A systems approach to improving health consideration in UK urban development: a real estate perspective

This research investigates how population health is considered in urban development decision-making by developing a causal loop diagram from 21 interviews with senior real estate actors. It classifies variables in the model in structural, attitudinal, and transactional dimensions, links them to relevant decision-making actors, and identifies key feedback loops. This enhances understanding of the system and informs intervention strategies for improving the consideration of health. Structural and attitudinal variables are powerful leverage points but are more challenging to influence directly and slower to change. Yet, when activated through a transactional variable, such as enhancing a data-led health metric to increase the ability of stakeholders to include health in planning, investment and development decisions, they generate virtuous feedback loops. These drive and sustain decision-making that shapes a healthier built environment.