Built environment stakeholders' experiences of implementing healthy urban development: an exploratory study

Healthy urban development, in the form of buildings and infrastructure, is necessary to reduce disease and injury internationally. The urban development process is complex, characterised by a plurality of actors, decisions, delays, and competing priorities that affect the integration of health and wellbeing. Despite clear shifts in the built environment sector towards considering health, there is a lack of research about how the principles of healthy design are put into practice in development projects. We explored this topic via semi-structured interviews with 31 built environment and public health professionals involved in such projects in Australia, China, England, the Netherlands, Sweden and the United States. We used thematic analysis and three themes emerged from our hybrid deductive and inductive approach, encompassing challenges and potential solutions for integrating health in development. Managing risk, responsibility and economic constraints were paramount to persuade developers to adopt healthy design measures. Participants could push business-as-usual practices towards healthy urbanism by showing economic benefits or piloting new approaches. Finally, participants had contrasting views on whether increasing professional knowledge is required, with several arguing that financial barriers are more problematic than knowledge gaps. This exploratory study contributes insights into an under-research topic and outlines priorities for further investigation.