Design and Health

by

Karen K. Lee

• LAST REVIEWED: 11 August 2022
• 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.

• Active Living Research.

  Provides literature that is targeted at both research- and practice-based audiences. Literature database provides scientific papers that meet inclusion criteria on the relationship between built environment design/policy and physical activity/obesity. The website also contains reference lists for papers not meeting inclusion criteria and research translation documents for practitioners and policymakers.

• City of New York. 2010. Active Design Guidelines.

  The Built Environment Program of New York City’s Health Department partnered with eleven non-health city agencies and leading academics to develop the Active Design Guidelines targeted at non-health audiences responsible for designing our built environments. Evidence-based strategies for urban and building design to promote physical activity are presented.

• Community Preventive Services Task Force. The guide to community preventive services.

  DOI: 10.1093/acprof:oso/9780195151091.001.0001

  This resource provides recommendations of the Community Preventive Services Task Force (established in 1996 by the US Department of Health and Human Services) for community-based interventions on the basis of systematic reviews. Effective environmental interventions for physical activity and healthier diets in worksites are presented.

• Transportation Research Board Health and Transportation Subcommittee.

  The Health and Transportation Subcommittee of the Transportation Research Board works to improve understanding of how transportation systems impact public health. Also maximizes health benefits while minimizing negative effects of transportation systems through planning, policy, engineering, design, interdisciplinary collaboration, and community participation. The subcommittee’s website makes available meeting minutes, annual reports, as well as reports of studies conducted.

• Urban Land Institute. 2013. Intersections: Health and the built environment.

  Provides an overview of key global health issues today that can be addressed by improving the design of our built environments, including community design and building design. Issues including active transportation, access to healthy food, healthy buildings, and clean air and water are addressed. Case studies of design best practices and innovations from around the globe are also presented.

• Victoria Transport Policy Institute. 2013. Health and fitness: Strategies that improve public health through physical activity. In TDM Encyclopedia.

  Presents an overview of the links of transportation to physical activity and health, including studies of mental health outcomes, information on the demand for active transportation, and a comprehensive list of transportation strategies that can improve physical activity.

• World Health Organization. 2010. Global status report on noncommunicable diseases 2010.

  Noncommunicable diseases are the leading causes of death. Key risk factors are tobacco use, physical inactivity, harmful use of alcohol, and unhealthy diets. Design of the physical environment plays a key role in physical activity through ensuring accessibility, walking and cycling safety measures, and maintenance of sports and recreation infrastructure.