SSM Research Summary Competition 2024 Winner Dr Anna Le Gouais

We are delighted to introduce Dr Anna Le Gouais, the winner of our SSM Research Summary Competition 2024. Read her winning entry below.

How to create healthier places: a multi-disciplinary qualitative Study exploring the complex system of Urban Development Decision-making

We conducted a large multi-disciplinary qualitative study to understand the complex system of urban development decision-making. This identified potential leverage points for interventions to support healthier place-making in towns and cities.

We conducted 123 semi-structured interviews with public, private and third-sector professionals spanning property development, urban and transport planning, real estate, finance, sustainability, public health, and elected representatives. We targeted stakeholders with expertise and influence in urban development decision-making in England. This explored actors, institutions and networks; perceptions of why healthy places are not delivered; and decision-making processes, including using evidence. Questions also covered community involvement, health economic valuation and legal considerations.

Our interview and analysis team involved researchers from different disciplines: management, public policy, urban planning, transport, public health, real estate, law and public involvement. We

used deductive and inductive coding (involving 16 weekly coding meetings) and wrote discipline-specific summaries. The findings of this study drew on these summaries, using meta-ethnography approaches, to conduct thematic analysis.

Three themes were developed: ‘competing priorities’, which result in trade-offs for key groups (national government, local government, private sector property developers) and health often not a priority; ‘getting around the ‘rules’’, considering how policies and legislation may insufficiently control urban development and meaningful community engagement; and ‘justifying a focus on health’, highlighting the need for greater clarity about what makes development ‘healthy’ to demonstrate responsibilities and increase funding. We took a systems perspective involving a socio-ecological model that identified challenges and potential leverage points at three levels: individual motivations, organisational priorities, and structural factors.

The study findings informed a series of interventions across the system:

• Developing and using new health economic modelling approaches to demonstrate the health impacts of environmental changes, working with local government (Bristol City Council), national government (Ministry of Housing, Communities and Local Government) and property investors;
• Increasing collaboration across urban development and public health sectors, at national and local government levels, for healthier urban development policies and practices;
• Behaviour change messaging and training for private sector developers;
• Demonstrating the value of Health Impact Assessments and strengthening legal capacity for health in urban development;
• Developing creative ways to involve the public in urban development decision-making through sharing lived experiences of health inequalities associated with the built environment.

Interventions and evaluations are ongoing. However, early insights show they are influencing policy and practice across the complex system of urban development, supporting the creation of healthier environments and tackling health inequalities.

Le Gouais A, Bates G, Callway R, Kwon HR, Montel L, Peake-Jones S, White J, Hasan MN, Koksal C, Barnfield A, Bondy K, Ayres S. Understanding how to create healthier places: A qualitative study exploring the complex system of urban development decision-making. Health Place. 2023 May;81:103023. doi: 10.1016/j.healthplace.2023.103023