Background Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities. Methods Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically. Results Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. ‘Evidence’ for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant. Conclusion We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

Walking and cycling infrastructure and quality open spaces ('active living infrastructure') can influence levels of physical activity and related risks of non-communicable disease. Understanding the challenges in creating active living infrastructure could help support the creation of more physically active communities. A qualitative study with nine semi-structured interviews was conducted with 10 expert stakeholders purposively sampled across the sectors of urban development, public health and civil society in Jamaica. Thematic analysis found that new active living infrastructure was challenging to provide because it did not fit with widely held views of 'development' which focused on road construction, driving and economics, not walking, cycling or nature. Public open spaces were lacking and the few good examples were expensive to maintain, deterring additional investment. Pedestrian infrastructure was poor quality and cycling infrastructure non-existent, making it dangerous for people to walk or cycle which particularly adversely affected people from deprived communities who may lack political voice. Greater collaboration between public health and urban planning, which appeared to be natural allies with shared interests, could help re-frame the multi-sectoral (including economic) benefits of active living infrastructure. Brokers may highlight problems associated with lack of active living infrastructure and also provide contextually relevant examples which go beyond generic international guidance.

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