Public Health England (PHE) report ‘Spatial Planning for Health, An evidence resource for planning and designing healthier places’, which looks at areas from neighbourhood design to the environment, calls on built environment professionals and public health officials to ‘communicate more’.
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PHE writes (p.63, ‘Discussion’):
Summary of findings
This umbrella review presents an overview of the evidence for the relationship between the built and natural environment and health. Evidence pertaining to five key aspects of the built and natural environment (neighbourhood design, housing, healthier food, natural and sustainable environment, transport) was collated, quality assessed and summarised to illustrate the linkages, strength of the evidence and recommendations for those working in the public health or planning professions.
Across all areas of the built and natural environment explored as part of this review, evidence was identified demonstrating an inextricable link between the built and natural environment and health.
In the case of neighbourhood design, improving neighbourhood walkability (i.e., an area that is supportive of walking) and infrastructure designed to promote walking and cycling, was found to be associated with numerous positive health outcomes, including: increased physical activity levels and improved social engagement among older adults.
Furthermore, areas of mixed land use (i.e., neighbourhoods that include green spaces), diverse housing types and high quality public transport were found to be associated with increased physical activity levels, reduced risk of pedestrian injury and road traffic collisions, and increased social participation among older adults, among other positive health outcomes.
An examination of the evidence on the influence of housing on health revealed that good quality housing (e.g., energy efficiency, housing refurbishment, and removal of home hazards) and affordable housing was associated with a variety of positive health outcomes, including improved social outcomes among older adults, reduced injury among older adults and children and improved general physical and mental health.
Among vulnerable groups (e.g., substance users, homeless, disabled), provision of affordable housing was associated with improved quality of life, mental health and clinical health-related outcomes.
Evidence for the impact of the food environment on health revealed that provision of healthier and affordable food could be effective in improving dietary attitudes and behaviours, and reducing dietary fat intake and BMI in public service settings (i.e., schools, community settings, council offices).
Research also indicated that multi-component interventions that take an integrated, whole school approach may be most effective in improving children’s diet and food choices in schools. Urban food growing was also found to be associated with improved attitudes towards healthy eating, increased opportunities for social connectivity and increased opportunities for physical activity.
Natural and sustainable environment
In terms of the natural and sustainable environment, there was evidence that improvement to air quality, prioritisation of neighbourhood tree planting, and provision of open and green spaces, was associated with increased physical activity, increased environmental cooling, and improved general physical health outcomes (e.g., reduce CVD mortality risk).
In addition, provision of infrastructure to support walking and cycling and increased access to buildings and facilities was associated with increased physical activity and improved social engagement among older adults. This section of the review also highlights the consequences of flooding. The review found that flooding was associated with a number of health related issues including carbon monoxide poisoning and poor mental health outcomes.
In the case of transport, evidence was found to demonstrate that infrastructure for walking and cycling, installation of traffic calming measures, and public realm improvements (e.g., street lighting) was associated with increased mobility, physical activity levels, reduced BMI and reduced risk of injury, among other positive outcomes.
Furthermore, the provision of open and green space, high quality public transport and improved air quality was associated with numerous positive health outcomes, including: increased physical activity, improved cardiovascular outcomes, and improved social participation, among others.
However, despite the wealth of evidence identified and reviewed, the findings need to be interpreted with caution. The majority of review level evidence examined was reliant on short-term, cross-sectional empirical studies. As such, in many cases it is impossible to identify the causal link between the aspect of the built environment and the health outcome(s). In the most part, this review has identified that numerous aspects of the built environment and health are related, but not necessarily causal.
However, the available evidence is suggestive that modification to certain aspects of the built and natural environment may impact positively upon specific health behaviours and health outcomes. Furthermore, the findings of this review reiterate the findings of a previous umbrella review (Bambra et al., 2010), that the impact of the built and natural environment on health inequalities remains inconclusive in some areas.
What is known on this subject
The natural and built environment plays a key role in shaping the social and economic determinants of health. Although the linkages between the environment and health have long been established, there is, in some cases, insufficient evidence to ascertain causality.
Nevertheless, the importance and influence of the built and natural on health and health outcomes is clear.
What this study adds
- this study systematically assessed evidence from recent systematic reviews on the linkage between the built and natural environment and health. The collation of evidence provides readers with an insight into the research that has been conducted in this field
- in certain cases, where appropriate and clearly identified, the information collected from the umbrella literature review was complemented by high quality evidence from other credible sources
- by adopting a systematic approach to evidence gathering, this study was able to clearly identify gaps in the evidence and make recommendations for further research
- the diagrams on each of the five aspects of the built environment examined as part of this review provide logical evidence-based messages to aid communication among planners and public health professionals
Implications for policy and practice
The environment in which people live has a profound impact on health and wellbeing. In addition to direct health benefits, enhancement of the built and natural environment can have an impact on people’s attitudes, behaviours and perceptions of their environment. For instance, reducing air pollution can improve perceptions of safety and promote outdoor physical activity and social interaction.
Findings from this review strengthen the argument for an upstream shift to address key obstacles to healthy living and improve circumstances that produces unhealthy behaviour.
Communication between built environment and health professionals is essential. By incorporating health needs and impact into the conceptualisation, design and planning of infrastructural projects, policy makers, planners and built environment professionals are able to trigger the development of sustainable communities.
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