Title: The long-term health and wellbeing impacts of Healthy New Towns: a six-month feasibility study of Healthy New Town demonstrator sites in England
Funder: Department of Health and Social Care

Abstract: The Healthy New Towns programme was commissioned by NHS England in 2015. Healthy New Towns are ten major housing developments across England. They aim to improve the health of individuals and communities by applying healthy design principles in the development of housing estates, transport, green spaces, water ways, and community spaces. Healthy New Towns seek to increase residents' use of healthy spaces, promote community activity, reduce loneliness, and create new ways of delivering more coordinated health and social care services. The Healthy New Towns programme offers a unique opportunity to study the long-term effects of these types of developments. Finding out how effective they are will provide important lessons to guide future developments and investment. Conducting a long-term study is not straightforward because of the complexity of the programme and the difficulties in measuring changes in health and well-being in a reliable way. We therefore plan to conduct an initial six-month study to gather information that will enable the design of robust longer-term research into the costs and benefits of Healthy New Towns. The longer-term research will enable funders and others to put a monetary value on what has been spent, and the benefits gained through their investment. To protect people’s privacy, individuals and households in the Healthy New Towns will not be personally identified. The study will focus on five Healthy New Towns sites where some local evaluation has already been carried out. The six-month study will involve the following steps: 1. We will gather social and economic information about Healthy New Towns, as well as information about their environments and building developments, and how land is used. 2. We will create visual maps, known as a 'system maps' in workshops with residents and local organisations within Healthy New Towns sites. The maps will show a 'snapshot' of relationships and links between people, places and things that improve or are barriers to health and wellbeing. The use of this method will enable the research team to compare the maps for the different Healthy New Towns and determine how they change over time through a longer-term study. 3. We will bring together information that has already been collected in local evaluations. This will enable the comparison of these findings with those obtained in future research, therefore allowing us to identify changes over time in people's experiences and views of the programme and its effects. 4. We will produce a set of health and well-being indicators, prioritised by residents and other stakeholders, which can be compared at different time periods and used to measure the effects of Healthy New Towns programmes. 5. We will actively seek to involve the other five Healthy New Towns sites where no evaluation has yet taken place in the planning of the longer-term research. 6. Representatives of residents from the Healthy New Towns will be brought together in a ‘Resident Representatives Group’ to advise on important research tools and policies, and plans and reports for feeding back and letting others know about the research and its findings. Public engagement activities will also involve local public health professionals, planners and politicians and other organisations. All these people and groups will be invited to work together with the researchers during the six-month study and in designing the proposal for a longer-term research study.

Lay abstract: BACKGROUND: Major public health challenges in England include high levels of health risk behaviour and associated diseases. In the context of an ageing population and falls in spending on adult social care, these challenges place huge pressure on health services. There is evidence to show that living environments can shape health, wellbeing and behaviour. However, there is an urgent need to understand how this evidence can be brought together to deliver healthy environments in local urban settings. The HNT programme was commissioned by NHS England in 2015 and is supported by Public Health England. HNTs are 10 major housing developments that aim to improve population health by applying healthy built environment design principles, increasing residents' use of healthy spaces, promoting community activation and cohesion to improve mental health and reduce social isolation, and creating new models for integrating health and social care. The programme provides a natural experiment in which to investigate the effects on health, wellbeing and inequalities of large-scale interventions targeting the wider social determinants of health. RESEARCH QUESTIONS: 1. What are the similarities and differences in the Healthy New Town (HNT) programme developments, activities and processes, contexts and expected impacts and outcomes across the HNT sites? 2. How feasible is the use of existing HNT evaluation data and data from routine sources as the baseline for a longer-term study to assess impact on health, wellbeing and behavioural outcomes, programme processes and mechanisms and Social Return on Investment? AIMS AND OBJECTIVES: 1) To produce participatory systems maps for 5 HNT sites, illustrating processes and expected outcomes from HNT activities and developing a theoretical framework for longer-term research. 2) To scope and synthesise available qualitative data produced through existing local evaluations and to test the feasibility of using this data to ground a longer-term qualitative study of HNT processes. 3) To define primary and secondary outcome measures for assessment of HNT effectiveness and Social Return on Investment, using existing HNT datasets and routinely available data. 4) To test the feasibility of expanding the research programme to include the 5 HNT sites that are not currently in the HNT Evaluation Collaborative to improve study power and representativeness. METHODS The proposed research involves workstreams to: a) use participatory systems mapping with stakeholders in each HNT to produce a theoretical framework for a longer term study on the HNT programme; b) scope and synthesise existing qualitative data from local HNT evaluations to understand local processes and intervention mechanisms; c) scope and standardise local and routinely available data to establish a baseline and feasibility for a longer term study of health and economic outcomes; d) build relationships and recruit 5 further HNTs into the proposed research. TIMELINE FOR DELIVERY The proposed research will be conducted between 1st November 2018 and 30th April 2019 to enable completion while HNT site leads are still in post. ANTICIPATED IMPACT AND DISSEMINATION The proposed research will produce a theoretical framework for the HNT programme, designed to guide further research on the health impacts of HNTs. Findings will be disseminated through peer-reviewed publications and presentations and local audiences including residents, local government and Public Health England.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: GENERIC HEALTH RELEVANCE