Methodology to integrate complex-systems thinking and multi-criteria decision analysis in health-oriented planning and application to a health-care example

Numerous empirical studies support the notion that urban built environments function as determinants of health, and society increasingly demands that urban planning and building positively impact community health outcomes. As behaviorally associated chronic diseases have become leading causes of morbidity and mortality, methodology is needed to support planners in their consideration of and contribution toward population health goals. Community health is best conceptualized as a complex system of interrelationships between economic, environmental, and social structures. This paper presents an approach that uses complex-systems thinking to identify drivers of community health in the context of planning possibilities. It then uses multi-criteria decision analysis from the field of operations research to support informed decision making that explicitly engages multiple and potentially conflicting stakeholder perspectives and objectives, including those of community members. As an illustration, the approach is applied to a health-care campus planning decision in an urban community long beset by disproportionately high rates of obesity and chronic disease. In this particular case, the results of the analyses included differing rankings of decision alternatives from the perspectives of the community and the decision-making organization, although there was alignment on most and least preferred choices. Results could differ in other project and community contexts, but the methodology provides insights on decision alternatives that can strengthen sound healthoriented decision making for urban planning and building projects.