Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD)

Our overarching research question is: How might prevention of risk factors causing Non-communicable diseases (NCDs) be considered and fully incorporated into urban planning and development in the UK? Context: Poor quality urban environments are important contributors to Non-Communicable Diseases such as lung and heart disease, diabetes and mental health problems. This is because they are associated with critical risk factors - including air pollution, noise, lack of physical activity, lack of green space, and obesity. Therefore, one way of preventing these future major chronic health problems is to go "upstream" and improve the urban environment so that it encourages healthy behaviours and reduces adverse risks. However, urban planning and development is a complex system of actors and processes operating over multiple layers of governance. . The driving force in urban planning and development are now the large private sector actors, particularly landowners, investors and developers. Narrow valuation mechanisms and short-term horizons are a central challenge as they do not factor in long-term health. Urban planning faces "super wicked" problems too - where "those who are in the best position to address the problem are not only those who caused it, but also those with the least immediate incentive to act". Researching these complex systems requires: consideration of whole and interconnected systems; clear visualisation and analysis; effective engagement and 'co-production' with a wide range of stakeholders, including public, private, third sector as well academia and the lay public. Applications: We aim to transform urban planning and development systems so that health and health inequalities are valued and integrated at each of the main roots of core decision-making. We will develop with urban development decision-makers at city, combined authority and national level interventions and methods for realigning the system for healthier public and private sector operations. The intervention has three components: evidence of health impact including economic valuation; opportunities for change; community-led creative arts media communicating health inequalities. We will identify the best leverage points for introducing the intervention. We anticipate a range of applications for the evidence and associated tools. They will provide measurable evidence of health impacts to be used in multiple ways including: local and national planning policy; local development management and planning permissions; cost-benefit analysis on infrastructure and other investment decision-making; and policy or legal mechanisms for re-aligning corporate governance towards long-term health outcomes. For example, we will seek to influence and introduce evidence on health impacts of urban planning into the Housing and Economic Land Availability Assessment, which determines what land is to be developed. Beneficiaries: The beneficiaries of this kind of whole system approach include: a) decision-makers by improving the quality of what they offer (e.g. local government will benefit politically by evidencing societal benefit; progressive investors and developers gain commercially by differentiating their 'product'); b) in the medium to longer term, urban and rural populations should be positively affected by better urban environments (e.g. reduced air pollution, better quality green infrastructure, improved physical environment); and c) taxpayers and central government over the long term due to decreased health burden on the NHS and increased levels of productivity.