Academic journal article Perspectives in Public Health

Joining Up Health and Planning: How Joint Strategic Needs Assessment (JSNA) Can Inform Health and Wellbeing Strategies and Spatial Planning

Academic journal article Perspectives in Public Health

Joining Up Health and Planning: How Joint Strategic Needs Assessment (JSNA) Can Inform Health and Wellbeing Strategies and Spatial Planning

Article excerpt


Health and Wellbeing Board; Health and Wellbeing Strategy; JSNA; Joint Strategic Needs Assessment; land use planning; wider determinants of health


There has been a welcome joining up of the rhetoric around health, the environment and land use or spatial planning in both the English public health white paper and the National Planning Policy Framework. However, this paper highlights a real concern that this is not being followed through into practical guidance needed by local authorities (LAs), health bodies and developers about how to deliver this at the local level.

The role of Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies (HWSs) have the potential to provide a strong basis for integrated local policies for health improvement, to address the wider determinants of health and to reduce inequities. However, the draftJSNA guidance from the Department of Health falls short of providing a robust, comprehensive and practical guide to meeting these very significant challenges.

The paper identifies some examples of good practice. It recommends that action should be taken to raise the standards of all JSNAs to meet the new challenges and that HWSs should be aligned spatially and temporally with local plans and other LA strategies. HWSs should also identify spatially targeted interventions that can be delivered through spatial planning or transport planning. Steps need to be taken to ensure that district councils are brought into the process.


In England (but not in Scotland, Wales and Northern Ireland), both the National Health Service (NHS) and the spatial (or land use) planning system have been subject to major reforms by the UK coalition government through the 2010 NHS white paper,1 the Health and Social Care Act 2012, the Localism Act 2011, the National Planning Policy Framework (NPPF)2 and the current Growth and Infrastructure Act 2013.

The Health and Social Care Act 2012 (see Box 1) introduced a new set of duties focusing upon public health. New bodies are being established such as the Health and Wellbeing Boards (HWB), Clinical Commissioning Groups (CCGs), HealthWatch and the NHS Commissioning Board (NHS CB). Public health services are reverting to local authorities (LAs) and Public Health England (PHE) is being established.

In parallel, the NPPF requires spatial planning to give consideration to public health issues alongside the LA duty on public health. Proposed changes to the Environmental Impact Assessment (EIA) Directive, due to come into effect in 2014, would also see the mandatory consideration of health for EIA development to complement the current requirement under the Strategic Environmental Assessment Directive3 affecting the assessment of plans and policies.

JSNAs were first introduced in the Health and Local Government Act 20075 and provide a crucial common evidence base. The draft guidance for JSNAs in the post-2012 Act system was published in July 20126 for consultation. Material for this paper is based on the Spatial Planning and Health Group (SPHAG) response7 and experience of the authors in encouraging the spatial planning system to address the public health agenda.

Collectively these changes create an opportunity to deliver a step change in the response to the wider determinants of health. This can be achieved by developing a coherent and integrated approach using the JSNA as a basis for both the HWS and the local plan within an horizon of 10 to 15 years rather than the one to five-year programmes that have traditionally been the case in the health sector.

The JSNA required primary care trusts (PCTs) and LAs to jointly and systematically review the health and wellbeing needs of their population, leading to agreed commissioning priorities that would improve health and wellbeing outcomes and reduce health inequalities. The scope includes all factors that impact on the health and wellbeing of local communities, such as employment, education, housing and environmental factors. …

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