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Tackling root causes upstream of unhealthy urban development (TRUUD): Protocol of a five-year prevention research consortium

Black, Daniel; Ayres, Sarah; Bondy, Krista; Brierley, Rachel; Campbell, Rona; Carhart, Neil; Coggon, John; Eaton, Eleanor; Fichera, Eleonora; Gibson, Andy; Hatleskog, Eli; Hickman, Matthew; Hicks, Ben; Hunt, Alistair; Pain, Kathy; Pearce, Nick; Pilkington, Paul; Rosenberg, Ges; Scally, Gabriel

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Daniel Black

Sarah Ayres

Krista Bondy

Rachel Brierley

Rona Campbell

Neil Carhart

John Coggon

Eleanor Eaton

Eleonora Fichera

Andy Gibson
Associate Professor in Patient and Public Involve

Eli Hatleskog

Matthew Hickman

Ben Hicks

Alistair Hunt

Kathy Pain

Nick Pearce

Ges Rosenberg

Gabriel Scally


Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact.

Journal Article Type Article
Acceptance Date Jul 5, 2022
Online Publication Date Jul 8, 2022
Publication Date Jul 25, 2022
Deposit Date Oct 20, 2022
Publicly Available Date Oct 21, 2022
Journal Wellcome Open Research
Electronic ISSN 2398-502X
Publisher F1000Research
Peer Reviewed Peer Reviewed
Volume 6
Pages 30
Keywords Commercial determinants of health, Decision-making, Upstream, Risk, Non-communicable disease, Power, Inequality, Valuation, Urban environments, Public involvement, Planetary health, Co-production, Short-termism
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Tackling root causes upstream of unhealthy urban development (TRUUD): Protocol of a five-year prevention research consortium (3.6 Mb)


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