New economic tool could push cities to put public health first in planning

Senior urban development decision-makers across England have admitted that there is currently little incentive for them to consider public health impacts when shaping towns and cities, a gap that researchers believe has left preventable disease embedded in the fabric of the built environment. A new study, led by academics at the University of East London in collaboration with the University of Bath and the University of Bristol, argues that an innovative economic valuation tool known as the Health Appraisal for Urban Systems, or HAUS, could fundamentally change that calculus by translating the health consequences of planning decisions into the financial language that governments and developers understand best.

The relationship between the urban environment and public health is one of the most robustly established findings in modern epidemiology. The quality of housing, the design of transport infrastructure, the availability of green space and the walkability of neighbourhoods all measurably influence the risk that residents will develop life-threatening conditions. Poorly connected communities with limited access to parks and active travel options show elevated rates of obesity, cardiovascular disease, respiratory illness and several cancers. Yet despite decades of evidence, improving urban environments as a preventative public health measure remains extraordinarily complex, because it demands coordinated action from multiple actors with different mandates, budgets and priorities. Planning authorities, housing developers, transport agencies and health services each hold only part of the levers required to create healthier places, and no single organisation bears the full cost of the diseases that bad design can produce.

It is precisely this fragmentation that the researchers set out to address. To assess how economic evidence could support more integrated decision-making, the team conducted 167 qualitative interviews with key stakeholders drawn from across England’s urban development system, spanning national and local government, private industry and civil society. The interviews explored in depth how the HAUS tool could support collaboration and informed decision-making across sectors that rarely share a common evidence base or a common metric of success. What emerged was a striking consensus: stakeholders recognised the value of HAUS as a new way to support shared decision-making and to create incentives for organisations to work together toward better health outcomes, precisely because it assigns an economic value to impacts that have historically been invisible in development appraisals.

The technical core of HAUS is a valuation model that links specific features of the environment to health outcomes and their associated economic costs. The tool quantifies and monetises changes in disease occurrence and premature mortality linked with different urban development interventions and affecting local populations. In practical terms, a proposal to add walkable streets, expand green infrastructure or improve housing quality can be assessed not only in terms of construction costs and property values, but also in terms of the expected reduction in NHS treatment costs, productivity losses and the broader societal burden of illness. By translating health outcomes into economic terms, the tool helps decision-makers grasp the long-term value of healthier urban environments and supports more informed investment and planning decisions that might otherwise be dismissed on short-term financial grounds.

The tool did not appear from nowhere. It was initially developed during an earlier research pilot and was further refined throughout the project in collaboration with the UK’s Ministry of Housing, Communities and Local Government, giving it an unusually direct route from academic prototype to policy application. That collaboration has now borne institutional fruit: the ministry has adopted HAUS in its appraisal guides for local authorities, embedding health valuation into the standard machinery of English planning assessment. For a field in which public health arguments have long struggled to compete with housing delivery targets and economic growth imperatives, this represents a significant shift in what evidence counts when the future of a city is decided.

Dr Andrew Barnfield, Senior Lecturer in public health at the University of East London and co-author of the study, emphasised that the tool changes what decision-makers are able to see. ‘The HAUS tool enables decision makers to account for health costs that are linked with the urban environment,’ he said. ‘As our work shows, this is vital for making healthier and more equitable places.’ The equity dimension matters because the health burden of poor urban design falls disproportionately on disadvantaged communities, which are more likely to live near major roads, in lower-quality housing and with limited access to green space. By making these costs explicit, HAUS gives advocates for those communities a quantitative argument that resonates in boardrooms and town halls alike.

Professor Sarah Ayres, from the University of Bristol’s School for Policy Studies, framed the development as a genuine methodological milestone. ‘The collaboration between TRUUD and the Ministry of Housing, Communities and Local Government has created a version of the Health Appraisal of Urban Systems model which is to be used for housing, community and local government interventions,’ she said. ‘For the first time, there are now methods to quantify and value the potential health impacts of urban interventions for specific populations.’ The reference to TRUUD, the research consortium on urban health decarbonisation and decision-making of which the three universities are part, underlines the scale of the effort required to move such tools from theory into the working routines of government.

Dr Geoff Bates, from the University of Bath’s Institute for Policy Research, argued that the economic framing is not a concession to fiscal orthodoxy but a strategic necessity. ‘Making the economic case to pursue preventative policies is one way that can persuade policymakers to act to improve long-term health and wellbeing,’ he said. ‘Improving policymaker access to evidence and tools like HAUS that demonstrate the savings to the public purse from investing in healthier housing and urban environments is a step towards improving public health.’ The logic is familiar from other domains of preventative policy: the costs of disease are diffuse and delayed, while the costs of intervention are immediate and concentrated, and only tools that render future savings visible can rebalance that asymmetry in political decision-making.

The findings arrive at a moment when the pressures on urban systems are intensifying. Rising obesity rates, an ageing population, persistent air pollution and the health impacts of climate change all converge on the built environment, and health services across the developed world are increasingly looking upstream toward prevention. The researchers conclude that HAUS provides valuable evidence to encourage cross-sector collaboration and to embed preventative public health into urban development decisions, shifting the question from whether cities can afford to prioritise health to whether they can afford not to. If the tool’s adoption by national government spreads through local authority practice, the healthier city may cease to be an aspiration and become, at last, an audited line in the appraisal.

Subject of Research: Economic valuation of public health impacts in urban development decision-making

Article Title: Economic tool could help cities prioritize public health in urban development

Article References: Economic tool could help cities prioritize public health in urban development. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: urban development, public health, HAUS tool, economic valuation, planning policy, prevention, health equity, built environment, stakeholder interviews, England, University of East London, ministry adoption