Liveability aspirations and realities: Implementation of urban policies designed to create healthy cities in Australia

The built environment and child obesity: A review of Australian policies

Child obesity is a serious public health challenge affected by both individual choice and societal and environmental factors. The main modifiable risk factors for child obesity are unhealthy eating and low levels of physical activity, both influenced by aspects of the built environment. Coordinated government policy across jurisdictions, developed using strong research evidence, can enable built environments that better support healthy lifestyles. This study reviewed current Australian and Western Australian government policies to understand if and how they address the impact of the built environment on child obesity, physical activity, sedentary behavior, and diet. Current government policy documents related to the built environment and child health were analyzed using the Comprehensive Analysis of Policy on Physical Activity framework. Ten Australian and 31 Western Australian government policy documents were identified. Most referred to the role of the built environment in supporting physical activity. Very few policies mentioned the built environment's role in reducing sedentary behaviors, supporting healthy eating, and addressing obesity. Few recognized the needs of children, and none mentioned children in policy development. Future government policy development should include the voices of children and child-specific built environment features. Inter-organizational policies with transparent implementation and evaluation plans are recommended.

Unveiling Seniors' Perception of Mobility: Urbanization, Region, and Physical Activity

Background

Maintaining mobility is fundamental to active aging, allowing older adults to lead dynamic and independent lives. The perception of mobility among older adults significantly impacts their overall well-being and quality of life. Given the aging population, mobility has become an increasingly pressing issue.

Aim

This study focused on the perception of urban neighborhoods, including considerations of urban tissue (crossings and sidewalk maintenance), urban scenes (benches and traffic), and safety (fears and street lighting quality). We investigated the differences in the perception of the surroundings of residences by urban and rural seniors concerning their demographic and social characteristics and environmental determinants.

Methods

A quantitative study design utilizing a questionnaire survey was employed. Data were collected mainly through face-to-face interviews in the field (PAPI) and via an online questionnaire (CAWI). The final sample comprised 525 participants. Hypotheses regarding the influence of gender, age, social status, level of physical activity, degree of urbanization, and region on environmental perception were tested using ordinal regression.

Results

The hypothesis regarding the dependence of the perception of the surroundings on the level of urbanization was confirmed; that regarding the dependence of the perception of the residence surroundings on seniors' age was not confirmed. The other hypotheses were partially confirmed. For the seven investigated environmental attributes, gender was significant in two cases, social status and physical activity in three cases, and region in four cases.

Conclusion

While most studies have focused on urban settings, this study highlights the situation in rural municipalities. Substantially worse pedestrian conditions in availability of pedestrian crossings, benches, and lighting were recognized in rural municipalities versus cities. Understanding the complexity of mobility and the spatial locations relevant for older persons concerning potential barriers and facilitators for mobility aids in planning and adapting neighborhood environments to promote active and healthy aging in place.

Assessing the construction of a Healthy City in China: a conceptual framework and evaluation index system

OBJECTIVES

COVID-19 has brought challenges to the health of all mankind. It is particularly important to promote the construction of a 'Healthy China' and build a 'healthy community'. The aims of this study were to construct a reasonable conceptual framework for the Healthy City concept and to assess Healthy City construction in China.

STUDY DESIGN

This study combined qualitative and quantitative research.

METHODS

This study proposes the concept model of 'nature-human body-Healthy City' and accordingly constructs an evaluation index system for the construction of a Healthy City that integrates five dimensions, namely, the medical level, economic basis, cultural development, social services, and ecological environment to explore the spatial and temporal heterogeneity of Healthy City construction in China. Finally, the influencing factors of Healthy City construction patterns are explored using GeoDetector.

RESULTS

(1) The pace of Healthy City construction is generally on the rise; (2) the construction of Healthy Cities exhibits significant global spatial autocorrelation and gradually increasing agglomeration. The spatial distribution of cold hotspot areas was relatively stable; (3) medical and health progress is an important factor; the level of economic development is the leading support; the endowment of resources and environment is the basic condition; public service support provides important support; and scientific and technological innovation capabilities provide technical support for the construction of a Healthy City.

CONCLUSIONS

The spatial heterogeneity of Healthy City construction in China is evident, and the state of spatial distribution is relatively stable. The spatial pattern of Healthy City construction is shaped by a combination of factors. Our research will provide a scientific basis for promoting the construction of Healthy Cities and helping to implement the Health China Strategy.

Investigating the measurement properties of livability: a scoping review

Connecting evidence-based public health recommendations to livability, a popular and relatable construct, can increase the policy relevance of research to improve community design. However, there are many different definitions and conceptualizations of livability and little consensus about its measurement. Improved measurement, including standardization, is needed to increase understanding of livability's influence on health and to facilitate comparisons across contexts. This study sought to review existing livability measures, how they were created, and evidence regarding their reliability and validity. A scoping review of three databases (PubMed, Google Scholar, and Web of Science) identified 744 eligible studies. After screening, 24 studies, 15 from the original search and 9 through backward citation searches, were included in the review. Most studies were carried out in an urban context. There was minimal consensus across studies on the conceptualization of livability. However, measure domains and indicators overlapped significantly. While the process used to validate the measures varied, most studies reported high levels of reliability and found that livability was correlated with similar measures (e.g. place satisfaction, neighborhood safety, and sense of place) and self-reported health and wellbeing. Further research is needed to develop parsimonious, standardized measures of livability in order to create and sustain livable communities worldwide.

Policy relevant health related liveability indicator datasets for addresses in Australia's 21 largest cities

Measuring and monitoring the spatial distribution of liveability is crucial to ensure that implemented urban and transport planning decisions support health and wellbeing. Spatial liveability indicators can be used to ensure these decisions are effective, equitable and tracked across time. The 2018 Australian National Liveability Study datasets comprise a suite of policy-relevant health-related spatial indicators of local neighbourhood liveability and amenity access estimated for residential address points and administrative areas across Australia's 21 most populous cities. The indicators and measures encompass access to community and health services, social infrastructure, employment, food, housing, public open space, transportation, walkability and overall liveability. This national 'baseline' liveability indicators dataset for residential address points and areas can be further linked with surveys containing geocoded participant locations, as well as Census data for areas from the Australian Statistical Geography Standard. The datasets will be of interest to planners, policy makers and researchers interested in modelling and mapping the spatial distribution of urban environmental exposures and their relationship with health and other outcomes.

Neighbourhood socioeconomic disadvantage and body size in Australia's capital cities: The contribution of obesogenic environments

Residents of socioeconomically disadvantaged neighbourhoods have higher rates of overweight and obesity and chronic disease than their counterparts from advantaged neighbourhoods. This study assessed whether associations between neighbourhood disadvantage and measured body mass index (BMI) and waist circumference, are accounted for by obesogenic environments (i.e., residential distance to the Central Business District [CBD], supermarket availability, access to walkable destinations). The study used 2017-18 National Health Survey data for working-aged adults (aged ≥18 years, n = 9,367) residing in 3,454 neighbourhoods across Australia's state and territory capital cities. In five of eight cities (i.e., Sydney, Melbourne, Brisbane, Adelaide, and Perth) residents of disadvantaged neighbourhoods had significantly higher BMI and a larger waist circumference than residents of more advantaged areas. There was no association between neighbourhood disadvantage and body size in Hobart, Darwin, and Canberra. Associations between neighbourhood disadvantage and body size were partially explained by neighbourhood differences in distance to the CBD but not supermarket availability or walkable amenities. The results of this study point to the role of urban design and city planning as mechanisms for addressing social and economic inequities in Australia's capital cities, and as solutions to this country's overweight and obesity epidemic and associated rising rates of chronic disease.

Examining the Contribution of the Neighborhood Built Environment to the Relationship Between Neighborhood Disadvantage and Early Childhood Development in 205,000 Australian Children

OBJECTIVE

We examined associations between neighborhood built environment features and early childhood development (ECD), and tested the contribution of the built environment to associations between neighborhood disadvantage and ECD.

METHODS

Spatial neighborhood built environment measures were linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children ∼5 years old living in Australia's 21 most populous cities. The 2015 AEDC contains teacher-reported national data on five key child development domains for children in their first year of formal full-time schooling (approximately 5 years old). AEDC scores were classified as 'developmentally vulnerable' (≤10th centile). Using multilevel modeling, 44 built environment measures were tested with developmental vulnerability on at least one domain of the AEDC, adjusting for socioeconomic factors and neighborhood disadvantage.

RESULTS

The dataset consisted of 205,030 children; 89.2% living in major cities. In major cities, children with more early childhood education and care services (OR 0.997) and preschool services (OR 0.991) exceeding Australian standards, and access to healthier food outlets within 3200 m of their home (OR 0.999) had decreased odds of developmental vulnerability, controlling for socioeconomic factors and neighborhood disadvantage. Neighborhood disadvantage remained significantly associated with developmental vulnerability after adjustment for child/family variables and neighborhood built environment characteristics.

CONCLUSIONS

The neighborhood built environment had small effects on the neighborhood disadvantage-ECD relationship at the national level. Few built environment measures were associated with ECD. Small effects at the population level may have wide-ranging impacts; modifying the built environment at scale are promising levers for supporting good child outcomes.

Australian State and Territory Eclectic Approaches to Obesity Prevention in the Early Years: Policy Mapping and Perspectives of Senior Health Officials

Background

The international increase in the prevalence of childhood obesity has hastened in recent decades. This rise has coincided with the emergence of comorbidities in childhood-such as type II diabetes, non-alcoholic fatty liver disease, metabolic syndrome, sleep apnoea and hypertension-formerly only described in adulthood. This phenomenon suggests global social and economic trends are impacting on health supportive environments. Obesity prevention is complex and necessitates both long-term and systems approaches. Such an approach considers the determinants of health and how they interrelate to one another. Investment in the early years (from conception to about 5 years of age) is a key life stage to prevent obesity and establish lifelong healthy habits relating to nutrition, physical activity, sedentary behavior and sleep. In Australia, obesity prevention efforts are spread across national and state/territory health departments. It is not known from the literature how, with limited national oversight, state and territory health departments approach obesity prevention in the early years.

Methods

We conducted a qualitative study including policy mapping and interviews with senior officials from each Australian state/territory health department. A series of questions were developed from the literature to guide the policy mapping, drawing on the World Health Organisation Ending Childhood Obesity Report, and adapted to the state/territory context. The policy mapping was iterative. Prior to the interviews initial policy mapping was undertaken. During the interviews, these policies were discussed, and participants were asked to supply any additional policies of relevance to obesity prevention. The semi-structured interviews explored the approaches to obesity prevention taken in each jurisdiction and the barriers and enablers faced for policy implementation. Thematic analysis was used to analyse the data, using NVivo software.

Results

State and territory approaches to obesity prevention are eclectic and while there are numerous similarities between jurisdictions, no two states are the same. The diversity of approaches between jurisdictions is influenced by the policy culture and unique social, geographic, and funding contexts in each jurisdiction. No Australian state/territory had policies against all the guiding questions. However, there are opportunities for sharing and collaborating within and between Australian jurisdictions to establish what works, where, and for whom, across Australia's complex policy landscape.

Conclusions

Even within a single country, obesity prevention policy needs to be adaptable to local contexts. Opportunities for jurisdictions within and between countries to share, learn, and adapt their experiences should be supported and sustained funding provided.

Methods for Evaluating Environmental Health Impacts at Different Stages of the Policy Process in Cities

PURPOSE OF REVIEW

Evaluating the environmental health impacts of urban policies is critical for developing and implementing policies that lead to more healthy and equitable cities. This article aims to (1) identify research questions commonly used when evaluating the health impacts of urban policies at different stages of the policy process, (2) describe commonly used methods, and (3) discuss challenges, opportunities, and future directions.

RECENT FINDINGS

In the diagnosis and design stages of the policy process, research questions aim to characterize environmental problems affecting human health and to estimate the potential impacts of new policies. Simulation methods using existing exposure-response information to estimate health impacts predominate at these stages of the policy process. In subsequent stages, e.g., during implementation, research questions aim to understand the actual policy impacts. Simulation methods or observational methods, which rely on experimental data gathered in the study area to assess the effectiveness of the policy, can be applied at these stages. Increasingly, novel techniques fuse both simulation and observational methods to enhance the robustness of impact evaluations assessing implemented policies. The policy process consists of interdependent stages, from inception to end, but most reviewed studies focus on single stages, neglecting the continuity of the policy life cycle. Studies assessing the health impacts of policies using a multi-stage approach are lacking. Most studies investigate intended impacts of policies; focusing also on unintended impacts may provide a more comprehensive evaluation of policies.

Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Australian local government policies on creating a healthy, sustainable, and equitable food system: analysis in New South Wales and Victoria

OBJECTIVE

To analyse local government (LG) policies concerned with creating a healthy, sustainable and equitable food system.

METHODS

All relevant policies on LG websites were identified and analysed against a framework of 34 recommendations for LG action on food system issues.

RESULTS

A total of 13 of 207 (New South Wales 128, Victoria 79) LGs had dedicated food system policies. Most actions on food system issues were in general (non-food specific) policies. Most LGs acted on food safety, sustainable local food production, food waste, drinking water access and food system-related education. Few used economic measures to support the consumption of healthier foods, restricted unhealthy food advertising, developed and implemented dietary guidelines in LG-managed settings or influenced the opening of unhealthy/healthy retail food outlets.

CONCLUSIONS

LGs undertook a range of actions relevant to creating a healthy, sustainable and equitable food system. Strategic opportunities for LGs include regulating the sale and marketing of unhealthy food and ensuring policy coherence.

IMPLICATIONS FOR PUBLIC HEALTH

LGs can be supported to act further on food system issues, including through 'joined-up' state and federal policies. Further research should address how relevant LG policies can be developed, implemented and monitored effectively to address the complex challenges created by contemporary food systems.

Achieving ‘Active’ 30 Minute Cities: How Feasible Is It to Reach Work within 30 Minutes Using Active Transport Modes?

Confronted with rapid urbanization, population growth, traffic congestion, and climate change, there is growing interest in creating cities that support active transport modes including walking, cycling, or public transport. The ‘30 minute city’, where employment is accessible within 30 min by active transport, is being pursued in some cities to reduce congestion and foster local living. This paper examines the spatial relationship between employment, the skills of residents, and transport opportunities, to answer three questions about Australia’s 21 largest cities: (1) What percentage of workers currently commute to their workplace within 30 min? (2) If workers were to shift to an active transport mode, what percent could reach their current workplace within 30 min? and (3) If it were possible to relocate workers closer to their employment or relocate employment closer to their home, what percentage could reach work within 30 min by each mode? Active transport usage in Australia is low, with public transport, walking, and cycling making up 16.8%, 2.8%, and 1.1% respectively of workers’ commutes. Cycling was found to have the most potential for achieving the 30 min city, with an estimated 29.5% of workers able to reach their current workplace were they to shift to cycling. This increased to 69.1% if workers were also willing and able to find a similar job closer to home, potentially reducing commuting by private motor vehicle from 79.3% to 30.9%.

Association of Urban Liveability with Cancer Incidence in Iran: A Nationwide Ecological Study

Background: Urban liveability is a multidimensional concept associated with many domains of human health. Objectives: This study aimed at investigating the association between urban liveability and cancer incidence in Iran. Methods: The data of provincial-level urban liveability were obtained from reliable sources. The data of cancer incidence were inquired from the population-based cancer registry of the Iranian Ministry of Health and Medical Education in 2016. Urban liveability scores were determined in all provinces of Iran by utilizing the Global Liveable City Index (GLCI) method. Negative binomial Poisson regression was used to examine the relationship between urban liveability and cancer incidence. Results: Provinces with a higher urban liveability had a higher likelihood of cancer incidence. Higher economic score was significantly associated with higher incidence in colorectal (IRR = 1.49, P = 0.005), liver (IRR = 1.48, P = 0.002), leukemia (IRR = 1.39, P = 0.005), lung (IRR = 1.39, P = 0.039), breast (IRR = 1.38, P = 0.011), and prostate cancers (IRR = 2.11, P < 0.001). Also, provinces with higher environmental friendliness and sustainability had significantly more stomach (IRR = 1.53, P = 0.004), colorectal (1.79, P < 0.001), lung (IRR = 1.43, P = 0.014), and prostate (IRR = 1.50, P = 0.032) cancer incidence. Provinces with higher political governance had significantly more breast cancer (IRR = 1.34, P = 0.002) and leukemia (IRR = 1.30, P = 0.016) incidence rates. Conclusions: Along with the development of urban liveability, the incidence of cancers is increasing in Iran. Cancer control strategies should be implemented especially in settings with higher urbanization.

Exploring the potential for planning support systems to bridge the research-translation gap between public health and urban planning

BACKGROUND

There is consensus that planning professionals need clearer guidance on the features that are likely to produce optimal community-wide health benefits. However, much of this evidence resides in academic literature and not in tools accessible to the diverse group of professionals shaping our cities. Incorporating health-related metrics into the planning support systems (PSS) provides an opportunity to apply empirical evidence on built environment relationships with health-related outcomes to inform real-world land use and transportation planning decisions. This paper explores the role of planning support systems (PSS) to facilitate the translation and application of health evidence into urban planning and design practices to create healthy, liveable communities.

METHODS

A review of PSS software and a literature review of studies featuring a PSS modelling built environmental features and health impact assessment for designing and creating healthy urban areas was undertaken. Customising existing software, a health impact PSS (the Urban Health Check) was then piloted with a real-world planning application to evaluate the usefulness and benefits of a health impact PSS for demonstrating and communicating potential health impacts of design scenarios in planning practice.

RESULTS

Eleven PSS software applications were identified, of which three were identified as having the capability to undertake health impact analyses. Three studies met the inclusion criteria of presenting a planning support system customised to support health impact assessment with health impacts modelled or estimated due to changes to the built environment. Evaluation results indicated the Urban Health Check PSS helped in four key areas: visualisation of how the neighbourhood would change in response to a proposed plan; understanding how a plan could benefit the community; Communicate and improve understanding health of planning and design decisions that positively impact health outcomes.

CONCLUSIONS

The use of health-impact PSS have the potential to be transformative for the translation and application of health evidence into planning policy and practice, providing those responsible for the policy and practice of designing and creating our communities with access to quantifiable, evidence-based information about how their decisions might impact community health.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

Defining pathways to healthy sustainable urban development

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.

Could smart research ensure healthy people in disrupted cities?

BACKGROUND

Since the late 19th century, city planners have struggled to cope with new types of urban transport and mobility that threatened the existing system, or even rendered it obsolete.

PURPOSE

As city planners confront the range of disruptive urban mobilities currently on the horizon, this paper explores how we can draw on a vast body of evidence to anticipate and avoid unintended consequences to people's health and wellbeing.

METHODS

This commentary involved a rapid review of the literature on transport disruption.

RESULTS

We found that to avoid the unintended consequences of disruption, research, policy and practice must think beyond single issues (such as the risk of chronic disease, injury, or traffic management) and consider the broader consequences of interventions. For example, although autonomous vehicles will probably reduce road trauma, what will be the negative consequences for physical inactivity, sedentary behavior, chronic disease, land use, traffic congestion and commuting patterns? Research is needed that considers and informs how to mitigate the range of potential harms caused by disruptive mobilities.

CONCLUSION

In the face of new disruptive mobilities, we must: (a) draw on existing evidence to shape new regulations that address the 'who, when and where' rules of introducing new mobilities (such as electric assisted bicycles (e-bikes) and scooters (e-scooters)) of which the health repercussions can be easily anticipated; (b) monitor and evaluate the implementation of any interventions through natural experiment studies; and (c) use innovative research methods (such as agent-based simulation and health-impact-assessment modelling) to assess the likely effects of emerging disruptive mobilities (e.g., autonomous vehicles) on health and wellbeing and on the environment.