Decision-making for active living infrastructure in new communities: a qualitative study in England.

A Le Gouais,D Ogilvie,L Foley,C Guell

doi:10.1093/pubmed/fdz105

Abstract

ABSTRACTBackgroundUrban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities.MethodsThirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically.ResultsPublic health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. ‘Evidence’ for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant.ConclusionWe have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

Highlights

The social determinants of health are shaped by policies and decisions in non-health sectors
We have developed a conceptual model with three factors needed to bridge the gap between evidence and active living’ infrastructure (ALI) being built: in uential public health practitioners; supportive policies in non-health sectors; and adequate resources
National and international policies increasingly acknowledge the impact that the built environment can have on population health through physical activity,[1,2,3] recognising the role that non-health sectors such as urban and transport planning can play in producing activitypromoting environments.[4,5]

Summary

Introduction

The social determinants of health are shaped by policies and decisions in non-health sectors. Urban designs are often locally developed by decisions-makers outside the health remit and broader concepts of ‘evidence’ than scientific research are involved.[6,7,8,9] The role of scientific evidence in influencing policy and practice has been widely researched,[10,11,12,13] but there remain limitations in understanding the facilitators and barriers to decision-making for healthy outcomes in traditionally non-health sectors.[14] Communication and co-production of research are promoted to improve the relevance of evidence for uptake for better decision-making,[13,14] but few studies have investigated the use of evidence, alongside other influences, at the local level.[15,16]. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities

Results

Discussion

Conclusion