A5. Place quality and physical health

Neighbourhood social cohesion, food stores and type two diabetes

Aims and method:

Data from the Jackson Heart Study in the USA was investigated to explore the associations between neighbourhood social and physical environments and the prevalence of type two diabetes in African Americans. Measures of neighbourhood social environments, and food and physical activity resources were derived using survey and GIS-based methods.

Key findings:

· Higher neighbourhood social cohesion was associated with a 22% lower incidence of type two diabetes.

· Higher density of unfavourable food stores was associated with a 34% higher incidence of type two diabetes after adjusting for individual-level risk factors.

Reference:

Gebreab, S. Y., Hickson, D. A., Sims, M., Wyatt, S. B., Davis, S. K., Correa, A., & Diez-Roux, A. V. (2017). Neighborhood social and physical environments and type 2 diabetes mellitus in African Americans: The Jackson Heart Study. Health & Place, 43, 128-137.

http://dx.doi.org/10.1016/j.healthplace.2016.12.001

Neighbourhood environments and children's physical activity

Aims and method:

Examines associations between clusters of neighbourhood attributes and non-school moderate to vigorous physical activity, sedentary time (objectively measured) and television viewing among children. Four distinct clusters were identified from seven objectively measured neighbourhood attributes (land use mix, traffic exposure, playground and sports venue availability, intersections and cul-de-sacs within 800m, crime/postcode).

Key findings:

· The cluster characterised by mixed land use and many playgrounds and sport venues was associated with less television viewing on weekends.

· Associations between the neighbourhood attributes and moderate to vigorous physical activity, sedentary time and television viewing were limited, but were consistent with the broader literature suggesting that access to places for physical activity and sport are important.

Reference:

Timperio, A., Crawford, D., Ball, K., & Salmon, J. (2017). Typologies of neighbourhood environments and children's physical activity, sedentary time and television viewing. Health & Place, 43, 121-127.

http://www.sciencedirect.com/science/article/pii/S1353829216304439

Neighbourhood design and air quality

Aims and method:

Examines three pathways by which single-use, low-density and land use patterns can adversely affect health: 1. reducing opportunity for active transportation, 2. stimulating increased time spent in vehicles, 3. increase per capita vehicle emissions and exposure to pollutants. The authors evaluated the association between a single index of walkability that incorporated land use mix, street connectivity, net residential density, and retail floor area ratios, with health-related outcomes in King County, Washington.

Key findings:

· A 5% increase in walkability is associated with a per capita 32.1% increase in time spent in physically active travel, a 0.23-point reduction in body mass index, and 6.5% fewer vehicle miles travelled,

· Also 5.6% fewer grams of oxides of nitrogen (NOx) emitted, and 5.5% fewer grams of volatile organic compounds (VOC) emitted.

Reference:

Frank, L. D., Sallis, J. F., Conway, T. L., Chapman, J. E., Saelens, B. E., & Bachman, W. (2006). Many pathways from land use to health: associations between neighborhood walkability and active transportation, body mass index, and air quality. Journal of the American planning Association, 72(1), 75-87.

http://www.tandfonline.com/doi/abs/10.1080/01944360608976725

Urban sprawl and health

Aims and method:

Discusses the relationship between sprawl and health based on eight considerations: air pollution, heat island effects, physical activity patterns, motor vehicles crashed, pedestrian injuries and fatalities, water quality and quantity, mental health, and social capital. This review article analyses the extensive literature review and data on each topic.

Key findings:

· Sprawl has negative health consequences (in obesity and inactivity) but suburban lifestyles can give access to the mental health benefits of greener and more peaceful environments

· Sprawl is associated with social stratification and loss of social capital and these phenomena are in turn associated with increased morbidity and mortality.

· Many health related threats associated with sprawl affect minority populations disproportionately, including air pollution and heat stress

Reference:

Frumkin, H. (2002). Urban sprawl and public health. Public health reports, 117(3), 201.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497432/pdf/12432132.pdf

Perceived neighbourhood quality and adult health

Aims and method:

Examines both objective and subjective assessments of neighbourhood conditions and the relative strength of their association with adult self-rated health. Data on perceived neighbourhood quality from Wave IV (2001/2002) of the nationally representative U.S. Americans Changing Lives study is merged with neighbourhood-level census tract data.

Key findings:

· Subjective assessments relating to perceived neighbourhood quality are strongly associated with health outcomes and more strongly associated than objective constructs such as neighbourhood disadvantage and affluence.

· The results demonstrate the independent associations between both objective and perceived neighbourhood quality and health, and highlight the particularly strong association between perceived neighbourhood quality and health.

Reference:

Weden, M. M., Carpiano, R. M., & Robert, S. A. (2008). Subjective and objective neighborhood characteristics and adult health. Social science & medicine, 66(6), 1256-1270.

http://www.sciencedirect.com/science/article/pii/S0277953607006260

Neighbourhood design and human health

Aims and method:

Surveys the state of the science on the impacts of urban design on human health and well-being. Drawing primarily on recent peer-reviewed literature in a broad array of health, planning, and environmental fields, it outlines the influence of design at three spatial scales on aspects of physical and mental health, and social and cultural vibrancy.

Key findings:

· At the parcel scale, greenery and access to it visually and physically are the principal keys to health.

· These elements must be incorporated into relatively high-density neighbourhood designs that include public buildings, open space, mixed land use, and pedestrian walkways to increase physical exercise and enhance civic life.

· Finally, neighbourhoods must be embedded in existing urban infrastructure to provide larger cultural and business opportunities and reduce reliance on driving.

Reference:

Jackson, L. E. (2003). The relationship of urban design to human health and condition. Landscape and urban planning, 64(4), 191-200.

http://www.sciencedirect.com/science/article/pii/S016920460200230X

Place-based regeneration and health

Aims and method:

Studies the general health impacts of urban regeneration programmes focused on the improvement of place with initiatives that mainly invested in people. A quasi-experimental design approach in Dutch cities compared the trend in good perceived general health in the target districts with comparison districts. Mixed models assessed the rate of change in prevalence of good health for three and a half years, including a prolonged period before and after the start of the interventions.

Key findings:

· Neither the target districts that invested mainly in place nor the ones with interventions focused on people showed trends in general health different from the comparison districts (p>0.05). However, only districts with interventions focused on place showed no deterioration in general health during the intervention period.

· The trend changes in these districts differed significantly from the change in the districts that invested mainly in people (p<0.05).

· Urban regeneration programmes that focus on place are more effective in promoting general health

Reference:

Droomers, M., Jongeneel-Grimen, B., Bruggink, J. W., Kunst, A., & Stronks, K. (2016). Is it better to invest in place or people to maximize population health? Evaluation of the general health impact of urban regeneration in Dutch deprived neighbourhoods. Health & place, 41, 50-57.

http://www.sciencedirect.com/science/article/pii/S1353829216300788

Neighbourhood age, character and well-being

Aims and method:

Aims to A linear regression analysis was run of the urban form indicator datasets for London (accessibility, building age, city-centre distance, connected node ratio, council tax bands, house or flat type, intersection density, green space, open space and population density) against the wellbeing and health indicators (childhood obesity, life expectancy and stated wellbeing).

Key findings:

  • The old inner suburbs seem best for life expectancy with well connected walkable neighbourhoods with most properties built before 1930 not too far from the city centre are most clearly associated with long life expectancy, with 50% of the increased life expectancy of their residents explained by urban form. Prosperity matters most in predicting well-being, longevity and childhood obesity, but walkability and urban form matters too
  • Green space and open space were not revealed as key determinants, with only one strong relation emerging: that between the presence of green space and lower childhood obesity. Here it is likely that methodological issues masked the great differences in the nature and distribution of green space between areas
  • The strongest urban form feature associated with good well-being and longevity outcomes was the connected node ratio. This is a measure of walkable connectivity defined as the number of real (non-dead end) intersections divided on the total number of intersections, normalized on neighbourhood area.

Reference:

Boys Smith, N. & Venerandi, A. (2016), Heart in the Right Street, London, Create Streets

http://dev.createstreets.com/front-page-2/campaigns-copy/heart-in-the-right-street/