Research Overview

Our main aim is to work with decision makers and communities to prioritise health in urban decision-making processes.  We are particularly focused on how non-communicable diseases (NCDs) can be prevented by changing the way that urban development decisions are made.

NCDs are illnesses that cannot be passed from person to person.  There has been a lot of research that have proven links between NCDs and the urban environment.

We are focusing on major new infrastructure and transport systems in our case study areas of Bristol and Greater Manchester.  We are working with senior decision-makers, related stakeholders (including community partners), and advisors at national, regional and city level.  With them, we will identify where the most influence on decision-makers lies (e.g. land disposal, procurement, regulation, economics), then develop and test ways to prioritise health.

We are also exploring the existing decision-making system (for example, the role of economic valuation in decision-making, alternative decision and valuation mechanisms, legal mechanisms such as Social Value Act).  We are working to understand the blockages in the current system that can prevent health being a priority when decisions are made about developments to our urban environment (e.g. corporate structures, values, incentives).

We plan to produce a decision-support framework that will outline and work within the limitations of the decision-making system.  We will also incorporate targeted industry-driven improvements to existing processes alongside these decision-support tools.

What is TRUUD?

TRUUD is a programme that contains six work packages (WP), delivered in four phases:

Phase 1: Understanding the urban decision-making system;

Phase 2: Developing and trialing the intervention;

Phase 3: Refining the intervention;

Phase 4: Sharing our findings.

We will develop an intervention with key users that will use evidence to target critical points of leverage within the urban development system. There are three components to the intervention:

Leverage points

We will work with key stakeholders to identify potential opportunities and mechanisms for improving health outcomes, e.g. health externalities integrated into: a) cost-benefit analysis (CBA), b) development control, c) infrastructure investment decision-making, d) governance restructuring (WP1 and 3).


We will use existing evidence to identify potential health improvements.  We will then develop a database to provide an estimated cost for potential changes and health outcomes (WP2).

Public involvement

We will work with community partners and decision makers, devising creative ways to communicate experiences of health inequalities driven by the physical environment (WP4). We will present this visual evidence to key decision-makers, and work with them to identify system changes that are deemed most likely to improve health and reduce health inequalities.

At both local and combined authority level we will start by using at least one large-scale development case study to make the benefits of the research relevant to decision-makers in the first phase of TRUUD. In the second and third phases we will test and refine the interventions. We will follow an iterative process, evaluating the extent to which attitudes, behaviours, policy and practice changes amongst our target users, refining and testing changes accordingly.

Systems modelling

Group model building workshops and system dynamics modelling: Taking a Critical Systems approach, conceptual models developed from qualitative data are being used to build and then test, in focus group and workshop settings, the multiple understandings (views) stakeholders have of land use decision-making in urban areas and how these impact on public health. Boundary critique, interdependency mapping and system dynamics modelling are some of the methods and tools being used to understand the problem structure, diagnose challenges and support the design of health improvement interventions.

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