Health consideration in UK urban development: Systems mapping insights for interventions

This article maps and explores the system influencing the consideration of health in UK urban development decision-making based on interviews with 132 decision-makers in public, private and third sector roles. It implements a novel approach to construct and aggregate multiple causal loop diagrams to synthesise the perspectives of different stakeholder groups in a single model. It illustrates how seven interventions targeting different parts of the system can influence feedback loops to drive change. Focusing on sub-models, the findings suggest that intervening to (1) change mindsets and (2) influence real estate investment practices of the private sector can shape pro-health attitudes, pro-health funding, and health-informed decisions, and (3) embedding a health valuation tool in national government can generate political support for health in policies, joined-up thinking and collective responsibility for health. Utilising health data in (4) transport strategies and (5) spatial planning, as well as (6) providing legal training, and (7) integrating lived experience in community engagement at a local and city-region level can enhance quantitative and qualitative health data in policies and decision-making while providing the capacity to legally defend those decisions. Overall, the causal loop diagram indicates that the interventions can reinforce the consideration of health in urban development decision-making without many factors resisting change. However, if health measures in urban development are perceived to limit profits rather than realise environmental, social and governance (ESG) value, then this acts as a balancing mechanism. The model can inform a systems-level evaluation by indicating the ripple effects and cumulative impact of interventions. • Presents system influencing health consideration in UK urban development decision-making • Causal loop diagram synthesises views of different stakeholder groups from interview findings. • Public and private sector sub-models identify key feedback loops driving perceived behaviours. • Seven interventions show potential to improve health consideration through feedback loops. • Model could inform a systems-level evaluation of the cumulative impact of interventions.