Embedding a Health in All Policies Approach to Local Planning: Lessons from East Lothian, Scotland

Issue/Problem

Spatial planning is a key determinant of population health and health inequalities. Across local authorities in Scotland, Public Health has historically had limited input on planning policies that shape health outcomes. To address this, local public health and spatial planning teams in East Lothian (locality with both urban & rural areas) collaborated to embed a Health in All Policies (HiAP) approach to the Local Development Plan (LDP), a statutory document created to guide future use of land.

Description of the Problem

We used a HiAP approach to embed health within statutory planning from early 2024 until April 2026. First, we ensured early and sustained engagement using joint meetings, shared problem‑solving, and relationship‑building to foster trust and mutual understanding. Second, public health and planning co‑produced a comprehensive health background paper to inform the LDP, explicitly linking health outcomes to spatial planning levers. Lastly, using participatory methods, jointly facilitated cross‑sector workshops and a Health Impact Assessment workshop were held involving a wide range of stakeholders.

Results

Findings highlighted: hidden poverty within apparently affluent areas; risk of poorly integrated new developments exacerbating inequalities between existing and incoming communities if poorly integrated; and propensity for health harming clustering in areas of high deprivation. Other issues included: gender and age‑specific safety concerns in public spaces, accessibility barriers, transport poverty and car dependence, and importance of an ‘infrastructure‑first’ approach to development.

Lessons

Effective HiAP implementation requires collaborative relationships, early engagement, and translating health evidence into planning logic. This practice‑based, transferable model demonstrates how public health and local planning can work effectively to address inequalities and positively influence the statutory planning process.

Key messages

• A Health in All Policies approach to spatial planning is more effective when public health and planning co produce evidence that links health outcomes to planning levers.

• Place based planning must address hidden poverty and integration of new and existing communities to avoid reinforcing health inequalities.