A dose of realism for healthy urban policy: lessons from area-based initiatives in the UK

Many urban policies aim to improve areas and address socioeconomic deprivation. The resulting investment is often delivered through area-based programmes which incorporate initiatives to improve the physical, social and economic environment. Hypotheses that these investments can contribute to wider public health strategies are based on epidemiological data and used to support the concept of healthy urban policy. However, there is little evidence on their ability to generate positive impacts on socioeconomic or health outcomes. The lack of validating evidence on actual impacts raises two important questions: (1) Is area-based investment an effective strategy to tackle socioeconomic deprivation? (2) What is the prospect for new and improved evaluations to provide stronger evidence? Both the programmes of area investment and their accompanying evaluations have been criticised for being overly ambitious in what can be achieved by the investment and what can be measured by an evaluation. Area-based approaches to tackling deprivation have their advantages but a mix of area and individual-level targeting is likely to be needed. While there is scope to improve the utility of evaluation data there are also inevitable constraints on assessing and attributing impacts from urban investment. The inherent limitations to an area-based approach and the ongoing constraints on impact evaluation will inevitably temper expectations of what healthy urban policy can achieve. However, lack of evidence is not grounds to abandon the concept of healthy urban policy; adoption of more realistic expectations together with improved evaluation data may help to increase its credibility.