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A Rank Forum was convened to discuss the evidence around food insecurity (FIS), its impact on health, and interventions which could make a difference both at individual and societal level, with a focus on the UK. This paper summarises the proceedings and recommendations. Speakers highlighted the growing issue of FIS due to current economic and social pressures. It was clear that the health implications of FIS varied geographically since food insecure women in higher income regions tend to be living with overweight or obesity, in contrast to those living in low-to-middle income countries. This paradox could be due to stress and/or metabolic or behavioural responses to an unpredictable food supply. The gut microbiota may play a role given the negative effects of low fibre diets on bacterial diversity, species balance and chronic disease risk. Solutions to FIS involve individual behavioural change, targeted services and societal/policy change. Obesity-related services are currently difficult to access. Whilst poverty is the root cause of FIS, it cannot be solved simply by making healthy food cheaper due to various ingrained beliefs, attitudes and behaviours in target groups. Person-centred models, such as Capability-Opportunity-Motivation Behavioural Change Techniques and Elicit-Provide-Elicit communication techniques are recommended. Societal change or improved resilience through psychological support may be more equitable ways to address FIS and can combine fiscal or food environment policies to shift purchasing towards healthier foods. However, policy implementation can be slow to enact due to the need for strong evidence, consultation and political will. Eradicating FIS must involve co-creation of interventions and policies to ensure that all stakeholders reach a consensus on solutions.
Female genital schistosomiasis (FGS) is a chronic disease manifestation of the waterborne parasitic infection Schistosoma haematobium that affects up to 56 million women and girls, predominantly in sub-Saharan Africa. Starting from early childhood, this stigmatizing gynaecological condition is caused by the presence of Schistosoma eggs and associated toxins within the genital tract. Schistosoma haematobium typically causes debilitating urogenital symptoms, mostly as a consequence of inflammation, which includes bleeding, discharge and lower abdominal pelvic pain. Chronic complications of FGS include adverse sexual and reproductive health and rights outcomes such as infertility, ectopic pregnancy and miscarriage. FGS is associated with prevalent human immunodeficiency virus and may increase the susceptibility of women to high-risk human papillomavirus infection. Across SSA, and even in clinics outside endemic areas, the lack of awareness and available resources among both healthcare professionals and the public means FGS is underreported, misdiagnosed and inadequately treated. Several studies have highlighted research needs and priorities in FGS, including better training, accessible and accurate diagnostic tools, and treatment guidelines. On 6 September, 2024, LifeArc, the Global Schistosomiasis Alliance and partners from the BILGENSA Research Network (Genital Bilharzia in Southern Africa) convened a consultative, collaborative and translational workshop: ‘Female Genital Schistosomiasis: Translational Challenges and Opportunities’. Its ambition was to identify practical solutions that could address these research needs and drive appropriate actions towards progress in tackling FGS. Here, we present the outcomes of that workshop – a series of discrete translational actions to better galvanize the community and research funders.
More people than ever are receiving support for mental health crises, and instances of suicide continue to grow. Mental health funding has recently increased, focusing on improving services that provide an alternative to emergency departments, such as urgent helplines and crisis cafés. However, there is a lack of literature examining the efficacy of these services, despite research suggesting they may be associated with lower hospital admission rates.
Aims
We aimed to evaluate the perspectives of people with lived experience of accessing a variety of mental health crisis services in the UK.
Method
One-to-one interviews were conducted with 25 individuals as part of a qualitative grounded theory analysis.
Results
The following themes were identified as important for recovery: more than a diagnosis (a need for person-centred care); instilling hope for the future (access to creative spaces and community); and a safe space for recovery (out-of-hours crisis cafés). Many have credited crisis cafés with saving their lives and felt there should be increased funding provided for collaboration between the National Health Service (NHS) and the third sector. Participants highlighted the need for interim support for those awaiting therapy via the NHS and continuity of care as key areas for improvement.
Conclusions
NHS services are struggling to meet the mental health needs of the population, resulting in lengthy waiting times for therapy and an over-reliance on the third sector. While crisis cafés are currently provided at a low cost and appear to result in satisfaction, policymakers must ensure they receive adequate funding and do not become overburdened.
Objectives/Goals: Bronchiolitis obliterans syndrome (BOS), a form of chronic lung allograft dysfunction (CLAD) that primarily affects the small airways, is often diagnosed too late using standard pulmonary function tests. This project aims to evaluate whether quantitative air trapping analysis can serve as an early diagnostic tool for BOS. Methods/Study Population: We performed a retrospective analysis of 134 computed tomography scans with inspiratory and expiratory protocols from 73 lung transplant recipients (48 male, 25 female). Quantitative air trapping analysis was performed by VIDA Diagnostics using a supervised machine learning technique called disease probability measure (DPM). Results/Anticipated Results: We found that lung transplant recipients exhibit significantly more air trapping compared to healthy controls and other small airway diseases, such as long COVID and cystic fibrosis. Notably, lung transplant recipients showed increased air trapping in the upper lobes. However, when separating participants into CLAD and non-CLAD groups, those meeting criteria for CLAD had significantly more air trapping in the left lower lobe. Additionally, only 2 out of 16 participants meeting CLAD criteria had less than 20% air trapping in their lungs, suggesting early involvement of the small airways. Discussion/Significance of Impact: Quantitative air trapping analysis seems to be an important diagnostic modality in the early detection of lung transplant-related small airway disease. Prospective longitudinal studies are needed to evaluate the spatial pathophysiology in these patients and to determine whether early air trapping can predict the development of CLAD.
Spatial planning is at a crossroads, with nearly half of UK planners now employed in the private sector. This book reveals what it's like to be a UK planner in the early twenty-first century and how the profession can fulfil its potential for the benefit of society and the environment.
Drawing on empirical data largely collected in 2017–2019 from focus groups (FGs), a Freedom of Information (FoI) request and biographical interview data, this chapter seeks to set out the systemic context of what is currently happening in the delivery of planning services in the UK. It sets out and reflects on what is driving these decisions: austerity, government policy preferences, local authorities’ (LAs) choices and consultancies’ involvement. It also sets out and discusses the arrangements that LAs are adopting to provide services, and where consultants and others fit into these arrangements. The aim is to consider the extent to which we might consider UK planning as privatised, the forms this is taking and how common the different forms of privatisation are. We frame this considering the broad definition of privatisation given in Chapter 1, encompassing the various ways in which public sector organisations have been wholly or partly sold off, outsourced or opened up to new forms of discipline and modes of working originating from the private sector.
Importantly, the responsibility to strategically plan for development (create a statutory local plan) and to regulate what is developed through development management decisions remains with the local planning authority (LPA, usually the relevant LA). This may take a variety of forms (this is discussed later on). All other actors involved in the process know that decisions on development must be made by the LPA. The design of the system enables commercial consultants to sell planning, legal and other expertise to clients who need this type of knowledge and experience to navigate the system to achieve their ends.
Consecutive central governments have widened the scope of how LA service provision, including planning provision, might be carried out, with a suggestion for more privatised solutions (for example, Audit Commission, 2006). Austerity, a focus on ‘delivery’ targets and shortages in the supply of planning staff have also shaped how the service might be provided by an LPA. Therefore, this chapter sets this statutory requirement as the baseline around which to consider the privatisation of this service, and sets out the different forms of provision of planning services.
There is a wealth of evidence supporting the notion that planning is becoming increasingly privatized, including the growth of planning personnel in private- sector positions; the packaging and marketing of planning services for sale (for example requests for information and data); and the prominent trend in planning education toward a development- oriented curriculum. Surprisingly, most of these tendencies seem to have been absorbed without comment into the realm of planning practice.
(Dear, 1989: 449)
Recent research has begun to fill the silence that Michael Dear (1989) diagnosed about the privatisation of planning expertise. An emerging literature has generated critical questions about the ideological, political and ethical implications of planning work being provided to paying clients through competitive markets. Understandably, much of this literature explores processes of privatisation and their effects in the contemporary context of neoliberal pressures for reform and reorganisation (for example, Moore, 2012; Raco, 2018; Zanotto, 2019; Linovski, 2019).
Under neoliberal government, distinctions between the public and private have been key to political projects to remake the state and the ways in which it governs. Public institutions and modes of working have been routinely criticised while ‘private’ enterprise has been celebrated for its proclaimed efficiency and effectiveness. Planning in its broadest sense, as a form of collective guidance of societal development, has been a particular object of criticism for neoliberal ideologues, generating pressure for market-orientated reforms.
Those contesting neoliberal drives towards privatisation have often viewed the past 40 years through a lens of declining publicness (Brown, 2015), considering the reworking of older configurations of public and private as a marked retreat from important values associated with distinctively public institutions and norms. However, metanarratives of decline may obscure the multiple and sometimes contradictory ways in which ideas of public-ness and their relations to private- ness have been articulated over time across different areas of social and political life (Geuss, 2001; Newman and Clarke, 2009). Therefore, focusing solely on the ways in which the ‘grand dichotomy’ (Weintraub, 1997) between public and private has been drawn under neoliberal rule may also limit our understanding of the range of possible meanings that have been associated with both public and private sector planning expertise.
My point is that the public interest will vary, depending on the type of development you’re dealing with for the context that it's being dealt with in, but I think it is a term I have understood, I think and it has guided what I do, but if you ask me to define it, I’d probably struggle.
Interviewee 5
This quote, from a consultant who had worked previously for many years in the public sector, seems to sum up many planners’ understanding of the public interest. It is a concept that planners hold on to as a guide for their practice, and something that they cleave to when legitimising their status. Yet, it is also very difficult to define and seemingly variable when they try to ‘apply’ it to actual development decisions. This quote also represents something deeper about the centrality of the public interest in planning, an ever- present idea that justifies the activity, yet is also deeply contested as to what it might mean or how we might secure it. Certainly, the idea of the public interest, or (less frequently) the common good (see Puustinen, Mäntysalo and Jarenko, 2017), is a shibboleth for planning and planners, being central to its self- understanding and the claims it has made for its existence. Professional codes of conduct cite it as a fundamental purpose of professional work. The American Institute of Chartered Planners states baldly in its Code of Ethics and Professional Conduct: ‘People who participate in the planning process shall continuously pursue and faithfully serve the public interest’ (American Institute of Chartered Planners, 2021: 1), while the RTPI in its guidance on probity in the profession views ‘acting in the public interest’ as a fundamental duty of the profession (Royal Town Planning Institute, 2020). Yet, as the quote from the planner illustrates, how we define it or meet the public interest in practice is far from simple.
The concept's centrality to justifying the activity of planning, yet the difficulty of actually pinning down what it means, has generated significant and ongoing debate.
In this appendix, we briefly describe the methodology of the ESRC funded ‘Working in the Public Interest’ (WITPI) project, which involved data collection and analysis between 2018 and 2020. The data from the project forms the basis for this book.
Aims
The overall aim of the WITPI project was to explore whether and how the privatisation of spatial planning activities was reshaping professional practices, including justifications for planning and how it serves the public interest. Five research questions (RQs) were identified to direct the research:
1. How have the respective roles of the public and private sectors in delivering public interest planning goals changed over the postwar period?
2. Through what public/ private organisational forms is planning now delivered?
3. How have professional planners working in diverse settings adjusted to changing organisational configurations, and how do they define and understand their professional identity in relation to these?
4. What effects do different organisational configurations have on the ways that planning's contested public interest purposes are defined and realised through planning work, particularly in relation to the complexities of place, democracy and local politics?
5. How can public service professional labour be reimagined as a means of better realising public interest goals, and challenging dominant understandings of what public services can and should legitimately deliver?
The first two RQs focused on producing a descriptive account of recent changes to the delivery of planning services, while the final three were concerned with how those changes have been understood by both professional planners and other groups, and the implications of those understandings for conceptualisations of the legitimacy of ‘public interest’ planning.
Conceptual approach
We looked to explore how processes of privatisation were changing ideas and practices of professionalism in spatial planning, starting from an understanding of professionalism as a set of claims to socially useful expertise made by organisational groups seeking to secure and control employment opportunities for their members (Larson, 1977). The planning profession in the UK grew as a postwar ‘state- bureau profession’ (Clarke and Newman, 1997), and has therefore exercised only limited control over the definition of its work.
Across the various chapters of this book, we have explored how different processes of change (privatisation, commercialisation, commodification and so on) are affecting the institutions, organisational settings and cultures within which spatial planners work. Throughout we have been concerned to think through how these changes might be reshaping, shifting or altering how the purposes of planning are understood and realised by professional planners in practice.
Questions concerning the purposes of planning have often been debated under the contested and problematically imprecise heading of the public interest or the public good. In this chapter we return to this concept to examine in more detail what relevance this has for planners and, by extension, the activity of planning today. Building on the more theoretical debates about the nature and meaning of the concept that were introduced in Chapter 3, our focus here shifts to the empirical level. Drawing on material gathered across the WITPI project and with a particular focus on biographical interviews and focus group discussions, we will discuss some of the key ways in which the term was understood by the planners we spoke with, the extent to which they felt it actively framed or justified their work, and the similarities and differences we found between those working in the public and private sectors.
Our approach builds on the work of others who have explored how planners talk about and use the public interest to justify or understand their practices (Howe, 1992; Murphy and Fox- Rogers, 2015; Maidment, 2016; Schoenboom et al, 2023). After briefly framing how we approached planners’ talk about the public interest, including the various ‘publics’ that it identifies (see Chapter 3), this chapter sets out five key ways in which we see the term being used in contemporary planning. We then go on to consider what these understandings tell us about the state of planning in the UK, focusing in particular on a range of factors planners identified as distorting the public interest. In doing so, the chapter opens up further, critical questions about the restricted purposes of planning and the limited agency or ‘acting space’ available to planners in the UK today (Grange, 2013).
This book, like its sister volume What Town Planners Do: Exploring Planning Practices and the Public Interest through Workplace Ethnographies (Schoneboom et al, 2023), flows from an Economic and Social Research Council (ESRC)- funded research project which collected data from and about practising planners in the UK between 2018 and 2020 called ‘Working in the Public Interest?’ (WITPI). The project and this book aim to paint a picture of the contemporary UK planning profession, situating this in an understanding of a complex and evolving set of organisational structures as well as historical contexts. This picture is necessarily partial, for example, focusing on planners rather than all stakeholders and influences in and on the endeavour of spatial or town planning. It might also be argued to be a product of the particular era when we undertook the research and analysis. In the years since, a great deal has happened, not least the COVID-19 pandemic. In writing up this book, we have tried to update our analysis in places, including reference to more recent literature. Unfortunately, though, the issues we consider here and critiques we ultimately make about the state of planning have, if anything, become all the more pressing in the years since our data collection.
During the process of finalising the book for publication, recent headlines have, for example, covered the increasingly perilous financial situation of many local authorities in England. Meanwhile, with a general election due in the UK in less than a year, the Labour Party Leader of the Opposition has been calling on the need to ‘bulldoze planning’ in order to ‘get Britain building again’. The temptation here would be to wonder whether perhaps a political party might be able to come up with more radical proposals to tackle the multiple crises engulfing our increasingly thin state under late capitalism than reform of the planning system. Yet good planning should matter in order to attempt to bring people together to try and address economic, social and environmental issues as varied as ensuring decent housing for all, adapting to climate change and trying to reduce biodiversity loss. Whether the planners and planning systems of the UK have the agency, resources and regulatory frameworks, and are working in organisational cultures which might allow meaningful action is, as we outline in this book, highly debatable.
Local government is now more actively income generat[ing] because we’re facing so many cuts, £30 million cuts means that I either have to sack all my staff or say to my staff ‘I’m sorry, you’re going to have to pay at least part of your wage by generating income’.
Interviewee 11 – Senior Planner, Local Authority
Introduction
The future has, of course, always been at the heart of planning thought. In the immediate postwar period, this was to be determined by planners advising political representatives, an understanding of planning that found itself in ideological harmony with prevailing governance common sense about the role of the state in proactively driving change. As disillusion with modernist planning grew, however, planning's grip on tomorrow became a little less sure, a trend only exacerbated by the rise and rise of neoliberalism and its attendant new common sense. The discussion of commercialisation in this chapter shows this shift, whereby planners now make the future on other people's terms, in the starkest light possible, clearly demonstrating how statutory planning in England is increasingly driven by logics that are alien to its founding aims and driving justifications.
Conceptually, the commercialisation of public sector planning in England is rooted in the changes brought by the rise of the New Right during the 1970s and 1980s, further enabled by the consolidation into the 1990s of NPM as a governmental technology (Clifford and Tewdwr- Jones, 2013). In this context it means that certain state functions come to be seen as marketable services and treated as such, with new regimes of fees and charges, and the constitution of quite different relationships between planners and publics, understood through a client/ customer matrix. In planning this understanding became consolidated in the 2000s, finding expression in key governmental initiatives like the Killian- Pretty Review (2008) in England, which drew together a number of previously existing discourses – against slowness, bureaucracy and complexity – to explicitly argue for greater ‘customer focus’, customers here being primarily those applying for planning permissions.
This book has explored the ways in which spatial planning in the UK has been reorganised over recent decades. By focusing on processes of organisational change and restructuring, and their consequences for the work that planners do, we have interrogated the remaking of British planning from a novel and previously overlooked perspective, countering tendencies within planning scholarship to see practice in terms of either the latest government reform initiative, or the ethical agency and situated judgements of individual planners. Although focused on charting the contemporary landscape of UK planning, the themes and issues discussed here are of wider relevance, given the hegemonic neoliberal remaking of the state which, however unevenly, has played out internationally, with significant implications for regulatory activities, including in relation to the management of built and natural environments.
We have shown how the work professional planners do, once synonymous with public sector employment, has been subject to a series of changes rooted in the neoliberal remaking of state and society, and the growing economic power of landowners and developers in the UKs property- led accumulation regime. The headline figure motivating the book is the remarkable growth of private sector employment of planners, from less than 20 per cent at the end of the 1980s to around 50 per cent by 2023. This transformation has been driven by growing demand for expert advice to navigate the regulatory complexities of planning systems, resulting in increasing numbers of ‘consultants and other experts operat[ing] in liminal governance spaces between private markets and the formal planning system’ (Raco et al, 2016: 218).
Alongside this growth in work directly serving private clients, public sector planning has been subject to a seemingly permanent managerial revolution that has sought to introduce new forms of commercial savvy and discipline into the workplace. Exacerbated by the strictures of austerity, this has generated an increasingly fluid and fragmented organisational landscape marked by increasing concern for financial revenue, precarious working and considerable work intensification. All of these changes have been enabled by the commodification of professional work which has increasingly been standardised and packaged up so that it can be understood as a tradeable good that can be bought, sold or re- engineered to squeeze more from less as part of a seemingly insatiable quest for (so- called) efficiency.