Built environment

In public health, built environment refers to physical environments that are designed with health and wellness as integral parts of the communities. Research has indicated that the way neighbourhoods are created can affect both the physical activity and mental health of the communities’ residents.[14] Studies have shown that built environments that were expressly designed to improve physical activity are linked to higher rates of physical activity, which in turn, positively affects health.[15][16]

A separated bike lane in New York City.

Neighbourhoods with more walkability had lower rates of obesity, as well as increased physical activity among its residents. They also had lower rates of depression, higher social capital, and less alcohol abuse. Walkability features in these neighbourhoods include safety, sidewalk construction, as well as destinations in which to walk.[14] In addition, the perception of a walkable neighbourhood, one that is perceived to have good sidewalks and connectivity, is correlated with higher rates of physical activity.[15]

Assessments of walkability have been completed through the use of GIS programs, such as the Street Smart Walk Score. This example of a walkability assessment tool determines distances to grocery stores and other amenities, as well as connectivity and intersection frequency using specific addresses.[17] Assessments such as the Street Smart Walk Score can be utilized by city and country planning departments to improve existing walkability of communities.

To implement walkable neighbourhoods, community members and local leaders should focus on policy development. An effective framework that has been utilized in an abundance of communities is the Complete Streets concept of community planning that has been developed by the National Complete Streets Coalition (NCSC).[18] NCSC states that the most successful policies are those that reflect input from a broad group of stakeholders, including transportation planners and engineers, elected officials, transit agencies, public health departments, and members of the community.[18] According to Riggs, 2016, policies may focus on a “Complete Streets” investment, which includes sidewalk bulb-outs and refuges to reduce crossing distances or street widths for pedestrians. Other investments should include installing crosswalks, road markings, benches, shelters and sidewalk art installations.[19] Every community will have a unique method of policy development depending on whether it is an urban, suburban, or rural community and how the policy will combine the variety of transportation modalities. Communities may choose to focus on walkability, but will also need to consider biking, wheeling/rolling, driving, and emergency vehicles. The NCSC policy workbook gives descriptive guidance on how to proceed with policy development whether they be council-driven, council-approved, directives, or citizen vote.[18] When deciding how to proceed with walkability policy development, considerations should be made regarding current and past transportation policies, local community and government support, and how transportation policies have been implemented in the past.

A community garden located in Montreal, Canada.

Public health also addresses additional components of built environments including “bikeability”, which refers to the access that an area has granted to safe biking through multiple bike paths and bike lanes.[20] Both walkability and bikeability have been cited as determinants of physical activity.[21]

Built environments containing recreational facilities have been associated with greater physical activity among children.[22] For example, one study found that walking paths, parks with playgrounds, swimming areas, basketball courts and other various recreational facilities increased physical activity among adolescent girls.[23] Urban planning and its utilization of mixed use development are key factors affecting childhood obesity. Mixed use spaces are composed of residential, commercial, cultural, and institutional components.[24] This type of development helps to reduce the distance residents have to travel to access a grocery store or school. It also creates a more walkable and bike friendly environment for residents. It has been proven that high-density environments, meaning mixed use spaces and neighborhoods with higher walkability and bikeability, will increase physical activity.[25] A multivariable cross-sectional study done by the Harvard School of Public Health examined the association of walkable built environment characteristics with body mass index (BMI) scores among a large sample of children and adolescents.[25] Eight geographic information system variables were used to characterize a walkable built environment. (1) A distance less than 15 km to a private or public recreational open space has been linked to an increase in physical activity among children.[25] This may be due to the influence children have on one another when they see others playing.[25] (2) Also, a higher number of open spaces increases the likelihood of physical activity among children.[25] (3) A more densely populated residential area can increase children's proximity to their peers creating a more walkable environment.[25] (4) Less traffic density can also increase physical activity among children because their parents feel safe when they are walking in the neighborhood.[25] (5-7) Lower neighborhood speed limits with more sidewalks and intersections also create a safer environment for children increasing their likelihood to walk in the neighborhood.[25] (8) Finally, a greater variety of land use mix, or mixed use spaces, result in more children walking.[25] These built environment characteristics that can increase walkability were found to be generally associated with a lower BMI scores among the children sampled.[25] Another study looking at active commuting, those reporting walking, biking, or skateboarding to school more than three times a week, among elementary aged children had significantly lower BMI than non-active commuters.[26] For these reason, mixed use lands within the built environment are imperative to helping address childhood obesity. Urban sprawl, which has been positively associated with increased obesity, and an overall decline in active transportation in recent decades presents a real need for improving health within the built environment.[26][27] High-density environments bring schools, parks, and grocery stores closer to residents making it convenient to potentially eat healthier foods and exercise on a regular basis. Comprehensive urban planning, such as mixed use development, promotes healthier lifestyles in general.

The strength of the evidence for reducing obesity through environment has been highlighted by the Centers for Disease Control in its Common Community Measures for Obesity Prevention Project, which includes measures of healthy food access and physical activity environments.[28]

Access to healthy food is also an important component of the built environment. A higher density of convenience stores has been associated with obesity in children.[29] In contrast, improved access to community supermarkets and farmer's markets is correlated with lower overweight status.[30] Specifically in low income neighbourhoods, the presence of a local grocery store is correlated with lower BMI/overweight risk.[31] Community gardens are also considered a part of the built environment, and have been shown to increase fruit and vegetable intake among gardeners.[32] Scholars say that community gardens have also been shown to have positive social and psychological impacts that lead to lower levels of stress, hypertension, and an improved sense of wellness, affecting the overall health of the individual and the community.

The intersection of public health with other disciplines is evident in the design process of built environments which includes environmental planning, policy development and land-use planning.[1] Research suggests that people are more active in mixed-use communities or those that incorporate retail and residential and densely populated areas as well as those with good street connectivity.[33] Those who preferred to walk and live in walkable environments often have lower obesity rates and drive less compared to those who preferred living in auto-dependent environments.[34]