Summary Land-use and transport policies contribute to worldwide epidemics of injuries and non-communicable diseases through traffic exposure, noise, air pollution, social isolation, low physical ...activity, and sedentary behaviours. Motorised transport is a major cause of the greenhouse gas emissions that are threatening human health. Urban and transport planning and urban design policies in many cities do not reflect the accumulating evidence that, if policies would take health effects into account, they could benefit a wide range of common health problems. Enhanced research translation to increase the influence of health research on urban and transport planning decisions could address many global health problems. This paper illustrates the potential for such change by presenting conceptual models and case studies of research translation applied to urban and transport planning and urban design. The primary recommendation of this paper is for cities to actively pursue compact and mixed-use urban designs that encourage a transport modal shift away from private motor vehicles towards walking, cycling, and public transport. This Series concludes by urging a systematic approach to city design to enhance health and sustainability through active transport and a move towards new urban mobility. Such an approach promises to be a powerful strategy for improvements in population health on a permanent basis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Summary Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that ...reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Summary Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were ...modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420–826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements—particularly a focus towards compact cities—that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Objectives Personal safety is commonly cited in qualitative research as a barrier to local walking, yet the relationship between safety and constrained physical activity has received mixed ...support in quantitative studies. This paper reviews the quantitative evidence to date, seeking to explain the inconsistencies, and offers recommendations for future research. Methods A social–ecological framework was adopted to explore the evidence linking crime-related safety, and factors that influence real and perceived safety, with constrained physical activity. Results Perceived safety tends to affect the physical activity of groups already known to exhibit greater anxiety about crime; and some elements of the built environment that influence safety appear to constrain physical activity. However the evidence is somewhat inconsistent, and this may be partly attributed to measurement limitations. Many studies employ generic safety measures that make implicit references to crime or use composite variables that lack specificity. Physical activity outcomes also require consideration, as only activities occurring locally outdoors are likely to be affected by neighborhood crime. Conclusions Further research is required to tease out associations between real and perceived crime-related safety and physical activity, ideally employing behaviour and crime-specific measures, and addressing the moderating role of the social and built environments.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Health aspects of day-to-day cycling have gained attention from the health sector aiming to increase levels of physical activity, and from the transport and planning sector, to justify investments in ...cycling. We review and discuss the main pathways between cycling and health under two perspectives - generalizable epidemiological evidence for health effects and specific impact modeling to quantify health impacts in concrete settings. Substantial benefits from physical activity dominate the public health impacts of cycling. Epidemiological evidence is strong and impact modeling is well advanced. Injuries amount to a smaller impact on the population level, but affect crash victims disproportionately and perceived risks deter potential cyclists. Basic data on crash risks are available, but evidence on determinants of risks is limited and impact models are highly dependent on local factors. Risks from air pollution can be assumed to be small, with limited evidence for cycling-specific mechanisms. Based on a large body of evidence, planners, health professionals, and decision-makers can rest assured that benefits from cycling-related physical activity are worth pursuing. Safety improvements should be part of the efforts to promote cycling, both to minimize negative impacts and to lower barriers to cycling for potential riders.
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BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Fifty per cent of all known health risk factors could be redressed with known, effective preventive policies or practices.1 Yet, widespread uptake of effective prevention is uncommon.2 Lack of ...program funding in prevention may be one reason why opportunities are missed.3 Another critical impediment is that there is insufficient field-level evidence on how to scale-up interventions across wider populations and adapt to different contexts without loss of fidelity. Implementation research seeks to address this important evidence gap, moving beyond research to describe, understand and test the effectiveness of prevention interventions on measures of community health, to instead describe, understand and test how effective prevention interventions are implemented integrated and adapted into clinical and community systems.4 Implementation research has considerable potential to improve public health. For example, reviews suggest that effects of interventions could be enhanced by two to 12 times with appropriate, relative to poor, implementation.5 However, as shown in Figure 1, evidence generation in intervention research remains skewed towards studies of efficacy, or ‘what works,’ in contrast to studies of how we can apply that knowledge in practice and maximise benefits. Figure 1. Comparison of school-based physical activity behavioural intervention randomised trialsa versus implementation randomised trialsb by decade. a: Data for behavioural trials were sourced from a Cochrane systematic review examining school-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 186 b: Data for implementation trials were sourced from two systematic reviews examining strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease7,8Implementation science is a field that has evolved to address this gap. Implementation science examines how to improve the translation of evidence-based interventions into routine practice.9 It includes studies of program scale-up across populations10 where the essential question is, was the program carried out as intended and what did it take to do so, alongside studies which identify local system dynamics and the knowledge generated from practitioners through the act of implementation.11,12 The latter reveal the multiple roles or functions programs can take in different contexts, which can be vital for supporting their sustainment.12,13 Thus, for many researchers, the focus of attention in implementation science expands to also include the insights and methods of improvement science, i.e. the science that underpins how practitioners attempt to solve problems and promote quality. Implementation science is recommended by the World Health Organization and other international agencies to maximise the impact of prevention policies and programs.16 However, Australia risks lagging behind unless we seek new ways to maximise investment and coordinate scarce research resources. Recognition that practice is both a “context for discovery” as well as a “context for program or practice delivery”17 also invites stronger collaborative research partnerships with state-based agencies and non-government organisations responsible for implementing prevention. We outline opportunities below to strengthen chronic disease prevention in Australia.
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BFBNIB, CEKLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A strong sense of community has been associated with improved wellbeing, increased feelings of safety and security, participation in community affairs and civic responsibility. Although interest in ...how the broader built environment influences sense of community is gaining momentum, there is a dearth of empirical research examining the association between sense of community and the quality of public space. This study investigates the relationship between four public spaces – Public Open Space (POS), community centres, schools and shops – and sense of community in residents of new housing developments in the Perth metropolitan area, Western Australia. Data was obtained from a cross-sectional survey (n = 911), a POS audit, and Geographical Information Systems, and analysed using linear regression. The perceived quality of neighbourhood POS and shops was significantly and positively associated with sense of community. This relationship appears to be unaffected by how frequently people use these spaces. High quality public spaces may be important settings for enhancing sense of community within residents of new housing developments.
► We investigate associations between four public spaces and sense of community (SoC). ► Public Open Space (POS) quality is significantly and positively associated with SoC. ► Shop quality is significantly and positively associated with SoC. ► Associations between public space quality and SoC appear unaffected by usage. ► High quality public space may enhance SoC in new neighbourhoods.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Previous studies have demonstrated links between cardiovascular disease and physical inactivity and poor air quality, which are both associated with neighborhood greenness. However, no studies have ...directly investigated neighborhood greenness in relation to coronary heart disease risk. We investigated the effect of neighborhood greenness on both self-reported and hospital admissions of coronary heart disease or stroke, accounting for ambient air quality, socio-demographic, behavioral and biological factors.
Cross-sectional study of 11,404 adults obtained from a population representative sample for the period 2003-2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600 m service area surrounding the residential address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Logistic regression was used to assess associations with medically diagnosed and hospitalization for coronary heart disease or stroke.
The odds of hospitalization for heart disease or stroke was 37% (95% CI: 8%, 57%) lower among adults in neighborhoods with highly variable greenness (highest tertile) compared to those in predominantly green, or predominantly non-green neighborhoods (lowest tertile). This effect was independent of the absolute levels of neighborhood greenness. There was weaker evidence for associations with the mean level of neighborhood greenness.
Variability in neighborhood greenness is a single metric that encapsulates two potential promoters of physical activity - an aesthetically pleasing natural environment and access to urban destinations. Variability in greenness within a neighborhood was negatively associated with coronary heart disease and stroke.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The World Health Organization calls upon local government worldwide to play a greater role in improving public health by improving the social determinants of health. This research aimed to determine ...how local governments in Victoria, Australia, conceptualised their organisational efficacy to address public health with reference to their statutory obligations.
Sixteen in‐depth interviews were conducted with Victorian local government health planners. Thematic analysis was used to determine the importance of state health priorities and the perceived organisational efficacy of local government to address health via social determinants.
While there were disparities between state and local priorities for health, local government believes it can make an important contribution to improving health through ‘upstream’ approaches.
Victorian local government has strongly adopted the socio‐ecological model of health and is aware of the important role that its diverse policy and program areas play in creating healthy communities. The Victorian State Government’s priorities, which adopted a more ‘downstream’ approach, were less influential.
State governments’ priority settings should be responsive to local governments’ unique local knowledge of health priorities. There is value in legislating a social determinants role for local government, provided it is supported by state and national government policies that facilitate public health.
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BFBNIB, CEKLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Pedestrian accessibility is an important factor in urban transport and land use policy and critical for creating healthy, sustainable cities. Developing and evaluating indicators measuring ...inequalities in pedestrian accessibility can help planners and policymakers benchmark and monitor the progress of city planning interventions. However, measuring and assessing indicators of urban design and transport features at high resolution worldwide to enable city comparisons is challenging due to limited availability of official, high‐quality, and comparable spatial data, as well as spatial analysis tools offering customizable frameworks for indicator construction and analysis. To address these challenges, this study develops an open source software framework to construct pedestrian accessibility indicators for cities using open and consistent data. It presents a generalized method to consistently measure pedestrian accessibility at high resolution and spatially aggregated scale, to allow for both within‐ and between‐city analyses. The open source and open data methods developed in this study can be extended to other cities worldwide to support local planning and policymaking. The software is made publicly available for reuse in an open repository.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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