In this article, Susan Thompson provides an overview of how urban environments can support health and well-being. She also suggests questions to ask of new developments about how they will support the community’s health – both those who already live in an area and aspiring residents.

 

Nearly every time you pick up a newspaper or magazine, turn on the television or listen to the radio, there is bound to be an item about health. And more often than not, obesity is part of the discussion. Given this, it’s not surprising to learn that obesity is a significant risk factor for our most common contemporary health problems – the so-called ‘lifestyle diseases’ – such as diabetes, coronary and chronic respiratory conditions, cancers, and mental health issues such as depression and anxiety.

And you may also have encountered debates about evidence linking these contemporary health problems to the way we live in cities. Diminishing opportunities for physical activity as part of daily living, our car dominated transport systems, increasing fast food availability and reduced ready access to affordable fresh food, and lack of social connection, are all implicated.

For some time, health professionals have acknowledged that to address these epidemics, we need to look well beyond costly medical treatments, drug therapies and surgical interventions. Rather than only caring for people once they are sick, the health system has to shift to a greater emphasis on prevention. And to do this successfully requires effective collaboration with other professions – especially developers, town planners, urban designers, landscape architects, transport planners and engineers. There is widespread agreement that our towns and cities can play an important role in supporting healthy behaviours as part of everyday living.

SO WHAT IS A HEALTHY BUILT ENVIRONMENT?

There is a growing body of research showing that urban form plays a significant role in both human and ecological health. Suburbs far away from the city centre, with low residential densities, segregated land uses, disconnected street patterns, limited provision of public transport and few local employment opportunities encourage car dependent, physically inactive and socially isolated lifestyles. These urban qualities also contribute to climate change with excessive greenhouse gas emissions. Alternatively, environments with higher residential densities, where shops and homes are located in close proximity and where it is easy to cycle and walk to commercial precincts, make a positive contribution to health. Such neighbourhoods are also good for environmental sustainability.

The University of NSW (UNSW) Healthy Built Environments Program (HBEP) has compiled much of this research, together with policy implications, in a comprehensive Literature Review (HBEP Review). This is free to download from the HBEP website. The HBEP Review defines three ‘domains’ of built environment influence in relation to supporting good health and well-being:

• The built environment and physical activity
• The built environment and social connection
• The built environment and access to healthy foods.

Below are some of the ideas from these domains which highlight key features of a healthy built environment.

A healthy built environment supports physical activity

Physical inactivity is a major risk factor for contemporary chronic disease. Physical activity helps to protect against heart disease and stroke, diabetes, and cancers such as colon and breast. It also diminishes the impact of clinical depression and anxiety. And it’s interesting to note that the protective effects of physical activity are independent of obesity – so even if you are overweight, being active will make a positive contribution to your health (see the NSW Premier’s Council for Active Living ‘Why Active Living Statement’ for more information).

A healthy built environment is one that encourages physical activity. This includes walking and cycling for transport, and using green open spaces for recreation. It’s also about designing buildings and public areas with easy-to-use stairs so that people are encouraged to move rather than standing still in a lift or travelling on escalators. Walking is perhaps the most common physical activity and is generally part of all non-car transport trips. Walking is available to nearly everyone. Participation can occur from a very young age to well into later life, irrespective of cultural background, income levels and education. So creating a walkable environment – one where it is easy, safe and enjoyable to walk for both recreation and transport – is central to a healthy built environment.

What is a Walkable Place?Accessibility is a key criterion. To encourage walking for transport, the services and facilities that people need to use on a daily basis have to be close, as does public transport. When thinking about walking for recreation, paths have to be handy to residential areas so it’s easy for people to use them. Connectivity is another principle of walkability, as is the quality of the infrastructure. Connections between walking and cycling paths, and quality green open space, are some of the issues here. Path width is an important consideration if walkers and cyclists are to be accommodated safely. Differently abled users, as well as parents with strollers and prams, may be another factor in determining the adequacy of shared paths. Facilities such as water fountains, seating (with shading), public toilets that are clean and well maintained, and rubbish bins are all characteristic of good quality walking infrastructure. Interesting things to see along the way, a pleasant ambient environment free of pollution and excessive noise will also encourage walking. And above all else, walkable areas are safe. Paths are free from trip and fall hazards and users perceive the locality to be safe for walking. This might mean ensuring that a wide range of demographic groups are out and about, and that behaviour on shared paths is respectful of multiple users – signage is important here.

Some other urban environmental features important in supporting physical activity are:

Distance and Density

The research evidence tells us that keeping everyday trip distances short by having mixed use neighbourhoods and compact development makes active transport a viable option by providing destinations to which people can walk and cycle. However, increasing the residential density of the built environment alone will not necessarily encourage increased active transport. Density, mixed use and micro-design elements in some combination are most likely to influence levels of physical activity (HBEP Review pages 47-52).

Street Networks

The research increasingly demonstrates that grid street patterns decrease distances between origins and destinations and encourage active transport (HBEP Review page 53). Street layouts, based on a grid, ensure direct and easy to navigate access to shops, schools and public transport stops. If there

is a cul de sac, pedestrians and cyclists should be given through access.

Open Green Space

There is strong evidence that people who live close to a variety of recreation facilities are more physically active than those who do not enjoy such proximity. Recreation activities can vary from organised sport, impromptu games and play, as well as walking, jogging and cycling (HBEP Review page 57). There are other significant health benefits of natural, green and open spaces. Research suggests that there is an instinctive bond between human beings and other living systems. Removal of this bond by ‘building out’ natural elements (including plants, animals and even the weather) is fundamentally detrimental to health (HBEP Review pages 66-68).

With continuing urban population growth, provision for additional green open space is essential. In rapidly developing urban areas where land costs are high, governments must ensure that funding is available for the purchase of adequate amounts of open space, as well as landscape design and ongoing maintenance. Policy needs to reflect the diverse array of users of open space, including children, older adults and those with disabilities. In addition to large areas of natural open space, the incorporation of nature into urban and building design should be pursued, particularly in higher density areas. This can include roof top gardens, green walls and feature plantings in window boxes and building entries. Importantly, provision needs to be made for these plantings to be well maintained.

A healthy built environment connects and strengthens local communities

A sense of community and belonging where people live, work and travel are important determinants of physical and mental health. The consequences of social isolation are loneliness, depression and anxiety, and while people of any age can be affected, older community members are most vulnerable. Sense of belonging fosters perceptions of security, confidence and comfort which can encourage people to be active and engaged in their neighbourhood, as well as socially connected to others. Incidental interaction enhances possibilities for human connection and caring. In turn, this increases perceptions of safety and reduces feelings of loneliness and isolation, all of which have benefits for mental health.

Considerations that relate to the urban environment to bring communities together are:

Incidental Social Interactions

Spaces between buildings – on the street and in town squares – are important for encounters and social interaction. An incidental greeting between individuals waiting for a bus or walking along the footpath can begin a conversation which contributes to a sense of community. Active transport (that is, walking, cycling and public transport use) presents further opportunities for casual interaction not afforded by the private motor car (HBEP Review pages p.69 and 71-74).

Safety

While sense of community and social interaction are key determinants of health, a large body of research suggests that people will not interact within, or feel part of, a community that is unsafe and/or is perceived to be unsafe (HBEP Review pages 74-75). Safety is an essential foundation of a healthy place. Policies need to ensure that urban areas include a variety of well-maintained and safe public spaces. Arrangements for the ongoing maintenance of such spaces should be formalised. Natural and physical territorial enforcement should be encouraged as a way to protect privacy. Involving communities in crime prevention programs and policies is also very important.

Open Space and Community Interaction

The location and treatment of green and open spaces can support both organised and incidental social interactions and activities. These spaces create a focal point for communities to meet and grow (HBEP Review pages 66-68). As cities densify – and the urban environment becomes busier with more hard surfaces and increased visual and aural stimulation – planning policies must support the provision of green open space.

A healthy built environment provides equitable access to healthy food.

Regular physical activity needs to be accompanied by a healthy intake of food to ensure that energy ‘in’ is balanced with energy ‘out’. This is the key to maintaining a healthy body weight. Research indicates that convenient food access is a determinant of food choice. Proximity of healthy food outlets, including supermarkets, can positively influence the consumption of health promoting foods.

Features supporting access to healthy food for everyone are:

Food Accessibility

The research indicates a relationship between exposure to healthy food options and healthy eating. Access to a supermarket or other reliable source of fresh, healthy produce appears to improve healthy food consumption (HBEP Review pages 86-88). Accordingly, it is important that food retail areas have a variety of food options. Supermarkets are ideally centrally located within urban areas to ensure equitable access.

Larger Scale Food Production

Urban agricultural lands play an important part in the production and supply of healthy food to urban areas in Australia and should be protected (HBEP Review page 93). Policies to assess the value of peri-urban land for food production should be encouraged prior to re-zoning.

Farmers’ Markets and Community Gardens

The link between exposure to community gardens and farmers’ markets, with increased consumption of fresh fruit and vegetables, is obvious although difficult to quantify. Markets and gardens also facilitate community interaction and physical activity. They are an extremely valuable element of a healthy built environment (HBEP Review page 92). Land use zoning should support, not prohibit, the use of land for farmers’ markets and community gardens. To be effective, these policies require support from other community agencies such as schools, gardening clubs, and recycling and sustainability groups.

CONCLUSION

To make the HBEP Literature Review findings more concrete, opposite are some questions to ask at different stages of the planning and development process when assessing if a new development supports health and wellbeing.

The built environment is pivotal in supporting healthy behaviours as part of daily life. The research is compelling and there is increasing acknowledgement that we have to work across health and the built environment sectors in order to be effective. Nevertheless, ensuring that new development supports healthy behaviour of both existing and future communities is not an easy task. Our best chance of successfully tackling these complex and challenging 21^st century issues is through collaboration and knowledge sharing, with health and built environment professionals working closely with local communities.

Also see the companion checklist – Assessing New Development to see how it supports Health and Wellbeing

Susan Thompson is an urban planner. She holds the positions of Associate Professor in the Planning and Urban Development Program and Associate Director (Healthy Built Environments) City Futures Research Centre, Faculty of the Built Environment at the University of New South Wales. All images were taken by Susan Thompson.

For more information about healthy built environments you can start with these websites:

UNSW Healthy Built Environments Program: http://www.be.unsw.edu.au/programmes/healthy-built-environments-program/about

Heart Foundation and active living: http://www.heartfoundation.org.au

Healthy Places and Spaces: http://www.healthyplaces.org.au

NSW Premier’s Council for Active Living: http://www.pcal.nsw.gov.au