Evidence alone is not enough to promote health in urban places

Anna Le Gouais has been with TRUUD since 2020 as our embedded researcher in local government with Bristol City Council. In this role she bridges the worlds of academia and practice to support the creation of healthier environments.  Here she reflects on the findings of her latest paper and the key learnings to increase health in urban areas.

 

My embedded researcher role has enabled me to learn about the challenges facing local government, and why it can be so difficult to ensure that healthy places are built. So while we have lots of health evidence to show that where we live, work and travel through can affect our health and wellbeing – issues like air pollution, noise, transport infrastructure, housing quality and cost, community spaces and greenspaces – evidence alone may not be enough to change an urban development system that may not prioritise health outcomes.

However, there are opportunities to increase health considerations as I discovered during my time with the city council’s regeneration team:

1. Increase collaboration across public health and urban development teams in local government. This can help to highlight health and wellbeing issues and opportunities for improvement through changing environments. This health evidence can supplement effective community involvement so that development plans can be produced with local community needs in mind. Roles that span across public health and urban planning are important to ensure relevance and impact, especially as different disciplines have different ways of doing things.
2. Health evidence can be used at multiple stages in a development project:
   – Early on it can highlight unhealthy problems in the local area, and identify issues that need consideration during design processes so that health improvements for local communities can be sought.
   – During design processes health evidence may support good, or aspirational, design solutions, such as increasing the quantity of greenspace. This can be useful to justify design solutions which may be more difficult or expensive to achieve. Demonstrating the health benefits can help achieve wider support.
   – During consideration of different design scenarios health evidence can inform consideration of competing issues. Highlighting how health outcomes may be affected by different scenarios, for example relating to housing affordability, heat vulnerability, movement, air quality, noise, and greenspaces, can ensure health considerations are factored into decisions, alongside other important issues, including deliverability of new homes.
3. Design processes can be supported by iterative Health Impact Assessments (HIAs), with a final HIA published at the end of the process which clearly states expectations for stakeholders to facilitate healthy place-making.

I have found that being an embedded research has been a useful way to develop trusted relationships with local government partners, enabling more in-depth understanding of challenges and opportunities than other research approaches may allow, such as through interviews alone. This has allowed us to test and evaluate health evidence interventions to support creation of healthier environments.

This type of collaborative approach, involving embedded researchers in partner organisations, can be a valuable approach to enable academics to better understand policy and practice contexts, and co-design interventions to increase our understanding of how to tackle complex public health challenges.

I hope that showing the value of public health involvement in urban development practice can lead to better integration across these important areas so that our towns and cities can be healthier places for all.