There is increasing public and political awareness of the impact of air pollution on public health. Strong scientific evidence links exposure to air pollution with morbidity and mortality. Deprived communities may be more affected, however, with limited evidence on how deprivation may influence their personal exposure to air pollution, both outdoors and indoors. This paper describes different factors that may lead to low-income households being exposed to higher levels of indoor air pollution than the general population, using available data and models for London (i.e. living in areas of higher outdoor air pollution, in poor-quality housing, undertaking more pollution-generating activities indoors and spending more time indoors). A systems approach is used to show how these factors lead to systemic exposure inequalities, with low-income households having limited opportunities to improve their indoor air quality. This paper can inform actions and public policies to reduce environmental health inequalities, considering both indoor and outdoor air.

Incorporating consideration of causal mechanisms of complex policy issues and goals is critical for policy design, but tools to support exploration of the interconnections, trade-offs and unintended consequences of a focused policy issue are limited. Understanding how to undertake systems-based policy design is crucial for designing effective policy interventions. Through a case study with two housing associations (HAs) in England, this paper explores how group model building (GMB) workshops, as a systems thinking tool, can elicit complex causal mechanisms to inform policy design. The paper presents a causal loop diagram (CLD) describing English HAs’ decision-making around sustainable and healthy housing in response to housing policies. The CLD illustrates how frequent policy changes and disjointed objectives can create disruptive challenges for HA’s long-term decisionmaking, increasing short-term decision-making, and compromising the delivery of housing policy goals as an unintended consequence. We argue that the systems perspective of the interlinkages between policy design, specifically inconsistencies and changes, and housing organisations’ reactions highlights the importance of the systems thinking approach of policy design to support HAs’ organisational decision-making for sustainability and social issues. Policy design elements that facilitate HAs’ long-term decision-making are discussed. Through the case study, we contribute to the housing policy literature by explicitly showing how policy changes affect HA’s decision-making. We advance the integration of policy design and soft operational research fields by describing the systems thinking approaches are used not only on the content of policy design to enhance a particular policy, but also on increasing our understanding of its process, by generating insights about the nature of decision-making dynamics and challenges faced. Limitations and implications for future research are discussed.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

In urban regeneration projects, balancing environmental, social, and economic aspects is crucial but challenging, often leading to mission drift when team focus deviates from the original goals. Through a case study of regeneration projects at a large U.K. housing association, we explore decision makers’ attention to sustainability, health, and well-being as core elements of social mission. We combined qualitative analysis with an examination of structural complexities and system behaviors, adopting a systems thinking perspective. Analysis of attention patterns in regeneration meetings reveals that attention to the social missions was not sustained, with evident attention shifts toward financial costs and risks. Also, sustainability is prioritized less than health and well-being topics. We use a causal loop diagram to describe the underlying mechanisms that drive attention dynamics, highlighting how the structural complexities can undermine sustainable development in regeneration. Finally, we propose strategies to sustain attention toward sustainability, health, and well-being in regeneration.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.