We need to overcome short-termism if we are to make healthy places to live

Short-term thinking is now widely recognised as a problem in modern societies, but the full extent of this folly remains at the margins. Daniel Black and Geoff Bates look at the implications for urban development, and set out key findings on this topic drawing on interviews with 153 urban decision-makers from public, private and third sectors.

Short-termism is a long-recognised, but unaddressed problem

Short-termism has long been recognised as a problem affecting decision-making across both public and private sectors: e.g. short political cycles, quarterly shareholder reporting. New economic students are taught that most people prefer to take £1000 now rather than £10,000 later – i.e. Aesop’s “a bird in the hand is worth two in the bush” fable – but this inherent myopia prevents us from addressing far larger future problems.

Non-communicable diseases (NCD) such as obesity, diabetes, respiratory illness and heart disease cause 89% of deaths in the UK and most are preventable. They cost us many £billions every year and, as Covid-19 demonstred, make us extremely vulnerable to far higher costs. The climate and biodiversity crises are increasingly recognised as major health threats, with growing evidence of existing costs (e.g. growing levels of anxiety from those repeatedly flooded) and the Intergovernmental Panel on Climate Change suggesting we may be moving towards mass migration and conflict.

As others have pointed out more recently, including investor Warren Buffet, the value of Aesop’s short-termist advice depends on a number of factors: e.g. how likely we are to get the two birds in the bush, when it might happen, and how valuable they are. In other words, short-termism is rational up to a point, but we appear to have taken it to an extreme, creating a pervasive failure in systems thinking and effective risk management. We become the snake, eating its own tail.

We were not surprised therefore that short-termism was one of the main problem areas identified in our research programme on urban health following analysis of 153 interviews and workshops.

Our analysis from over 150 interviews

There has been increasing interest recently in how industry influences our health – the ‘commercial determinants of health’ – especially from ‘unhealthy commodities’ like foods high in sugars and fats, and ultra-processed foods. These issues are highly pertinent in urban development where the private sector plays a very significant role in maintaining and changing the places that we live and work in. As stated by the World Health Organisation: “Companies shape our physical and social environments”.

The quality of the places we live in are determined by highly complex ‘systems of systems’ that interconnect in many and varied ways, and there is no silver bullet: our pilot study identified 110 barriers and 76 opportunities for addressing issues of poor urban health across eight themes. In our follow-on much larger research programme, we uncovered a good deal more. We learned, for example, that:

1. ‘Health’ is both marginal and marginalised: Both public and private sectors recognise that ‘health’ is not being adequately accounted for or prioritised in urban development decision-making. Prevention is not considered holistically by those in charge; reactive healthcare dominates.
2. Quantity is given primacy, not quality: We see this in new housing targets and associated policies such as public asset disposal, which support the delivery of car-dominated urban sprawl and poor quality ‘permitted development’ refurbishment.
3. The private sector is supportive of change: Despite clear tensions and misunderstandings between public and private sector, many private sector actors are supportive of change, as long as it’s fair and with the right kind of regulation.
4. Legislation and minimum standards depend on leadership and culture change: Examples like the pioneering Future Generations Act 2015 (Wales) are revealing that even the best legislation is reliant on leaders and their people. The same is true of minimum standards, whether voluntary or otherwise, in organisations.
5. Finance and land are the primary controlling assets: The power of The City and who controls and values land were raised repeatedly as primary levers, with the potential for both immutable inertia and radical change. Planetary health – which includes human health and equality – should be the guiding principle on all board-level decision-making and on every meeting agenda.
6. Impact assessments can do little downstream: By the time impact assessment is carried out on a development proposal, the key ingredients have already been determined. If impact assessment is to be used effectively, it needs to be shifted radically upstream to the top tiers of decision-making.
7. Digi-tech needs numbers, not quality of life: ‘PropTech’’ is a rapidly increasing phenomenon (e.g. trading ‘illiquid’ assets, data ‘lakes’) and it is bringing rapidly shifting power dynamics. Given the inherent challenges in adequately and comprehensively quantifying social and environmental externalities, there is a clear incompatibility here that we need need to be aware of.

Making short-termism a strategic issue

Our recent paper on short-termism suggests suggests 16 key messages, the majority of which point to the need for bolder government intervention targeted specifically at reining in unhealthy commercial activities in urban development (e.g. car dependent housing and sprawl, unhealthy food and drink, air pollution, destruction and suppression of biodiversity). Our evidence shows that government intervention is expected and would be supported by private sector, if fairly enacted and strategically coherent.

Achieving change is easier said than done of course, and complex trade-offs are inevitable. Radical change may be needed and – just as coal-workers need new jobs – those people and companies whose practices need to shift will need support in this transition. Yet there will be just as many winners too in these new systems of delivery and we all will ultimately be better off. “More research needed” is a clichéd academic ending, but for the next steps in this area of research we’d like to see more work on understanding:

1. How can human and planetary health be prioritised at the heart of government and in every business, and especially in financial and property transactions?
2. How can government recognise the value of (and incentivize) quality alongside quantity?
3. What is – and what might be – the role of law in determining urban health outcomes?
4. What needs to change in order for public and private sector actors in urban development to work better together?
5. How else can we value planetary health, other than quantitively?
6. What complex trade-offs are needed, and how will these be negotiated?
7. How can digital technology serve us, rather than the other way around? What amount of technology is appropriate?

We started this blog with the image of the snake – ourselves – eating itself. It feels apposite therefore to end with another image of a snake, this one the universal symbol for health: the Rod of Ascelpius, the Greek God of Medicine.