Tackling complex system challenges like creating healthy environments requires understanding priorities and structures affecting multiple actors. This qualitative study, involving 132 multi-sectoral stakeholders spanning the urban development decision-making system, explores how to influence healthier place-making. Using thematic analysis we develop themes around competing stakeholder priorities; structural 'rules' and influential relationships; and justifying a focus on health, requiring greater clarity and consensus around definitions of 'healthy' urban development. Building on the socio-ecological model we highlight how a multi-faceted approach is required for change at multiple levels in the complex system to target individual actor motivations, organisational priorities and structural 'rules'.

Large scale, multi-organisational collaborations between researchers from diverse disciplinary backgrounds are increasingly recognised as important to investigate and tackle complex real-world problems. However differing expectations, epistemologies, and preferences across these teams pose challenges to following best practice for ensuring high-quality and rigorous qualitative research, while maintaining goodwill and team cohesion across team members. This article presents critical reflections from the real-world experiences of a team navigating the challenges of collaborating on a large-scale, cross-disciplinary interview study. Based on these experiences, we extend the literature on large team qualitative collaboration by highlighting the importance of balancing autonomy and collaboration, and propose eight recommendations to support high quality research and team cohesion. We identify how this balance can be achieved at different times: when centralised decision-making should be prioritised, and autonomy can be allowed. We argue that prioritising time to develop shared understandings, build trust, and creating positive environments that accept and support differing researcher perspectives on qualitative methods is paramount. By exploring and reflecting on these differences, teams can identify how and when to support autonomy in decision-making, when to move forward collaboratively, and how to ensure that shared processes reflect the needs of the whole team. The reflexive findings, emanating from practical experience, can inform large research teams undertaking qualitative studies to explore complex issues. We make an original contribution to qualitative methods research by arguing that balancing autonomy and collaboration is the key to promoting high quality research and cohesion in large teams.

A local plan is a statutory policy document that supports urban development decisions across a local government area in England. Local plans are reported to need more specific requirements for development proposals regarding wider health determinants to address potential health outcomes and health inequalities. This study reviews the integration of Health in Local Plans of seven local planning authorities through documentary analysis methods. A review framework was formulated based on health and planning literature regarding local plans, health policy and determinants of health and dialogue with a local government partner. The findings identify opportunities to strengthen the consideration of Health in Local Plans, including ensuring that policies are informed by local health priorities and signpost national guidance, strengthening health-related requirements for developers (e.g., indoor air quality, fuel poverty and security of tenure) and improving implementation of requirements for developers (e.g., through adoption of health management plans and community ownership). The study identifies further research needs regarding how policies are interpreted by developers in practice, and on national guidance for Health Impact Assessment. It highlights the benefit of undertaking a comparative review, contrasting local plan policy language and identifying opportunities to share, adapt and strengthen planning requirements regarding health outcomes.

Background: Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for ‘active living’ infrastructure (ALI)—walking and cycling infrastructure and open spaces in new communities. Methods: Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically. Results: Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. ‘Evidence’ for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant. Conclusion: We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

The aim of this article is to examine what needs to happen in central, sub-regional and local government to ‘level up’ public health in the United Kingdom (UK). The Government’s recent Levelling Up White Paper outlined ambitious targets for reducing regional disparities, including a ‘mission’ to tackle inequalities in healthy life expectancy and reduce inequalities in the social determinants of health outcomes. However, the approach has been criticised for failing to integrate population health policy objectives, programmes and interventions into the implementation of the levelling up agenda and its associated ‘missions’. Drawing on a case study of promoting healthy urban development in the UK, we examine how the wider determinants of health might be incorporated into the Government’s levelling up strategy. Based on in-depth interviews with 132 urban development actors, our findings reveal that long-term investment in healthy urban development could play a key role in levelling up public health but is not currently part of the Government’s plans. We make a timely contribution to the levelling up debate by placing public health centre stage in social science debates. We conclude by offering a series of recommendations for transformative policy change to level up health.