Policy and governance challenges

The second podcast in the series from the TRUUD research programme explores the challenges of translating urban health research into effective government policy and action. 

Host Andrew Kelly is in conversation with Professor Sarah Ayres, University of Bristol, and Dr Geoff Bates, University of Bath, about their work on the TRUUD project, specifically examining how to make government take notice of evidence and implement long-term preventative strategies. They discuss the Health Appraisal of Urban Systems model for understanding the costs of unhealthy urban environments, the importance of cross-departmental collaboration, and the potential of devolution and a focus on wellbeing economies. 

The conversation also reflects on the impact of COVID-19 and concludes with an optimistic outlook on achieving meaningful change through sustained engagement with civil servants.”

Funded by the UK Prevention Research Partnership which aims to reduce non-communicable diseases such as cancers, type-2 diabetes, obesity, mental ill-health and respiratory illnesses, TRUUD is providing evidence and tools for policy-makers in government and industry.

Find more at the TRUUD website: https://truud.ac.uk/

Books recommended in the episode:

Sarah Ayres:

Managing Complex Networks by Walter Kickert, Erik Hans Klijn, Joop Koppenjan

Managing Uncertainty in Networks by Joop Koppenjan

Geoff Bates:

Muscle: Confessions of an Unlikely Bodybuilder by Samuel Wilson Fussell

Andrew Kelly:

The Child in the City by Colin Ward

Other recommended resources:

About The Green Book from HM Treasury to appraise policies, programmes and projects.

Music credit: New York London Tokyo by Petrenj Music

Produced by Beeston Media.

Transcript

00:00:03 Andrew Kelly 

Welcome to the Second TRUUD podcast from the University of Bristol. I'm Andrew Kelly. Previously we looked at urban health and TRUUD research in shaping Urban Development for healthier lives. 

00:00:14 Andrew Kelly 

How do we translate this work into government action now and for the long term so that we can prevent future problems today rather than waiting to cure them later? 

00:00:24 Andrew Kelly 

Various party manifesto commitments since the Marmot review in 2010 have argued for this, but there's been little change. Levelling up didn't work. Labour's health mission called for a prevention first revolution, but will this lead to change? I'm joined by Professor Sarah Ayers, School for Policy Studies, University of Bristol, 

00:00:44 Andrew Kelly 

And Dr Geoff Bates from the Institute for Policy Research, University of Bath. 

00:00:48 Andrew Kelly 

Sarah leads the TRUUD national government intervention programme and Geoff is one of the researchers on this. Sarah, the national intervention programme is about getting evidence into policy making. What makes civil servants and politicians take notice and give us some examples. 

00:01:03 Prof Sarah Ayres 

There's probably three things that we've learned from TRUUD. The first is having a really good pitch into government, so being really clear about how our expertise and our evidence can contribute to solving a particular challenge Government is working with. 

00:01:19 Prof Sarah Ayres 

The second issue we've thought hard about is being solutions focused. Governments really good at understanding all the problems and all the barriers. We've been mindful not to focus on that too much. So when we're going into government, we're thinking about how we can look for opportunities, how we can resolve some issues that they're facing. 

00:01:40 Prof Sarah Ayres 

How we can be at their service? 

00:01:42 Prof Sarah Ayres 

And then the final thing we've spoken about really is about thinking about high quality Co production relationships. So we've got a really good set of relationships with the Ministry of Housing Communities, Local Government, but also across government. So we've been able to drop the performativity, roll up our sleeves. 

00:02:02 Prof Sarah Ayres 

Work in partnership get the right people in the room with the right vision and good things have happened. 

00:02:08 Andrew Kelly 

Geoff, you've done the some of the research for this. You've done over 120 interviews. Who did you talk to and what did you learn from this? 

00:02:18 Dr Geoff Bates 

Yeah. So the interviews were done by the whole TRUUDteam and one of the benefits was that was due to the wide range of expertise on the, on the project, we're able to interview people from across the public, private, third sectors from sort of local to national level. 

00:02:32 Dr Geoff Bates 

covering a wide range of of disciplines. So urban planning, housing developers, investors, policymakers, lawmakers and so on. I won't list them because we’d be here all day, but that enabled us to get a really well-rounded understanding of how decisions are made that shape, urban developments where the problems sit that prevent sort of further integration of health into that. 

00:02:53 Dr Geoff Bates 

Process and probably really importantly, where we can look to implement solutions. 

00:02:58 Dr Geoff Bates 

So across all those interviews were identified 50 specific problems preventing healthy urban developments, and that enabled us to provide the rationale for us to take forward the interventions that we've developed in TRUUD. So just for example, on Sarah and my part of the project with national governments, it was things like a lack of joined up working between. 

00:03:18 Dr Geoff Bates 

Health officials and Urban Development officials and governments. A lack of data and tools to help officials to include health in their decision making when they're deciding sort of what to fund. 

00:03:28 Dr Geoff Bates 

And and so that gave us the the rationale for us to take forward our work. 

00:03:32 Andrew Kelly 

And you also reviewed relevant documentation which found that health is rarely featured at all in that material. 

00:03:41 Dr Geoff Bates 

Yeah, that's right. And what was really interesting was that over time, we can see a slight shift towards a greater inclusion of health. 

00:03:48 Dr Geoff Bates 

Maybe not to the extent that we'd like, and certainly still perhaps subordinate to other, more sort of powerful agendas influencing government thinking. 

00:03:57 Dr Geoff Bates 

But certainly more space for health to be part of the sort of housing and transport policies than previously, which is obviously a good thing. 

00:04:03 Andrew Kelly 

So you had 50 recommendations, did you say? 

00:04:08 Dr Geoff Bates 

Yeah, that's right. And we've been trying to conceptualise them all and it's very difficult to put them all in one sort of nice easy image to understand and they cover such a wide range of problems and some. 

00:04:18 Dr Geoff Bates 

Of them are really sort of large, overarching structural issues like political short termism or the dominance of sort of economic growth models shaping government decisions. And then others are more sort of down or not downstream but more straightforward concepts like a lack of evidence, a lack of data, and so our role on TRUUD was to decide. 

00:04:39 Dr Geoff Bates 

All of these are important, but which can we tackle within the constraints for a program like this? 

00:04:43 Andrew Kelly 

Sarah, you came up with the HAUS model, the health appraisal of urban systems. So tell us about that. 

00:04:49 Prof Sarah Ayres 

Yeah, that's a model that's been developed by our Bath team. Eleanor Eaton, Alistair Hunt. And that model shows three key things. First is the link between different features of the urban environment and health outcomes. Second, the costs associated with ill health linked to the urban environment. 

00:05:10 Prof Sarah Ayres 

And 3rd, where in the system those costs land and they don't always land in the health sector, they can be crime and disorder, work and pensions, education. So an example of a pathway might be noise pollution in cities. 

00:05:26 Prof Sarah Ayres 

ADHD in children, disruption at schools, cost to the education system and by showing those pathways, it incentivises actors who don't think that they have a remit in health to understand their impact on health outcomes. And that's been a really powerful, persuasive tool in government. 

00:05:46 Prof Sarah Ayres 

Across government, bringing them together around this issue. 

00:05:50 Andrew Kelly 

Because one of the problems with things like this, isn't it , is the silo mentality you have in government of, you know, some people might say, well, we want to run that program or it's the responsibility of the Department of Health and Social Care. 

00:06:03 Andrew Kelly 

Do you think you found that silo mentality changing as you've worked on this project? 

00:06:08 Prof Sarah Ayres 

We've encountered both those positions, so an example would be speaking to somebody with a remit in housing who says we build housing. We don't deal with asthma cases. 

00:06:18 Prof Sarah Ayres 

Working with the Ministry for Housing and Communities and Local government health actors saying should we be leading this? This is our issue and we've had to navigate all of that in TRUUD. 

00:06:28 Prof Sarah Ayres 

But I think what we have seen is a real appetite for systems thinking, working across government departments. Geoff and I have delivered master classes in government and webinars about how you can inject systems thinking into political policy decision making. Those have been well attended. 

00:06:49 Prof Sarah Ayres 

But the TRUUD work has been a real example of how you can do that in practice. 

00:06:54 Prof Sarah Ayres 

So I think lots of civil servants across government know they need to think about the intersectionalities or the links across government departments. They know they need to think about systems, they know as an education or housing specialist that they do have an impact on health outcomes. But how can they get hold of the problem? How can they actually do something about it? 

00:07:13 Prof Sarah Ayres 

What we've shown by using a model like the health appraisal for urban systems model that shows the impact of a housing decision on health, it allows civil servants to understand the part and the role they can play. And that's been really important in us being able to pull together a group of civil servants. 

00:07:33 Prof Sarah Ayres 

Across the departments and let them know what stake they can have in in the problem. 

00:07:38 Andrew Kelly 

So this is more than the Ministry of Housing Communities and Local Government, you've been able to get beyond that ministry. 

00:07:45 Prof Sarah Ayres 

Absolutely and really key brilliant colleagues in the Department for Health and Social Care and Office of Health Improvement and Disparities have been part of this discussion right from the start. They've helped us stress test the model. They've made us jump through difficult hoops. 

00:08:00 Prof Sarah Ayres 

They've made sure that the evidence within the model is robust and fit for purpose, and those interventions have been really important. Likewise with Treasury, very supportive of the work we're doing. Transport, Defra, work and pensions. We've spoken to them all and we've managed to convince them through our pitch that they all have a role to play. 

00:08:21 Prof Sarah Ayres 

The question of next steps is what is that role? What's it look like? How can we help them find it? 

00:08:26 Andrew Kelly 

I was intrigued, Geoff, in a briefing paper you contributed to about the post war. 

00:08:32 Andrew Kelly 

Labour government where Nye Bevin was responsible not just for housing but for health, is that the kind of spirit you've been trying to encourage and action in fact. 

00:08:42 Dr Geoff Bates 

I think it's. It's what we'd maybe like to see. We certainly know that that compared to where when Bevin was around that that the role of housing minister is more separate from. 

00:08:53 Dr Geoff Bates 

Health now, or at least. 

00:08:54 Dr Geoff Bates 

Has been, but because they're so interlinked and what we'd like is the the housing minister and the health minister to be to be speaking and working to a a shared objective, yes. 

00:09:05 Andrew Kelly 

And and Sarah coming back to you on the you talked about civil servants on what about politicians nationally? Have you had much discussions with them? 

00:09:13 Prof Sarah Ayres 

They've been part of the discussion and I think we have at arms length through our civil servants, but we've seen quite a big churn in both the government and ministers since we've been working in TRUUD and I've been quite relaxed about that. So instead of engaging with politicians directly, we've been engaging with really senior. 

00:09:31 Prof Sarah Ayres 

civil servants with the power and agency to actually make big decisions, and those people haven't changed. So the change in government and narratives and slogans, whether it's levelling up or mission orientated, they come and go and we've had to craft our pitch accordingly to make sure that you know what we're talking about. 

00:09:51 Prof Sarah Ayres 

Responds and has a hook in the sort of political debates, but the big challenge is promoting public health, tackling health inequalities. They haven't changed, and the civil servants in government, with a commitment to tackling those in new and creative ways, haven't changed. And that that's who we've been working with. 

00:10:10 Andrew Kelly 

Can I pursue the issue of long term change with with both of you? First of all, Sarah, you've talked there about the importance of those connections and links with civil servants and so on. How do you encourage that over a a much longer term period than say the period of a government of say four to five years? 

00:10:28 Prof Sarah Ayres 

I think getting departments, civil servants to think about long term preventative is a huge challenge set to get even harder if the cuts around welfare are due to come in, how do you persuade relevant actors whether they be politicians or civil servants to invest 

00:10:46 Prof Sarah Ayres 

Over a 30 year period, when there's such immediate pressures around, you know, delivery of the health, the health service is in crisis. But I think it doesn't take much persuading to know that the system is broken. And if we don't do something about it, we are just locked into this path dependency of failure, really. You know, we've got widening health. 

00:11:07 Prof Sarah Ayres 

Inequalities, we've got more working age people out of work than ever before. Rising waiting lists. We have to think differently. We have to think about preventative and if we don't, we're just in this constant churn of crisis management. 

00:11:20 Prof Sarah Ayres 

I don't think anybody in government needs persuading about the need to do something more radical about that. 

00:11:27 Andrew Kelly 

And Geoff, that's national government. What about local government? What kind of work has taken place there? What kind of thinking is, is the thinking similar, for example, when it comes to national government deal with officers, established relationships there? 

00:11:41 Dr Geoff Bates 

I think lots of the issues are really similar. 

00:11:43 Dr Geoff Bates 

There I think maybe there's a bit more scope at the local level for for thinking differently. All the things that Sarah just said about, you know, being stuck in the system and needing to be sort of ambitious and do things differently I think are are are really important. I think at the local level we can support local authorities to be ambitious and to think differently about. 

00:12:03 Dr Geoff Bates 

How they measure success and think long term 

00:12:06 Dr Geoff Bates 

So just for example, we could support local authorities to adapt the principles and frameworks of things like well-being economies. We're seeing a an appetite for that in the UK and internationally. So instead of measuring policy success by sort of short term growth and productivity outcomes, thinking about health and well-being at the heart of policies and how we understand. 

00:12:27 Dr Geoff Bates 

And and measure their their their impact. 

00:12:29 Dr Geoff Bates 

On another project that some of us from TRUUD are moving on to called “local health global profits”, we are we're we're doing exactly this. We're looking to enable local authorities to think differently about well-being economies and to support them to take action against sort of these upstream determinants of health. And there is an appetite there. And so I think that's the sort of thing that that gives you cause for optimism. 

00:12:49 Andrew Kelly 

We're entering quite an important phase of devolution, Sarah. 

00:12:53 Andrew Kelly 

I think for the first time, there could be substantial shifts in the way this this country is run with much more local powers. How important is that for this program? 

00:13:03 Prof Sarah Ayres 

I think it's really important. Through our evidence of doing interviews with 132 stakeholders across the Urban Development system from state 

00:13:12 Prof Sarah Ayres 

Market and civil society. We know that local leaders really want to act on health. We know that they want to create healthy urban environments, but the incentive structures just aren't there to do it. Nobody has a remit for creating healthy urban environments. 

00:13:27 Prof Sarah Ayres 

So how do you inject that capacity? That wiggle room to think creatively at a local level? And that was the problem space that prompted our intervention, really. How can we soften the system upstairs in Westminster and Whitehall to create the right incentive structures to allow local actors to behave differently? 

00:13:48 Prof Sarah Ayres 

I've been working on devolution for nearly 25 years. Since the start of my PhD, and I've seen these narratives. 

00:13:55 Prof Sarah Ayres 

about a big devolution drive, a devolution revolution and while there's tinkering at the edges, what we haven't seen is a fundamental devolution of power and authority to local levels. So while I think we've got to be mindful of the opportunities that the devolution White Paper offers, we've also got to be realistic about it doesn't mean a massive overhaul of 

00:14:16 Prof Sarah Ayres 

The British political tradition and the way things operate. But I think what local actors and areas really do need is more control and discretion over the objectives they set. 

00:14:27 Prof Sarah Ayres 

The ability to via funds or move funds across budget headings to be able to think creatively about healthy Urban Development and maybe a health investment in infrastructure and housing, and also accountability structure. So mayors and local leaders, when they do creative joined up system sinking the accountability. 

00:14:48 Prof Sarah Ayres 

Structures are there. 

00:14:48 Prof Sarah Ayres 

There so that they get the credit they deserve. So there's an imperative and incentive for them to act in those difficult spaces. 

00:14:55 Andrew Kelly 

And isn't there there a crunch point coming of this with housing, Geoff, because we're entering a massive programme of housing, I mean going back to Bevin, he talked about, you know, we might be judged initially on the number we build, but really it's about the types we build in the end and actually the quality of communities we create I guess. 

00:15:13 Dr Geoff Bates 

Yeah, absolutely. We know there's a huge housing shortage and we need to build houses, but we don't just need the numbers of housing, we need the right types of housing and the right types of development. 

00:15:23 Dr Geoff Bates 

And we think that by putting health just as one factor that that decision makers are are thinking about when they're deciding what types of developments to create and what types of regeneration to do, then that is has been something that's been missing and that we're hoping we can support through the work we've been doing in TRUUD. 

00:15:40 Andrew Kelly 

And this is critical for TRUUD , If we're creating housing, we've gotta create the right types of housing and we've gotta create the right types of things needed around them. 

00:15:51 Prof Sarah Ayres 

And we've also been mindful though, Andrew, where it you know it, there's sometimes people think better housing needs to cost more and often it does. The more money you can throw at this, the better outcomes you get. But we've been mindful in our pitch to government that actually you can make cost neutral benefits as well. 

00:16:10 Prof Sarah Ayres 

So having better housing doesn't necessarily mean less. So what the HAUS model, The health appraisal for urban systems model allows decision makers to do. 

00:16:19 Prof Sarah Ayres 

If they have a finite pot of money, do you invest in a cycle path or insulation in homes? At the moment those difficult decisions decision makers are working blind. They haven't got the health evidence in front of them, so they can make informed decisions. So now they can use the health evidence in a cost neutral way 

00:16:40 Prof Sarah Ayres 

To say, let's just make better decisions, not necessarily more costly decisions. And I think that's important in the current climate 

00:16:47 Andrew Kelly 

And how receptive do you think the Treasury will be to those? Let's talk about the Treasury, where the the crunch point will come on money, for example. 

00:16:53 Prof Sarah Ayres 

the Treasury have been really supportive of our work in TRUUD. we've engaged the Treasury in two ways. 

00:17:01 Prof Sarah Ayres 

One was their cross departmental team that are charged with a remit of thinking about creative systems thinking and they were really interested in our work as an exemplar of how that can happen. Treasury have been supporting us along the way with that, and I think they can see the potential for it to be extended to other departments like transport. 

00:17:21 Prof Sarah Ayres 

And Defra and our vision in TRUUD, potentially. Is that the model might appear at some point down the line in the Green Book. If we make the right noises and and do the right thing. So I think there is an appetite. They can see the benefit of thinking. 

00:17:34 Prof Sarah Ayres 

About cross departmental links, they can see the benefits of better social science. Evidence on the table to make informed decisions, and where you can get a health return on investment while you're building houses while you're building roads. It's a no brainer. 

00:17:51 Andrew Kelly 

Thank you, Sarah. Can I ask about COVID? It's it's been five years. What changed with COVID? What did you learn from COVID for your research and what should have changed? Geoff, to start with you? 

00:18:01 Dr Geoff Bates 

I think what COVID was highlight a lot of problems with the way things are currently in in different ways. So firstly, in terms of we know that people in certain urban conditions did experience worse COVID related outcomes. So if if you lived in areas of higher air pollution or in higher density housing areas, then people were more likely to catch COVID in a more like to have worse. 

00:18:21 Dr Geoff Bates 

Health outcomes as a result, and secondly, what I think became strong sort of well established narratives at that time in, in the public and in the media was our experiences during sort of periods of lockdown and other sort of restrictions on social movement and on on social distancing. 

00:18:38 Dr Geoff Bates 

Because our experience is there really varied relating to the the types of places we lived. If you had a big garden, was very different than if you were in a, a kind of cramped high rise flat for example. It also really showed the impact of reducing traffic on the road. You had lots of stories how nice it was being outside in these sort of car free roads. 

00:18:58 Dr Geoff Bates 

And there's a lot of optimism at the time about how this, how things could be done differently. Sarah talked earlier about the kind of the existing system and the problems within it. Well, this showed what happens if you change that. 

00:19:09 Dr Geoff Bates 

But what we came up against was that these are really difficult things to change in the long term. And so that kind of optimism hasn't necessarily been seen through in rapid policy change. But we have seen indications of change over time since the height of COVID. For example, we now see more low traffic neighborhoods, we see more cycle paths being put in. 

00:19:29 Dr Geoff Bates 

You see health is featuring more within sort of government narratives in the urban space. We can't say all that's because of COVID, but it It may well have contributed to that. 

00:19:38 Andrew Kelly 

Sarah? 

00:19:39 Prof Sarah Ayres 

But just to add to that, I think it showed two things for me. One was the big links between health and the economy. You know, if you get a big health crisis, lots of people out of work, what it means for the economy and how important a healthy workforce and a healthy population is to UK PLC. The second thing it showed. 

00:19:58 Prof Sarah Ayres 

Linking to Geoff's point was that some people were disproportionately affected. People from ethnic minorities, women, people living in the north. You know, why is it that some people had a really difficult time; mental, physical health, out of COVID and other people weathered that storm. That’s wrong 

00:20:17 Prof Sarah Ayres 

And that's what we need to address in TRUUD. And in society, you need to tackle those health inequalities. One, because there's a productivity case, you know, people are unhealthy, it's not good for the economy, but also in terms of social justice and equality, democracy, fairness. And then the final thing, like the observation, we've just recently written a journal article. 

00:20:38 Prof Sarah Ayres 

Asking why didn't the COVID pandemic lead to more fundamental rethinking in government? Placing health at the 

00:20:46 Prof Sarah Ayres 

Centre of lots of debates. We did our interviews at the height of COVID in 2021, so we did them online and at the time the COVID pandemic was live in the political and social narrative, shaping policy and public debates. 

00:21:02 Andrew Kelly 

And that brings me on to to how optimistic do you feel with with all this work you've done that it will have an influence in government. 

00:21:10 Dr Geoff Bates 

It's a good question because when we started. 

00:21:12 Dr Geoff Bates 

I was a bit unsure about and I think we all were about how this would go, but what we found from our first attempts to engage really with the Ministry of Housing Communities and Local government officials, there was a real receptiveness from them to doing this work. And since then we've had over 100 meetings with our core partners in Ministry of Housing, Community of Government. 

00:21:32 Dr Geoff Bates 

And other teams in their departments and other departments. 

00:21:36 Dr Geoff Bates 

And that's a lot of time investment on on their part. It shows that real receptiveness for this and sort of willingness to work through the challenges in order to to pick up the model, the HAUS model and the related thinking and evidence we're giving them. So I do feel optimistic there that there is a commitment amongst officials, maybe the the caveat around it, so the the other side of the coin is just. 

00:21:56 Dr Geoff Bates 

We know that efforts to to tackle public health at the policy level have been implemented many times over the years. There's been lots of warm words and new strategies, but they haven't always led to to long lasting change. And so with the new health mission from the government that put tries. 

00:22:12 Dr Geoff Bates 

To put prevention, tries to raise the profile of health prevention, for example, and lots of other strategies that the government are introducing around child health, around dental health and breakfast clubs and things like this. These are all pointing really positive direction. They've increased the budget, the public health budget which is, which is really great. We just know that there's these changes are vulnerable. 

00:22:34 Dr Geoff Bates 

To other agendas and changing political situations, and so that's always in the back of my mind 

00:22:38 Andrew Kelly 

Sarah, how optimistic are you? 

00:22:41 Prof Sarah Ayres 

Yeah, I'd echo that. I'm not trying to gloss over the challenges of embedding systems long term preventative approaches to policy making. We've been navigating that for the past two years and as Geoff said, it's a huge amount of time and it's not easy, but I'm feeling really positive actually based on the engagement that we've had with. 

00:22:59 Prof Sarah Ayres 

MHCLG, Treasury health transport, Defra, other departments. 

00:23:06 Prof Sarah Ayres 

I see that the the barrier for us is that we haven't had the research and resource capacity within our team to service all the interest that we have. So I have really high hopes if we can get future funding that the door is open to us from those departments to extend the work. What's the big win for us is that we set up a cross departmental 

00:23:25 Prof Sarah Ayres 

Working group that's meeting at intervals to come together as a collective to discuss TRUUD work. The economic valuation model, how they can filter that into government. That was a massive win for us and it shows a commitment on the part of government. 

00:23:40 Prof Sarah Ayres 

And we've also set up one at a local level, mayor or Combined Authority working group. Again, a grouping of mayor combined authorities wanting to work with TRUUD, wanting to get their hands on this model. So I have high hopes for this work moving forward. 

00:23:55 Andrew Kelly 

Thank you. We also asked you to recommend some books to read for our TRUUD bookshelf. Sarah, what do you recommend? 

00:24:03 Prof Sarah Ayres 

OK, so there's two books that have been really influential in my career. The first one, Managing Complex Networks, was published in 1997. When I first started my PhD that was gospel. 

00:24:16 Prof Sarah Ayres 

And then the second one, Managing Uncertainty in Networks published in 2004, the year before I arrived at Bristol, both written by colleagues at Erasmus University, and they're really about when you have complex social problems like healthy Urban Development and you cannot solve that within a system of siloed government. 

00:24:37 Prof Sarah Ayres 

You have to engage with actors. You have to work in collaboration. How do you do it? How do you get people in the room when you can't rely on 

00:24:46 Prof Sarah Ayres 

Process and rules. You have to rely on vision, persuasion, empathy, humility, working together. And that's what we've been doing in TRUUD for the past two years. So these books are, you know, I don't mind dealing with complexity and uncertainty. You get the right people in the room. You have the right vision, things can happen 

00:25:005 Andrew Kelly 

Geoff? 

00:25:07 Dr Geoff Bates 

Very different answer from me. A book that I found incredibly important for my thinking about how society shapes our own health and experiences, and this is what led me down sort of a research route really that ended up focusing much more on thinking about communities and thinking about policies and politics, was a called a book called Muscle: Confessions of an Unlikely Bodybuilder  

00:25:30 Dr Geoff Bates 

By a guy called Sam Fussell, who was an Oxford academic who moved to the States and ended up going down a career path to being a competitive bodybuilder. So I used to do lot of work on substance use. So I came across it through there, but actually at its heart, that book is really about how the communities we live in and the people around us and how we feel safe and our experiences 

00:25:50 Dr Geoff Bates 

Shape and can completely turn our lives in completely different directions. And so for the first time I went from my sort of psychology background thinking about quite individual factors and some sort of social networks and importance that thinking about much bigger issues and that led me on to the world of sort of systems thinking and wider determinants of how. 

00:26:09 Andrew Kelly 

My book recommendation is a classic first published in 1978. Colin Ward's The Child in the City looked at the ways in which our experiences of the city affects how we grow up, as well as making these experiences better. 

00:26:23 Andrew Kelly 

I thought about this book most recently when I saw the TRUUD film, I Fell Asleep At School, which tells the story of Samuel and his two young children living in a cramped one bedroom flat near the top of a high rise in brick. 

00:26:38 Andrew Kelly 

There's no places to play and limited space to live together. There's no space to be children. The impact on health is substantial. It sums it all up in 5 minutes. 

00:26:49 Andrew Kelly 

My takeaways from today: Accept the system is broken but don't get locked into failure, prevention not cure, drop performativity, overcome silos, roll up our sleeves, work in partnership. Get the right people in the room with the right disciplines and experience. You get vision then and it means good things can happen. 

00:27:10 Andrew Kelly 

The right disciplines, include urban planners, but it's much wider. Health and housing transport and the law developers and communities, for example, and devolved governments, so that local change can be led by local government and local people. Well, thank you. Thank you. Sarah Ayers and Geoff Bates for joining me today. Our next podcast looks at long term. 

00:27:31 Andrew Kelly 

Systems change in Urban Development. The TRUUD website truud.ac.uk has links to all the podcasts, background research and issues, papers and recommendations discussed today. Thank you very much. 

00:27:44 Prof Sarah Ayres 

Thank you, Andrew 

00:27:45 Dr Geoff Bates 

Thank you, Andrew.