How to create healthier places: a multi-disciplinary qualitative study exploring the complex system of urban development decision-making

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Changes to the urban environment can influence mental, physical and planetary health. This includes walking and cycling infrastructure, green spaces and quality and affordability of homes. Many factors and types of stakeholders can influence the complex system of urban development decision-making and health may not be prioritised. We aimed to understand this complex system and identify possible leverage points for interventions to support creation of healthier environments.
Researchers from diverse disciplines collaboratively conducted 123 semi-structured interviews with multi-sectoral stakeholders to understand health considerations within urban development. Participants were professionals spanning urban and transport planning, property development, finance, sustainability and public health, as well as elected representatives. Purposive sampling targeted individuals with expertise and/or influence in urban development decision-making in England. Interview topics included: actors, institutions and networks; perceptions of why healthy places are not delivered; use of evidence in decision-making processes, including health economic valuation; community involvement; and legal considerations. Analysis stages involved deductive and inductive coding, production of discipline-specific summaries, and thematic analysis.
Three themes were developed: ‘competing priorities’ (trade-offs for national government, local government, private sector property developers); ‘getting around the ‘rules’’ (limited policies and legislation to ensure healthy development and meaningful public involvement); and ‘justifying a focus on health’ (need for clarity and consensus on what makes development ‘healthy’). A systems perspective was taken, adapting a socio-ecological model, to identify potential leverage points spanning individual motivations, organisational priorities and structural factors. Interventions are required at multiple levels for system change, such as targeting demand, processes and policies.
Original languageEnglish
Publication statusPublished - 14 Nov 2023
EventUKPRP Prevention Research Conference - Edinburgh, United Kingdom
Duration: 14 Nov 202315 Nov 2023


ConferenceUKPRP Prevention Research Conference
Country/TerritoryUnited Kingdom


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