Tackling the Root Causes of Unhealthy Planning, Economics and Decision-making: An Urban Systems Approach

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This grant is funded by the UK Prevention Research Partnership (UKPRP) which is administered by the Medical Research Council on behalf of the UKPRP’s 12 funding partners: British Heart Foundation; Cancer Research UK; Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Health and Social Care Research and Development Division, Welsh Government; Health and Social Care Public Health Agency, Northern Ireland; Medical Research Council; Natural Environment Research Council; National Institute for Health Research; The Health Foundation; The Wellcome Trust.

Non-communicable diseases (NCD), such as obesity, respiratory illness and mental health disorders, are demonstrably linked to the quality of urban environments. So far, most research has been investigating “mid-stream” actors: e.g. engineering, architecture, urban design. Instead, research needs to start focusing on the root causes “up-stream”, including the type and quality of decision-making and the capacity and resource of those with most influence. In the UK’s market-led system of urban development, city governments and the private sector – corporations, landowners, financiers, and developers – are the creators of urban environments. Core questions relate to how interests, motivations and needs align to long-term health outcomes.

This challenge links public health to diverse additional disciplines including law, corporate governance, finance, and risk management. Economic and related
quantitative valuation methods are also fundamental to market-led decision-making
and government intervention, and so too are variables beyond the business case including prior beliefs and attitudes, education, cultural history, and ethics. A transdisciplinary, transinstitutional, systems-based approach co-created with experienced practitioners operating upstream at executive level is required.

Working with two prominent city regions as case studies, Bristol and Manchester, which link the macro-national to the micro-local, TRUED proposes to investigate and communicate clearly who and what are the main influencing agents and processes, and what health evidence those sectors currently consider in decision-making. We then propose to develop and test targeted decision support models and new models of evaluating multiple interventions across complex urban systems (e.g. health outcomes from City Cabinet response to economic evidence of ill-health). TRUED will also examine the system as a whole to understand the blockages to the creation of health urban environments (e.g. legislation, capacity, incentives) and identify the role of national and local government in encouraging improved systems of corporate
public and private sector governance for transformative prevention nationally.