Connecting Public Health to Urban Design and Planning

Abstract

The collaboration between health of the city’s residents and the study of physical planning faded after 1900s. While both the fields together tackled various outbreaks in the 1800s. Active lifestyle among the residents has decreased significantly in the past decades impacting citizens mental as well as physical health. Lately the developing literature and research illustrates the crucial part that built environment plays in influencing the overall health of the people; mostly focusing on physical action and movement. Many studies reported relation among built environment traits and physical action & movement, however it is still not clear that at what geographic scales and magnitude – built environment traits will promote active lifestyle. Furthermore, to produce supportive built environments which promote physical activity engagement reviewing these scales of geography will help and guide urban planners in development decision making and designs. It is crucial for re-linking the disciplines of health and urban and planning.

Literature Study: The Built Environment and Health Outcomes

The formal relation between planning of cities which includes design, structure, facilities and utilities of cities and health of its residents was established in nineteenth century acknowledging virus epidemics (Snow, 1855). Throughout this period field of planning was seen as a central practice to promote better health but this relation declined during twentieth century.

Growing interest and research in the impact of the built environment on health can be seen growing in the last decade. Expanding evidences and studies states that the built environment directly or indirectly promotes active lifestyles and influences physical and mental health of an individual. A population-based study, studies the linkage between design features of built environment and social interactions, the observations resulted that design features that provide direct, in-person interactions might be beneficial for Hispanic elder’s psychological health and reduce distress (Scott C. Brown, 2009). Another study examined that for increasing NMT for transport, that is increasing physical activity, incorporating helpful environments such as creative green and good – looking neighborhood surroundings; low vehicular speed and increased road network connectivity; campaigns aimed at strengthening positive attitudes and confidence to cycle, walk etc. is important, thus promoting better physical and mental health (Titze, 2010).

Similarly, multilevel analysis found that individuals living in counties that are more walkable tends to walk more and to have lower body mass indices (BMIs) than people living in less walk-able and more crime-prone areas. The results suggested that to promote physical activity and health, planners should contemplate community walkability and safety (Scott Doyle, 2006). The majority of studies examine physical activity outcomes (e.g., walking, cycling and recreational physical activity) to assess the link between built environment and health. From a physical activity viewpoint, ‘walkability’ is the key term to conceptualize built environment, a fused index bringing together a number of neighborhood design attributes like open spaces, public infrastructure as representing the degree of pedestrian-friendliness. Further emerging evidence base shows that lower housing concentrations, single land uses, insufficient social infrastructure, limited access to public transport, and public places of poorer quality are also related with major diseases several risk aspects, such as inactive lifestyle, obesity, and most importantly poorer psychological well-being (Healthy spaces and places, 2009).

WHO estimates 36 million deaths per year, about 63% of global mortality is because of noncommunicable diseases (NCDs) and moreover large part of these deaths are attributable to risks associated to the urban built environment (Kari). Thus, calls to reconnect the two disciplines of planning and health are emerging once again.

Why focusing so much on ‘Physical Health’?

Physical activity can improve not only your physical well-being but also your mental well- being. It can be described as a movement of the body that works with your muscles, needing more energy than rest. Few examples of physical activity are walking, swimming, yoga, and gardening. Improved physical health has many benefits as it fosters less tension, stress, anxiety and mental fatigue, a natural energy boost, improved sleep, a sense of achievement, less anger or frustration, better social life, detoxifying the body. It has been proven that anxiety and depression levels can be reduced through Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, (M, 2004).

Furthermore, eradication of physical inactivity would surge the life expectancy of the world’s population by 0·68 (range 0·41-0·95) years (Lee & Group, 2012). Physical activity has positive long- term influence on noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus (Miriam Reiner, 2013). Latest figures indicate that physical inactivity, combined with low walkability and lack of access to leisure areas, accounts for 3.3 per cent of world deaths. The Global Forum on Urbanization and Health took place in the context of increased international attention to the effects and consequences of urbanization, particularly on public health. Also, 3.2 million deaths annually are because of increase in physical inactivity, suggesting that among urban populations, health risks are likely to be much larger (Kari).

The term “physical activity” & “exercise” are often used in place of each other but there is a slight difference among the two, that is “exercise” is a subcategory of physical activity which is structured and repetitive, aiming to improve or maintain physical fitness. Physical action can be classified into further categories based on their purpose such as recreational, occupational, transportation and domestic activities. But built environment  links much closely and strongly with recreational and transportation physical activities. Beyond considering exercise as the only kind of physical activity, any other physical activity that is done during leisure time, is recreational physical activity whereas transport related physical movement are those carried out to achieve a certain purpose using energetic modes of transport such as walking, running or bi-cycling. For example, walking or cycling to work, market or for any other purpose is transport linked physical activities while playing badminton, tennis or walking is recreational physical activity (Handy, 2008).

Furthermore, general involvement in the physical activity has shown continuous declination over the last years, in spite of the advantages of physical activity with the major drops occurring in physical activity related to occupation and transport (Brownson RC, 2005). For instance, data from sampled countries depicts that a third of grown-ups are not active physically, ranging from seventeen percent to forty-three percent in Southeast Asia and in the Americas & Eastern Mediterranean respectively (Hallal, 2012).

Given the inadequate achievement of individual tactics (for instance directing individuals through behavioral transformation approaches), socioecological models are becoming increasingly popular as the hypothetical basis for interventions aimed at promoting healthy behaviors, including physical action and movement (Sallis & Kerr, 2006; Sallis, Owen, & Fisher, 2008). Furthermore, behaviors are influenced at various points, like that of living, psychological, cultural and physical environment as suggested by socioecological models.

The essence of the built environment as a potential implementor or blockade has been emphasized by studies using socioecological frameworks to understand the determinants of physical activity (Handy, Boarnet, Ewing, & Killingsworth, 2002). In this socioecological framework, built environment is a subset of the entire environment having different uses such as residential, transportation, commercial etc., mainly produced by human (Saelens & Handy, 2008). Referring to the context where people’s behaviors occur, here environmental interventions can play a huge role in influencing individual’s physically active lifestyle (Boarnet & Takahashi, 2011).

Built environment traits play an important role, especially in an environment that is not helpful in creating a behavior change than an environment which is encouraging people to change a behavior (such as physical activity). Furthermore, altering the built environment can have a longstanding effect on the physical & mental well-being (Sallis, Floyd, Rodríguez, & Saelens, 2012).

Even though built environment strategies are firstly expensive due to construction costs, if done correctly from the outset, the durability and capacity to affect a big population make these interventions lucrative in the long-term. Besides, there are benefits in several sectors such as traffic managing, environmental safety, etc. (Giles-Corti, Foster, Shilton, & Falconer, 2010).

There remains a challenge to create and redevelop built environments that provide improved health outcomes, even though these associations exist. The main reason behind this is that the evidence for urban planners and designers regarding the amount and type of infrastructure required to promote public wellbeing and active lifestyle is missing.

In order to provide specific criteria to urban planners about the expanse and combination of built environment traits required to support active lifestyle and improved health results, focus on developing clear, evidence-based guidance for various built environment attribute thresholds and scales is necessary and need of the hour. Progressing research translation linking public well-being and urban planning will be substantially assisted by providing these tools.

Also Read: Benefits of a Healthy Lifestyle

Design Principles

To plan for healthy built environment and communities, key design principles have been identified by the researchers (Healthy spaces and places, 2009; Miriam Reiner, 2013; Titze, 2010):

• Active Transport: promoting walking, cycling and other modes of travel that involve physical activity, and also increasing public transport usage that can be accessed through walking or
• Aesthetics and Environment: The complete experience and use of a place is greatly dependent on and affected by the attractiveness of a place or area. For example, walking, cycling, viewing and talking, the concept of eyes on the street. To use and enjoy its public spaces and to feel safe an attractive neighborhood invites
• Connectivity: The ease with which people can walk and cycle around a neighborhood and between places, the directness of links and the number of connections in a path or street, all these elements are
• Environment for all people: regardless of age, ability, culture or income, places should be safe and easily accessible for everyone, with an appropriate range of amenities and services that are available to all that is universal
• Mixed density: It promotes a more diverse community and caters to various stages of life for example residential development containing a mix of housing types, like single dwellings and multi- units and development with varying size and height. Mixed density is promoted for new residential projects to include a variety of housing options, optimize infrastructure and land and promote public transport provision. A mixed density residential development will aid, increase the use of public transport and integrate transport services.
• Mixed land use: When people can conveniently undertake multiple activities at one destination, they are more likely to walk, cycle or take public transport. To promote active transport to and between different activities, complementary uses such as houses, shops, schools, offices, libraries, open space and cafes, are co-located.
• Open space and green areas: preservation of natural environments, green space. Reserving land for passive recreation, sport and other
• Safe environment: Design that aims to reduce crime can play a crucial role in enhancing the physical, mental and social wellbeing of a community as the nature and extent of use of spaces and places by people is greatly influenced by perceptions of
• Social inclusion: It refers to a society where there is an opportunity for all people and communities to participate fully in political, cultural, civic and economic
• Supporting infrastructure: To encourage regular and safe physical activity appropriate amenities should be provided such as walking-footpaths, lighting, water fountains and signs, cycling-bike paths, bike lockers, signs and showers, public transport- safe shelter, lighting and signs, social interaction- seating, shade, shelter and toilets and recreation- seating, play equipment and facilities.

Finding suitable geographical scales

The areas in which linkages can be identified among the built environment and physical action & movement is basically known as Geographical scale. The most commonly applied scale has been already defined boundaries by the administration (Riva, Gauvin, & Barnett, 2007). However, different associations with physical activity are shown, when applied geographical scales differs. Such problems are known as the Modifiable Areal Unit Problem (MAUP). MAUP includes two distinctive but related problems: the scale and the zoning; and refers to the variability of the results due to the spatial units from where collection of data took place (Openshaw, 1984). Scale related problem reflects how final result differ due to the presence of number of entities in a particular area. However, Zoning related problems relate to how outcome changes when regrouping takes place differently of the number of entities (Openshaw & Taylor, 1979).

Emphasis on Modifiable Areal Unit Problem and its consequences in studies inspecting the built environment traits supporting physically active lifestyle and health is insufficient, while it has received much attention in statistical and geographical literature. The concept of active spaces and neighborhood characterizations in relation to physical activity have been explored by a number of studies (Villanueva, 2012). A study analyzed in what way children’s active travelling to schools will be affected by traits of the built environment within activity spaces through studying how far children actively travel from their homes (Villanueva, 2012). The study resulted that factors such as liberty, local destinations and road safety can impact the design of active spaces for children.

For built environment traits population, type of physical activity, and the trait being examined usually results in differing of the ideal geographical scales supporting physically active lifestyle. In case of comparison of young adult with older citizens and children, young adult can walk for longer distances than the older citizens and children. Further, a need to examine impact of different geographical scales on different physical activities while focusing on specific population subset is also there. To identify the built environment traits and potential active spaces supporting physical activity, new GIS & remote sensing-based technology can be used.

Also Read: Built Environment

Effective Thresholds 

The association between built environment and physically active lifestyle in the existing research has been mainly about linear linkages among built up traits and walking; for example, closeness in terms of distance between destinations relates to higher probability of walking. However, these linkages may not be always this direst. Besides, values that are either ideal or threshold might be there supporting planners with data to inform planning decision making process (Sugiyama, 2012). Thus, built environment traits require threshold values to encourage various types of physical activity, which are not known. Further to generate behavior change, amount of a particular attribute needed is also not known. For example, when parks are located beyond a certain walkable distance from residents home, the consequence of the longer distance becomes evident.

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• Healthy City | Implication of public health and environment protection
• Tips for Promoting Healthy Cities
• What is New Urbanism? | Definition, Concept & Benefits

Conclusion

After decades of departure within a socioecological framework, the association between urban planning and public health is essential to facilitate physical activity; whereby reconnecting the two fields of urban planning and public health is the major component towards producing spaces that encourage physical activity. Ideas and measures for the built environment are contributed by urban planning and in order to establish the associations between the built environment and health outcomes, public well-being delivers a comprehensive output of the effects of the built environment on health outcomes (Sallis, 2009). However, to develop the results into practice, health and policy researchers will have to rely on urban planning experts. To re-link public health and urban planning, impending research on scales and ideal can play an important role. Moreover, in creating an environment that support active spaces impending guidance based on evidences will be critical.

Author Bio: I’m Rupal Srivastava currently pursuing my Bachelors in Planning from SPA Delhi. I have a deep interest in public health matters and how planning can play a crucial role in improving both the mental and physical health of the city residents.

References

• Boruff, B., Nathan, A., & Nijenstein, S. (2012). Using GPS technology to (re)-examine operational definitions of ‘neighbourhood’ in place-based health research. International Journal of Health Geographics, 11(1), 22
•  Boarnet, M. C., & Takahashi, L. M. (2011). Interactions between public health and urban design. In T. Banerjee & A. Loukaitou-Sideris (Eds.), Companion to Urban Design (pp. 198- 207): Routledge.
•  Brownson RC, B. T. (2005, april 21). Declining rates of physical activity in the United States: what are the contributors? Annual Review of Public Health.
•  Chaix, B., Kestens, Y., Perchoux, C., Karusisi, N., Merlo, J., & Labadi, K. (2012). An interactive mapping tool to assess individual mobility patterns in neighborhood studies. American Journal of Preventive Medicine, 43(4), 440-450.
•  Colabianchi, N., Dowda, M., Pfeiffer, K., Porter, D., Almeida, M., & Pate, R. (2007). Towards an understanding of salient neighborhood boundaries: adolescent reports of an easy walking distance and convenient driving distance.
• International Journal of Behavioral Nutrition and Physical Activity, 4(1), 66.
•  Giles-Corti, B., Foster, S., Shilton, T., & Falconer, (2010). The co-benefits for health of investing in active transportation. New South Wales Public Health Bulletin, 21(6), 122-127.
•  Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012). Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247-257.
•  Handy, B. E. (2008). Built Environment Correlates of Walking: A Review. (2009). Healthy spaces and places. Kingston. Retrieved from http://www.healthyplaces.org.au/userfiles/file/HS &P%20An%20overview.pdf
• Handy, S. L., Boarnet, M. G., Ewing, R., & Killingsworth, R. E. (2002). How the built environment affects physical activity: views from urban planning. American Journal of Preventive Medicine, 23(2, Supplement 1), 64-73.
•  Jennifer Weuve, S., Jae Hee Kang, S., & JoAnn E. Manson, M. (2004). Physical Activity, Including Walking, and Cognitive Function in Older Women.
•  Kaczynski, A. T., Potwarka, L. R., Smale, B. J. A., & Havitz, M. E. (2009). Association of parkland proximity with neighborhood and park-based physical activity: variations by gender and age. Leisure Sciences: An Interdisciplinary Journal, 31(2), 174-191.
•  Kari, W. (n.d.). Healthy urban planning. Retrieved from        World        Health    Organisation: https://www.who.int/sustainable- development/cities/strategies/urban-planning/en/
•  Lee, S. E., & Group, L. P. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.
• Learnihan, V., Van Niel, K. P., Giles-Corti, B., & Knuiman, M. (2011). Effect of scale on the links between walking and urban design. Geographical Research, 49(2), 183-191.
• Guszkowska, M (2004, july-august). Effects of exercise on anxiety, depression and mood.
• Miriam Reiner, C. N. (2013, september). Long- term health benefits of physical activity – a systematic review of longitudinal studies. BMC Public health.
• Oka, M. (2011). Toward designing an environment to promote physical activity. Landscape Journal, 30(2), 280-298
• Openshaw, S. (1984). The modifiable areal unit problem. Concepts and Techniques in Modern Geography, 38, 1-41.
• Openshaw, S., & Taylor, P. (1979). A million or so correlation coefficients: three experiments on the modifiable areal unit problem. In N. Wrigley (Ed.), Statistical applications in the spatial sciences (pp. 127-144). London: Pion.
• Richards, H. R. (2003). Does active leisure protect cognition? Evidence from a national birth cohort.
• Riva, M., Gauvin, L., & Barnett, T. A. (2007). Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. Journal of Epidemiology and Community Health, 61(10), 853-861.
• Sallis, J. F. (2009). Measuring physical activity environments: a brief history. American Journal of Preventive Medicine, 36(4, Supplement), S86-S92.
• Sallis, J. F., Floyd, M. F., Rodríguez, D. A., & Saelens, B. E. (2012). Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation, 125(5), 729-737.
• Scott C. Brown, C. A.-Z. (2009, february). The Relationship of Built Environment to Perceived Social Support and Psychological Distress in Hispanic Elders: The Role of “Eyes on the Street”.
• Scott Doyle, A. K.-S. (2006). Active Community Environments and Health: The Relationship of Walkable and Safe Communities to Individual Health. Journal of the american planning association.
• Snow, J. (1855). On mode of communication of cholera. London.
• Sugiyama, T., Neuhaus, M., Cole, R., Giles-Corti, B., & Owen, N. (2012). Destination and route attributes associated with adults’ walking: a review. Medicine & Science in Sports & Exercise, 44(7), 1275-1286.
• Titze, G.-C. B. (2010). Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. Journal of physical activity and health.
• Villanueva, K., Giles-Corti, B., Bulsara, M., McCormack, G. R., Timperio, A., Middleton, N., . .. Trapp, G. (2012). How far do children travel from their homes? exploring children’s activity spaces in their neighborhood. Health & Place, 18(2), 263- 273.
• Van Dyck, D., Cerin, E., Conway, T. L., De Bourdeaudhuij, I., Owen, N., Kerr, J., . . . Sallis, J. (2013). Perceived neighborhood environmental attributes associated with adults’ leisure-time physical activity: findings from Belgium, Australia and the USA. Health & Place, 19(0), 59-68.