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 refiningthe 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.
Highlights
Introduction and rationaleUpstream determinants of urban health There is substantial evidence linking non-communicable diseases (NCDs, e.g. respiratory illness, cardiovascular disease, diabetes, mental disorder, cancer) to: the quality of urban environments[1,2,3]; socio-economic inequalities[4,5,6]; and global environmental degradation, mainly caused by the resource consumption in cities[7,8]
Outputs: The main outputs from this work package are: i) a book or monograph aimed at the academic community and taking a critical theory lens to the call for new approaches to researching complex societal challenges, considering governance, operationalisation and structural barriers in particular, using TRUUD as a case study; ii) a Health Valuation and Integration Toolkit (H-VIT) with Strategy Guidance Note aimed at city, region and national level decision-makers in public and private sector, which bridges the economic database model to urban governance contexts, and provides a framework for its application with wider, qualitative valuation techniques; iii) a paper reporting on the findings from integrating multiple approaches in the development and evaluation of a multi-action intervention across multiple sectors and systems of decision-making
In addition to the meta-research work package, we have pervasive reflexive interests stimulated by a shifting emphasis from “public health research” to the broader disciplinary and practical embrace of “health of the public research”[16], and will draw on new approaches such as those being pioneered in the field of team science[60,106,107]
Summary
Outputs: The main outputs from this work package are: i) a book or monograph aimed at the academic community and taking a critical theory lens to the call for new approaches to researching complex societal challenges, considering governance, operationalisation and structural barriers in particular, using TRUUD as a case study; ii) a Health Valuation and Integration Toolkit (H-VIT) with Strategy Guidance Note aimed at city, region and national level decision-makers in public and private sector, which bridges the economic database model (from WP2) to urban governance contexts, and provides a framework for its application with wider, qualitative valuation techniques; iii) a paper (or papers) reporting on the findings from integrating multiple approaches in the development and evaluation of a multi-action intervention across multiple sectors and systems of decision-making.
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