Health and the built environment: exploring foundations for a new interdisciplinary profession

Associations of the built environment with type 2 diabetes in Asia: a systematic review

OBJECTIVES

Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia.

DESIGN

Systematic review of the literature.

DATA SOURCES

Online databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023.

ELIGIBILITY CRITERIA

Eligible studies included cohort, cross-sectional and case-control studies that explored associations of built environment characteristics with T2D among adults 18 years and older in Asia.

DATA EXTRACTION AND SYNTHESIS

Covidence online was used to remove duplicates and perform title, abstract and full-text screening. Data extraction was carried out by two independent reviewers using the OVID database and data were imported into MS Excel. Out of 5208 identified studies, 28 studies were included in this systematic review. Due to heterogeneity in study design, built environment and outcome definitions, a semiqualitative analysis was conducted, which synthesised results using weighted z-scores.

RESULTS

Five broad categories of built environment characteristics were associated with T2D in Asia. These included urban green space, walkability, food environment, availability and accessibility of services such as recreational and healthcare facilities and air pollution. We found very strong evidence of a positive association of particulate matter (PM_2.5, PM₁₀), nitrogen dioxide and sulfur dioxide (p<0.001) with T2D risk.

CONCLUSION

Several built environment attributes were significantly related to T2D in Asia. When compared with Western countries, very few studies have been conducted in Asia. Further research is, therefore, warranted to establish the importance of the built environment on T2D. Such evidence is essential for public health and planning policies to (re)design neighbourhoods and help improve public health across Asian countries.

PROSPERO REGISTRATION NUMBER

CRD42020214852.

The impact of the built environment on loneliness: A systematic review and narrative synthesis

Loneliness is a pressing public health issue. Although quintessentially individual, it is shaped by wider environmental, cultural, socio-economic, and political circumstances. Using a systematic review methodology, this paper draws on interdisciplinary research to conceptualise the relationship between the built environment and loneliness. We present a narrative synthesis of 57 relevant studies to characterise the body of evidence and highlight specific built-environment elements. Our findings demonstrate the need for further conceptual and empirical explorations of the multifaceted ways in which built environments can prevent loneliness, supporting calls for investment into this public-health approach.

Multi-, Inter-, and Transdisciplinarity within the Public Health Workforce: A Scoping Review to Assess Definitions and Applications of Concepts

In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges.

Urban Air Pollution, Urban Heat Island and Human Health: A Review of the Literature

Many cities of the world suffer from air pollution because of poor planning and design and heavy traffic in rapidly expanding urban environments. These conditions are exacerbated due to the Urban Heat Island (UHI) effect. While there have been studies linking the built environment and air pollution with health, they have ignored the aggravating role of UHI. The past urban planning literature in this field has also ignored the science of materials, vehicles and air pollution, and technological solutions for reducing cumulative health impacts of air pollution and UHI. Air Pollution, built environment and human health are complex discussion factors that involve several different fields. The built environment is linked with human health through opportunities of physical activity and air quality. Recent planning literature focuses on creating compact and walkable urban areas dotted with green infrastructure to promote physical activity and to reduce vehicle emission-related air pollution. Reduced car use leading to reduced air pollution and UHI is implied in the literature. The literature from technology fields speaks to the issue of air pollution directly. Zero emission cars, green infrastructure and building materials that absorb air pollutants and reduce UHI fall within this category. This paper identifies main themes in the two streams of urban air pollution and UHI that impact human health and presents a systematic review of the academic papers, policy documents, reports and features in print media published in the last 10–20 years.

Health Impacts of the Built and Social Environments, and Travel Behavior: The Case of the Sunshine State

As physical inactivity statistics for the U.S. population show an alarming trend, many health problems have been increasing among Americans in recent decades. Thus, identification of the factors that influence people’s physical activity levels and health outcomes has become ever more essential to promote public health. The built envSFironment is among the main factors that impact individuals’ health outcomes. However, little is known about the health impacts of built environment factors at large geographical scales such as those of the metropolitan area of residence. Further, the health impacts of travel behavior such as telecommuting and teleshopping remain unclear. This study uses an ecological model framework to probe the roles of travel behavior and built as well as social environments at different spatial levels in health. Instrumental variable binary probit models have been developed to examine the complex interlinks between measures of travel behavior, physical activity levels, built and social environment characteristics, and individuals’ health outcomes. Findings indicate that built and social environment factors at different spatial levels, including the metropolitan area, are correlated with individuals’ health outcomes. Additionally, the findings suggest that increased levels of telecommuting and teleshopping within communities may lead to unfavorable health outcomes. The findings shed light on the most promising policy interventions that can promote public health through modifications targeting people’s travel choices as well as the built and social environments within urban areas.

Space and spatial practices in times of confinement. Evidence from three European countries: Austria, France and Poland

In the first half of 2020, millions of people were subjected to drastic restrictions aimed at limiting the spread of the Covid-19 disease. Austria, France and Poland have implemented a lockdown to varying degrees and for varying lengths of time. This is an unprecedented situation in Europe: until now, even in times of war, curfew measures have never been applied 24 h a day. The research presented in this article was carried out in real time, in April and May 2020, with the help of urban planning students from three countries. Its objective is to observe the interaction between these measures and the urban space in two dimensions. On the one hand, we analyse the impact of these measures on the urban space and on the spatial practices of the inhabitants. On the other hand, we examine the conditions which different types of urban and rural space have provided for the inhabitants experiencing confinement. This empirical study leads to a discussion and recommendation for the town planners of the future.

Status report, The Public Health and Planning 101 project: strengthening collaborations between the public health and planning professions

INTRODUCTION

Land use planning is a complex field comprised of legislation, policies, processes and tools. A growing body of evidence supports the relationship between land use planning decisions, community design and health. The built environment has been shown to be associated with physical inactivity, obesity, cardiovascular disease, respiratory disease and mental illness. Consequently, there is a growing interest within public health to work with planners on land use planning initiatives such as official plans and transportation master plans.

METHODS

Two surveys were developed: one for public health professionals and the other for planning professionals (survey questions available upon request to the corresponding author). The surveys were pilot tested in two separate focus group sessions with public health and planning professionals. Focus group volunteers helped to validate the surveys by verifying survey questions, design and overall flow.

RESULTS

In early 2012, 304 public health professionals and 301 planning professionals completed the two separate surveys, comprising the total survey respondents for each respective profession used to calculate proportions. The survey results represent a convenience sample and are not generalizable to the entire population of public health and planning professionals in Ontario. Results compare survey responses from both groups where appropriate. Most respondents worked either as public health staff (78%) or planners/senior planners (58%). A smaller percentage of public health and planning professionals worked either as managers (15% and 11%, respectively) or directors (5% and 9%, respectively).

CONCLUSION

Health is associated with how communities are planned and built, and the services and resources provided within them. Inspired by the results of our survey and based on user feedback from the pilot tests, a free online training program entitled "Public Health and Planning 101: An Online Course for Public Health and Planning Professionals to Create Healthier Built Environments" was launched in 2016 by OPHA as a collaborative project with OPPI and PHAC. This course is designed to bridge the gaps between the two professions, as well as provide greater opportunities for developing collaborative partnerships to help create and foster healthy built environments.

A dynamic framework on travel mode choice focusing on utilitarian walking based on the integration of current knowledge

Recently, research on utilitarian walking has gained momentum due to its benefits on both health and the environment. However, our overall understanding of how built and social environments affect travel mode choice (walking or not) is still limited, and most existing frameworks on travel mode choice lack dynamic processes. After a review of several mainstream theories and a number of frameworks, we propose an integrated framework. The basic constructs in the travel mode choice function are utilities, constraints, attitudes, and habits. With a hierarchical structure and heuristic rules, the travel mode choice function is modified by individual characteristics and travel characteristics. The framework explicitly presents several dynamic processes, including the perception process on the environment, attitude formation process, habit formation process, interactions among an individual's own behaviors, interactions among travelers, feedback from travel to the built and social environments, and feedback from other behaviors to the built and social environments. For utilitarian walking, the framework may contribute to the study design, data collection, adoption of new research methods, and provide indications for policy interventions.

'Including health in systems responsible for urban planning': a realist policy analysis research programme

INTRODUCTION

Realist methods are increasingly being used to investigate complex public health problems. Despite the extensive evidence base clarifying the built environment as a determinant of health, there is limited knowledge about how and why land-use planning systems take on health concerns. Further, the body of research related to the wider determinants of health suffers from not using political science knowledge to understand how to influence health policy development and systems. This 4-year funded programme of research investigates how the land-use planning system in New South Wales, Australia, incorporates health and health equity at multiple levels.

METHODS AND ANALYSIS

The programme uses multiple qualitative methods to develop up to 15 case studies of different activities of the New South Wales land-use planning system. Comparison cases from other jurisdictions will be included where possible and useful. Data collection includes publicly available documentation and purposively sampled stakeholder interviews and focus groups of up to 100 participants across the cases. The units of analysis in each case are institutional structures (rules and mandates constraining and enabling actors), actors (the stakeholders, organisations and networks involved, including health-focused agencies), and ideas (policy content, information, and framing). Data analysis will focus on and develop propositions concerning the mechanisms and conditions within and across each case leading to inclusion or non-inclusion of health. Data will be refined using additional political science and sociological theory. Qualitative comparative analysis will compare cases to develop policy-relevant propositions about the necessary and sufficient conditions needed to include health issues.

ETHICS AND DISSEMINATION

Ethics has been approved by Sydney University Human Research Ethics Committee (2014/802 and 2015/178). Given the nature of this research we will incorporate stakeholders, often as collaborators, throughout. We outline our research translation strategies following best practice approaches.

Lessons in promoting active living: the collaborative perspective

CONTEXT

Collaborative groups are integral in health promotion and disease prevention and use an ecological approach to address complex health conditions in community settings. Little is known about collaborative efforts to promote active living.

OBJECTIVE

The objective of this analysis is to explore successes and challenges of collaborative groups in promoting active living in their communities.

DESIGN/SETTING

One-time, structured telephone interviews were conducted to assess the composition tactics and activities and approaches used by collaboratives to promote active living.

PARTICIPANTS

Collaborative groups were referred by Physical Activity Policy Research Network members or found through online searches. Interviews were conducted with coordinators of 59 collaborative groups.

MAIN OUTCOME MEASURE(S)

Analysis focused on successes and challenges of collaborative groups' policies, programs, and/or projects as described by collaborative group coordinators. We used the Grounded Theory method approach to code and abstract themes from 2 open-ended response sets.

RESULTS

Collaboratives' most successful projects centered on strategies using environmental (41%) or policy (31%) approaches to promote active living. While 80% of groups reported that their most successful project was funded, funding was also identified as a primary challenge for 71% of the collaboratives. Personnel issues were a common challenge for 54%. Opposition to successful projects ranged from community issues to collaborative member issues, although more than half the groups experienced no opposition.

CONCLUSIONS

Groups that aligned goals, strategies, and funding to advance changes to the built environment were likely to identify their projects as successful. Perceptions of opposition and attitudes toward success may be important precursors to project outcomes of active living collaboratives and warrant further investigation. Lessons from these active living collaborative groups can provide guidance for other groups planning for environmental and policy change.