Overcoming Systemic Barriers Preventing Healthy Urban Development in the UK: Main Findings from Interviewing Senior Decision-Makers During a 3-Year Planetary Health Pilot

Abstract

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.

‘Harnessing the power of the law’: a qualitative analysis of the legal determinants of health in English urban planning and recommendations for fairer and healthier decision-making

“…These actors were identi ed through desk-based searches, literature reviews, stakeholder mapping and a pilot project. (21) Second, teams reduced their initial invitee list to a maximum of ten individuals who best met the criteria, and third engaged in snowball sampling to maximise system coverage. (22) Ultimately, the participants interviewed covered a wide range of roles in urban planning, such as local government o cers, local government elected members, national government actors, real estate actors, property developers and consultants.…”

Developing and testing an environmental economics approach to the valuation and application of urban health externalities

“…For example, a series of 30 interviews with senior decision-makers from public and private sectors suggest that there is a strong desire for more comprehensive, approaches to valuation of health in urban areas (10). These interviews highlight a range of potential areas of application, including: government investment programs, land valuation, private sector investment and planning decisions (12,13).…”

Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD): Protocol of a five-year prevention research consortium

“…However, opinion as to the efficacy of its use in valuing human and planetary health varies 32 – 34 . As the UPSTREAM pilot and other projects suggest, decision-makers are aware that these types of valuations are not comparable to standard cost-benefit analysis, and are used to making decisions with limited information 28 . Over and above the challenge of effective valuation of externalities, there appears to be little evidence or understanding on how to integrate such external costs specifically into urban planning and development decision-making 28 , 35 .…”

“…As the UPSTREAM pilot and other projects suggest, decision-makers are aware that these types of valuations are not comparable to standard cost-benefit analysis, and are used to making decisions with limited information 28 . Over and above the challenge of effective valuation of externalities, there appears to be little evidence or understanding on how to integrate such external costs specifically into urban planning and development decision-making 28 , 35 . There appears to be a need therefore not only to develop and test new means of valuation targeted at key leverage points 36 – 38 , but also determine the strategic, political, ethical and behaviour shifts needed in corporate governance and associated regulation for prevention to be factored routinely in to core decision-making 17 , 39 – 45 .…”

“…Research design in this space must look beyond simply the application of systems approaches 27 , 63 . There is a need for: state and non-state actors to work together 64 , 65 ; governance of multi-actors settings without reverting to command and control (‘meta-governance’) 23 , 66 ; recognition of local governments' limitations 28 and the dominant roles of the many and varied private sector controlling agencies and the wider political economic landscape 6 , 17 , 39 , 44 . Considerable challenges in better decision-making include not only the inevitable lack of evidence, but also demonstrably linking upstream decision-making with downstream health outcomes 67 – 69 .…”