Identifying intervention areas to shape healthier urban development in the United Kingdom

Abstract
The quality of urban environments is an important determinant of public and planetary health globally, yet often they do not provide the conditions for good health. Many of the causes of poor-quality environments are located far upstream in areas of policymaking, governance and control of the complex urban development system, involving a diverse range of stakeholders across multiple sectors, tiers of decision-making, and publics. There is a lack of clarity about the challenges involved, and where to prioritise actions to effectively transform the system towards healthier urban development. This article identifies multiple areas in the United Kingdom’s urban development systems where interventions can be targeted to shape the development of healthier and more sustainable urban environments. The study sets out the main findings from the first phase of a large-scale, five year research programme. It takes a systems-based approach to specify and prioritise the upstream problems that restrict healthy urban development. We focus on two key sectors of development that affect health outcomes through a variety of pathways: property development and transport planning. We identify 50 ‘intervention areas’, specifying the problems and where they can be tackled, and report areas prioritised for intervention. The intervention areas identified reveal three broad and mutually reinforcing themes: (i) a lack of prioritisation of health in urban agenda setting and subsequent policy making, (ii) deeper structural barriers, both national and international, and (iii) existing points for leveraging health that do not currently maximise health impacts. The findings contribute to the literature on creating healthy and sustainable urban environments, and extend debates on how health can be understood through systems-based approaches to upstream decision-making and wider structural and institutional forces. Practically, they provide potential areas of intervention for strategies towards improving the quality of urban environments, which are essential for safeguarding future human and planetary health.

Author summary
Urban environments are an important influence on human health and environmental sustainability. Currently, many of these environments are not producing good health outcomes. Their development is shaped by many stakeholder groups and interacting factors. Some of these are, in theory, within our control (e.g., government policies), while others are largely outside (e.g., global forces). All these areas are typically outside of the scope of public health interventions, and there is a lack of clarity about what needs to change. We aimed to identify areas of critical decision-making in the United Kingdom’s urban development systems where interventions can be targeted to shape the development of healthier and more sustainable cities. We identify 50 ‘intervention areas’, specifying the problems and where they can be tackled, and report areas prioritised for intervention in a large-scale research project. The intervention areas were grouped into three broad themes: prioritising health in the policies that shape urban development, deeper structural barriers to healthy urban development, and opportunities within existing mechanisms for promoting health impacts. Our study provides new insights into strategies that are needed to improve the quality of urban environments, which are essential for safeguarding future human and planetary health.