Law and urban governance for health in times of rapid change

Abstract

Summary Governance is an important factor in urban health, and law is an important element of healthy governance. Law can be an intervention local government wields to influence behavior and shape environments. Law can also be an important target of health promotion efforts: Law and the enforcement and implementation behaviors it fosters can promote unhealthy behaviors and environmental conditions, and can act as a barrier to healthy interventions or practices. Finally, law is a design and construction tool for the organization of governance. Law is the means through which cities are formally established. Their powers and duties, organizational structure, boundaries and decision-making procedures are all set by law. Regardless of the form of government, cities have legal levers they can manipulate for health promotion. Cities can use tax authority to influence the price of unhealthy products, or to encourage consumption of healthy foods. Cities can use their legal powers to address incidental legal effects of policies that they themselves cannot control. Cities may also have the authority to use law to address deeper determinants of health. The overall level of income or wealth inequality in a country reflects factors well-beyond a local government’s control, but city government nonetheless has levers to directly and indirectly reduce economic and social inequality and their effects. A renewed focus on law and urban governance is the key to assuring health and well-being and closing the health equity gap.

‘Harnessing the power of the law’: a qualitative analysis of the legal determinants of health in English urban planning and recommendations for fairer and healthier decision-making

“…Following recommendations from the Lancet -O’Neill report, officers working in LPAs and the planning inspectorate may be trained and empowered to use the law in a way that consistently promotes health in urban planning. Increased legal capacity for health would also allow local government to improve health at local level in the three ways postulated by Burris and Lin: to change individual behaviour; to target health promotion efforts; and to (re)organise governance [ 16 ].…”

“…Burris and Lin’s broad understanding of the law was used to analyse the data, i.e. law encompasses ‘legal texts like constitutions and statutes, but also the formal policies of public and private institutions, the implementation/enforcement practices of legal agents and the beliefs about the law prevailing among those subject to it’ [ 16 ]. The method of analysis and findings from all disciplines are discussed in two separate papers [ 26 , 27 ].…”

“…Within urban environments themselves, the law plays a critical role. Burris and Lin identified three ways law can be used by local authorities to improve health: the law may be used as a tool to change individual behaviour, through for example creating non-smoking zones or measures to reduce air and water pollution; as a target of health promotion efforts, such as changing restrictive abortion laws or punitive drug laws that have negative consequences on health; and to (re)organise governance, including by taking a health-in-all policies approach and fostering collaboration between departments such as public health and safety – or for this study, planning [ 16 ]. Using the law to reduce health inequalities and promote well-being is anchored in literature on the legal determinants of health [ 17 ].…”

“…As such it impacts health, including the creation and perpetuation of health inequalities. However, despite a well-documented role of the law to reduce health inequalities and promote well-being, studies have called for more research on the impact at the local level [ 16 , 18 ]. How is the law ‘activated’ at the local level in English urban planning?…”

“…How is it perceived and used (if at all) by actors in urban development to promote health? This study is necessary to supplement research on the legal determinants of health with empirical data and understand how to deploy law to improve urban health at the local level [ 16 , 17 ].…”