A vision of healthy urban design for NCD prevention

Non-communicable diseases (NCD), such as cancer, heart disease, type II diabetes mellitus, chronic respiratory conditions like asthma, and poor mental health, are some of the most common causes of death in the UK and Australia. The design of our cities play an important role in preventing these chronic diseases and have a significant consequent impact on the quality of life and life expectancy of their citizens. However, in a rapidly evolving urban age, urban designers, urban planners and public health practitioners still know surprisingly little about how best to design our cities in order to prevent NCD and their known risk factors.
This proposal is innovative because we are harnessing perspectives of scientists from a wide range of different disciplines across urban design, public health and computer science. Through novel methods, we aim to provide better understanding of how the design of our cities impacts on NCD and their known risk factors in the UK and Australia, and how we can best effect change for the better.

Our overarching aim is to generate evidence and tools to support the urban planning and health sectors to better understand how to design our cities to prevent NCD. We will also involve local citizens in discussions about our findings so they can effectively and powerfully advocate for change in their own cities. The research project has the following objectives:
1. Use new methods in computer vision and artificial intelligence to explore the relation between urban design and NCD in cities across the UK and Australia.
2. Investigate how different designs within cities impact on health inequalities including NCD.
3. Combine data from different sources to investigate the mechanisms by which the design of our cities causes NCD.
4. Learn lessons about how different ways of designing our cities prevent NCD and their known risk factors.
5. Develop a toolkit for action for local citizens, urban designers and planners, public health practitioners and policy makers, to help inform future policies and lead to powerful, actionable changes in the city.
6. To build a legacy of transdisciplinary research capacity in public health science, urban design and computer science, with clear pathways to impact.

The project involves 3 work packages. The first involves building the evidence base on the relationship between urban design and NCD. This will be comprised of two levels of analysis: the city level and individual level. This acknowledges that people's health is affected by their immediate environment and, at same time, by the way the entire city is organised. This will help us better understand which features of the built environment are associated with city designs, NCD and their known risk factors, such as not being physically active, having poor diet, smoking, consuming alcohol and being exposed to air pollution. A further work package will then test changes to the design of our cities to analyse how they will help prevent NCD and reduce known risk factors. The findings will help inform future policies and practices leading to actionable changes in the design of our cities to make them healthier places for people to live. Finally, we will develop a toolkit that urban designers and planners, public health practitioners, students, policymakers and local citizens can use to advocate and lobby for actionable healthy changes to their cities. At the end of the study we will meet with experts from different fields of research, to help us further interpret our findings and discover how they might apply to other contexts and cities to prevent NCD.

This project uses state-of-the-art approaches to (i) generate evidence on the impacts of urban planning in NCD and health inequalities in UK and Australian cities, and (ii) provide stakeholders engaged in the urban planning and health sectors with tools for advocacy and informing decisions to achieve healthier cities for all. In WP 1, we will expand the evidence base on the relationship between urban design and NCD. First, we will sample local-level images of all UK and Australian cities with populations > 100,000 to obtain detailed information of urban characteristics of interest (e.g., road, cycling networks, greenspace). A combined process using convolutional neural networks and self-organising maps will identify cities and locations that can be grouped according to consistencies in urban design both between and within cities. The ecological association between city and area types and NCD risk factors and outcomes will be estimated. Second, we will apply Bayesian networks onto prospective health cohorts with objective built environment data to investigate, at the individual level, the causal pathway between built environment, lifestyle factors, and NCD incidence, and effect modification by socioeconomic position. In WP 2, we will estimate the health impacts of actionable changes, at different scales, in urban design. Using health impact assessment modelling, we will calculate the NCD burden that could be averted if cities were to adopt urban features of healthier counterparts. A similar approach will be applied on finer-grained scale within all case study cities, enabling assessment of health impacts of changes in individual locations. WP 3 will provide an interactive web-based toolkit to enable urban designers, planners, policymakers and the public to engage with our findings and inform the decision-making cycle, co-designed with the intended users through a usability study involving participatory workshops and user-testing of early versions of the toolkit.

Our partners have identified a range of beneficial impacts. We have designed our communication strategy (see Communication Plan) to maximise these benefits both for our partners and for our wider stakeholder community. Benefits range from a deeper understanding of how urban design and effective urban planning can prevent NCD, how future programmes and policies may be better able to harness the power of the built environment to generate meaningful changes in NCD risk factors and consequent incidence at the population level, and practical pathways for changes using a nearest-neighbour strategy. This range of benefits is briefly discussed below.
Promoting transdisciplinarity and ensuring stakeholder engagement will help us to deliver high-impact research, with multiple beneficiaries in the UK, Australia and beyond, including: the general public; public health practitioners; urban designers and planners; and policy makers across the UK and Australia. A number of academic beneficiaries are detailed elsewhere (see Academic Beneficiaries).
Considerable time and resources have been included in the grant to ensure that key stakeholders are involved throughout the study in order to maximise benefits and that the proposed collaborations are ongoing. Long term, we envisage such benefits to include the development of programmes and policies that utilise the urban environment for NCD prevention and reduced NCD risk factors, leading to better quality of life and life expectancy. Our Impact Advisory Panel will ensure that study findings are disseminated in a meaningful and appropriate manner. Ongoing development of the research series will provide benchmarks and a methodological platform for future researchers to launch additional research efforts from.
The general public will benefit through the practical application of this research and embodiment into planning regimes. We aim to increase public engagement through events undertaken by organisations with a remit for NCD prevention such as the Public Health Agency, the British Heart Foundation, Cancer Research UK, Town and Country Planning Association UK, Heart Foundation Australia, Diabetes Australia, the Australian Local Government Association, and the Planning Institute of Australia.
Urban design and planning practitioners will benefit from a deeper understanding of how urban design and effective planning can prevent NCDs and reduce NCD risk factors.
Public health practitioners will benefit from knowledge gained through the workshops hosted in partnership with our multi-disciplinary stakeholders, and delivered as part of the implementation of the Public Health Agency's Knowledge Management Strategy and the work of the Northern Ireland Public Health Research Forum (of which Kee was the inaugural Director). Parallel workshops will be planned for practitioners in the rest of the UK and Australia in collaboration with our project partners, such as Public Health England and the NIHR's Public Health Policy Advisory Board. These workshops will particularly focus on how best we can incorporate and elicit mechanisms of urban design and planning to inform NCD prevention policy and practice.
Policy makers and funders of research will find the research of value in assessing the public health priorities and novel approaches to NCD prevention and reduction of NCD risk factors. We have engaged with urban design experts from the outset, to ensure that this work will have long term policy relevance and impact. While the timelines for research and policy may not always be aligned, we will maintain our strong relationships with key decision makers to ensure that they have access to updates on new research and emerging results.
All beneficiaries will come together in a parallel plenary workshop in the UK and Australia of thought leaders (from public health, urban design, artificial intelligence) to build consensus and think about how changes might be effected within complex urban systems.