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This paper sets out the main findings from two rounds of interviews with senior representatives from the UK’s urban development industry: the third and final phase of a 3-year pilot, Moving Health Upstream in Urban Development’ (UPSTREAM). The project had two primary aims: firstly, to attempt to value economically the health cost-benefits associated with the quality of urban environments and, secondly, to interview those in control of urban development in the UK in order to reveal the potential barriers to, and opportunities for, the creation of healthy urban environments, including their views on the use of economic valuation of (planetary) health outcomes. Much is known about the ‘downstream’ impact of urban environments on human and planetary health and about how to design and plan healthy towns and cities (‘midstream’), but we understand relatively little about how health can be factored in at key governance tipping points further ‘upstream’, particularly within dominant private sector areas of control (e.g. land, finance, delivery) at sub-national level. Our findings suggest that both public and private sector appeared well aware of the major health challenges posed by poor-quality urban environments. Yet they also recognized that health is not factored adequately into the urban planning process, and there was considerable support for greater use of non-market economic valuation to help improve decision-making. There was no silver bullet however: 110 barriers and 76 opportunities were identified across a highly complex range of systems, actors and processes, including many possible points of targeted intervention for economic valuation. Eight main themes were identified as key areas for discussion and future focus. This findings paper is the second of two on this phase of the project: the first sets out the rationale, approach and methodological lessons learned.

The city of Bristol currently generates around 48,000 tonnes of household food waste every year. This waste incurs loss of resources and environmental damage throughout the food cycle. In this paper we quantify and value the baseline socio-environmental impacts from household food waste in Bristol before examining the potential costs and benefits that may result from changes to food waste behaviour. In so doing, we look to better inform the choice of food waste reduction methods in public policy. The environmental impacts of two possible policy targets are explored: (1) a 20% increase in food waste recycling and (2) an overall decrease in food waste of 20%. Environmental impacts are estimated for 13 different hazards, including Global Warming Potential, Particulate Matter, Human Toxicity and Water Depletion. The societal consequences of these environmental changes are monetised using non-market values which allows us to directly compare the relative importance of different environmental impacts and the trade-offs between these impacts in each scenario. For example, we estimate that the Global Warming Potential of Bristol’s annual food waste equates to around 110,000 tonnes CO2, or 25,000 additional cars on the road every year. We find that a 20% improvement in recycling behaviour would lead to an annual reduction of 113 tonnes of CO2 equivalent, whilst a 20% reduction in food waste would result in an annual reduction of 15,000 tonnes CO2 equivalent. Findings suggest that the environmental impact of waste management is significantly overshadowed by the impact of resources used in food production and distribution before it becomes waste.

Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact.

BackgroundPoor quality urban environments have substantial impacts on public and planetary health. These costs to society are not readily quantifiable and remain largely external to mainstream measures of progress. Methods for accounting for these externalities exist, but their effective application is in development. Yet there is an increasing urgency and demand given the profound threats to quality of life both now and in the future.MethodsWe combine data from a series of systematic reviews of the quantitative evidence linking characteristics of the urban environment with health consequences and the economic valuation of these health impacts from a societal perspective within a spreadsheet-based tool. The tool–named HAUS–allows the user to estimate the health impacts of changes in urban environments. The economic valuation of these impacts in turn facilitates the use of such data in broader economic appraisal of urban development projects and policies.FindingsUsing the Impact-Pathway approach, observations of a variety of health impacts associated with 28 characteristics of the urban environment are applied to forecast changes in cases of specific health impacts that result from changes in urban contexts. Unit values for the societal cost of 78 health outcomes are estimated and incorporated in the HAUS model in order to allow the quantification of the potential effect size of a given change in the urban environment. Headline results are presented for a real-world application in which urban development scenarios that have varying quantities of green space are evaluated. The potential uses of the tool are validated via formal semi-structured interviews with 15 senior decision-makers from the public and private sectors.InterpretationResponses suggest that there is significant demand for this kind of evidence, that it is valued despite the inherent uncertainties, and has a very wide range of potential applications. Analysis of the results suggest expert interpretation and contextual understanding is critical for the value of evidence to be realized. More development and testing is needed to understand how and where it may be possible to apply effectively in real world practice.

Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact.

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Bristol, one of the United Kingdom’s (UK) nine Core Cities, is seeking to achieve Zero Waste City status by 2049. This study combines macro-economic valuation with transition pathway mapping and adapted participatory scenario planning to stress test the city’s ambitious food waste targets. The primary aim is to enable better understanding of who might be affected by achieving these targets, both locally and nationally, the potential scale of impacts, and therefore the potential barriers and policy opportunities. The valuation focuses on household and commercial food waste, combining available site and city data with national level proxies. Impact areas include changes in sectoral income, employee income, capital owner income, tax revenue, and carbon emissions. Four scenarios, based on two extreme cases, are modelled to consider food waste reduction and potential shifts in consumption patterns. Results indicate that current market and governance failures incentivise waste, and suggest potential routes to transition, including trade-offs and resource reallocation, alongside the need to acknowledge and respond to these profound structural barriers. With further development and testing, the approach may contribute to a better understanding of how to achieve city socioenvironmental targets.