The Built Environment and Health

by

Lawrence Frank, Josh van Loon, Sarah Kavage

• LAST REVIEWED: 30 September 2013
• LAST MODIFIED: 30 September 2013
• DOI: 10.1093/obo/9780199756797-0135

Introduction

For years urban planning researchers have been documenting associations between the built environment and health-related outcomes. This body of research has expanded exponentially in recent years, with contributions from the health field and an increasing interdisciplinary emphasis. Much of this research has focused on links between patterns of development, travel behavior, physical activity, pedestrian safety, air quality, and obesity. Recent research has also included diet, social capital, mental health, and respiratory function. A few studies have also included a range of chronic ailments. Additional areas of inquiry include studies of healthy housing and linkages between health and food access. This research is largely premised upon ecological theories of behavior, which posit that both individuals and the environments to which they are exposed jointly shape behavior. The built environment is composed of physical, human-made features and may be evaluated at different scales, including the home, neighborhood, city, or region. Environments may influence health both through exposure (e.g., exposure to injury risk or exposure to air pollution), and by shaping behaviors (e.g., diet, or physical activity levels from active transportation such as walking or biking). Several populations have been identified as being relatively vulnerable to environmental conditions, including youth, the elderly, and the poor. Research has sought to identify how exposure and behavioral relationships with the built environment vary across demographic subgroups. Some studies have examined inequalities in access to environments that positively or negatively influence health. Geographic information systems (GIS), behavior tracking hardware such as accelerometers, and global positioning systems (GPS) have rapidly advanced this field. Most studies to date are based on cross-sectional designs with limited ability to infer any causal relationships between health outcomes and built environments. These studies do not account for underlying attitudinal predisposition where people “self-select” neighborhoods based on underlying preferences. Cross-sectional studies also do not capture an ordered stimulus-response relationship where impacts on a health-related outcome are evaluated before and after the change occurs. More recent studies have begun to address such limitations by explicitly controlling for neighborhood preferences and using longitudinal study designs.

General Overviews

Studies linking the built environment and health gained increasing prominence throughout the 1990s, coalescing around several themes, including how large-scale changes in the built environment characterized as “urban sprawl” influence health. The Active Living Research web page is an up-to-date reference on this subject, while Frank, et al. 2006 is an important example of research examining multiple pathways connecting the built environment and health. This research is rooted in the study of social determinants of health that originally shifted focus away from the individual to broader policy and environmental influences, as exemplified in Wilkinson and Marmot 2003. More recent works, such as Lopez 2012, have attempted to tie together more disparate strands of research involving the study of built environment influences on health. Both Jackson and Sinclair 2011 and Vlahov, et al. 2004 provide accessible introductions to the topic.

• Active Living Research.

  A valuable resource for researchers, practitioners, and others on the design of active communities. Includes links to topical research briefs, policy case studies, and a literature database.

• Frank, Lawrence D., James F. Sallis, Terry L. Conway, James E. Chapman, Brian E. Saelens, and William Bachman. 2006. Many pathways from land use to health: Associations between neighborhood walkability and active transportation, body mass index, and air quality. Journal of the American Planning Association 72.1: 75–87.

  DOI: 10.1080/01944360608976725

  Significant early study demonstrating how the built environment can influence health through multiple pathways, in this case via active transportation and air pollution exposure.

• Jackson, R. J., and S. Sinclair. 2011. Designing healthy communities. San Francisco: Jossey-Bass.

  Practical introductory resource on healthy community design, with a strong emphasis on case studies. Useful for communicating planning processes related to health promotion to a broad audience.

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

  DOI: 10.1057/9781137002440

  An accessible reference for wide-ranging audiences, including undergraduates. Expansive in scope, this book provides a high-level overview of topics related to the built environment and health, with a very strong focus on environmental justice and a historical perspective.

• Vlahov, David, Emily Gibble, Nicholas Freudenberg, and Sandro Galea. 2004. Cities and health: History, approaches, and key questions. Academic Medicine: Journal of the Association of American Medical Colleges 79.12 (December): 1133–1138.

  DOI: 10.1097/00001888-200412000-00003

  A straightforward, concise overview of issues associated with cities and health, including a brief history of thinking on the subject.

• Wilkinson, R. G., and M. Marmot. 2003. Social determinants of health: The solid facts. 2d ed. Copenhagen: World Health Organization, Regional Office for Europe.

  Situates the research of built environment influences on health within the context of social determinants of health.