Public Health Design and Health
by
Karen K. Lee
  • LAST REVIEWED: 15 June 2015
  • LAST MODIFIED: 29 September 2014
  • DOI: 10.1093/obo/9780199756797-0137

Introduction

The design of the built environment (or human-made environment) consisting of our buildings, streets, neighborhoods, and their amenities has long been important in either propagating or assisting to control disease epidemics. Throughout much of the world prior to the 20th century, including in major cities such as New York, there was a lack of clean drinking water, dark dank streets with standing water breeding insect vectors of disease such as mosquitoes, and overcrowded living conditions in buildings without light and air. These were among some of the key conditions that bred infectious disease epidemics such as cholera and yellow fever. These conditions also propagated the spread of the then endemic diseases such as tuberculosis. Through the sanitation movement, we have seen the introduction of clean drinking water, proper removal of human and animal waste, street designs that set buildings back from the streets to allow sunlight and air to enter and circulate, building designs with windows for fresh air and light, and even public transportation systems such as subways that allowed people to disperse to areas outside overcrowded living neighborhoods: all are key factors assisting in the major declines seen in mortality from infectious diseases, even prior to the widespread use of antibiotics. Even in the early 21st century a key component of infectious disease prevention and control remains environmental design: providing populations with clean water and safe food, proper waste removal, and adequate ventilation and sanitation design factors within buildings. In the early 21st century, however, the leading causes of death globally have also shifted to noncommunicable diseases such as cardiovascular diseases, cancers, chronic obstructive pulmonary diseases, and diabetes. The four key risk factors to be addressed in the control of these diseases and conditions are tobacco use, physical inactivity, harmful use of alcohol, and unhealthy diets. There is growing evidence that environmental design is associated with these risk factors, particularly physical activity. In the case of physical activity, major scientific review bodies such as the Community Preventive Services Task Force recommend environmental interventions to increase physical activity on the basis of sufficient and strong evidence. Thus, addressing health through design must necessarily address design that increases physical activity to prevent and control deadly noncommunicable diseases.

Introductory Works

Four key introductory sources for relevant literature on recommendations and the evidence for designing built environments to address the major preventable risk factors for noncommunicable diseases, particularly physical inactivity, come from the World Health Organization, the Community Preventive Services Task Force in the United States, the Active Living Research Program of the Robert Wood Johnson Foundation, and the City of New York. First, World Health Organization 2010 presents both the burdens of mortality caused by noncommunicable diseases and their four major risk factors of tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets, as well as the main evidence-based recommendations for addressing each risk factor. For physical activity, design of the physical environment is cited as having a key role to play in promoting walking and cycling as well as active recreation. Design of neighborhoods can also play an important role in reducing harmful use of alcohol through restrictions on alcohol outlet density. The second key source for literature on recommendations and the evidence for designing built environments to address physical activity and other risk factors for non-communicable disease prevention and control is The Guide to Community Preventive Services, also known as The Community Guide. The Community Guide uses systematic reviews of the literature conducted by or with participation of the US Centers for Disease Control and Prevention to recommend community interventions based on the level of scientific evidence. For physical activity, four types of environmental design interventions are recommended for increasing physical activity based on sufficient or strong levels of scientific evidence based on systematic reviews. For dietary behaviors within worksite settings, improving access for healthy food is also recommended. Another great introductory resource to the research literature on built environment design and health is the Active Living Research website. This website provides literature targeted at both research- and practice-based audiences. The Active Design Guidelines, developed by the City of New York with participation from its Department of Health and Mental Hygiene, Design and Construction, Transportation and City Planning as well as eight additional city departments, leading academics, and other partners, presents evidence-based strategies for promoting physical activity in urban and building design. Three additional key introductory works are also included here from urban development and transportation planning sources. From the development perspective, Urban Land Institute 2013 presents an overview of world health issues that can be addressed by improving community and building design, as well as case studies of best practices and innovations in design. From the transportation perspective, important sources are Victoria Transport Policy Institute 2013, which presents an overview of transportation links to physical activity and health and lists transportation strategies that can improve physical activity, and the Transportation Research Board Health and Transportation Subcommittee website.

Reference Works

Reference works for the topic of design and health need to target a variety of audiences, including researchers, practitioners, policymakers, students, and advocates from health and non-health disciplines. Some references, such as textbooks provided in the Textbooks section, provide background information for students from a variety of disciplines (health, architecture, urban planning, among others) learning about the relationships of built environment design to a variety of health issues, including physical activity. From a research perspective, literature reviews and summaries are presented by the sources in the Introductory Works section. One additional comprehensive review of the built environment and key noncommunicable disease risk factor relationships, including physical inactivity and diets, is presented in Kent, et al. 2011 from the University of New South Wales. Additionally, although affecting practices and policies related to built environment design requires the practitioners and policymakers responsible for our buildings, streets, neighborhoods, and their amenities to be targeted for engagement, until the early 21st century few if any publications were created for these audiences. In particular, reference works focused on providing evidence-based strategies for noncommunicable disease prevention, particularly for the risk factor of physical inactivity where the evidence for built environment factors is particularly robust, appear to be almost nonexistent until around the early 21st century. Surveys of architects and designers in New York City conducted in 2009 and 2010, however, show that only 32 percent of those surveyed use research journals as a source of new knowledge and information. The majority of respondents, however, reported using guidelines, and the vast majority reported attending continuing education-accredited conferences and seminars. Since 2006, the Built Environment Program of the New York City Department of Health and Mental Hygiene has partnered with non-health-sector partners in other city agencies, academia, professional organizations, and the private sector to mount cross-sector conferences and seminars, as well as to create a series of evidence-based guidelines and reference works targeting a variety of audiences, particularly non-health practitioners and policymakers responsible for designing, constructing, and managing our built environments. These reference works involving and/or targeting cross-sector audiences, in particular non-health audiences who design and construct our built environments, are presented below. In 2003 the World Health Organization published Healthy Urban Planning in Practice: Experience of European Cities to describe six case studies of health integration into urban planning. In 2012 Johns Hopkins Center for Injury Research and Policy, New York City Department of Health and Mental Hygiene, and Society for Public Health Education partnered to develop Active Design Supplement: Promoting Safety, providing an evidence review of the impact that active living strategies can have on safety (see Johns Hopkins Center for Injury Research and Policy, et al. 2012). Many built environment strategies to promote active living were found to have synergistic positive impacts on safety, and many strategies to improve neighborhood, street, and building safety, in turn, could promote active living. In response to cost concerns of affordable housing developers in implementing Active Design Guideline strategies, Nicoll, et al. 2013 developed Active Design: Affordable Designs for Affordable Housing targeting housing developers, designers, and agencies. Also in 2013, the New York City Departments of City Planning, Health and Mental Hygiene, Design and Construction, and Transportation produced Active Design: Shaping the Sidewalk Experience and its companion document on resources and tools Active Design: Shaping the Sidewalk Experience—Tools and Resources provide a guide for designers and professionals involved in sidewalk and public realm design and construction in design considerations to promote and maximize sidewalk use for walking (see New York City Departments of City Planning, Health and Mental Hygiene, Design and Construction, and Transportation 2013a).

  • Johns Hopkins Center for Injury Research and Policy, New York City Department of Health and Mental Hygiene, and Society for Public Health Education. 2012. Active Design Supplement: Promoting Safety.

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    Funded by the US CDC, the Johns Hopkins Center for Injury Research and Policy, the New York City Health Department, and Society for Public Health Education collaborated on a literature review of the evidence for associations between physical activity-promoting strategies and safety outcomes including intentional and unintentional injuries.

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    • Kent, J., S. M. Thompson, and B. Jalaludin. 2011. Healthy built environments: A review of the literature. Sydney: Healthy Built Environments Program, City Futures Research Centre, University of New South Wales.

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      This 2011 comprehensive review of the built environment and noncommunicable disease risk factor literature presents a recent review on the built environment factors associated with increased physical activity and healthy eating. Key findings for increasing physical activity and for improving diets are included.

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      • New York City Departments of City Planning, Health and Mental Hygiene, Design and Construction, and Transportation. 2013a. Active design: Shaping the sidewalk experience.

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        This study conducted by the New York City Department of City Planning, with funding from the US CDC through New York City’s Health Department, presents best practices in sidewalk design based on assessments of sidewalks found in different neighborhoods in eight different US cities to promote walking.

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        • New York City Departments of City Planning, Health and Mental Hygiene, Design and Construction, and Transportation. 2013b. Active design: Shaping the sidewalk experience—tools and resources.

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          This companion document to Active Design: Shaping the sidewalk experience by the New York City Department of City Planning, with funding from the US CDC through New York City’s Health Department, presents tools and resources that can be used for best-practices in sidewalk design to promote walking.

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          • Nicoll, Gayle, Karen K. Lee, and Jennifer DuBose. 2013. Active design: Affordable designs for affordable housing.

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            Affordable housing provides populations on limited incomes with subsidized housing. Improving the design of affordable housing developments is an important opportunity to address health disparities. This study presents costs of implementing physical activity-promoting strategies into eleven affordable housing development case studies across three different US cities.

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            • World Health Organization Europe. 2003. Healthy urban planning in practice: Experience of European cities.

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              This report describes six case studies integrating health considerations into urban planning projects in European cities. One of twelve key health topics under consideration in the case studies was: do policies and proposals promote and encourage healthy exercise? The report involved urban planners from these cities in the case studies.

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              Textbooks

              Textbooks focusing on design of the built environment to address the most prominent burdens of illness really began appearing in the 21st century, based on increasing interests in the topic and a growing evidence base. These textbooks are available for and can be used by students in a variety of disciplines including public health, urban planning, urban design, architecture, landscape architecture, and environmental sustainability, among others. Lee and Lee 2013 has a chapter on “Active Design: Converging Efforts to Promote Environmental Sustainability and Address Today’s Leading Causes of Death,” targeted at healthcare design and environmental sustainability audiences. Textbooks devoted to the topic of built environment and public health included here are Lopez 2012; Dannenberg, et al. 2011; Corburn 2009; Kopec 2008; Freudenberg, et al. 2006; and Frumkin, et al. 2004. Lopez 2012 discusses the intersection of public health and urban planning, including history as well as assessment tools and approaches and policies to promote walking. Dannenberg, et al. 2011 is on the impacts of community design on various health conditions. Corburn 2009 addresses the issues of planning and human health, including historical discussions as well as discussions of contemporary topics such as urban governance, the politics of healthy city planning, and health impact assessments. Kopec 2008 addresses the intersection of environmental sustainability and health, with a chapter devoted to healthy lifestyles.

              • Corburn, J. 2009. Toward the healthy city: People, places, and the politics of urban planning. Cambridge, MA: MIT Press.

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                Corburn’s book covers a variety of topics related to urban planning and health, starting with the history of public health and urban planning and continuing on to contemporary issues in human health and urban planning. Included topics are urban governance, politics, and health impact assessments.

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                • Dannenberg, A., H. Frumkin, and R. Jackson, eds. 2011. Making healthy places: Designing and building for health, well-being, and sustainability. Washington, DC: Island.

                  DOI: 10.5822/978-1-61091-036-1Save Citation »Export Citation »E-mail Citation »

                  Covers the impacts of community design on various health conditions and risk/protective factors, including physical activity in chapter 2 (pp. 33–49), as well as potential built environment solutions through various settings and a chapter on measurement/assessment (pp. 303–320). Issues related to mental health and social capital are also covered in chapter 8 (pp. 117–128).

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                  • Freudenberg, N, S. Galea, and D. Vlahov, eds. 2006. Cities and the health of the public. Nashville: Vanderbilt Univ. Press.

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                    This is a book on a wide variety of health issues in cities past and present. Also includes chapters focused on the physical environment and on urban sprawl and human health.

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                    • Frumkin, H., L. Frank, and R. Jackson. 2004. Urban sprawl and public health: Designing, planning, and building for healthy communities. Washington, DC: Island.

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                      A predecessor to Dannenberg, et al. 2011, this book focuses on urban sprawl and impacts on human health and health-related issues. Health topics include air quality, physical activity, injuries, water quality and quantity, mental health, social capital, and special populations. Chapter 11 (pp. 201–222) proposes some solutions.

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                      • Kopec, D. 2008. Health, sustainability and the built environment. London: Bloomsbury Academic.

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                        Kopec, a professor of interior design, addresses the intersection of environmental sustainability and human health. Chapter 10 (p. 293) is devoted to promoting healthy lifestyles.

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                        • Lee, Karen K., and Joyce Lee. 2013. Active design: Converging design efforts to promote environmental sustainability and address today’s leading causes of death. In Sustainable healthcare architecture. 2d ed. Edited by R. Guenther and G. Vittori, 33–35. Hoboken, NJ: John Wiley.

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                          Presents the opportunities to improve physical activity and noncommunicable disease outcomes and environmental outcomes synergistically with design interventions in architecture, particularly in healthcare-related settings that can help set examples and standards for healthy design while concomitantly addressing issues of high energy usage.

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                          • Lopez, Russell. 2012. The built environment and public health. San Francisco: Jossey-Bass.

                            DOI: 10.1057/9781137002440Save Citation »Export Citation »E-mail Citation »

                            This textbook covers the intersection of public health and urban planning, including the origins, evidence, and health conditions impacted by built environment design. Issues covered include history, chronic diseases, as well as approaches and policies to promote walking and assessment tools.

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                            Health Journals

                            Articles on design and health have been published across a wide range of journals from different countries and disciplines, contributing to the overall evidence base and literature on built environment design and health, particularly related to behavioral factors such as physical activity. Health-focused journals that publish articles on the relationship between built environment design factors and physical activity, as well as health-related outcomes of built environment intervention evaluations, are commonly those that focus on public health, prevention, and health promotion. They include journals such as the American Journal of Public Health, the American Journal of Preventive Medicine, Preventive Medicine, Health and Place, and the American Journal of Health Promotion. A more recent physical activity–focused journal such as the Journal of Physical Activity and Health also routinely publishes articles on this topic. Health journals featuring research on urban health issues, such as the Journal of Urban Health, also sometimes publish articles on this topic. Several journals have also had special full supplements devoted to the topic of built environment and health, especially physical activity, including the American Journal of Public Health (September 2013 and September 2003), Annals of Behavioral Medicine (February 2013), the American Journal of Preventive Medicine (November 2012, April 2009, February 2009, February 2008, February 2005), Health and Place (January 2012), the Journal of Physical Activity and Health (January 2011 and February 2006), Preventive Medicine (January 2010), and the American Journal of Health Promotion (March/April 2007 and September/October 2003). An extensive list of all the journals, including non-English language journals, that has published articles on the topic of the built environment and physical activity is also catalogued in the literature database of Active Living Research, cited under Introductory Works.

                            Non-Health Journals

                            Journals that target audiences outside the health sector, particularly planning and transport audiences, also publish health-related articles. These journals do not necessarily deal solely with relationships between built environment design factors and health outcomes, but they may present health outcomes in the context of other outcomes of concern to non-health disciplines such as transportation mode share and environmental sustainability. Of course, outcomes related to active modes of transportation such as walking and bicycling, and outcomes related to the environment such as air quality ultimately still impact on human health factors as well. Examples of such non-health journals include the Journal of the American Planning Association, Transport Policy, Transport Reviews: A Transnational Transdisciplinary Journal, Transportation, Transportation Research A, Transportation Research Record, Urban Forestry and Urban Greening, and Urban Studies.

                            • Journal of the American Planning Association.

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                              This journal of the American Planning Association is a quarterly journal that publishes peer-reviewed, original research and analyses, as well as commentaries and book reviews targeting practicing planners, policymakers, academics and students, as well as citizens.

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                              • Transport Policy.

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                                This international journal publishes articles pertaining to concerns centered on bridging transport theories and practices and provides original analyses related to policy decisions, policy impact monitoring, and policy improvements. The journal targets policymakers in government, industry, voluntary organizations, and the public. Topics include infrastructure and design, traffic calming and management, and regulations.

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                                • Transport Reviews: A Transnational Transdisciplinary Journal.

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                                  Publishes research-based reviews covering all aspects of transport, including new methods, analyses, perspectives, and original data. It takes submissions from different disciplines and from academics as well as practitioners, policymakers, and consultants from government departments, not to mention local authorities and international agencies.

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                                  • Transportation.

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                                    This journal covers topics related to policy, evaluation, and operational management of transport systems and deals with each specifically or in relationship to other parts of the social, economic, or physical environment. It targets transportation theorists, practitioners, and policymakers.

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                                    • Transportation Research A.

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                                      Transportation Research is an international journal with six parts. Parts A, B, and D feature articles on physical activity-related issues. Part A focuses on general interest issues in transportation including policy analyses, evaluation, planning, and management. Part B is on methods, and Part D is on transport and environment.

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                                      • Transportation Research Record.

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                                        The journal of the Transportation Research Board provides technical peer-reviewed papers refereed by TRB technical committees to disseminate transportation research results. The TRB also publishes special reports, cooperative research program reports, project and program briefs, a quarterly newsletter, conference proceedings, and circulars.

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                                        • Urban Forestry and Urban Greening.

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                                          This international refereed journal publishes research on the use, planning, design, establishment and management of urban and peri-urban vegetation. It publishes basic and applied research papers as well as reviews and short communications. A wide range of disciplines, including urban planning and design, and medicine, are invited to submit contributions.

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                                          • Urban Studies.

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                                            This peer-reviewed journal publishes international studies of cities and regions. It publishes interdisciplinary work focusing on theoretically informed issues from those working in social science disciplines.

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                                            Additional Evidence Reports

                                            Institute of Medicine 2005 is a consensus report on the built environment and physical activity.

                                            The Community Guide Evidence Reviews

                                            From a research perspective, literature reviews and summaries are presented by the sources provided in the Introductory Works section. Several key peer-reviewed papers of the evidence used by these sources, particularly The Community Guide, are presented below also, starting from the most recent. Soler, et al. 2010 provides a systematic review update of the stair prompt literature; based on this evidence review, evidence for the recommendations for placing point-of-decision stair prompts to increase physical activity through stair use was upgraded from having “sufficient evidence” to “strong evidence” by the Task Force on Community Preventive Services in 2010. Anderson, et al. 2009 and its systematic literature review on worksite setting nutrition and physical activity interventions to address overweight and obesity presents evidence-based interventions that include physical environment changes. This was followed by a recommendation published by the Task Force on Community Preventive Services in 2009 on the list of physical activity and/or healthy eating–related interventions, including physical environmental design interventions, shown to be effective at addressing overweight or obesity problems. Heath, et al. 2006 systematically reviewed the literature on urban design, land use, and transport policy interventions to increase physical activity and concluded there is sufficient evidence for community-scale and street-scale urban design and land use policies and practices. Zaza, et al. 2005 provides a comprehensive list of interventions recommended by the Community Preventive Services Task Force, on the basis of sufficient or strong levels of scientific evidence based on systematic literature reviews conducted, including built environment design interventions to increase physical activity. Based on the systematic review conducted by Kahn, et al. 2002 on interventions to increase physical activity, the Task Force on Community Preventive Services 2002 published recommendations for community-level interventions to increase physical activity on the basis of sufficient or strong evidence, including environmental interventions such as stair prompts and enhancing access to places for physical activity.

                                            • Anderson, L. M., T. A. Quinn, K. Glanz, et al. 2009. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. American Journal of Preventive Medicine 37.4: 340–357.

                                              DOI: 10.1016/j.amepre.2009.07.003Save Citation »Export Citation »E-mail Citation »

                                              Presents the results of systematic literature reviews conducted on worksite setting physical activity and healthy-eating interventions to address overweight and obesity. Effective interventions include changes to the physical environment.

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                                              • Heath, G. W., R. C. Brownson, J. Kruger, et al. 2006. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: A systematic review. Journal of Physical Activity and Health 3.1: S55–S76.

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                                                This systematic review adds to the evidence base of effective interventions for increasing physical activity by focusing on urban design, land use, and transport policies. The review concludes that there is sufficient evidence for community-scale and street-scale urban design and land-use policies and practices to increase physical activity.

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                                                • Kahn, E. B., L. T. Ramsey, R. Brownson, et al. 2002. The effectiveness of interventions to increase physical activity: A systematic review. American Journal Preventive Medicine 22.4S: 73–107.

                                                  DOI: 10.1016/S0749-3797(02)00434-8Save Citation »Export Citation »E-mail Citation »

                                                  Presents a systematic review of the literature for various types of interventions to increase physical activity and concludes that there is sufficient evidence for some interventions and strong evidence for others. Other interventions without sufficient evidence are also presented.

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                                                  • Soler, R. E., K. D. Leeks, L. Ramsey Buchanan, et al. 2010. Point-of-decision prompts to increase stair use: A systematic review update. American Journal of Preventive Medicine 38.2S: 292–300.

                                                    DOI: 10.1016/j.amepre.2009.10.028Save Citation »Export Citation »E-mail Citation »

                                                    Presents a systematic review update of the studies on the impacts of stair prompt signage posting on stair use, showing strong evidence for this intervention.

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                                                    • Task Force on Community Preventive Services. 2002. Recommendations to increase physical activity in communities. American Journal Preventive Medicine 22.4S: 67–72.

                                                      DOI: 10.1016/S0749-3797(02)00433-6Save Citation »Export Citation »E-mail Citation »

                                                      Presents the recommendations of the Community Preventive Services Task Force of a list of community-level interventions to increase activity on the basis of sufficient or strong evidence.

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                                                      • Task Force on Community Preventive Services. 2009. A recommendation to improve employee weight status through worksite health promotion programs targeting nutrition, physical activity, or both. American Journal of Preventive Medicine 37.4: 358–359.

                                                        DOI: 10.1016/j.amepre.2009.07.004Save Citation »Export Citation »E-mail Citation »

                                                        Gives recommendations of the Community Preventive Services Task Force on a list of physical activity and/or healthy eating–related interventions in worksites, including physical environmental design interventions, shown to be effective at addressing overweight or obesity, based on sufficient or strong levels of scientific evidence from a systematic literature review.

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                                                        • Task Force on Community Preventive Services. 2010. Recommendation for use of point-of-decision prompts to increase stair use in communities. American Journal of Preventive Medicine 38.2S: 290–291.

                                                          DOI: 10.1016/j.amepre.2009.10.031Save Citation »Export Citation »E-mail Citation »

                                                          Includes recommendations from the Community Preventive Services Task Force for using point-of-decision prompts to increase stair use based on the systematic review conducted by Soler, et al. 2010 updating the evidence from sufficient to strong.

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                                                          • Zaza, S., P. A. Briss, and K. W. Harris, eds. 2005. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta: Oxford Univ. Press.

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                                                            Presents a comprehensive list of interventions recommended by the Community Preventive Services Task Force. The list is chosen on the basis of sufficient or strong levels of scientific evidence based on systematic literature reviews conducted. They include built environment design interventions to increase physical activity.

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                                                            Additional Evidence Reviews

                                                            In addition to the above, a number of other systematic reviews of the literature assess the relationship between the built environment and health including physical activity, injury, patient outcomes in hospitals, social capital, and depression. Rothman, et al. 2014 systematically reviewed the built environment correlates of safe walking and child injury. Drahota, et al. 2012 reviews 102 studies assessing sensory environments in hospitals and patient outcomes. O Ferdinand, et al. 2012 is a systematic review paper on built environments and physical activity. Renalds, et al. 2010 reviewed the associations of “walkable” neighborhoods with various health outcomes, including social capital and depression. Mair, et al. 2008 reviewed the published studies examining the associations of neighborhood characteristics and depression.

                                                            • Drahota, A., D. Ward, H. Mackenzie, et al. 2012. Sensory environment on health-related outcomes of hospital patients. Cochrane Database System Review 3:CD005315.

                                                              DOI: 10.1002/14651858.CD005315.pub2Save Citation »Export Citation »E-mail Citation »

                                                              This is a review of 102 studies inclusive of randomized and non-randomized controlled trials, controlled before-and-after studies, and interrupted time-series studies of environmental interventions in adult hospital patients. It did not find any studies meeting inclusion criteria to assess the impacts of art, access to nature, ceilings, hospital noise, patient controls, wayfinding aids, or provision of windows. The authors conclude that music appears to have beneficial impacts on patient outcomes such as anxiety; however, evidence for benefits on physiological outcomes and medication use is not as strong.

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                                                              • Mair, C., A. V. Diez Roux, and S. Galea. 2008. Are neighborhood characteristics associated with depression? A review of the evidence. Journal of Epidemiology and Community Health 62.11: 940–946.

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                                                                In this review of published observational studies of neighborhood characteristics and depression, thirty-seven of forty-five English-language studies found positive associations. Of structural characteristics assessed, including socioeconomic and racial composition as well as the built environment, built environment measures were the most consistently associated with depression; however, the number of studies focused on the built environment and depression were small.

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                                                                • O Ferdinand, A., B. Sen, S. Rahurkar, S. Engler, and N. Menachemi. 2012. The relationship between built environments and physical activity: A systematic review. American Journal of Public Health 102.10: e7–e13.

                                                                  DOI: 10.2105/AJPH.2012.300740Save Citation »Export Citation »E-mail Citation »

                                                                  Presents a systematic review of the literature on the relationship between built environments and physical activity or obesity rates. The article concludes that although 89.2 percent of the 169 included articles demonstrated beneficial relationships, more rigorous studies are still needed: studies with objectively measured outcomes and that focused on children in community settings, as well as studies with academic first authors were less likely to demonstrate a beneficial association.

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                                                                  • Renalds, A., T. H. Smith, and P. J. Hale. 2010. A systematic review of built environment and health. Family Community Health 33.1: 68–78.

                                                                    DOI: 10.1097/FCH.0b013e3181c4e2e5Save Citation »Export Citation »E-mail Citation »

                                                                    This systematic review paper examined twenty-three studies on the associations of neighborhoods characterized as “walkable” with various health outcomes. The authors conclude that more “walkable” neighborhoods are associated with physical activity, lower overweight, lower depression, increased social capital, and less reported alcohol abuse.

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                                                                    • Rothman, L., R. Buliung, C. Macarthur, T. To, and A. Howard. 2014. Walking and child pedestrian injury: A systematic review of built environment correlates of safe walking. Injury Prevention 20.1: 41–49.

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                                                                      In fifty walking and thirty-five child pedestrian injury studies, traffic calming and presence of playgrounds and recreation areas were consistently associated with more walking and less pedestrian injury.

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                                                                      History

                                                                      The history of public health is a story of the success of built environment design and infrastructure interventions in the defeat of infectious disease epidemics, the key causes of mortality prior to the 20th century. A number of books document this history of public health, particularly of the environmental sanitation movement in the 19th century. In particular, the growth of this movement in England and its subsequent uptake in the United States, beginning in cities such as New York, has been well documented. Works documenting this history include Duffy 1992, Jones 2005, Rosen 1993, Rosner 1995, and Rosner 2006. Duffy 1992 chronicles the efforts to address environmental conditions for public health in 18th- through 20th-century East Coast cities in the United States. Jones 2005 discusses environmental conditions and diseases in the 19th century and public health efforts in New York City to address building and street conditions, and food and water supplies. Rosen 1993 discusses the history of public health in 18th- and 19th- century England and the United States. Rosner 1995 describes New York City’s history of epidemics and environmental conditions, and Rosner 2006 broadens his public health history discussions to multiple US cities.

                                                                      • Duffy, J. A. 1992. The sanitarians: A history of American public health. Chicago: Univ. of Illinois Press.

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                                                                        John Duffy, a leading authority on American medical history and public health, writes of efforts to address environmental conditions including safety of food and water supplies, proper disposal of human wastes, and quarantine. Duffy addresses the health and sanitary problems of East Coast cities in the 18th through 20th centuries.

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                                                                        • Jones, M. M. 2005. Protecting public health in New York City: 200 years of leadership: 1805–2005.

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                                                                          This document describes the environmental conditions that propagated diseases of the 19th centuries and the environmental interventions undertaken by public health in the City of New York including those related to building conditions, street conditions, and water and food supplies.

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                                                                          • Rosen, G. 1993. A history of public health. Baltimore: Johns Hopkins Univ. Press.

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                                                                            This book on the history of public health discusses the issues, including environmental conditions, associated with infectious disease epidemics of the 18th and 19th centuries in England and the United States. A chapter is specifically devoted to the sanitary movement in England and the United States.

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                                                                            • Rosner, D., ed. 1995. Hives of sickness: Public health and epidemics in New York City. New York: Museum of the City of New York.

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                                                                              In this book, public health epidemics and environmental conditions in the history of New York City are discussed.

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                                                                              • Rosner, D. 2006. Public health in U.S. cities: A historical perspective. In Cities and the health of the public. Edited by N. Freudenberg, S. Galea, and D. Vlahov, 129–142. Nashville: Vanderbilt Univ. Press.

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                                                                                Discusses the history of public health in US cities, including the sanitation issues and environmental conditions that had to be addressed.

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                                                                                Case Studies

                                                                                In addition to the scientific literature presenting studies of evidence linking built environment design factors to physical activity and other key behavioral factors related to noncommunicable diseases, case studies are often helpful for demonstrating the feasibility of real-world implementation, which can assist with uptake and dissemination of policy and practice interventions across communities. In addition to the previously presented 2003 World Health Organization Europe report documenting six case studies in European cities, a number of available reports highlight case studies in the United States. Many of these reports come from the work of the New York City Health Department, where since 2006 extensive research translation of the available scientific evidence into guidelines, as well as policy and practice initiatives, has been occurring. The Active Living Research program funded by the Robert Wood Johnson Foundation and based at University of California San Diego presents case studies, which include those of each year’s “Translating Research to Policy” Award Winners. Haggerty and Melnick 2013 present lessons learned from a Bicycling and Pedestrian Master Plan Health Impact Assessment done in Clark County, WA. In recent years, organizations in a number of countries have also launched websites documenting case studies within their countries, as well as more globally. The New South Wales Government Premier’s Council on Active Living in Australia, has assembled a website presenting Active Living Case Studies. Day, et al. 2013 discusses the built environment design and chronic disease challenges facing cities in China and presents New York City interventions as a case study of possible interventions. New York City is currently recognized as a leader in the field of improving environmental design to address chronic diseases and their risk factors, and several publications document the city’s innovative interventions for different audiences. Lee 2012 invited commentary in Health and Place describes the lessons learned from developing and implementing the Active Design Guidelines. New York City Department of Health and Mental Hygiene 2013 presents the environmental, policy, and systems change interventions for obesity prevention implemented with Communities Putting Prevention to Work grant funding from the US Centers for Disease Control and Prevention. New York City Department of Health and Mental Hygiene 2011 was prepared for the United Nations General Assembly 2011 Summit on Non-Communicable Diseases to highlight innovative public health solutions that have been implemented, including key design interventions for physical activity.

                                                                                • Active Living Research.

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                                                                                  Active Living Research (ALR) produces documents targeted at researchers, policymakers, and practitioners of different disciplines working on built environment and physical activity issues. Case studies include Clark County, Washington; Cook County, Illinois; Lee County, Florida; Montgomery County, Maryland; Newark, New Jersey; New York City, New York; Portland, Orlando; and Tampa Bay, Florida.

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                                                                                  • Day, K., M. Alfonzo, Y. Chen, Z. Guo, and K. K. Lee. 2013. Overweight, obesity, and inactivity and urban design in rapidly growing Chinese cities. Health and Place 21:29–38.

                                                                                    DOI: 10.1016/j.healthplace.2012.12.009Save Citation »Export Citation »E-mail Citation »

                                                                                    Discusses the issues of unplanned growth, increasing sprawl and rising noncommunicable and obesity rates in Chinese cities, as well as case studies of cities such as New York City that are addressing these issues successfully.

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                                                                                    • Haggerty, B., and A. Melnick. 2013. Translating research to policy through health impact assessment in Clark County, Washington: A commentary to accompany the active living research supplement to Annals of Behavioral Medicine. Annals of Behavioral Medicine 45.1: S6–S8.

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                                                                                      To address the obesity epidemic, officials in Clark County, Washington, conducted a Health Impact Assessment (HIA) on the county’s Bicycle and Pedestrian Master Plan in order to estimate health impacts and propose policies and programs to prioritize active transportation. Lessons learned from the policy process are shared.

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                                                                                      • Lee, K. K. 2012. Developing and implementing the Active Design Guidelines in New York City. Health and Place 18.1: 5–7.

                                                                                        DOI: 10.1016/j.healthplace.2011.09.009Save Citation »Export Citation »E-mail Citation »

                                                                                        This invited commentary in Health and Place presents the case study of the development and implementation of the Active Design Guidelines in New York City, created by a joint effort of twelve city agencies. Process lessons related to engagement and roles of non-health sectors are shared.

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                                                                                        • New South Wales Government Premier’s Council on Active Living.

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                                                                                          The New South Wales Government Premier’s Council on Active Living (PCAL) in Australia, comprised of government, industry and community representatives, aims to build and strengthen physical and social environments for active living. PCAL has compiled a series of New South Wales case studies of successful application of active living design considerations which may be useful to health professionals, town planners, traffic and civil engineers, road safety officers, community safety officers, architects and urban designers, developers and local government councillors.

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                                                                                          • New York City Department of Health and Mental Hygiene. 2011. Preventing Non-Communicable Diseases and Injuries: Innovative Solutions from New York City.

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                                                                                            Prepared for the United Nations General Assembly Summit in 2011 focused on noncommunicable diseases, this New York City Health Department report highlights innovative public health solutions that have been implemented for tobacco, physical activity, healthy eating, injuries, and air quality, including key design interventions for physical activity.

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                                                                                            • New York City Department of Health and Mental Hygiene. 2013. New York City: Communities Putting Prevention to Work 2010–2012.

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                                                                                              With US CDC 2010–2012 funding to address environmental, policy, and systems change interventions for obesity prevention, New York City Health Department’s Built Environment Program used these funds to implement design training and policy initiatives with non-health professionals and to implement local community built environment design improvements with community groups.

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                                                                                              Cross-Sector Conference Reports

                                                                                              Since 2006, New York City’s Health Department has partnered with the American Institute of Architects New York Chapter to hold annual Fit City conferences that include presentations of the latest evidence as well as case studies from New York City and elsewhere around the world. The seven Fit City conference reports are a good source of case studies, and in progression, can also highlight how a health and design initiative can be initiated, developed, and expanded over time. American Institute of Architects New York Chapter 2007 identified the initial ideas brainstormed from a first gathering of health and design professionals, along with the policy recommendations stemming from them. American Institute of Architects New York Chapter 2008 presents New York City case studies to demonstrate feasibility of the ideas brainstormed in American Institute of Architects New York Chapter 2007. American Institute of Architects New York Chapter 2009 introduced case studies from outside New York City to highlight global best practices in design and physical activity, such as in Copenhagen, and a new stair prompt sign was introduced. American Institute of Architects New York Chapter 2010 introduced the Active Design Guidelines under development. American Institute of Architects New York Chapter 2011 discussed early and anticipated implementation issues with the Active Design Guidelines released in January 2010; also additional case studies from New York, Canada, and Norway were presented. American Institute of Architects New York Chapter 2012a focused on design and childhood obesity issues. In addition to undertaking the work within New York, the Built Environment Program in the New York City Health Department was also given a grant by the US Centers for Disease Control and Prevention to mentor fourteen other US communities on improving the built environment for physical activity and obesity between 2010 and 2012. The work undertaken during this grant period also provided opportunities for the New York City Health Department, in partnership with the American Institute of Architects, to hold Fit Nation conferences in 2011 in Washington, DC, and New Orleans, addressing policy and practice initiatives on the built environment and physical activity and obesity occurring across different US cities. The American Institute of Architects New York Chapter 2012b and American Institute of Architects New York Chapter 2012c published the Fit Nation/DC and Fit Nation/NOLA reports documenting case studies of cross-sector work to improve built environment design for physical activity and health in Washington, DC as well as other US cities.

                                                                                              Master Plans and Ordinances Incorporating Health

                                                                                              Master plans and ordinances are key planning tools for setting overall direction and mandates for planning for a local jurisdiction that shape a jurisdiction’s built environment design. The following master plans and ordinances provide examples of documents with language present to integrate health considerations and health-related factors, including physical activity–relevant items, into urban planning. The American Planning Association (APA), with funding and participation from the US Centers for Disease Control and Prevention, has also analyzed the process of integrating health into comprehensive plans in seven local jurisdictions presented in American Planning Association 2014a. American Planning Association 2014b also analyzed the inclusion of key health issues—active living, emergency preparedness, environmental exposures, food and nutrition, health and human services, and social cohesion and mental health—in twenty-two comprehensive and sustainability plans.

                                                                                              • American Planning Association. 2014a. Healthy plan making: Integrating health into the comprehensive planning process—an analysis of seven case studies and recommendations for change.

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                                                                                                This report presents an in-depth, qualitative analysis of the comprehensive planning process in seven local jurisdictions and the integration of health. It presents the strengths and areas in need of improvement across jurisdictions, as well as recommendations and next steps (including a model) for integrating public health into the comprehensive planning process.

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                                                                                                • American Planning Association. 2014b. Healthy planning: An evaluation of comprehensive and sustainability plans addressing public health.

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                                                                                                  In this report, twenty-two comprehensive and sustainability plans were analyzed for inclusion of six key health issues: active living, emergency preparedness, environmental exposures, food and nutrition, health and human services, and social cohesion and mental health. Plan strengths listed include address of active living across all plans in parks and open space, transportation, urban design, and health/healthy communities elements in plans. Environmental exposures policies also tended to be well represented. Plans tended to be subpar, however, in addressing food and nutrition, and emergency preparedness and were weak in addressing health and human services, and social cohesion and mental health issues.

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                                                                                                  • City and County of Denver. 2004. City and county of Denver pedestrian master plan.

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                                                                                                    This master plan serves as a framework for implementing new city policies in Denver, Colorado, that include the importance of the pedestrian in planning. The plan specifically supports the goals of safety, accessibility, education, connectivity, streetscape, land use, and public health.

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                                                                                                    • City of New York. 2011. PlaNYC version 2.

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                                                                                                      PlaNYC is a master plan created by the City of New York to prepare for the coming of one million more residents, as well as to strengthen the economy, combat climate change, and enhance quality of life. Bringing together over twenty-five agencies, the plan was updated in 2011, specifically incorporating topics such as public health.

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                                                                                                      • City of Philadelphia. 2011. Philadelphia2035.

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                                                                                                        The Philadelphia Department of Public Health and the Department of City Planning Commission worked together to incorporate strategies within Philadelphia2035, the city’s master plan that focuses on pedestrian- and bike-friendly neighborhood centers, transit-oriented development and transit, improved park and recreation spaces, and greater healthy food and beverage options.

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                                                                                                        • Los Angeles County Department of Regional Planning. 2013. Healthy design ordinance.

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                                                                                                          Funded by Los Angeles County Public Health, the Healthy Design Ordinance developed by the Los Angeles County Department of Regional Planning introduced changes to planning regulations in the unincorporated parts of Los Angeles County for the purposes of increasing walking, bicycling, exercise, and access to healthy foods and beverages.

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                                                                                                          • Multnomah County. 1998. Portland pedestrian design guide.

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                                                                                                            The master plan integrates a range of design criteria and practices into a set of standards and guidelines to promote an environment conducive to walking, applicable to most situations.

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                                                                                                            • Peel Region Official Plan.

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                                                                                                              This master plan for Peel Region outside Toronto, Canada, establishes a long-term regional strategic policy framework for guiding growth and development and includes ensuring health for those living and working in Peel as a purpose, with healthy communities as a key theme and creating healthy communities as a goal.

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