The links between public health and urban environments emerged as a key narrative during the pandemic. However, despite optimism at the time that this could lead to the re-integration of health in urban development policy there has not been transformative change in this area in England. To understand why not, this article explores COVID-19 as a ‘critical juncture’ for healthy urban development. Critical junctures provide opportunities for change in path-dependent policies if institutional constraints on policy actors are loosened and new ideas and narratives gain support. We interviewed senior Whitehall officials working at the heart of urban development policy in 2021. Drawing on these interviews and analysis of urban development policy documents published in 2023–24, we demonstrate that while there is evidence of increased support amongst policy officials for health which remains visible in recent policy developments, the dominance of institutional agendas and political ideologies that marginalise health policy objectives in city planning in England was not dislodged, limiting the opportunity for radical change. Greater leadership at local and national government levels for preventative health as a cross-sector priority is required to help overcome political and institutional constraints and support incremental change towards policy that will support healthier placemaking.