The Government's English devolution agenda is introducing many new responsibilities and ways of working. Mayors will be required to publish a local growth plan, a spatial development strategy and a transport strategy. They will have a duty to reduce health inequalities and improve health. Perhaps most significantly, the Government has made a large number of commitments to collaborative governance relationships with mayoralties.
Mayors' assortment of new functions will give them space for innovative thinking and new forms of local data. One new mechanism that meets this need is the Health Appraisal of Urban Systems (HAUS) model. It uses an economic valuation approach to estimate the potential effects of development decisions on population health.
HAUS was developed by economists at the University of Bath as part of a major research project led by the University of Bristol, known as TRUUD (Tackling Root causes upstream of Unhealthy Urban Development). The Ministry of Housing, Communities and Local Government has recently decided to include HAUS in its appraisal guide on the health impacts of urban design.
Health researchers have long been aware that people's wellbeing is hugely influenced by wider determinants: housing, transport, environment and socio-economics.
The HAUS model evolved out of a desire to express those relationships in a way that made it easy for local decision-makers to take account of them.
Historically, much UK government spending has been ‘silo-based', managed by central government departments. This can lead to overlaps between similar spending programmes operating separately in the same locality.
Mayors have made some progress in tackling this problem locally. For instance, Tracy Brabin, the mayor of West Yorkshire, said that ‘crime does not just come from bad people. It comes from poor housing, a lack of skills and opportunity and a lack of transport to get to jobs and training'.
The Government has made efforts to encourage and reward mayors who join up local policy, making changes to the ways in which it seeks to hold mayors accountable.
In 2023, the Government introduced an ‘integrated settlement' for the grant funds paid to leading mayoralties. This replaced departmental accountability with a single system based on several dozen outcomes measures.
This understanding – that good policies link up locally – creates an opportunity for mayors. Spending public money on one of their functions might lead to better outcomes and/or savings in another of their functions. But how can they prove it?
This is where the HAUS approach comes in. It uses an economic valuation approach to assess the potential impact of local conditions on population health. For instance, in many residential areas, people are living in cold or damp accommodation or live more than a kilometre from a green space.
HAUS assesses the economic effect of improving insulation or damp-proofing, or of creating additional green space as part of an urban development scheme.
It can forecast the effects that different options in a development scheme could have on population health in the area and shows how these health effects could save money.
This matters because it allows decision-makers to compare the effects of different policy interventions. It means they can make more informed choices about where to spend public money. It also means mayors can show that those decisions have been based on comparison and analysis. That is valuable in a sphere like population health, which has many causal factors.
HAUS is designed specifically to allow local leaders to assess the impact of urban developments.
But the HAUS approach has wider uses. Economic valuations would allow mayors' teams to compare the potential effects of different policies across different aspects of the local quality of life.
They could even justify a public body spending money on a project that appeared to lie outside its mandate. For instance, a health authority could choose to provide funding for a park or open space within a new development, in the expectation that public health would improve locally and this would save money.
Governments are often nervous about giving away decision-making powers, in spite of commitments to do so.
Christopher Hood, renowned Gladstone professor of Government at Oxford and a founder of the Centre for Analysis of Risk and Regulation at the London School of Economics and colleagues have highlighted how most UK governments for the last 30 years have used ‘input controls' to judge local governments' performance – that is, looking at money spent and decision-making.
‘Outcome controls', focusing on the overall effects of policies, are the exception to the rule. But this also reflects that changing outcomes takes time.
Government departments with long-established practices need a carefully-mapped path if they are to be confident in new ways of working. HAUS helps to map that path by providing clarity and transparency about the expected effects of spending decisions on places.
Mark Sandford is a senior research analyst at the House of Commons
