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

Abstract

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.

Balancing Autonomy and Collaboration in Large-Scale and Disciplinary Diverse Teams for Successful Qualitative Research

“…The interview study team involved nine sub-teams of researchers from five universities working together to critically explore England’s complex urban development system as part of the TRUUD (‘Tackling the Root causes Upstream of Unhealthy Urban Development’) research project (Black et al, 2021). The study we reflect on here aimed to increase understanding of decision-making about health in this complex system.…”

‘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

“…Between May and October 2021, 123 interviews were conducted with 132 key stakeholders as part of the transdisciplinary project [name redacted for review]. (19) (20) Interviews were conducted by seven disciplinary teams with expertise in public health, urban planning, real estate, transport, public policy, management and public administration. A team with expertise in law designed a 'law question' to be asked to all interviewees (Box 1).…”