Qualitative Urban Health Research: The 5C Framework

The 2026 Developing the 5C mayoral framework for action on health study found that London mayors can influence health through five dynamic modes of action: convene, champion, collaborate, challenge and command.

The qualitative urban health research used semi-structured interviews with 35 senior leaders who had worked with or closely observed the London Mayor over 25 years, then used constant comparison, memoing and category development to build a provisional framework.

• In 2026, the study identified five modes of mayoral action: convene, champion, collaborate, challenge and command.
• The researchers interviewed 35 senior leaders in 2026, with participants bringing experience of the London mayoralty over the previous 25 years.
• The study used an abbreviated constructivist grounded theory-informed analysis, including constant comparison, memoing and category development.
• The researchers described the 5C Mayoral Framework for Action on Health as provisional and London-derived in 2026.
• The study concluded in 2026 that the framework should be tested in cities with different governance structures and statutory powers.

The 2026 study found that mayors can improve urban health by using several forms of influence, even when mayors do not directly control healthcare services.

According to the study abstract, London was a useful case because the Mayor has no direct responsibility for healthcare services but can influence health through statutory strategies and wider policy responsibilities. The researchers examined how formal and informal powers operate across urban leadership.

The study’s five modes are convene, champion, collaborate, challenge and command. The authors wrote that the findings gave rise to these “five key dynamic modes of Mayoral action to improve urban health and healthcare.”

The five modes should be interpreted as connected leadership behaviors rather than a rigid sequence. The researchers described the framework as a way of “understanding and guiding Mayoral action to improve health and healthcare, ” while also stating that its wider applicability requires further testing.

The 2026 study shows that urban health policy teams should analyze leadership as a set of context-dependent actions rather than as a single formal authority.

According to the study, mayors can affect health through responsibilities such as transport, planning, housing and economic development, which means qualitative research must connect leadership accounts to multiple policy domains. Interview analysis should therefore preserve both explicit descriptions of authority and indirect accounts of influence.

The 5C framework also illustrates why qualitative policy research benefits from systematic comparison. Researchers can compare how different participants describe convening, championing, collaborating, challenging and commanding across departments, time periods or policy areas.

AI-enabled qualitative research can support this work by organizing large interview collections, surfacing recurring themes and identifying differences between stakeholder groups. Human researchers must still interpret context, assess evidence quality and decide whether a code represents a meaningful analytic category.

The authors’ 2026 conclusion limits the framework’s scope: the 5C model is London-derived and should not be treated as universally validated. Any application in another city should test how local governance powers, institutions and political norms change the meaning of each mode.

The 2026 London study demonstrates how qualitative urban health research can turn leadership interviews into a practical framework for policy analysis. The five Cs, convene, champion, collaborate, challenge and command, give researchers a structured way to examine how mayors influence health beyond direct healthcare control. AI-enabled qualitative analysis can make this work more efficient while preserving the human interpretation needed to test whether a framework travels across cities. To analyze interviews and policy documents with thematic and cross-segment methods, try Evidano for free.