of their contribution towards the promotion of health and the mitigation of poor health.

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Active Design Principles in Local Policies

A growing number of local authorities are making use of the Active Design Principles. There are examples of their use in individual projects environmental projects and at master plan and local plan level.

Brooklands, Milton Keensxxxiv

A 2,500 house urban extension to the east of Milton Keynes, led by Places for People. The original Active Design principles were embedded in the master plan back in 2007. The development is now well advanced and the ten principles are now evident. The development contains a comprehensive framework of green open spaces, with schools, play and recreation facilities connected by a network of leisure routes that provide multiple opportunities for activity.

Mini-Hollands Cycling schemexxxv

The Mini-Holland programme was conceived to encourage Londoners to use cars less and walk, cycle and use public transport more. Mini-Hollands have features that make cycling feel safer and more convenient. The programme targets people who make short car journeys in outer London that could easily be cycled or walked instead. The Mini-Holland schemes exemplifies a number Active Design principles; Adapting the spaces incorporating high quality infrastructure creating a connected cycle route that promotes activity, improves health and creates stronger communities.

Crawley Urban Design SPDxxxvi

"Urban Design can play an important role in promoting opportunities to encourage sport and physical activity through the design and layout of the built environment. A built environment that is designed well will make places that are better for people where making the active choice is both an easy and attractive one. The principles of Active Design should be considered when preparing a plan for development."

Liverpool Draft Local Planxxxvii

"Public Realm design should also contribute to enhancing opportunities for physical activity as set out in Sport England's Active Design guidance.

This will contribute to creating a healthy city. Including appropriate street lighting and signage would contribute to ensuring safe and legible environments."

Active Design is referenced within Policy UD2 Development Layout and Form and Policy UD4 Inclusive Design.

South Derbyshire Design Guide SPDxxxviii

This SPD is linked to Local Plan policy BNE1 ii) All proposals for new development will be assessed against the Council’s Design SPD.

The Active Design principles are included under the heading of Healthy Lifestyles.

Essex Design Guidexxxix "The Essex Design Guide has always been about more than

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architecture; it’s about creating distinctive places that people want to live; it’s about building communities and making sure that the infrastructure and facilities are in place at the right time."

"Active Design Principles have been embedded within the Essex Design Guide to identify ten key areas where specific design guidance can help to activate spaces."

It should also be noted that some authorities are writing their own set of design principles which have significant overlap with Active Design, such as Islington Council who published an SPD on inclusive design for housing in 2014xl and an urban design guide in 2017xli. They based their policies on the following principles:

Ease of use and versatility are important features of an Inclusive Design. “Ease of use" means that access to, and enjoyment of, an environment should require minimal strength stress and effort and should be achievable in comfort; independently and/or with assistance delivered on the users’ terms. "Versatility" suggests a lack of prescription in a design and as a result, flexibility in use. Versatile solutions take into account diverse and evolving needs, whilst minimising the need for structural adaptation - an essential aspect of sustainability.

Logic, safety and legibility are essential aspects of an Inclusive Design because logical layouts and clear sightlines enable spaces and places to be understood without recourse to excessive text based signage. They inspire a sense of security and promote confidence, minimising the need for active surveillance and/or personal support.

Places and spaces that are convenient and enjoyable for all to use, must be designed with diversity in mind; addressing the specific and potentially conflicting physical, sensory, cognitive and social needs of people protected by current equalities legislation. This will ensure that barriers are designed out and flexibility built in. The provision of accessible, essential and appropriate services to support a development will also provide for and will enhance independence and contribute to the cohesion and sustainability of the community.

The success of an Inclusive Design will often be affected as much by its management as by its physical form. Shortcomings in the latter frequently place unreasonable and unsustainable demands on the former, and vice versa. Implications for the management of spaces and places, particularly when considering diverse and changing needs, should be considered and resolved at the earliest design stages.

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Informing the approach to the Community Infrastructure Levy – Active Design can assist in identifying the scope of infrastructure that might be supported by the Community Infrastructure Levy.

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Appendix

Beyond the headline indicators on physical activity, there are further indicators which give extra context at a district level. These are all based upon the Sport England Active Lives survey.

Figure 7xlii: Percentage of adults who do any walking, at least once per week 2014/2015

Figure 8xliii: Percentage of adults who do any cycling, at least once per month 2014/2015

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Figure 9xliv: Map of Physically Active Adults by district and quintile 2017/2018

Figure 10: District Dashboard

District Percentage of physically active adults 2017/2018

Percentage of physically inactive adults 2016/2017

Percentage of adults who do any walking, at least once per week 2014/2015

Percentage of adults who do any cycling, at least once per month 2014/2015

Excess Weight in Adults 2016/2017

Estimated Diabetes Diagnosis 2016/2017

England 66.3% 22.2% 80.6% 14.7% 61.3 78.0

Lancashire 66.5% 22.0% 78.3% 14.4% 63.9 78.2

Burnley 63.3% 25.9% 78.4% 5.0% 66.9 83.9

Chorley 73.8% 17.2% 77.4% 14.7% 63.9 73.0

Fylde 65.8% 21.4% 78.1% 11.5% 61.2 67.4

Hyndburn 63.1% 28.4% 75% 10.9% 68 87.1

Lancaster 70.4% 15.8% 81.3% 21.8% 61.5 78.7

Pendle 60.3% 24.9% 79.6% 10.3% 61.1 83.8

Preston 66.3% 22.0% 76.7% 18.1% 58.4 88.5

Ribble Valley 68.6% 18.4% 84.4% 11.9% 63.7 67.6

Rossendale 62.1% 26.5% 74.7% 9.9% 67.6 80.6

South Ribble 63.9% 23.9% 78.9% 19.6% 63.4 75.6

West Lancashire

70.6% 19.9% 76.5% 9.9% 63.2 77.1

Wyre 64.1% 24.8% 79% 17.9% 67.7 74.2

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Figure 11xlv: Physical Activity Benefits Infographic

Figure 12xlvi: TCPA Planning Healthy Weight Environments

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iSport England (2015): Active Design. Planning for health and wellbeing through sport and physical activity https://www.sportengland.org/media/3964/spe003-active-design-published-october-2015-high-quality-for-web-2.pdf

iiPublic Health England - Physical activity: applying All Our Health (2018) https://www.gov.uk/government/publications/physical-activity-applying-all-our-health/physical-activity-applying-all-our-health

iiiDepartment of Health, Physical Activity, Health Improvement and Protection (2011) Start Active, Stay Active :A report on physical activity for health from the four home countries’ Chief Medical Officers https://www.gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-officers

iv Physical activity, Lancashire Insight https://www.lancashire.gov.uk/lancashire-insight/health-and-care/lifestyle/physical-activity/

v NHS: Get active for mental wellbeing https://www.nhs.uk/conditions/stress-anxiety-depression/mental-benefits-of-exercise/

viPublic Health England and UCL Institute of Health Equity: Local action on health inequalities: Improving access to green spaces https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/357411/Review8_Green_spaces_health_inequalities.pdf

viiEverybody active, every day: An evidence-based approach to physical activity https://www.gov.uk/government/publications/everybody-active-every-day-a-framework-to-embed-physical-activity-into-daily-life

viii Physical activity and the environment (2018) https://www.nice.org.uk/guidance/NG90

ix Health and Wellbeing: The role of health and wellbeing in planning (2017) https://www.gov.uk/guidance/health-and-wellbeing

x NICE (2018) Physical activity and the environment: NICE Guideline https://www.nice.org.uk/guidance/ng90

xi Public Health England (2018) Spatial planning for health: An evidence resource for planning and designing healthier places https://www.gov.uk/government/publications/spatial-planning-for-health-evidence-review

xii BMC Public Health (2015) Associations between neighbourhood walkability and daily steps in adults: a systematic review and meta-analysis https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2082-x

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xiii Beard JR, Petitot C. Ageing and Urbanization: Can Cities be Designed to Foster Active Ageing? Public Health Reviews. 2010 https://link.springer.com/article/10.1007/BF03391610

xiv McCormack and Shiell: In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. International Journal of Behavioral Nutrition and Physical Activity 2011 https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-8-125

xv BMC Public Health: Current influences and approaches to promote future physical activity in 11–13 year olds: a focus group study, 2015 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2601-9

xvi BMC Public Health: Cross-continental comparison of the association between the physical environment and active transportation in children: a systematic review, 2015 https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-015-0308-z

xvii International Journal of Public Health: Objectively measured walkability and active transport and weight-related outcomes in adults: a systematic review, 2013 https://www.ncbi.nlm.nih.gov/pubmed/23224518

xviii Journal of Physical Activity and Health: Associations between active school transport and physical activity, body composition, and cardiovascular fitness: a systematic review of 68 studies, 2014 https://www.ncbi.nlm.nih.gov/pubmed/23250273

xix Preventative Medicine: Health impact assessment of active transportation: A systematic review, 2015 https://www.ncbi.nlm.nih.gov/pubmed/25900805

xx American Journal of Preventative Medicine: Active transport, physical activity, and body weight in adults: a systematic review, 2012 https://www.ncbi.nlm.nih.gov/pubmed/22516490

xxi Obesity Reviews: A Systematic Review of Built Environment Factors Related to Physical Activity and Obesity Risk: Implications for Smart Growth Urban Planning, 2011 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079793/

xxiiGómez, Luis & Sarmiento-Suárez, Rodrigo & Ordóñez, Maria & Pardo, Carlosfelipe & Sa, Thiago & H. Mallarino, Christina & Miranda, J. Jaime & Mosquera, Janeth & C. Parra, Diaca & Reis, Rodrigo & Quistberg, D Alex. (2015). Urban environment interventions linked to the promotion of physical activity: A mixed methods study applied to the urban context of Latin America. Social Science & Medicine (1967). https://www.researchgate.net/publication/273140327_Urban_environment_interventions_linked_to_the_promotion_of_physical_activity_A_mixed_methods_study_applied_to_the_urban_context_of_Latin_America

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xxiii The International Journal of Behavioural Nutrition and Physical Activity: In search of causality: a systematic review of the relationship between the built environment and physical activity among adults, 2011 https://www.ncbi.nlm.nih.gov/pubmed/22077952

xxiv World Health Organization Regional Office for Europe: Tackling Obesity by Creating Healthy Residential Environments, 2007 www.euro.who.int/__data/assets/pdf_file/0012/98697/E90593.pdf

xxv European Journal of Public Health: Cycling for transport and public health: a systematic review of the effect of the environment on cycling, 2011 https://www.ncbi.nlm.nih.gov/pubmed/20929903

xxvi BMC Public Health: Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study, 2015 https://www.ncbi.nlm.nih.gov/pubmed/26002342

xxvii Loo CKJ, Greiver M, Aliarzadeh B, et al. Association between neighbourhood walkability and metabolic risk factors influenced by physical activity: a cross-sectional study of adults in Toronto, Canada. BMJ Open 2017 https://bmjopen.bmj.com/content/7/4/e013889

xxviii Cochrane Library: Street lighting for preventing road traffic injuries, 2009 https://www.ncbi.nlm.nih.gov/pubmed/19160240

xxix The International Journal of Behavioural Nutrition and Physical Activity: In search of causality: a systematic review of the relationship between the built environment and physical activity among adults, 2011 https://www.ncbi.nlm.nih.gov/pubmed/22077952

xxx Public Health England: Everybody Active Every day, An evidence-based approach to physical activity, 2014 https://www.gov.uk/government/publications/everybody-active-every-day-a-framework-to-embed-physical-activity-into-daily-life

xxxi Sport England: Active Design, Planning for health and wellbeing through sport and physical activity, 2015 https://www.sportengland.org/facilities-planning/active-design/

xxxii Lancet: Impact of Physical Inactivity on the World’s Major Non-Communicable Diseases 2012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/

xxxiii Glasgow Centre for Public Health: Concepts Series 11 - The built environment and health: an evidence review, 2013 http://www.gcph.co.uk/publications/472_concepts_series_11-the_built_environment_and_health_an_evidence_review

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xxxiv Active Design Principles - Brooklands Case Study https://www.essexdesignguide.co.uk/case-studies/brooklands-milton-keynes-active-design-principles/

xxxv Active Design Principles - Mini-Hollands Case Study https://www.essexdesignguide.co.uk/case-studies/mini-hollands-london-active-design-principles/

xxxvi Urban Design Supplementary Planning Document, Supporting the Crawley Borough Local Plan 2015-2030 www.crawley.gov.uk/pw/web/PUB279795

xxxviiLiverpool Local Plan 2013 -2033 Pre-submission draft January 2018 https://liverpool.gov.uk/council/strategies-plans-and-policies/environment-and-planning/plan-making-in-liverpool/current-local-plan-documents/local-plan/

xxxviiiDraft South Derbyshire Design Guide, Design Supplementary Planning Document, May 2017 https://www.south-derbys.gov.uk/our-services/planning-and-building-control/planning/planning-policy/current-consultations/design-guide-draft-supplementary-planning-document

xxxix The Essex Design Guide https://www.essexdesignguide.co.uk/

xlInclusive Design in Islington, Supplementary Planning Document (February 2014) https://www.islington.gov.uk//~/media/sharepoint-lists/public-records/planningandbuildingcontrol/publicity/publicconsultation/20132014/20140314inclusivedesignspdadopted

xliIslington Borough Council, Urban Design Guide Supplementary Planning Document, January 2017 https://www.islington.gov.uk/~/media/sharepoint-lists/public-records/planningandbuildingcontrol/publicity/publicconsultation/20162017/20170131islingtonurbandesignguidespdjan2017.pdf

xlii https://fingertips.phe.org.uk/profile/physical-activity

xliii https://fingertips.phe.org.uk/profile/physical-activity

xliv https://fingertips.phe.org.uk/profile/physical-activity

xlvGuidance: Physical activity - applying All Our Health https://www.gov.uk/government/publications/physical-activity-applying-all-our-health/physical-activity-applying-all-our-health

xlvi TCPA Publications https://www.tcpa.org.uk/healthyplanning