Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD)

我们的首要研究问题是：如何将导致非传染性疾病（NCDs）的风险因素预防考虑并充分纳入英国的城市规划和发展？背景：城市环境质量差是造成肺病和心脏病、糖尿病和精神健康问题等非传染性疾病的重要因素。这是因为它们与关键的风险因素有关，包括空气污染、噪音、缺乏体育活动、缺乏绿色空间和肥胖。因此，预防这些未来重大慢性健康问题的一种方法是“逆流而上”，改善城市环境，从而鼓励健康行为并减少不利风险。然而，城市规划和发展是一个复杂的系统，参与者和过程在多层治理上运行。城市规划和发展的驱动力现在是大型私营部门行为者，特别是土地所有者、投资者和开发商。狭窄的估值机制和短期眼光是一个主要挑战，因为它们没有考虑到长期健康。城市规划也面临着“超级邪恶”的问题——“那些最有能力解决问题的人不仅是那些造成问题的人，而且是那些最没有立即行动动力的人”。研究这些复杂的系统需要：考虑整体和相互关联的系统；清晰的可视化和分析；与广泛的利益相关者（包括公共、私营、第三部门以及学术界和普通公众）进行有效的参与和“合作生产”。应用：我们的目标是改变城市规划和发展系统，使健康和卫生不平等在核心决策的每个主要根源中得到重视和整合。我们将与城市发展决策者一起，制定权力和国家一级的联合干预措施，并制定调整系统的方法，使公共和私营部门的运作更加健康。干预措施有三个组成部分：健康影响的证据，包括经济评估；变革的机会；社区主导的传播健康不平等的创意艺术媒体。我们将确定引入干预的最佳杠杆点。我们期待证据和相关工具的一系列应用。它们将提供可衡量的健康影响证据，以多种方式加以利用，包括：地方和国家规划政策；地方开发管理和规划许可；基础设施及其他投资决策的成本效益分析；以及重新调整公司治理以实现长期健康结果的政策或法律机制。例如，我们将设法影响城市规划对健康影响的证据，并将其引入住房和经济用地可用性评估中，该评估决定要开发哪些土地。受益者：这种整体系统方法的受益者包括：a)决策者通过提高他们所提供的质量（例如，地方政府将通过证明社会效益而在政治上受益；进步的投资者和开发商通过区分他们的“产品”而在商业上受益）；B)从中长期来看，城市环境的改善（例如空气污染减少、绿色基础设施质量提高、自然环境改善）应对城市和农村人口产生积极影响；c)纳税人和中央政府长期受益，因为NHS的健康负担减轻了，生产力水平提高了。

Our overarching research question is: How might prevention of risk factors causing Non-communicable diseases (NCDs) be considered and fully incorporated into urban planning and development in the UK?Context: Poor quality urban environments are important contributors to Non-Communicable Diseases such as lung and heart disease, diabetes and mental health problems. This is because they are associated with critical risk factors - including air pollution, noise, lack of physical activity, lack of green space, and obesity. Therefore, one way of preventing these future major chronic health problems is to go "upstream" and improve the urban environment so that it encourages healthy behaviours and reduces adverse risks. However, urban planning and development is a complex system of actors and processes operating over multiple layers of governance. . The driving force in urban planning and development are now the large private sector actors, particularly landowners, investors and developers. Narrow valuation mechanisms and short-term horizons are a central challenge as they do not factor in long-term health. Urban planning faces "super wicked" problems too - where "those who are in the best position to address the problem are not only those who caused it, but also those with the least immediate incentive to act". Researching these complex systems requires: consideration of whole and interconnected systems; clear visualisation and analysis; effective engagement and 'co-production' with a wide range of stakeholders, including public, private, third sector as well academia and the lay public. Applications: We aim to transform urban planning and development systems so that health and health inequalities are valued and integrated at each of the main roots of core decision-making. We will develop with urban development decision-makers at city, combined authority and national level interventions and methods for realigning the system for healthier public and private sector operations. The intervention has three components: evidence of health impact including economic valuation; opportunities for change; community-led creative arts media communicating health inequalities. We will identify the best leverage points for introducing the intervention.We anticipate a range of applications for the evidence and associated tools. They will provide measurable evidence of health impacts to be used in multiple ways including: local and national planning policy; local development management and planning permissions; cost-benefit analysis on infrastructure and other investment decision-making; and policy or legal mechanisms for re-aligning corporate governance towards long-term health outcomes. For example, we will seek to influence and introduce evidence on health impacts of urban planning into the Housing and Economic Land Availability Assessment, which determines what land is to be developed. Beneficiaries: The beneficiaries of this kind of whole system approach include: a) decision-makers by improving the quality of what they offer (e.g. local government will benefit politically by evidencing societal benefit; progressive investors and developers gain commercially by differentiating their 'product'); b) in the medium to longer term, urban and rural populations should be positively affected by better urban environments (e.g. reduced air pollution, better quality green infrastructure, improved physical environment); and c) taxpayers and central government over the long term due to decreased health burden on the NHS and increased levels of productivity.