Healthy Urban Places: a systems approach to understanding how to harness local places as tools to improve population health and reduce inequalities

Healthy Urban Places: HUP-North
The places in which we live can make us healthy or ill. In the UK, 85% of people live in cities so it is important to make sure these are healthy places to live. Clean air, quality housing, parks, public transport, access to shops, arts and cultural opportunities, schools and health services all make a difference to our physical and mental health. Unfortunately, some areas have more unhealthy environments which means people living in these areas experience poorer health.
By improving the places where people live, we have an opportunity to improve the health of communities in most need. But what we improve needs more consideration - for example, should we improve parks, provide more sporting facilities, build more homes, reduce traffic, regenerate high streets, reduce the number of fast-food outlets or open more libraries?
HUP-North's aim is to help the people in charge of cities make the best decisions they can through a focus on research evidence, and by working with communities, researchers, and decision-makers in Bradford (West Yorkshire) and Liverpool (Cheshire and Merseyside). We have chosen these places as they both have large cohort studies including >3million people. Cohort studies follow the health of large groups of people over time to understand what causes ill-health. They do this by collecting information from people using surveys, and from information collected by GPs, hospitals and schools. In Bradford our cohorts have been running for 15 years and in Liverpool they have just started.
Communities should be central to discussions and decisions about improving local places for health. HUP-North will set up two 'Community Collaboratives' in Bradford and Liverpool which will bring together communities, researchers and decision-makers to guide our work. We will work in eight different neighbourhoods in Bradford and Liverpool and train community members to be peer researchers. These peer researchers will speak to over 1000 residents to explore the relationship between health and place. Using maps, we will explore how history has shaped the places in which we live, and we will combine these maps with community-collected information about issues important to residents (e.g. youth centres, fly tipping, areas they feel unsafe, public transport times, traffic). Using our cohorts, we will look to understand those features within local places that are most important for health. By working in an inclusive way with communities we can give decision makers the information they need to improve places.
To evaluate the health impact of place-based changes it is important to collect health information before and after changes have been made. In the past, opportunities for collecting this information have been missed as policy makers and researchers have not worked together. HUP-North will demonstrate different ways to evaluate place-based changes by making good use of our existing cohorts. In Bradford, we will look in detail at how the city has changed over a 10 year period (e.g. increases in cycling infrastructure, green spaces, or reductions in pollution) and how this has affected the health of the Bradford population. In Bradford, as we have strong relationships with our council, we can directly influence and evaluate changes. We will work with communities to prioritise case studies to evaluate: for example, improving housing quality, changing neighbourhoods to encourage active travel, improving local green spaces, and increasing access to cultural opportunities. Using our cohorts we will look at how health has changed before and after these changes, examining what has worked well, and what has not worked well. We will also explore whether the investments represent value for money. In Liverpool we will use learning from Bradford to develop future place-based changes.
We will ensure our learning is shared widely with policy makers, researchers and communities across the UK.

Multiple environmental exposures interact to promote or harm health. There is limited research evidence about how we can modify these exposures to improve health. Our cluster will unite communities, interdisciplinary researchers and stakeholders to identify how we can harness the potential of the places in which communities live and work to improve population health.
ENHANCED SPATIAL DATA: Our cluster is embedded in two city regions in the North of England with strong data infrastructure (Born in Bradford cohorts, N>60,000; Connected Bradford linked data N>1m; Children Growing up in Liverpool cohort N~25,000, Civic Data Cooperative for Liverpool, N>2.8m). Data scientists will work with communities to co-produce longitudinal, linked, granular spatial data and on four interlinked work-packages:
1: HOW CAN WE IDENTIFY AND MEASURE WHAT MAKES A HEALTHY PLACE? Spatial, historical, and participatory research approaches in eight spatial hubs across Bradford and Liverpool will identify key features of place that influence health and inequalities.
2: WHAT FEATURES OF OUR ENVIRONMENT ARE MOST IMPORTANT FOR HEALTH AND WHAT ARE THE MECHANISMS BEHIND THEIR IMPACT? Integrated community, spatial, health and metabolomics data will be used to determine effects of multiple exposures on multiple outcomes.
3: HOW CAN WE IMPROVE THE EVIDENCE BASE EVALUATING THE IMPACTS OF PLACE BASED INTERVENTIONS ON HEALTH/INEQUALITIES? Longitudinal linked spatial/health data will explore how city-wide changes impact population health and natural and quasi-experiments will evaluate exemplar interventions (eg housing improvement, green space, active travel, cultural assets).
4: HOW CAN WE DEMONSTRATE THE HEALTH AND ECONOMIC IMPACT OF POLICIES TO MAKE LOCAL PLACES HEALTHIER? Multi-sectoral economic evaluation will explore short and long term outcomes.
TRAINING AND CAPACITY BUILDING will build national inter-disciplinary expertise through secondments, mentoring and research networks.