Finance • Private sector lending is more expensive and readily available; public funding is cheaper, but often unavailable • Public transport infrastructure takes time to develop and funding is rarely available, which adds pressure to allow parking and increase car use Land: • Land is cheaper in areas of low demand yet development is unviable and vice versa Politics: • Mayoral system offers greater powers, but success depends on the direction of travel and suffers from the usual political swings • Prioritisation of issues is critical, but there is no clear strategy of governance towards long-term health outcomes Policy: • ‘Five-year land supply’ policy is meant to free up land but naturally encourages strategic holding • Certain policies (e.g. PPG3) have been designed to improve quality of built environment, but misalignment with implementation has resulted in worse quality urban environments Capacity: • Significant potential for planning to affect health, but in practice this is very difficult to achieve due to lack of capacity and resource • The private sector expect initiatives in urban health to come from the public sector, but the latter lacks resource at local level and prioritisation of longer-term issues at national level