Fixing gaps to promote good health through the art and science of city making
TRUUD External Advisory Board Chair, Sunand Prasad OBE explains why and how this research programme is cutting-through to improve place-making for better health in the UK.
I am delighted to have taken on chairing the External Advisory Board for TRUUD, which is a huge, and hugely promising, research project: Tackling Root Causes Upstream of Unhealthy Urban Development. The quirky and earnestly academic title describes the research aim with high precision.
There is wide consensus about the impact of urban environments on personal and population health. The veteran Public Health expert Richard Jackson used to tell the story of seeing a middle-aged woman walking along the dusty verge by side of a six-lane highway in Los Angeles, struggling with shopping bags, in high summer heat under a harsh. Richard wondered about stopping to help but drove on, inhibited by that confusion so many feel at such times. Feeling guilty, he started imagining the woman collapsing, being taken to hospital, and dying. He imagined the Death Certificate stating ‘Cause: Heatstroke’. Then it occurred to him that it should be ‘Cause: Bad Urban Design’.
There are many ways in which our built and natural environment has positive and negative impacts on health. Access to open space and nature, or residential design that enables social interaction promote good physical and mental health. Ambient air pollution, noise, the urban heat island effect, unsafe or convoluted pedestrian routes harm health. Such determinants of health intersect with income and wealth inequalities, magnifying them such that, as the Marmot Review found, life expectancy in neighbourhoods drops by one year per London Underground stop going east from Westminster.
These impacts are well evidenced and have been known about for years. The science and art of city making is not short of big ideas and highly plausible solutions to create healthier and safer places. There are many dedicated, well informed experts and lay people working hard to improve things. However, implementing even simple good practice is frustratingly difficult. TRUUD is identifying precisely where, at the head of decision making chains, are the weak links that let through policies, procedures and cultures which give rise to health harming urban developments. At the same time potential correctives are being proposed and tested through extensive engagement both with specialists and the public.
One of the areas of intervention tackles ways to position health and health inequality more centrally in the mindsets of senior decision makers. This is ultimately about behaviour change and about as upstream as you get: very ambitious but being approached in a logical and targeted way. Another strand of the work seeks to incorporate health considerations in property investment and land development processes. Can health and wellbeing indicators be incorporated alongside, or as part of, ESG measures in property financial investment risk appraisal? Can health elements weigh more in local planning procedures for land development and valuation, both economic and social? A third strand is exploring the use of law to promote the value of health, with a focus on health promotion and prevention of non-communicable diseases.
These intervention areas are supplemented by two major projects on the ground. The team is participating actively in developing Bristol City Council’s Frome Gateway spatial regeneration framework. For example, TRUUD researchers are evaluating different design options by modelling the health impacts associated with different environmental features and sharing this with the design team. Meanwhile, in Manchester the research grounding concerns transport planning. TRUUD is investigating how to use health impact measures to evaluate the impact of the Streets for All strategy.
The era when people automatically trusted experts is long past. It is not enough for policy to be science based and well-evidenced for it to attract consensus. The furor regarding the expansion of London’s Ultra Low Emission Zone is a prime example of this. So a further dose of realism in TRUUD’s work is provided by a sixth Intervention Area: Public Engagement, to make sure that the kinds of people on whom urban developments have the most impact are strongly involved in the TRUUD programme.