Tackling Root Causes Upstream of Unhealthy Urban Development (TRUUD): Protocol of a five-year prevention research consortium

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.


Introduction and rationale
Upstream determinants of urban health There is substantial evidence linking non-communicable diseases (NCDs, e.g. respiratory illness, cardiovascular disease, diabetes, mental disorder, cancer) to: the quality of urban environments (e.g. air pollution, noise, lack of green space, physical inactivity, obesogenic food 'deserts') [1][2][3] ; socio-economic inequalities 4-6 ; and global environmental degradation, mainly caused by the resource consumption in cities 7,8 . NCDs are responsible for 89% of deaths in the UK, most of which are seen as avoidable 9,10 . Responsibility is dispersed across many agents 11,12 . Fast growing cities are the primary incubators of cultural, social, and political innovation, particularly the UK's Core Cities 13 , and local and devolved government plays a pivotal role at the interface between multiple private, public and third sector agencies 14 . However, the driving force in urban planning and developed in the UK, and across many industrialised nations globally, are large private sector actors -landowners, investors, developers -and political will focused on short, unsustainable timescales 15,16 . Increasingly, there is a push towards investigating upstream 17 , with a particular focus on the 'commercial determinants of health' 6 , the role of the private sector 18,19 , and to systems of governance 20 - Figure 1. This shift is described as part of a 'fifth wave of public health' 18,21 where key problems and solutions are to be found in the domains of, for example, international finance, trade, investment 22-27 . Public costs from environmental health outcomes downstream are increasingly recognised, but there appears to be a limited understanding of potential solutions.

Amendments from Version 1
As suggested, we have: added new information on UK NCDs; shifted the order of the Protocol section; added further details on more recent ethics approvals; updated the Figure 2- Figure 4 as recommended; provided information on the databases used in the literature review; added further detail on the evaluation approach. We have also responded in full to the reviewers comments.
Economics, valuation, decision-making and risk Key areas of concern in urban planning are likely to relate to narrow valuation mechanisms, prioritisation, issues of agency and power, short-term horizons, and inequality 18,28-32 . The role of monetary valuation is widely thought to be fundamental; it is a dominant mechanism in decision-making 22,33 . However, opinion as to the efficacy of its use in valuing human and planetary health varies [34][35][36] . As the UPSTREAM pilot and other projects suggest, decision-makers are aware that these types of valuations are not comparable to standard cost-benefit analysis, and are used to making decisions with limited information 30 . Over and above the challenge of effective valuation of externalities, there appears to be little evidence or understanding on how to integrate such external costs specifically into urban planning and development decision-making 30,37 . There appears to be a need therefore not only to develop and test new means of valuation targeted at key leverage points 38-40 , but also determine the strategic, political, ethical and behaviour shifts needed in corporate governance and associated regulation for prevention to be factored routinely in to core decision-making 19,41-47 .
Inequality and effective public engagement Material and power inequalities are primary drivers behind current tensions in society 4 . Investigating disparities in resource distribution and power dynamics is therefore fundamental 48,49 , as is the role of values in governance, and their implications for institutional agents 19,44 . Involvement of the lay public in urban planning is already mandatory and has been for many decades, yet societal impact remains limited [50][51][52][53] . A further challenge therefore relates to how meaningful and effective communication on health inequalities can take place between the lay public downstream and the complex systems of decision-making upstream 54 . Issues include: the complexity of the problem, the wide range of disciplines involved, the resource needed for effective co-production, the core focus on real-world impact, and the need for effective bridging between academia and practitioner groups. New approaches to research management, clear understanding of context, and the use of the creative arts in surmounting these barriers to communication may be part of the solution 55,56 .
Complexity, causation and the need for new approaches Addressing these highly complex challenge areas requires new approaches to research 18,57 based on strong theory that not only embrace systems approaches 58-60 , inter-/trans-disciplinary working and co-production with real world decision-makers and impacted stakeholders 61,62 , but also that have societal impact as a strategic goal and critical reflective practice as a central mechanism 57,63 . Systems approaches can enable researchers to navigate complexity, put 'strategic investment of energy in particular parts and processes of the system' 38 , and enable navigation of complexity by making 'implicit mental models explicit' 31 . Yet intervening in urban governance 'systems of systems' is not straightforward 64 . It requires us to 'balance between complexity and the reduction of that complexity' and to 'weigh the costs and the benefits' 65 . Research design in this space must look beyond simply the application of systems approaches 29,66 . There is a need for: state and non-state actors to work together 67,68 ; governance of multi-actors settings without reverting to command and control ('meta-governance') 25,69 ; recognition of local governments' limitations 30 and the dominant roles of the many and varied private sector controlling agencies and the wider political economic landscape 6,19,41,46 . Considerable challenges in better decision-making include not only the inevitable lack of evidence, but also demonstrably linking upstream decision-making with downstream health outcomes 70-72 . This is particularly challenging given the length of time it can take for urban developments to be built, the need for political will to change, and the significant uncertainty around future impact 32,43,73,74 . Researchers must work alongside real-world actors if solutions to these complex global challenges are to be found [75][76][77] . This has potentially profound implications for research governance and leadership, linked reflective practice and critical theory 78,79 .

Research setting
This research focuses on two case study areas of major urban development in the UK, Bristol (City) and Greater Manchester (Combined Authority), and their associated national governance systems: i) large-scale mixed-use (housing and commercial) development in Bristol City Council (BCC); and ii) major transport plans and projects in Greater Manchester Combined Authority (GMCA). Within those areas we will focus both on a) the 'keystone' actors and processes that control the primary assets and functions of urban planning and development, working with local government partners, while focusing in particular on the dominant private sector actors, as well as b) the communities and 'lay' publics affected by these keystone decision-makers. At the national level, we will engage with actors from the legal, regulatory and wider policy systems, including the third sector. We will undertake at least 200 interviews and 20 systems focus groups.

Study aims
Our overarching aim is to develop and test a replicable multi-action and adaptable framework intervention in two large-scale case study urban challenge areas (major transport and mixed-use housing development plans and projects) -Figure 2 -in order to enable a paradigm shift in how health is valued and integrated at root-cause decision-making points.
Our work package (WP) aims are as follows: • WP1 aims to: map and understand the main drivers of urban development and management; test and refine the co-produced multi-action intervention.
• WP2 aims to discover the type of new evidence that can enhance the economic valuation of health impacts associated with the urban environment.
• WP3 aims to maximise societal impact through strategic coordination of the research programme and co-production of the intervention.
• WP4 aims to develop and test professionally produced, citizen-led creative arts projects that will help decision-makers to understand better the challenges of health inequality.
• WP5 aims to enable a comprehensive programme of knowledge exchange, and monitor and evaluate the impact strategy.
• WP6 aims to maximise the efficacy of inter-and trans-disciplinary working and impact planning.

Research question, primary objectives and study design
Our overarching research question is: how might prevention of risk factors causing NCDs and negative planetary health outcomes be fully incorporated by those with the most control of urban development in the UK? Our primary objectives are: 1. To engage the wide range of actors involved in shaping decision-making in urban planning and development within our two case studies.
2. To map and understand the systems of urban development decision-making across central and city-regional government, and communicate these to identified stakeholders, including the lay public.
3. To co-produce, and test with a wide range of stakeholders an intervention and evaluation framework, embedded in robust societal impact strategy, made up of three areas of evidence, and targeted at critical points of leverage within these urban development systems: i. Health improvements: Modelled economic valuation of changed health outcomes, linked to those responsible for payment.
ii. Opportunities for change: mechanisms identified and tested with users and stakeholders for improving policy and practice in both private and public sector, at local and national level. iii.
Health inequalities: Citizen-led, professionally curated creative arts outputs that represent the life experience, views and wishes of those suffering from health inequalities.
4. To deliver a highly impactful knowledge exchange programme with our broad range of users and advisors to ensure long-term health improvement beyond the five year TRUUD programme. The programme involves substantial co-production and knowledge exchange throughout, via interviews, focus groups, embedded researcher engagement and observations, industry roundtables, annual advisor conferences, parliamentary events and linked ad hoc engagement. End-user testing is central to the design throughout; we will follow an iterative process of co-production, evaluating the changes in attitudes, behaviours, policy and practice amongst our target users, and refining and testing the intervention accordingly.

Programme coordination and work packages
The six work packages are highly integrated and interdependent. WPs 1-4 make up the core research activity: stakeholder engagement, primary data collection and analysis (WP1); economic valuation (WP2); programme integration, intervention co-production and impact-orientation (WP3); lay public engagement, creative arts and health inequalities (WP4). WP5 is responsible for internal and external communications, knowledge exchange and impact evaluation across the programme. WP6 is tasked with supporting and enabling the consortium to reflect upon and improve their research practice.

WP1: Decision-maker engagement and intervention testing
Methods: Phase 1 data collection will focus on understanding and mapping the case study systems: actors, mechanisms, data used, power dynamics, dominant drivers/incentives, priorities, wider influencers, boundaries, dependencies/interdependencies, barriers, 'tipping' points, and regulations. It will also include the extent to which: a) the public are already involved in decision making at a strategic level, and b) decision-makers understand how their decisions impact on local communities. Methods employed will include: a) Actor mapping -inclusion criteria: perceived level of influence in large-scale property development and transport planning: public (policymakers, politicians, civil servants, council officers); private (asset owners, financiers, agents, consultants); third sector (social housing providers, NGOs); lay public experientially affected by linked aspects of the urban environment (e.g. lack of access to green space, air pollution, noise).
b) Literature review -search terms based on findings from open investigation across multiple disciplines; ten core concepts: 'power', 'governance', 'institutions', 'change management', 'networks', 'decision-making', 'type/ use of evidence', 'systems thinking', 'value/valuation' and 'risk management'; inclusion criteria in the form of four research questions focused on: robustly defining these ten concepts, key conceptual insights, theories used, and interventions used/suggested. (An initial scoping exercise, the main purpose of this was to enable the newly recruited group to familiarise themselves with each others' knowledge domains; multiple databases from each of the disciplines are used).
c) Semi-structured interviews (>200) -purposive sample recruited primarily through existing networks; additional participants identified through snowball sampling; individuals approached by telephone and in writing to inform them of the project, invite their participation; interviews to be conducted in short term and where necessary (e.g. COVID-19) via video-conference, face to face where possible; interviews conducted by experts in the field matching those of the participant to ensure strong rapport with participants and richest possible data.
d) Observations -undertaken by two full time participant observers (PO) seconded part time to Bristol City Council (Growth, Investment and Infrastructure) and Greater Manchester Combined Authority (Research Division) respectively; data to be gathered constantly, recorded in research diaries (consistent across both case study sites), on ten core concepts; supported where possible by documentary evidence (e.g. meeting minutes). e) Systems workshops (>20) coordinated via WP3participants identified and recruited as with (and following) interviews; identified knowledge holders to discuss and debate the findings, and help to provide additional clarity on data gathered through the interviews, earlier focus groups, and observations; workshop purpose and focus directed by focus area research lead; task management, workshop design and facilitation support provided by group systems engineers; workshops conducted via video conference; timing will vary depending on purpose, but typically will require three hours; various online software will be used (e.g. Miro, Mural) designed for the purpose of collective 'whiteboarding' and generation of systems diagrams.
Regarding private sector engagement, focus on corporate governance will go beyond standard functions -marketing, strategy, and financial reward -to include overarching issues relating to prevention of ill-health: strategic priorities; ownership; distribution of surplus profit; horizon of decision-making; control (instruments and exercise); commitment to 'Environmental, Social, and Governance' (ESG); structure and functioning of the Board of Directors 44,45 . Industry focus groups will be co-coordinated with membership bodies, NGOs and invited senior practitioners.
Outputs: The main outputs from WP1 will be from interview and focus group preparation and outputs, including: literature and policy reviews, graphic visualisations, findings reports and analysis; a public health assessment tool for corporations involved in urban development, which will be of use to public and private sectors to align their own organisational structure to long-term health outcomes, and to improve their procurement and partnership strategies; guidance on organisational models and structures that are better aligned with long-term social and environmental health.

WP2: Economic Valuation
Methods: An extensive critical evaluation of the current literature (focused on quality, uncertainty, validity of method) will enable us to construct a single-source database and modeling tool of the quantitative and economic evidence, building on previous work 80 . It will incorporate academic and grey literature and will utilize a quality-based classification system and grade the associated uncertainty. Principal search terms include: 'Valuation of health disutility', 'willingness to pay', 'cost of illness', 'non-market valuation' and 'health preferences'. Inclusion criteria include: the alignment of the health outcome definition in the valuation study with that in the epidemiological health impact studies; English language; publication in the previous 20 years, and; being a primary research study. Primary databases to be searched include: Econlit, Scopus, Web of Science, and IBSS. These valuations will use a combination of both market and non-market (revealed and stated preference) methods to estimate the cost components of health impacts. It will enable a more comprehensive coverage of health in economic appraisal than that existing to date which has primarily focussed on the air quality context 81 . Existing tools used by decision-makers -primarily spreadsheet models -that utilise the data generated in this WP will be used to generate cost-benefit estimates of individual urban development design decisions as well as policy-level decisions. Costs associated with urban form will be derived from the range of stakeholders involved in the project, and will be based on publicly available market data (e.g. pollution; noise; modal share; green space).
Output: The main output will be an interactive and adaptable economic database model applicable in a range of core decision areas, which will be a core part of the overarching TRUUD decision support framework.
WP3: Programme integration, impact-orientation and co-production of interventions Concurrently, co-production of interventions requires an initial focus on early programme integration and management, through co-development with WP Leads of detailed, interdependent implementation plans for WPs 1, 2, 4 and 5. The detailed WP3 implementation plan will then build on the early theoretical framing and will include strategic considerations in programme integration and detailed steps for co-producing the multi-action intervention at the end of each phase. A core innovation in this WP is the integration of the multiple approaches in to a soft systems framework for evaluating causal links and probabilities between decisions made far upstream and health outcomes downstream based on the hierarchy of research impact 83-86 . The intervention, impact and evaluation strategies will be co-produced and tested iteratively internally and externally with end users. In this way we are in accordance with latest MRC/NIHR guidelines on complex interventions, given we will be working with stakeholders to assess which outcomes are the most important and agree how to deal with multiple outcomes in the analysis 87 Example evaluation methods we will be employing include: group model building, social network analysis, economic modelling, and qualitative interviewing and workshop-based data gathering. The implementation plan will require sufficient flexibility such that intervention design can respond to a wide range of upstream contexts and applications that will be identified during the first and second rounds of engagement (decision tools span multiple actors and sectors and may include, e.g.: corporate strategy, KPIs, risk management, Cost Benefit Analysis, Multi-Criteria Analysis (MCA), Red Book Valuation or Green Book Valuation) 88-90 . Initial development will take place in Phase 1 with refinement in Phases 2-4. The programme as a whole will be underpinned by a strategic impact planning and evaluation framework drawing on Fast Track Impact templates (stakeholder analysis, impact planning, impact monitoring) and Mission-Oriented Research, ensuring integration with our working theory of change and pathways to impact models, and alignment to the UK Prevention Research Partnership (UKPRP)'s broader theory of change - Figure 4. These combined strategies will draw on emerging best practice in the fields of the 'Science of Team Science', including the Four-Phase Model of Transdisciplinary Teambased Research 62,91,92 .
Outputs: The main outputs from this work package are: i) a book or monograph aimed at the academic community and taking a critical theory lens to the call for new approaches to researching complex societal challenges, considering governance, operationalisation and structural barriers in particular, using TRUUD as a case study; ii) a Health Valuation and Integration Toolkit (H-VIT) with Strategy Guidance Note aimed at city, region and national level decision-makers in public and private sector, which bridges the economic database model (from WP2) to urban governance contexts, and provides a framework for its application with wider, qualitative valuation techniques; iii) a paper (or papers) reporting on the findings from integrating multiple approaches in the development and evaluation of a multi-action intervention across multiple sectors and systems of decision-making.

WP4: Citizen-led communication of health inequalities through the creative arts
Methods: The creative outputs from WP4 will therefore need to meet two design criteria -they need to be: 1) authentic in terms of articulating the impact of health inequalities on the lives of people living in underserved communities; 2) impactful in terms of relevance to upstream decision makers and their core values. In Phase 1 the WP4 team will focus on developing an understanding of: a) decision-makers' core values and how they think of health inequalities (in collaboration with WP1); b) what creative arts approaches will be most effective in communications. In order to achieve this the WP4 team will co-design the creative outputs with input from both upstream decision makers and community representatives and organisations. Grounding their work in good quality involvement practice (UK Standards for public involvement), the team will work closely with two community-based organizations in Manchester and Bristol, Live Well, Make Art (LWMA) and Knowle West Media Centre (KWMC). The team will: recruit community representatives -initially, two from each location -to help us co-design the creative outputs; develop a brief for the production of the creative outputs, informed by the evidence generated by WP1 and identify and approach upstream decision makers to participate in the co-design of the outputs (based on advice from the External Advisory Board and via WP1 networks). Recruitment will be based on possession of relevant skills and lived experience within the communities we are working with. We will, as far as possible, recruit a diverse group in terms of ethnicity, gender and social class. We will recruit approximately 5-6 public contributors in total from each location, who will then form the TRUUD public advisory group. Applications to carry out the work will be open to organizations with a proven record of accomplishment in this area of work, and will be judged by a management group consisting of the WP4 Lead, SRF, TRUUD Director, two community representatives and representatives of LWMA and KWMC. This group will also oversee the co-production of the outputs and ensure that work meets the specifications laid down in the project brief. The output will be incorporated into the TRUUD intervention, presented to decision-makers as part of the second and/or third phase interviews and focus groups (WPs1 and 3), and evaluated in line with work carried by WP3.
Outputs: WP4 is responsible for the production of: three professionally produced, community-led creative arts outputs on community health inequalities aimed at decision-makers; a Quality of Involvement Tool (QUALIT:I) designed to help researchers, users and lay publics understand which key stakeholders are involved and to what extent.

WP5: Knowledge exchange and impact monitoring
Work Package 5 is split in to two sub-WPs: knowledge exchange (WP5a); impact monitoring (WP5b).

[WP5a: Knowledge exchange]
Methods: In addition to digital and printed communications (website, social media, video, policy briefings), the knowledge exchange programme will employ a broad range of channels of communication designed to maximise two-way flow of information amongst identified stakeholders and advisors. These will include four annual one-day workshops will be held for critical sense-checking and co-production of next steps, including advisory support and Q&A with 100 advisors and stakeholders. There will also be annual meetings with the External Steering Board, and the Lay Public Advisory Board. At least one parliamentary event will be held, targeted at key actors within government and key members In addition to main outcomes during award period and post-award, the TRUUD ToC addas an explicit impact strategy (focused on societal impact) input across the programme, as well as a meta-research evaluation of methods and award outcomes, and monitoriting and legacy of outputs and post-award outcomes. NCD -non-communicable disease.
from the advisory groups who have committed to engage at national level.
Outputs: The main knowledge exchange outputs from WP5 will be both internal and externally facing and will include: a knowledge exchange, communications and social media strategy; high quality policy briefing notes and industry reports aimed at key decision-making groups; three (public sector, private and lay public) 3-8 minute videos clearly articulating in lay terms the identified findings, opportunities, and new research areas; website (with all documents and media).

[WP5b: Impact monitoring]
Methods: The impact evaluation framework will be developed from the WP3 impact strategy document and will be likewise co-produced by all consortium members, using the Fast Track Impact templates in the first instance 83 . The impact strategy will have incorporated data from the WP1 stakeholder analysis and will consider both a) users' interests, influence, motivations and needs and b) the lay public engagement work (WP4; e.g. strong/weak publics) 83,93,94 . The effectiveness of the impact strategy will be monitored throughout the programme across all WPs, with particular reference to key stakeholder groups. The impact strategy will be designed to interface with the knowledge exchange strategy, particularly during the final evaluation in year 5, to maximise long-term societal impact of TRUUD.
Outputs: Impact planning outputs will include the impact strategy (programme coordination), stakeholder analysis (WP1) and impact planning/monitoring frameworks.
WP6: Meta-research and group reflective practice Methods: An initial literature review has drawn on the Web of Science and Scopus databases. Initial search terms were for 'meta-research', 'transdisciplinary', and transdisciplinary -'research', 'framing', 'impact', 'innovation', 'assessment' and 'evaluation'. Given limited papers in this area, searches also included consideration of salient papers references and journals. Data is being collected through annual qualitative interviewing and ongoing researcher observation, reflection and analysis from and about the research team themselves and other actors in the research by means of reflective learning logs, worldview and research paradigm assessment by way of questionnaire, and methodology, method, tool and process appraisal for points of interaction and diversion. The sample will include researchers and stakeholders active on the TRUUD project. Participants will fluctuate over time as the meta-study evolves in response to participation in the larger project. There will be three key types of participant: 1) academic partners (<30); 2) research staff recruited to work on the project (typically research associates) (<50); and 3) non-academic city partners (<30). Participant inclusion criteria: role in the TRUUD project; relevance to current foci of WP6 meta-research; proportionate across both academic, public and private sectors and levels of seniority; participants agreement to take part. Exclusion criterion: those not working on TRUUD (including academics, and stakeholder practitioners from the public, private and third sectors). Evaluation and recommendations will take place through all phases of the project to ensure reflective practice across all WPs. The learning from WP6 will comprise two areas. Firstly an internal focus on coproducing: learning how to enhance the effectiveness of the TRUUD research processes and impacts, and understanding the degree to which inter-and transdisciplinary approaches support successful research. Secondly there will be an external focus: using the opportunity presented by the diversity of researcher and scale of research activity aiming to make a wider contribution to UK research effectiveness. This will include investigating how to balance between fully transdisciplinary research and using evidence from single disciplines in delivering impactful outcomes.
Outputs: Learning will be captured in an Impact-Oriented Trans-disciplinary Assessment framework (IOTA) designed for those undertaking meta-research of their own complex co-produced research projects.

Public involvement
Our public involvement strategy starts with the question: how can the lay public be meaningfully involved in complex systems of urban decision-making? Instead of undertaking yet more (often mandatory) consultation with citizens on development proposals, we will establish (in addition to the lay public aspect of the intervention in WP4) a Lay Public Advisory Group (LPAG). The LPAG will include 6 to 12 members who reflect the diversity of the lay publics, they will meet twice a year in each case study location. The LPAG will also participate in the annual wider Advisory Group (WP5); two representative LPAG members will sit on our External Advisory Board. Lay training modules on the challenge areas (e.g. urban health issues, urban planning, power structures) and language will be developed to support the lay advisors and enable them to advise on key areas including interview questions, analysis of qualitative data, development of bridging mechanisms and policy recommendations. Where needed training and lay public learning modules will be provided in upstream urban governance.

Analysis plan
Analysis of WP1 data will help to inform the design of the multi-action intervention through WP3, and in WP4. Data collected in Phases 2 and 3 will evaluate the extent to which the intervention impacts on policy and practice, and help to develop the next iteration of the intervention, and will be analysed using actor, game and network 95 , thematic 96-98 , and critical, socio-legal and regulatory analysis 99 , as well as drawing on approaches from systems science, risk management and scenario modelling 100-102 . At each tier of governance we will need to identify what is within the control of decision-makers involved in the study ('endogenous') and those factors that are largely exogenous (e.g. technological futures, European/global geo-politics) 40 . Under WP3, soft systems methods will be applied as appropriate (in this and other WPs), and graphic mapping will be employed to enable complex system navigation, understanding and communication. These methods may draw on a range of systems tools and processes including: problem structuring, rich pictures, actor constellations, system dynamics and causal loop models 103-106 . The stated preference, survey-based, research in WP2 will draw upon a range of econometric methods to interrogate data that looks to derive monetary values and the determinants of these values. Parameterization of the attendant uncertainties will inform the ways in which data on monetary valuation is subsequently communicated in the case study interventions. In WP6 data will be analyzed iteratively following a Grounded Theory approach 107,108 . This will be used to develop a map of concepts and hypothesis relating to the research foci of interest for each phase of the TRUUD work programme. This will form the first stage in the inductive and abductive reasoning to link the TRUUD research findings and impact (outcomes) to the TRUUD research assets, people (academic and stakeholder networks), processes (methods and methodologies) and practices (interventions). If required, statistical analysis will be small-scale and present straightforward statistical analyses on specific issues, e.g. the results of polling and surveys. . Where other institutions are involved, they have reviewed relevant ethics applications and decisions and provided written approval. All participants in the research will be asked to provide written informed consent before participation in the research. No individual participants will be identifiable from publications resulting from this study.

Ethics and risks
All data provided will be kept confidential and anonymised. Risks include: change in political administration in partner local governments; alignment of research with real world timescales; effective integration of wide ranging disciplines within limited time and resource constraints; academic structures limiting societal impact. We are mitigating these risks through: embedding researchers in residence; high level of co-production with practitioners; highly integrated research design; governance structure with central coordination function responsible for societal impact strategy. Other risks include: loss of key personnel and case study projects being delayed, which we will mitigate through identification of proxies and identifying a range of potential projects, respectively.

Dissemination of findings
The research will be disseminated through academic channels (peer-reviewed publications and conference presentations), but also, to maximise the impact of the research, there will be a strong focus on sharing the results of the research with urban development decision-makers. A primary activity in TRUUD is the co-production, with potential end users and stakeholders (including lay public), of the intervention. Throughout there will be an ongoing programme of knowledge exchange through WP5, the strategy for which will also be coproduced with key stakeholders, decision-makers and lay public. We will use a variety of communication channels to reach a broad range of audiences in order to maximise both the societal and academic impact of the research.

Study status
The research programme started on 1 October 2019.

Discussion and conclusion
Identified challenges relate primarily to: a) the effective integration of (the wide range of) researchers and disciplines, and their collective orientation towards a shared societal goal; b) addressing uncertainties in the evidence base; and c) the design and evaluation of beneficial impact on health outcomes (downstream, resulting from decisions made far upstream and in complex real-world situations). This is a large programme of research that brings together many diverse disciplines alongside multiple stakeholders and sectors. We anticipate practical/operational issues, common to all large, highly interdisciplinary projects. The level of complexity and the core focus on demonstrable real-world impact require new ways of working and justifies an additional level of coordination and structuring 18 Conversely, they also warn that "these differences can result in conflict and negatively impact team performance, if the conflict is not managed". In addition to the meta-research work package, we have pervasive reflexive interests stimulated by a shifting emphasis from "public health research" to the broader disciplinary and practical embrace of "health of the public research" 18 , and will draw on new approaches such as those being pioneered in the field of team science 62,109,110 . The challenge relating to uncertainties links not just to the economic valuation, which is based on assumptions and partial data availability, but also to wider decision factors: full information is rarely available to decision makers, future scenarios maybe unknowable, and therefore decision-making with uncertainty is inevitable. With regards the former, we will ensure that the evidence available for the economic valuation is sourced as comprehensively as possible, but are aware too that significant uncertainties will remain. The challenge for the group will be in identifying salient narratives and developing a supporting framework for decision-making that takes these uncertainties in to account. Risk management approaches are likely to play a prominent part. Within a five-year research project, it will not be possible to demonstrate reduction in NCDs. Apart from abrupt shifts in urban management policies (e.g. congestion charging), urban infrastructure changes slowly, over decades and centuries. The complex range of variables mean that demonstrating clear causation is also impossible. Our goal therefore, is to test demonstrable and immediate changes in attitudes and behaviours amongst the target user groups, as well as changes to policy and practice, within the award period; in particular in decision-making within the systems of governance in Bristol, Manchester (and London in relation to national-level mechanisms linked to city development).

Data availability Underlying data
No data are associated with this article.

Open Peer Review
This is an elaborate and interesting project involving multiple stakeholders, especially those who are responsible for urban planning and development, exchanging knowledge, and creating arts outputs, in my understanding in order to change the practice on urban planning and development. Even though this is a study protocol paper, details of the protocol are not provided (just showing the overall framework). Thus, it was difficult for me to provide comments. I have some additional comments for clarification as shown below:

Protocol:
Please clarify whether the study protocol approved by the University of Bristol's Faculty of Health Sciences Research Ethics Committee is the same as this paper or not. Did the authors submit to the ethics committee a more detailed protocol? Or, did the authors submit the same, one protocol?

Other minor comments:
16. What kind of reporting guideline will be used to report case studies? ○ 17. The authors emphasize "two case studies". When reporting in academic journals, will the authors merge them or separately report? ○ Is the rationale for, and objectives of, the study clearly described? Yes

Are the datasets clearly presented in a useable and accessible format? Not applicable
Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
Author Response 04 Jul 2022 Daniel Black, University of Bristol, Bristol, UK Reviewer 3 comment: This is an elaborate and interesting project involving multiple stakeholders, especially those who are responsible for urban planning and development, exchanging knowledge, and creating arts outputs, in my understanding in order to change the practice on urban planning and development. Even though this is a study protocol paper, details of the protocol are not provided (just showing the overall framework). Thus, it was difficult for me to provide comments.

Authors' response:
We are grateful to the reviewers for taking the time to feedback on our Protocol, and apologies for delay in the response. The reviewers' concerns are understandable and expected, given the wide range of interconnected knowledge domains involved. One of the challenges inherent in developing new approaches to public health research in areas that span multiple knowledge domains outside public health is the challenge of reviewing articles that seek to bring together so many different areas of specialism (Bammer G, 2013).
I have some additional comments for clarification as shown below: Authors' response: We did not undertake a formal assessment in the WP1 literature review (such as PRISMA, which we do use in WP2's systematic reviews) as it was not a formal systematic review. See above comment in response to MEDLINE/PubMed suggestion.
I could not find an explanation about methods for evaluating changes in attitudes, behaviors, policy, and practice (WP1-Yr4 in Figure 3). Please clarify.

Authors' response:
In the methods section of WP3 we state: "The intervention, impact and evaluation strategies will be co-produced and tested iteratively internally and externally with end users." This echoes MRC's latest guidelines on complex interventions (Skivington et al, 2021), which states: "A crucial aspect of evaluation design is the choice of outcome measures or evidence of change. Evaluators should work with stakeholders to assess which outcomes are most important, and how to deal with multiple outcomes in the analysis." They cite as an example group model building and social network analysis, which we are using, but we are also employing health and environmental economic modelling and qualitative interview and workshop data gathering. We have already started evaluating the process through critical reflection and will continue to do so formally through the intervention design and evaluation stages, in order to inform development of programme theory. We are also undertaking 'evaluability assessments' as part of the feasibility work. To respond to this concern, we have added some further descriptive text, but it remains the case that it is yet to be co-designed.

Abbreviation of Lay Public Advisory Board is shown as LPAG. Is this correct?
Authors' response: Thank you for flagging this. It's not consistent and we have changed. We sometimes use the word 'Board' and 'Group' interchangeably.

Figure 2:
It would be nice if which part indicates "3-part intervention" as there are many arrows.

Authors' response:
The whole diagram illustrates the intervention given co-production and testing of the intervention with stakeholders is core to the process, but the circle on the left indicates the three main areas of evidence. We have therefore updated the image to indicate that more clearly and hope this addresses the reviewer's concern.
Figure 3: WP1 includes evaluating changes in attitudes, behavior, policy, and practice. I want to know their indicators and study design for assessment (e.g., qualitative study, etc.) in this figure.

Authors' response:
We have yet to detail the evaluation design in detail, which could not be predetermined until it was clear where we would be intervening, not least as a core part of the evaluation needs to be developed with stakeholders. We will likely use a combination of qualitative data gathering through stakeholder engagement (interviews, surveys) alongside the quantitative valuation from the economic modelling, combined with systems approaches (e.g. ripple effect mapping). We have added a few words to that effect in the box indicated, though given there is limited space, it does not describe in full. We are honored to provide an integrated review of this study protocol based on both public health and urban planning points of view. The authors of this protocol introduced their proposed prevention program to address the unhealthy urban development issue as a root cause of noncommunicable diseases (NCDs). In brief, the authors tried to fill the gap in knowledge and executive steps of inappropriate urban development with this research protocol. Although the project and the provided protocol are well thought and designed, we found many major concerns regarding the proposed plan, which comments are as follows in this letter. Additionally, we read the previous comments of the reviewer and the responses to those comments and tried not to emphasize duplicate issues; however, in some cases, it is inevitable as the issue is major and could not be neglected.
Overall, the draft is too complicated. We understand the nature of such work necessitates providing this much information. However, scientific writing always comes alongside simplicity besides the right and essential components of science, and in case of complexity, even some simple points could be missed and make the research less advantageous.
Regarding the sections of protocol papers, the format varies based on submitted journals. However, following rational formatting is necessary anyway. Section and subsections of this paper could be divided into three major sections of "Introduction and rationale", "Protocol", and "Discussion and conclusion" for a better understanding. It seems that the authors could not follow the coherent presentation of data in the protocol section and the subsections are out of order and this is where the audience of the paper gets bored and confused. Absolutely a revision of the core of this manuscript which is the "Protocol" section could help the reader of this paper.
"Introduction and rationale": this section lacks the necessary information about the burden of NCDs in the real world, especially the investigated country, the UK. In fact, similarly, all parts of the paper lack the proper and essential views of public health experts and this is a major shortcoming of the current draft. The provided material is mainly for urban planning experts and policymakers; however, the goal of this project is to reach optimum health among the population. Therefore, adding some details and the language of public health to this manuscript is necessary in this regard, mainly in the introduction and discussion sections, where the importance of this topic and the ultimate results of this project should be highlighted.
"Protocol": as the major section of this protocol, this section may cause significant confusion in readers. The information presented in each part of the work packages (WPs) is too much and does not follow a coherent format. A revision of this section to make it more understandable and only bringing practical points in this protocol paper could help more.
One major concern about this protocol is about the period of this project. Based on available information about the current project, it is planned for five years of action starting in 2019, and at this time, about two years have passed. Publication of a protocol of such a huge project, while it reached about half the way, is an alarming concern. In fact, protocols are meant to provide a clear vision of a prospective project, and publishing a complicated protocol like this in the current approved and executed format could be less useful for the scientific communities of both public health and urban planning. However, some amendments in this manuscript by providing the report and results of what the investigators did in these two years and the achievements they accomplished may be helpful to enable the audience to judge the feasibility and efficacy of such a program. For example, the state and results of the designed workshops mentioned in the protocol should be provided in this manuscript. Since a major time has passed, a progress report is necessary.
Similar to the previous review, there is still concern about the two cities chosen for the implementation of policies proposed in this protocol. Authors need to clearly state why they chose the mentioned cities for the specific policies. What made the cities special for running the proposed ideas in this project should be elaborated for readers. This point is very important regarding making the study reproducible in other regions and countries of the world.
"Discussion and conclusion": as mentioned before, an essential part is missing in this section talking about the potential public health effects of this protocol. A logical estimation of the results and impacts of the implemented policies.
Is the rationale for, and objectives of, the study clearly described? Partly

Is the study design appropriate for the research question?
number of the knowledge domains lie far outside traditional public health and urban planning (e.g. real estate finance, political science, corporate decision-making, law) so it requires an understanding of these other areas to see the implicit linkages within this brief text. Also, the approach is based fundamentally on co-creation, so as the first reviewer observes, it's not possible to second guess what will emerge. We have been tasked by our funders, the UK Prevention Research Partnership, to develop 'new approaches to population health research'; in other words, this type of research is still new (Skivington et al, 2021).
Where there are specific suggestions for how to simplify, we have taken them on board, but we are unable to respond to generalised concerns.

Reviewer 2 comment:
Regarding the sections of protocol papers, the format varies based on submitted journals. However, following rational formatting is necessary anyway. Section and subsections of this paper could be divided into three major sections of "Introduction and rationale", "Protocol", and "Discussion and conclusion" for a better understanding. It seems that the authors could not follow the coherent presentation of data in the protocol section and the subsections are out of order and this is where the audience of the paper gets bored and confused. Absolutely a revision of the core of this manuscript which is the "Protocol" section could help the reader of this paper.

Authors' response:
We contest that presentation is not coherent, and are sorry to hear that you became bored and confused. We do follow the Wellcome Open Access guidelines, which says too that it is 'flexible'. However, in order to respond to this concern we have moved 'Research Setting' to the top, and moved the section on 'Ethics and Risks' to after the 'Analysis Plan'.
Reviewer 2 comment: "Introduction and rationale": this section lacks the necessary information about the burden of NCDs in the real world, especially the investigated country, the UK. In fact, similarly, all parts of the paper lack the proper and essential views of public health experts and this is a major shortcoming of the current draft. The provided material is mainly for urban planning experts and policymakers; however, the goal of this project is to reach optimum health among the population. Therefore, adding some details and the language of public health to this manuscript is necessary in this regard, mainly in the introduction and discussion sections, where the importance of this topic and the ultimate results of this project should be highlighted.

Authors' response:
We agree that information on the burden of NCDs is limited, but this is necessary/intentional, and for two main reasons: i) a key requirement is that these protocols are brief so we are restricted in the level of detail of each of the knowledge domains we are uniting (not just information on NCDs); ii) we anticipate that those who read these publications will already be largely familiar with the now relatively well-known population health issues (issues of pollution, mental health, obesity, diabetes are well understood, even by the public in the UK). The material is not provided for urban planning experts alone, but a much wider range of experts. In fact, we are aiming that this is read by those outside of public health. That said, we have added a small amount of additional information on the burden of NCDs in the UK and we have signposted the reader to further information on our public-facing blog, which simplifies the NCD challenge area.
Reviewer 2 comment: "Protocol": as the major section of this protocol, this section may cause significant confusion in readers. The information presented in each part of the work packages (WPs) is too much and does not follow a coherent format. A revision of this section to make it more understandable and only bringing practical points in this protocol paper could help more.
Authors' response: See above.

Reviewer 2 comment:
One major concern about this protocol is about the period of this project. Based on available information about the current project, it is planned for five years of action starting in 2019, and at this time, about two years have passed. Publication of a protocol of such a huge project, while it reached about half the way, is an alarming concern.
In fact, protocols are meant to provide a clear vision of a prospective project, and publishing a complicated protocol like this in the current approved and executed format could be less useful for the scientific communities of both public health and urban planning. However, some amendments in this manuscript by providing the report and results of what the investigators did in these two years and the achievements they accomplished may be helpful to enable the audience to judge the feasibility and efficacy of such a program. For example, the state and results of the designed workshops mentioned in the protocol should be provided in this manuscript. Since a major time has passed, a progress report is necessary.
Authors' response: This protocol was published just over a year into the programme of research, not two: it was published very early in 2021 and the project formally started late in 2019. 2020 was also the year Covid first hit so there have been understandable delays to the programme due to (e.g.) university recruitment freezes. As such, it was still in the very early stages of the 5-year programme when it was published and could not have been published any sooner. The proposal also went through a form of peer review via the application process itself; the protocol therefore is a formalisation of the application form, which was approved by a large advisory group of public health and linked experts. With regards amending the manuscript by providing a report on our first two years of activity, we provide comprehensive annual reports to our funders annually (each around 30 pages in length), which is reviewed each year by that same advisory group and a separate External Advisor Board, made up of leading experts in a wide range of areas both academic and practice based, who we meet with on a quarterly basis. It's possible we could provide a short summary from these reports -the executive summaries -to add to this Protocol, but it's not clear, given the complexity, how this information would provide the reviewer with substantive additional information, nor whether the reviewer would expect the same for all future annual reports. It's also not clear why the reviewer specified the state and result of the designed workshops specifically, as the bulk of the data from Phase 1 is derived from the interviews and these are all being written up and published separately. We also have several more detailed design protocols for specific aspects of the evolving research, including the phase 2 intervention design and evaluation, which will be published separately. We will also be providing short and accessible progress reports on our website alongside the range of papers described.
Reviewer 2 comment: Similar to the previous review, there is still concern about the two cities chosen for the implementation of policies proposed in this protocol. Authors need to clearly state why they chose the mentioned cities for the specific policies. What made the cities special for running the proposed ideas in this project should be elaborated for readers. This point is very important regarding making the study reproducible in other regions and countries of the world.

Martin McKee
London School of Hygiene and Tropical Medicine, London, UK I find it very difficult to provide a meaningful review of this protocol. First, the project has already been through an extensive process of peer review. Almost inevitably, additional reviewers will have their own preferences about what might be emphasised, added, or subtracted, but given the extensive planning that has already gone into such a complex project, it is difficult to see how this will be particularly helpful to the research team. This is even more so when I read that the research programme started on the 1 October 2019.
Second, as this particular proposal places a very great emphasis on co-creation with local communities, it is difficult for an external reviewer to second guess what will emerge. There are many questions which one might wish to ask but, realistically, may not be answerable at this stage in the research. I am also conscious of the importance of brevity and I consider it unrealistic to expect the authors to provide the mass of detail that I'm sure they already have. As a consequence, I have limited my comments to those aspects of the proposal that I felt could usefully be clarified, as seen from the perspective of someone reading about the project for the first time.
My first impression is that there are an awful lot of ideas packed into this protocol, and not always as clearly structured as I felt they might be. Commercial determinants of health feature prominently and, linked to that, power asymmetries. If space permits, it would be helpful to elaborate on this a little further. For example, we know that developers have been very effective in lobbying to influence the planning rules in England. Perhaps something more could be written on this. Linked to this, as we have seen during the pandemic with pressures to reopen office space, the meaning of property in certain discourses has changed. Once, it was about providing shelter, in which people could live or work. Now, for many people, it is an investment vehicle. Again, the consequences of this change, while implicit in some of what is written, could be developed further. For example, they mention how the problems and solutions are to be found in areas such as international finance and investment. This will be very clear to anyone reading the property pages of, for example, some Asian newspapers where the UK property market features prominently as an investment opportunity, something that has contributed to the high level of empty properties in some parts of the country, coinciding with high levels of homelessness. These considerations and others take us to the crucial issue of power. I'm sure that the research team have thought a lot about this, but it would be good to know more of their thinking.
Given the centrality of power, I wonder if the team have ways of capturing the relevant dynamics, particularly when some aspects of the decision-making are likely to be hidden, either in informal meetings or shielded behind commercial in confidence restrictions? We also know that major capital developments are often an invitation to corruption, favouritism, or to coin a contemporary popular term the "chumocracy". Has this been considered?
A related issue is the political dimension. Both Manchester and Bristol are held by Labour, while central government is Conservative. As was seen in the midst of the pandemic in disputes between Manchester and London, this can be problematic. Has this been taken into account? And how?
The section on valuation was tantalising but brief. I accept that the proposal envisages a substantial body of work to develop thinking on this issue, but again it would be good to have a little more detail of their thinking. Some contemporary thinking is referenced, such as the work of Raworth and Mazzucato, but at present we simply have a list of references to their work without any discussion of what ideas have emerged from their reading of it.
Public involvement is crucial. However, the public is far from homogeneous and the sorts of interventions that are being considered will bring winners and losers. Put bluntly, policies and housing developments that create more heterogeneous communities, however measured, will be welcomed by some but not by others. How will they address the inevitable tensions that may arise with an advisory board of 6 to 12 members?
I did feel that the section and dissemination of findings could be elaborated a little more. There is now a wealth of opportunities for communicating the findings of research going far beyond the traditional outlets of peer-reviewed journals. Given the importance of community engagement in this project, it would be interesting to know if the team have come up with any innovative ideas for making this work.
In summary, this will be a very interesting project and, given the iterative nature of its development, it is unrealistic to expect too much detail at this point. However, I hope that my comments help in pointing to areas where the protocol could be clarified a little more.
Is the rationale for, and objectives of, the study clearly described? Yes

Is the study design appropriate for the research question? Yes
Are sufficient details of the methods provided to allow replication by others?
challenge is such that, we would argue, it won't allow for that easily within the limited space available, though we would be pleased to respond to specific areas of change needed. The method and findings papers from the UPSTREAM pilot, which are due for publication at the beginning of April 2021, should provide considerable additional context. A quote from that paper's abstract, which struggles with the same issue, echoes the points made here: "the value of this broad, systems-wide approach is not in the depth of disciplinary investigation, but in its breadth, and the opportunity to draw together multiple strands from multiple systems, thereby balancing complexity and the reduction of that complexity" (De Pinho, 2018).
Reviewer comment: Commercial determinants of health feature prominently and, linked to that, power asymmetries. If space permits, it would be helpful to elaborate on this a little further. For example, we know that developers have been very effective in lobbying to influence the planning rules in England. Perhaps something more could be written on this.

Authors' response:
We find that the 'commercial determinants of health' framing resonates well with the world of urban development, as it appears to do with unhealthy commodities. The recognition of the dominance of the private sector in UK urban development, and specifically in large-scale property and infrastructure development, is one of the central features of this study. While lobbying and power were not specific themes investigated in the UPSTREAM pilot, commercial factors relating to urban health, and associated aspects of power (and control -e.g. access to land), were revealed across a number of areas: e.g. the implications of short-termism on quality of urban environments (estate management, stock market investor interest); ○ the challenge of front-loading essential infrastructure investment for long-term health in the face of narrow and short-term viability appraisal; ○ the lack of equity stake-holding (which ultimately dictates control) by public agencies and citizens ○ justifying public space management budgets within existing models of urban development, planning and management ○ Power and power asymmetries are central themes within the project. For instance, in Phase One, we are creating our samples from individuals who are deemed to be influential within and knowledgeable about the system. Our focus is thus to talk to the power elite in an effort to understand the system, but also to make these power structures, and thus the asymmetries they create explicit so that they can be understood and challenged. We are also currently recruiting a PhD to look specifically at understanding the power structures of the system, but also how to best intervene at individual, group, and institutional levels.
In WP4 (lay public engagement) we are interested explicitly in issues of inequality and 'citizen voice', which also overlaps substantially with issues of power. It's perhaps worth flagging that the TRUUD programme is the focus not just on large-scale property development, but also city-region transport, where the role of the private sector is arguably less visible, and yet regardless there are significant economic pressures alongside questions of inequality, which relate to commerce and power (e.g. the challenge of tackling congestion due to the inevitable tensions between winners and losers). We also recognise the different and hybrid forms of commercial power exerted by a range of actors in a neo-liberal political economy: e.g. professional architects, planners, designers, marketing, facilitating the circulation and accumulation of capital via built development; city authority collaborations with developers to attract inward investment to cities through the commodification and 'branding' of urban space; property, public and private, and pension funds in an investor society. In WP4 (lay public engagement) we are interested explicitly in issues of inequality and 'citizen voice', which also overlaps substantially with issues of power. In particular we will explore how traditional hierarchies of evidence marginalise the knowledge of local people, which is nevertheless crucial to understanding how the built environment, human agency and health interact. We will exploring creative ways of presenting lay evidence to decision makers as a way of challenging this form of epistemic inequality Reviewer comment: Linked to this, as we have seen during the pandemic with pressures to reopen office space, the meaning of property in certain discourses has changed. Once, it was about providing shelter, in which people could live or work. Now, for many people, it is an investment vehicle. Again, the consequences of this change, while implicit in some of what is written, could be developed further. For example, they mention how the problems and solutions are to be found in areas such as international finance and investment. This will be very clear to anyone reading the property pages of, for example, some Asian newspapers where the UK property market features prominently as an investment opportunity, something that has contributed to the high level of empty properties in some parts of the country, coinciding with high levels of homelessness. These considerations and others take us to the crucial issue of power. I'm sure that the research team have thought a lot about this, but it would be good to know more of their thinking.

Authors' response:
With regards the shift from property as shelter to property as investment, this too is a highly complex area with a range of development, investment and delivery issues to bear in mind. The reviewer rightly flags issues caused by recent more rapid changes in global real estate investment -enabled in large part through digitisation of real asset trading (e.g. via Real Estate Investment Trusts (REITs)), the linked internationalisation of investment capital -and the associated flows of global capital into major cities, especially London in the UK, which is having considerable impact on property prices and issues of affordability. The return to public and private investors on propertyhigh-value commercial offices, residential and mixed-use -is extending to niche residential suburban area, e.g. elderly, special needs and social housing. This overseas investment in UK property -as investment vehicles -is driven in large part by the UK's persistent current account deficit. We require overseas investment into the UK and the sale of UK assets to close the gap in our current account caused by deindustrialisation. On the other hand, property investment with a longer-term view (e.g. patient capital) is also seen as critical if we are to enable medium-high density development that can promote walking, cycling and public transport. With regards political narratives, property investment is mostly justified in political discourse by housing supply imperatives -i.e. the need to build to meet demand. Political struggles then take place at a local or city level over the affordability of that supply, social segregation in developments, and unmet wider housing needs -rather than questioning the imperative to build more, per se. However, the dominant housing or property discourse is being increasingly challenged by those who argue that affordability problems are caused by the financialisation of housing, not excess demand over supply. The UK's housing supply model is also shaped by a political assumption that the public sector should have a minimal role in delivery of urban infrastructure, and yet the state has nonetheless a major role in supporting the balance sheets of the volume property developers and in maintaining house prices, through policies such as Help to Buy and Stamp Duty holidays. A deeper point being made by the reviewer -which is also of real interest to our group and is now part of a wider societal discussion across multiple sectors related to urban development -relates to cultural norms about what is acceptable business practice in hybridized stakeholder assemblages -local authorities, quasi-public sector developerhousing management associations, consultancies, brokers, promoters, landlords, owners, etc. Again, as per the discussion section of the UPSTREAM findings paper, the use of land as a means of generating "unearned income" was decried by none other than Adam Smith and Winston Churchill. The extent to which we can get to grips with all these highly complex areas is to be seen. As above, we are consciously spreading ourselves relatively thinly in order to take a more comprehensive systems view, and in so doing we will be limited in terms of how deeply we can dive in to any given area.
Reviewer comment: Given the centrality of power, I wonder if the team have ways of capturing the relevant dynamics, particularly when some aspects of the decision-making are likely to be hidden, either in informal meetings or shielded behind commercial in confidence restrictions? We also know that major capital developments are often an invitation to corruption, favouritism, or to coin a contemporary popular term the "chumocracy". Has this been considered?
Author's response: This is an important question for a tricky areas that we are very mindful of. Of particular interest is actor-network centrality and the 'black box' intermediation spaces where largely 'off the record' negotiations take place, e.g. discretionary planning preapplications, planning agreements for large investment reduced planning risk, CIL, s106 and development viability analysis. Over and above our work on economic valuation, the bulk of our data gathering is focused on qualitative interviews (200+), workshops and industry roundtables (20+) with a wide range of stakeholders. We also have two participant observers working with the relevant councils. We will use the interviews to map actor networks, as far as possible to include those that are hidden within informal settings. But we will also need to use documentary evidence where it exists, including public records (e.g. of Ministerial meetings, registers of interests, donations to parties.) In our experience, using multiple, and different, data sources, tends to mean that at least some of these hidden areas are hinted at, giving us an opportunity to follow up as best as possible. These hidden areas can be challenging to uncover, but it is also the case that some participants, typically in interviews or participant observer work, can be quite candid, giving us glimpses of the hidden world. Combined with an experienced team who already has some knowledge of hidden discussions and negotiations, we hope to be able to dig deeper, making them explicit. In terms of the tools to do this, they include well thought through sampling principles for our starting purposive sample and a snowball sample focused on identifying influential people and structures, detailed field notes, open questions enabling participants to speak freely, creation of safe spaces for communication, and by aggregating and analysing the information across multiple stakeholders. This of course while ensuring that findings made public do not compromise those wishing to be more outspoken. Through this approach, we aim to bring to the surface as many of the barriers and opportunities as possible.
and practice and so can not foretell either the stakeholders or the possible tensions, but we will seek to ensure, as much as possible within the constraints of the programme, that representation is met and opportunities for discussion fully provided.
It's also worth underlining perhaps that the rationale for our approach to public engagement was based in large part on the understanding that very significant amounts of public engagement and involvement already takes place in urban development, and so the core purpose of the public engagement work is to develop a method of disrupting existing means of public engagement, with a focus on inequality and the use of the creative arts.
Reviewer comment: I did feel that the section and dissemination of findings could be elaborated a little more. There is now a wealth of opportunities for communicating the findings of research going far beyond the traditional outlets of peer-reviewed journals. Given the importance of community engagement in this project, it would be interesting to know if the team have come up with any innovative ideas for making this work.