Delivering system-wide interventions to improve health

How is TRUUD addressing the issues and barriers facing different systems and stakeholders through a range of targeted interventions?     

 

We created a conceptual framework diagram to demonstrate how we are intervening across different sectors and levels of government to improve the quality of the urban environment and reduce non-communicable diseases.

This illustrates the problems we identified; the mechanisms for delivering interventions; and the outcomes anticipated in areas targeted by interventions.

Conceptual Framework

Conceptual framework

TRUUD’s conceptual framework

To complement the framework, this chart provides evidence points for further reading. See also our TRUUD Phase 1 Report for the background to how we arrived at seven interventions.

Intervention areas problems mechanisms and outcomes

Intervention
Area		 Problems Identified1 Mechanism Expected Outcomes
Private Sector: Changing Mindsets
  • Relative inertia on health for many reasons
  • Feelings of powerlessness to change2
  • Evidence-informed influencer model (drawing on HAUS, lived experience and legal team insights)
  • Increased recognition of health responsibilities of industry
  • Increased intention to act on health
  • Increased joined up working on health
Private Sector: Real Estate Investment
  • Lack of health data to inform commercial real estate investment decision making that mitigates ESG societal health risks and optimises returns to investors3
  • New valuation tool (HAUS)
  • Health data intelligence for application in real estate asset investment management
  • Increased pro-health commercial real estate investment aligned with societal wellbeing
National Government: Urban Policy
  • Lack of health outcomes in funding4
  • Lack of joined up working
  • Wider determinants not considered5
  • New valuation tool (HAUS)
  • Combined with governance improvements
  • HAUS tool included in related government tools and processes
  • Greater coherence between government departments on health (DHSC, DLUHC, Treasury)
  • Awareness and advocacy for
    HAUS tool in national level
    stakeholders
City-Region Government: Transport Strategy
  • Lack of small area health outcome data
  • Transport policy criss-crosses different policy sectors and there are tensions to align different priorities
  • Improve the shared evidence base for joint working6
  • Improved data and KPIs
  • Health measures embedded in urban development practice
  • More sustainable impact through action learning
  • Co-created tools and visualisations
Local Government: Spatial Planning
  • Health not fully factored into spatial plan and planning policy7
  • Healthier place-making principles in spatial regeneration framework
  • Stronger health requirements, language and signposting in local plans in Bristol and other local authorities
  • Health Impact Assessment communicates health impacts and stakeholder requirements
Local Government: Legal Capacity
  • Lack of legal confidence in LPAs
  • Lack of consistency at PI8
  • Training modules/materials
  • Increased legal capacity to
    effectively use Health Impact
    Assessment in planning
    process
Local Community: Enhanced Engagement
  • Weak voice of those experiencing inequalities
  • Health data and sharing of lived experience lacking in public-decisionmaker interface
  • Engagement activities more likely to meet the needs of decision-makers than the public8
  • Deliberative engagement process for health-promoting initiatives
  • Increased sharing of health evidence with the public to inform early deliberations
  • Improved messaging to and communication with lay publics
  • Improved public understanding of factors driving decisions and decision-making process
  • Increased communication of lived experiences (especially experiences of health inequalities) to decision makers and amongst stakeholder publics
  • Public engagement meets the needs of decision makers and public

1 Understanding how to create healthier places in Health and Place (2023)
2 Changing corporate mindsets briefing
3 Theory of change presentation and urban planning and public health editorial in Built Environment (2023)
4 Briefing notes on shaping the use of health impact evidence and revealing the health costs of the urban planning policy environment; papers on what needs to happen to level up public health in Contemporary Social Science and how value is enacted by public actors within urban development funding and the implications for levelling up in England in Environment and Planning (2023); and an evidence submission to the Public Accounts Committee inquiry on delivering value from government investment in major programmes.
5 Papers on What types of health evidence persuade policy actors in a complex system in Policy and Politics (2023), Urban policies and the creation of healthy urban environments: A review of government housing and transport policy documents in the United Kingdom in Journal of Urban Affairs (2023); article Tackling Health Inequalities in IPPR Progressive Review (2023) and evidence submission to the Public Accounts Committee inquiry on cross government working.
6 Briefing Introducing a health evidence base with Transport for Greater Manchester and paper Meaningful Engagement an Approach to Healthier Urban Development and Planning in Built Environment (2023)
7 Papers Exploring the views of planners and public health practitioners on integrating health evidence into spatial planning in England in Journal of Public Health (2021), Urban planning as an enabler of urban health: Challenges and good practice in England following the 2012 planning and public health reforms in Land Use Policy (2019), Integrating Health into Local Plans: A Comparative Review of Health Requirements for Urban Development in Seven Local Planning Authorities in England in International Journal of Environmental Research and Public Health (2023) and a study report for Public Health England (2019)
8 Papers Harnessing the power of the law: a qualitative analysis of the legal determinants of health in English urban planning and recommendations for fairer and healthier decision-making in BMC Public Health (2023) and Who determines ‘the legal’ within the legal determinants of health? A qualitative analysis of actors’ use of the law to promote health in the English urban planning system (to be published).
9 Briefing Using lay knowledge to transform understanding of links between the built environment and health (2024)

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