Encouraging change in different parts of government
Aims
To increase receptiveness for, and inclusion of, health and health inequalities in Whitehall urban development decision making.
Methods
Using insight from 123 in-depth interviews we applied a systems thinking perspective to demonstrate how economic valuations of health can incentivise and shape collective decision-making.
This included more than 120 meetings across government and the introduction of a Cross-Whitehall Working Group and a Mayoral Combined Authorities Working Group to discuss the use of TRUUD evidence at multi-governance levels. To incentivise change across government, civil servants, think tanks, policy advisors and combined authorities were involved in the development of the Health Appraisal in Urban Systems (HAUS) model.
Read our report from our latest government event: Creating Healthy Urban Environments Through Systems Thinking (June 2025)
Outputs
Our work has instigated:
- The inclusion of the HAUS model in related government tools and processes, specifically the formal adoption by the Ministry of Housing, Communities and Local Government (MHCLG) in its revised appraisal guidance. This means that any national investment in major urban development programmes will have an opportunity to consider the impact on public health and the associated costs of ill-health;
- Greater coherence and partnership working between government departments on health prevention, including the Ministry of Housing, Communities and Local Government, HM Treasury and Department of Health and Social Care; and
- Awareness of and advocacy for the HAUS tool among stakeholders at a national and sub-national level. We expect the HAUS tool to be used by government departments, combined and local authorities and relevant private and third sector actors.
Importantly, we expect the new relationships fostered by our co-production work, cross government collaboration and systems thinking to continue.
Resources
Read our briefing notes to find out more about our research journey and how we have achieved impact
Promoting health in government development funding and strategic decisions
Identifying what needs to change for healthier urban development
Adding value to existing government guidance with HAUS
Evidence used in the HAUS model
Joining up government for public health
Empowering mayors for preventative health
Planning reform and public health
Tackling health inequalities with healthy urban development
Health in government housing and transport policies
What needs to happen to ‘level up’ public health?
What types of health evidence are persuasive in a complex system?
How value is considered and used in urban development with implications for the levelling up agenda
Revealing the health costs of the urban planning policy environment
Discover our academic papers
Bates, G., Newberry, P., McClatchey, R. et al. How can health be further investigated in urban development policymaking in the United Kingdom? A systems mapping approach in Health Research Policy and Systems 23, 96 (2025). https://doi.org/10.1186/s12961-025-01379-9
Bates, G., Black, D., Ayres. S., Bondy, K., Carhart, N,. Kidger, J. (2025) Identifying intervention areas to shape healthier urban development in the United Kingdom PLOS Sustainability and Transformation, doi.org/10.1371/journal.pstr.0000176
Ayres, S., Newman, J., Sandford, M., Barnfield, A. and Bates, G. (2025) How democratically elected mayors can achieve mission-oriented policies in turbulent times. Regional Studies 59(1), pp. 1–14. doi: 10.1080/00343404.2025.2472014.
Barnfield, A. and Bates, G. (2025) Coding with a transdisciplinary team – A project exploring unhealthy urban development. Area. doi: 10.1111/area.12998.
Ayres, S., Newman, J., Bates, G., Le Gouais, A., McClathey, R. and Pearce, N. (2025) Are we any closer to tackling health inequalities in England?Contemporary Social Science 19(4), pp. 531–554. doi: 10.1080/21582041.2024.2430586.
Bates, G., Barnfield, A., Pearce, N. and Ayres, S. (2024) Why didn’t the ‘critical juncture’ of the COVID-19 pandemic lead to the re-integration of public health into urban development policy in England?Cities & Health, pp. 1–13. doi: 10.1080/23748834.2024.2442840.
Bates, G., Hasan, M.N., Barnfield, A. and Bondy, K. (2023) Urban policies and the creation of healthy urban environments: A review of government housing and transport policy documents in the United Kingdom. Journal of Urban Affairs, pp. 1–19. doi: 10.1080/07352166.2023.2260029.
Ayres, S., Barnfield, A., Bates, G., Le Gouais, A. and Pearce, N. (2023) What needs to happen to ‘level up’ public health? Contemporary Social Science 18(3-4), pp. 500–526. doi: 10.1080/21582041.2023.2232765.
Bates, G., Ayres, S., Barnfield, A. and Larkin, C. (2023) What types of health evidence persuade policy actors in a complex system?Policy & Politics, pp. 1–27. doi: 10.1332/030557321×16814103714008.
Barnfield, A. (2023) How value is enacted by public actors within urban development funding and the implications for levelling up in England. Environment and Planning F 3(4), pp. 323–342. doi: 10.1177/26349825231155880.
Bates, G., Le Gouais A., Barnfield, A., Callway, R., Md Nazmul, H., Kwon, H. R., Peake-Jones, S., White, J., Bondy, K., Ayres, S. (2023). Balancing Autonomy and Collaboration in Large-Scale and Disciplinary Diverse Teams for Successful Qualitative Research. International Journal of Qualitative Methods 22. doi: 10.1177/16094069221144594.
Discover our Theory of Change, events and evidence to government
Events
Creating Healthy Urban Environments through Systems Thinking (June 2025) event programme
Unhealthy Urban Development Root Causes Programme 2 July (July 2024) event programme
Evidence to government
Newman, J., Ayres, J., Bates, G. Written evidence to the Public Administration and Constitutional Affairs Committee, Mission Government, (April 2025) (MIG-15).
Jack Newman, Sarah Ayres, Geoff Bates and Anna Le Gouais. Submission to the National Planning Policy Framework review (Sept 2024).
Jack Newman, Sarah Ayres, Geoff Bates and Rachael McClatchey. Submission to the Public Accounts Inquiry on Delivering value from government investment in major projects (May 2024). Read the written evidence.
Sarah Ayres, Geoff Bates and Alex Wallace. Submission to the Public Accounts Committee Inquiry on Cross Government Working (November 2023) Evidence to public accounts committee on cross government working Nov 23
Geoff Bates, Andrew Barnfield, Sarah Ayres. Submission to the Department of Health and Social Care for evidence to support a Major Conditions Strategy (June 2023): Major conditions strategy response_submitted
Joint response to the Health and Social Care Committee Inquiry on Prevention in Health and Social Care (February 2023): AYRES Submission HSC Committee Prevention Inquiry
Listen to Professor Sarah Ayres and Dr Geoff Bates discuss policy and governance challenges
“I think TRUUD will have influence not just in the Ministry for Housing, Communities and Local Government but across departments in terms of their thinking. The research opens up lots of potential avenues where it is possible to intervene, improve health and make people’s lives better.”
Andrew Charlesworth-May, Appraisal Lead at the MHCLG
Academics
Professor Sarah Ayres at the University of Bristol
Dr Andrew Barnfield at the University of Bristol
Dr Geoff Bates at the University of Bath
Dan Black at the University of Bristol
Dr Eleanor Eaton at the University of Bath
Dr Alistair Hunt at the University of Bath
Dr Rachael McClatchey at the University of Bristol
Dr Jack Newman at the University of Bristol
Professor Nick Pearce at the University of Bath