How can critical actors be incentivised to take a systems approach to pursue preventative public health?

Introduction In this article we explore how critical actors can be incentivised to take a systems approach to pursue preventative public health. More specifically, we focus on the link between urban environments and their effect on non-communicable diseases (NCDs), such as obesity, cancers, cardiovascular and respiratory disease. Improving urban environments as a route to preventative public health is well known but it is complicated and requires multi-actor decision-making. For example, reducing cardiovascular disease through better urban design will require global investment companies, central government, local planners, public health teams, private house builders and local residents to find ways to develop joint solutions. Methods We draw on 167 qualitative interviews with key actors from across the urban development system in England to explore how an innovative economic valuation tool – the Health Appraisal for Urban Systems (HAUS) tool – could support multi-actor decision-making. Analytic plan We analyse the data using a multi-stage, transdisciplinary thematic analysis. Coding involved a collaborative deductive and inductive process. Results Findings reveal that actors from state, market and civil society could see the value of this tool, which evidences the link between different features of the urban environment, health outcomes and their economic valuation. Indeed, actors confirmed that the tool offered something new to incentivise joint decision-making and there was an appetite for its use. Conclusion We conclude by arguing that the HAUS tool offers an important source of evidence to encourage cross-system collaboration for promoting preventative public health.