The long-term health and wellbeing impacts of Healthy New Towns: a six-month feasibility study of Healthy New Town demonstrator sites in England

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.