Built Environment – Healthy Cities Toolkit

Description

Built environment refers to structures built by man to support human activity and includes physical structures such as buildings, roads, parks, sidewalks, commercial signage, and street furniture [Portella 2014].

There is increased interest in exploring how interventions in built environments can improve health outcomes, and evidence is beginning to accumulate [Rutt 2008].

Impact

Interventions in built-up environments have the potential to improve a variety of health outcomes. However, quantifying the extent to which such interventions influence health and other outcomes is currently unclear [Bird 2018; Shannon 2020; Sarkar 2018].

Results

A total of 17 reviews comprising 966 studies were identified. One of these reviews [Samarasinghe 2019] was an overview of systematic reviews and an evidence map.

Outcome: Health

Street environment, transportation infrastructure, and green and open spaces were positively associated with physical health [Kim 2019; McCormack 2019].
In flooding situations, green building designs can reduce the risk of waterborne diseases, flood-related morbidity and mortality, psychological harm, and the interface between humans and wildlife [Houghton 2017].
In both adults and children, higher rates of crime and proximity to fast food restaurants were associated with increased body mass index (BMI) [Malecki 2014].
The effect of heat exposure on health outcomes in built-up environments is uncertain [Ellena 2020].
Housing refurbishment and modifications, provision of adequate heating, and improvements to ventilation and water supply were associated with improved respiratory outcomes [Ige 2019].

Outcome: Mental health and wellbeing

Mental health and self-rated health were associated with neighbourhood built and social environments [Malecki 2014].

Proximity and access to fast food, greenspace, parks and recreation features were associated with the risk of depression [McCormack 2019].
Non-food-related land use and destination features (e.g., proximity to general and specific land uses and destinations) were significantly associated with depression/anxiety [McCormack 2019].
In adolescents, access to neighbourhood resources was minimally associated with depressive symptoms; however, there was a significant association between neighbourhood perceptions and depressive symptoms [Whitt 2013].
There was no evidence of an association between mental health and ‘urban regeneration’ and ‘improving green infrastructure’ studies [Moore 2018].
Neighbourhood social environments have a significant relationship with older adults’ psychosocial health; however, the results of neighbourhood-built environments are mixed [Gan 2017].
Significant positive relationships were found between social cohesion and destination accessibility/walkability, between social cohesion and the overall built environment, and between overall social capital and the built environment [Mazumdar 2018].
Better place quality adds socio-economic value and improves health and environmental outcomes [Carmona 2018].

Outcome: Physical activity

Safe, walkable, and aesthetically pleasing neighbourhoods positively influenced the participation of older adults in physical activity [Barnett 2017; Rachele 2019].
Exercise facilities, enjoyable scenery, frequency of seeing others exercise, presence of and satisfaction with recreation facilities, presence of nonresidential destinations, and pedestrian sidewalks were associated with higher levels of physical activity [Malecki 2014; Smith 2017; Zapata-Diomedi 2016].

Strength of the Evidence

Eight reviews reported on the quality of included studies. In Samarasinghe 2019, only 15/131 reviews were reported to be of high quality. The overall quality was low in four reviews [Ige 2019; Moore 2018; Rachele 2019; Smith 2017], low to moderate in two reviews [Barnett 2017; Zapata-Diomedi 2016], and moderate in one review [Mazumdar 2018].

The evidence base is heterogenous and requires further robust research to underpin future interventions and policy.

Resource implications

Only one study conducted in the US [Smith 2017] assessed economic impact (cost-effectiveness of built environment intervention). These ranged from US$45,000 per park for the implementation of fitness zones to US$5.5 million for two major playfield renovations.

Recommendations

Future systematic reviews and evidence maps of built environments should include descriptions of methods, providing datasets and interactive visualizations.
Future research should identify independent influencers of neighbourhood-built environments.
Research on the impact of built environment interventions should be expanded to include low- and middle-income countries (LMICs)
The development and use of standard methods for reporting the association between the built environment and physical activity is imperative.
Future studies should incorporate cost-benefit analyses (and resource implications) into research designs and adequately control for confounders.
Google Street View (GSV) should be utilised to explore untapped areas of health research, such as identification of sources of pollution, design of parks and amenities, and longitudinal research.
Future research studies should be better designed and have methodological rigour.
There is a lack of standardized definitions across different types of research syntheses across disciplines, and poor reporting quality of research syntheses [Samarasinghe 2019]

Related Resources

Portella 2014. “Built Environment.” In: Michalos, A.C. (eds) Encyclopedia of Quality of Life and Well-Being Research. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0753-5_240.
Rutt 2008. “Using policy and built environment interventions to improve public health.” Journal of public health management and practice : JPHMP vol. 14,3 (2008): 221-3.
Bird 2018. “Built and natural environment planning principles for promoting health: an umbrella review.” BMC public health vol. 18,1 930. 28 Jul. 2018.
Shannon 2020. “Application of Theory in Studies of Healthcare Built Environment Research.” HERD vol. 13,3 (2020): 154-170.
Sarkar 2018. “Neighbourhood walkability and incidence of hypertension: Findings from the study of 429,334 UK Biobank participants.” International journal of hygiene and environmental health vol. 221,3 (2018): 458-468.

Reference to Reviews

Samarasinghe 2019. “A visualized overview of systematic reviews and meta-analyses on low-carbon built environments: An evidence review map.” Solar Energy Volume 186, 1 July 2019, Pages 291-299.

Kim 2019. “How Does the Built Environment in Compact Metropolitan Cities Affect Health? A Systematic Review of Korean Studies.” International journal of environmental research and public health vol. 16,16 2921. 14 Aug. 2019, doi:10.3390/ijerph16162921.

McCormack 2019. “A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence.” “Examen de la portée sur les associations entre aménagement urbain et santé : les données quantitatives canadiennes.” Health promotion and chronic disease prevention in Canada : research, policy and practice vol. 39,5 (2019): 187-200. doi:10.24095/hpcdp.39.5.03.

Houghton 2017. “Health Co-Benefits of Green Building Design Strategies and Community Resilience to Urban Flooding: A Systematic Review of the Evidence.” International journal of environmental research and public health vol. 14,12 1519. 6 Dec. 2017, doi:10.3390/ijerph14121519.

Malecki 2014. “The Wisconsin Assessment of the Social and Built Environment (WASABE): a multi-dimensional objective audit instrument for examining neighborhood effects on health.” BMC public health vol. 14 1165. 13 Nov. 2014, doi:10.1186/1471-2458-14-1165.

Ellena 2020. “The heat-health nexus in the urban context: A systematic literature review exploring the socio-economic vulnerabilities and built environment characteristics.” Urban Climate Volume 34, December 2020, 100676.

Rzotkiewicz 2018. “Systematic review of the use of Google Street View in health research: Major themes, strengths, weaknesses and possibilities for future research.” Health & place vol. 52 (2018): 240-246. doi:10.1016/j.healthplace.2018.07.001.

Ige 2019. “The relationship between buildings and health: a systematic review.” Journal of public health (Oxford, England) vol. 41,2 (2019): e121-e132. doi:10.1093/pubmed/fdy138.

Whitt 2013. “Impact of the built environment on urban adolescent depressive symptoms.” Dissertation Abstracts International Section A: Humanities and Social Sciences. 2013.

Moore 2018. “The effects of changes to the built environment on the mental health and well-being of adults: Systematic review.” Health & place vol. 53 (2018): 237-257. doi:10.1016/j.healthplace.2018.07.012.

Gan 2017. “Neighborhood effects for aging in place: a transdisciplinary framework toward health-promoting settings.” Housing and Society Volume 44, 2017 – Issue 1-2: Pages 79-113. https://doi.org/10.1080/08882746.2017.1393283.

Mazumdar 2018. “The Built Environment and Social Capital: A Systematic Review.” Environment and Behavior, 50(2), 2018: pages 119–158. https://doi.org/10.1177/0013916516687343.

Carmona 2018. “Place value: place quality and its impact on health, social, economic and environmental outcomes.” Journal of Urban Design, DOI: 10.1080/13574809.2018.1472523.

Barnett 2017. “Built environmental correlates of older adults’ total physical activity and walking: a systematic review and meta-analysis.” The international journal of behavioral nutrition and physical activity vol. 14,1 103. 7 Aug. 2017, doi:10.1186/s12966-017-0558-z.

Rachele 2019. “Neighbourhood built environment and physical function among mid-to-older aged adults: A systematic review.” Health & place vol. 58 (2019): 102137. doi:10.1016/j.healthplace.2019.05.015.

Smith 2017. “Systematic literature review of built environment effects on physical activity and active transport – an update and new findings on health equity.” The international journal of behavioral nutrition and physical activity vol. 14,1 158. 16 Nov. 2017, doi:10.1186/s12966-017-0613-9.

Zapata-Diomedi 2016. “The association between built environment features and physical activity in the Australian context: a synthesis of the literature.” BMC public health vol. 16 484. 8 Jun. 2016, doi:10.1186/s12889-016-3154-2.