Public Health The Built Environment and Health
Lawrence Frank, Josh van Loon, Sarah Kavage
  • LAST REVIEWED: 05 May 2017
  • LAST MODIFIED: 30 September 2013
  • DOI: 10.1093/obo/9780199756797-0135


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.

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    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.

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  • 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: 10.1080/01944360608976725Save Citation »Export Citation » Share Citation »

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

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

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    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.

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

    DOI: 10.1057/9781137002440Save Citation »Export Citation » Share Citation »

    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.

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  • 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: 10.1097/00001888-200412000-00003Save Citation »Export Citation » Share Citation »

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

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

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

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Understanding the Research—Theory

Research on built environment influences on health is largely premised on ecological theories. Key elements of these theories are introduced in Sallis, et al. 2002. Giles-Corti 2006 and Sallis, et al. 2012 exemplify the application of such models to analysis, clearly illustrating how the theories underpin research in this area. Kok, et al. 2008 reviews the application of these theories to health promotion policy.

  • Giles-Corti, Billie. 2006. People or places: What should be the target? Journal of Science and Medicine in Sport 9.5: 357–366.

    DOI: 10.1016/j.jsams.2006.06.021Save Citation »Export Citation » Share Citation »

    This paper addresses, through a study of correlates of walking, a key aspect of ecological models of health behavior: the interaction between the individual and environmental influences. A good introductory paper on ecological models for graduate students.

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  • Kok, Gerjo, Nell H. Gottlieb, Matthew Commers, and Chris Smerecnik. 2008. The ecological approach in health promotion programs: A decade later. American Journal of Health Promotion 22.6: 437–442.

    DOI: 10.4278/ajhp.22.6.437Save Citation »Export Citation » Share Citation »

    While not focusing solely on the built environment, this review highlights important developments in the application of ecological models to health promotion aimed at supporting practitioners in the design of effective programs and policies.

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  • Sallis, James F., Myron F. Floyd, Daniel A. Rodríguez, and Brian E. Saelens. 2012. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation 125.5 (7 February): 729–737.

    DOI: 10.1161/CIRCULATIONAHA.110.969022Save Citation »Export Citation » Share Citation »

    Provides a valuable summary and schematic (Figure 1) of an ecological model of physical activity behavior. The schematic presented, while focused on physical activity, can be adapted to other health outcomes.

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  • Sallis, James F., Neville Owen, and Edwin B. Fisher. Ecological models of health behavior. 2002. In Health behavior and health education: Theory, research and practice. 3d ed. Edited by Karen Glanz, Barbara K. Rimer, and Frances Marcus Lewis, 465–482. San Francisco: Jossey-Bass.

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    A clear and concise overview of ecological models of health behavior. The authors highlight how these models specify relationships between environments and individual health, and they illustrate what implications these models have for policy through several concrete examples.

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Understanding the Research—Methodological Issues

Much of the complexity in modeling environmental influences on health arises from challenges in how to conceptualize environments. Green and Flowerdew 1996 focuses on one central challenge of representing environments, the modifiable areal unit problem (MAUP). Cummins, et al. 2007 addresses additional complexities, drawing attention to limitations of current approaches to representing place. Measures of environmental characteristics are commonly categorized as either objective or subjective, but the relationships between the two types of measures are rarely explored. In explicitly examining this gap, Gebel, et al. 2009 provides a useful overview of the distinction and previous research on the subject. Oakes, et al. 2009 takes a broader view of methodological issues, providing an excellent summary of both limitations to current approaches and recommendations for further research.

  • Cummins, Steven, Sarah Curtis, Ana V. Diez-Roux, and Sally Macintyre. 2007. Understanding and representing “place” in health research: A relational approach. Social Science & Medicine 65.9 (November): 1825–1838.

    DOI: 10.1016/j.socscimed.2007.05.036Save Citation »Export Citation » Share Citation »

    An important conceptual discussion of the representation and modeling of place. Useful as a reference for researchers, this paper highlights several key considerations for the design of studies of environmental influences on health.

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  • Gebel, Klaus, Adrian Bauman, and Neville Owen. 2009. Correlates of non-concordance between perceived and objective measures of walkability. Annals of Behavioral Medicine 37.2: 228–238.

    DOI: 10.1007/s12160-009-9098-3Save Citation »Export Citation » Share Citation »

    Provides a useful introduction to two distinct types of measures of the environment commonly used in built environment-health research: objective measures, and measures of perception.

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  • Green, M., and R. Flowerdew. 1996. New evidence on the modifiable areal unit problem. In Spatial analysis: Modelling in a GIS environment. Edited by P. Longley and M. Batty, 41–54. Cambridge, UK: GeoInformation International.

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    An overview of the modifiable areal unit problem (MAUP). Useful for graduate students, and complementary reading to Cummins, et al. 2007.

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  • Oakes, J. Michael, Louise C. Mâsse, and Lynne C. Messer. 2009. Work group III: Methodologic issues in research on the food and physical activity environments: Addressing data complexity. American Journal of Preventive Medicine 36.4 (Suppl.): S177–S181.

    DOI: 10.1016/j.amepre.2009.01.015Save Citation »Export Citation » Share Citation »

    A valuable reference for researchers, succinctly reviewing methodological issues related to theory, study design, analytical technique, and measurement error.

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The Built Environment, Transportation, and Health

The built environment influences health through multiple pathways related to transportation. This section includes resources related to several of these pathways: active transportation and physical activity, air pollution exposure, safety of pedestrians and bicycles from traffic, mental health and stress, and social capital.

Active Transportation, Physical Activity, Body Weight, and Related Chronic Disease

Studies connecting the built environment, transportation, and health are exemplified in Frank, et al. 2004, which highlights the role that community design and time spent in cars has on obesity levels. This research is more broadly summarized in Transportation Research Board 2005, a seminal report, and is now international in scope, as illustrated in Sallis, et al. 2009. As this field has grown in depth, several reviews have been published on built environment influences on active transportation by mode, including walking (Saelens and Handy 2008) and biking (Pucher, et al. 2010). Linkages between active modes and transit usage have also been examined in studies such as Besser and Dannenberg 2010. As both sites for physical activity and destinations for active transportation, parks and recreation sites have been widely studied. This body of research is summarized in Kaczynski and Henderson 2007, while the Trust for Public Land website serves as a clearinghouse for research and policy relating to parks.

  • Besser, Lilah M., and Andrew L. Dannenberg. 2010. Walking to public transit: Steps to help meet physical activity recommendations. American Journal of Preventive Medicine 29.4: 273–280.

    DOI: 10.1016/j.ampre.2005.06.010Save Citation »Export Citation » Share Citation »

    A good example of recent research on how transit use and access relates to physical activity.

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  • Frank, Lawrence D., Martin A. Andresen, and Thomas L. Schmid. 2004. Obesity relationships with community design, physical activity, and time spent in cars. American Journal of Preventive Medicine 27.2: 87–96.

    DOI: 10.1016/j.amepre.2004.04.011Save Citation »Export Citation » Share Citation »

    Critical early large study that found associations between the built environment and obesity, using objective measurement of built environment and physical activity (both of which were relatively new at the time). First study to find an association between sedentary time spent in cars and obesity—this link between sedentary travel behavior and obesity has been replicated in several other studies since.

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  • Kaczynski, Andrew T., and Karla A. Henderson. 2007. Environmental correlates of physical activity: A review of evidence about parks and recreation. Leisure Sciences 29.4: 315–354.

    DOI: 10.1080/01490400701394865Save Citation »Export Citation » Share Citation »

    Detailed, systematic review of research on how parks influence physical activity. Includes many useful meta-analyses, such as a review of associations by activity setting (e.g., parks vs. trails), and an analysis of associations between proximity to recreational settings and physical activity.

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  • Pucher, John, Jennifer Dill, and Susan Handy. 2010. Infrastructure, programs, and policies to increase bicycling: An international review. Preventive Medicine 50.1 (January): S106–S125.

    DOI: 10.1016/j.ypmed.2009.07.028Save Citation »Export Citation » Share Citation »

    A clear reference for practitioners seeking insight on research findings on bike infrastructure. Table 1 provides a concise summary of research, by infrastructure type.

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  • Saelens, Brian E., and Susan L. Handy. 2008. Built environment correlates of walking: A review. Medicine and Science in Sports and Exercise 40.7: S550–S566.

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    Systematic review of research of built environment correlates of walking, with a detailed review matrix and discussion highlighting research progress and limitations.

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  • Sallis, James F., Heather R. Bowles, Adrian Bauman, et al. 2009. Neighborhood environments and physical activity among adults in 11 countries. American Journal of Preventive Medicine 36.6 (June): 484–490.

    DOI: 10.1016/j.amepre.2009.01.031Save Citation »Export Citation » Share Citation »

    A recent eleven-country study, highlighting the importance of several built environment characteristics in supporting physical activity. These include the presence of sidewalks and proximity to transit stops.

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  • Transportation Research Board, Committee on Physical Activity, Health, Transportation, and Land Use. 2005. Does the built environment influence physical activity? Examining the evidence. TRB Special Report 282. Washington, DC: Transportation Research Board.

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    A seminal report summarizing some of the literature to 2005 on built environment influences on physical activity. A plain-English reference for practitioners and graduate students new to the field.

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  • The Trust for Public Land.

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    A valuable resource for researchers and practitioners interested in demonstrating the importance of parks for health. Provides links to resources on policy, as well as research summaries useful for park planners.

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Air Pollution Exposure, Asthma, and Respiratory Illness

Air pollution exposure is a function of pollutant concentrations, duration of exposure, and proximity to major pollution sources. Transportation arterials are often primary nonpoint air pollution sources, and many studies have focused on exposure to traffic-related pollution. Hertel, et al. 2008 illustrates how bicycle and bus route choice influence exposure. Chertok, et al. 2004, in contrast, focuses on how mode choice influences exposure. While neighborhood walkability has been favorably linked to many health-related behaviors and health outcomes, Hankey, et al. 2012 points to potential challenges in planning healthy communities by examining relationships between walkability and air pollution exposure.

  • Chertok, Michael, Alexander Voukelatos, Vicky Sheppeard, and Chris Rissel. 2004. Comparison of air pollution exposure for five commuting modes in Sydney: Car, train, bus, bicycle and walking. Health Promotion Journal of Australia 15.1: 63–67.

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    Representative study contrasting differences in exposure to air pollution by mode of transportation.

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  • Hankey, Steve, Julian D. Marshall, and Michael Brauer. 2012. Health impacts of the built environment: Within-urban variability in physical inactivity, air pollution, and ischemic heart disease mortality. Environmental Health Perspectives 120.2: 247–253.

    DOI: 10.1289/ehp.1103806Save Citation »Export Citation » Share Citation »

    Examines how exposure to air pollution may offset health benefits arising from increased physical activity in high-walkability neighborhoods. Important reference for policymakers and researchers, providing further evidence of the need to address both physical activity and air pollution in future planning efforts.

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  • Hertel, Ole, Martin Hvidberg, Matthias Ketzel, Lars Storm, and Lizzi Staussgaard. 2008. A proper choice of route significantly reduces air pollution exposure: A study on bicycle and bus trips in urban streets. Science of the Total Environment 389.1: 58–70.

    DOI: 10.1016/j.scitotenv.2007.08.058Save Citation »Export Citation » Share Citation »

    Illustrates how route choice can dramatically influence exposure to air pollution in urban settings.

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Safety of Pedestrians and Bicycles from Traffic

Built environment influences on traffic safety have been extensively studied and are synthesized in Ewing and Dumbaugh 2009. Retting, et al. 2003 summarizes engineering approaches to addressing safety, while Pucher and Buehler 2008 takes a broader view in presenting policy aimed at improving safety based on approaches adopted in Europe.

  • Ewing, R., and E. Dumbaugh. 2009. The built environment and traffic safety: A review of empirical evidence. Journal of Planning Literature 23.4: 347–367.

    DOI: 10.1177/0885412209335553Save Citation »Export Citation » Share Citation »

    An integrative review with an emphasis on differences in traffic safety between high-density urban and low-density suburban neighborhood types. This review highlights literature that runs counter to “accepted transportation engineering theory,” but it presents a valuable discussion of both alternative and accepted theory.

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  • Pucher, John, and Ralph Buehler. 2008. Making cycling irresistible: Lessons from the Netherlands, Denmark, and Germany. Transport Reviews 28.4: 495–528.

    DOI: 10.1080/01441640701806612Save Citation »Export Citation » Share Citation »

    Normative summary demonstrating wide-ranging policy approaches toward increasing cyclist safety adopted in the Netherlands, Denmark, and Germany that might be applied in the United States.

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  • Retting, Richard, Susan Ferguson, and Anne T. McCartt. 2003. A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health 93.9: 1456–1463.

    DOI: 10.2105/AJPH.93.9.1456Save Citation »Export Citation » Share Citation »

    Review of engineering speed control, pedestrian/vehicle separation, and pedestrian visibility improvement measures, demonstrating built environment modifications that are potentially beneficial for reducing pedestrian-vehicle crashes. Summary tables (Tables 1–4) provide a practical reference for researchers and practitioners.

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Mental Health and Stress

Mental health linkages to the built environment are becoming increasingly well documented. As summarized in Evans 2003 and Matheson, et al. 2006, wide-ranging stressors can influence health outcomes related to mental health and cognitive development. Noise impacts have been particularly well studied (Clark and Stansfeld 2007), and the World Health Organization has published guidelines on ambient noise levels for specific environmental contexts (Berglund, et al. 1999). The importance of nature for mental health has also been widely demonstrated, as synthesized in Maller, et al. 2006. Gee and Takeuchi 2004 and Sturm and Cohen 2004 provide recent examples of the burgeoning field studying built environment impacts specifically related to transportation and sprawling urban form.

  • Berglund, Brigetta, Thomas Lindvall, and Dietrich H. Schwela, eds. 1999. Guidelines for community noise. Geneva, Switzerland: World Health Organization.

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    Policy statement from WHO providing guidelines for ambient noise levels in specific environments, such as inside dwellings and schools.

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  • Clark, Charlotte, and Stephen A. Stansfeld. 2007. The effect of transportation noise on health and cognitive development: A review of recent evidence. International Journal of Comparative Psychology 20.2–3: 145–158.

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    Clearly written review summarizing nonauditory influences of noise on health, including implications for hypertension, stress hormones, and cognitive development.

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  • Evans, Gary W. 2003. The built environment and mental health. Journal of Urban Health: Bulletin of the New York Academy of Medicine 80.4: 536–555.

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    Review of mental health influences of the built environment, including such diverse environmental characteristics as high-rise housing and furniture placement. Table 1 provides a helpful quick reference on the research summarized.

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  • Gee, Gilbert C., and David T. Takeuchi. 2004. Traffic stress, vehicular burden and well-being: A multilevel analysis. Social Science & Medicine 59.2: 405–414.

    DOI: 10.1016/j.socscimed.2003.10.027Save Citation »Export Citation » Share Citation »

    Multilevel study demonstrating impacts of traffic stress on self-reported health of urban populations.

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  • Maller, Cecily, Mardie Townsend, Anita Pryor, Peter Brown, and Lawrence St. Leger. 2006. Healthy nature healthy people: “Contact with nature” as an upstream health promotion intervention for populations. Health Promotion International 21.1: 45–54.

    DOI: 10.1093/heapro/dai032Save Citation »Export Citation » Share Citation »

    Seminal work synthesizing research on the importance of contact with nature for health.

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  • Matheson, Flora I., Rahim Moineddin, James R. Dunn, Maria Isabella Creatore, Piotr Gozdyra, and Richard H. Glazier. 2006. Urban neighborhoods, chronic stress, gender and depression. Social Science & Medicine 63.10: 2604–2616.

    DOI: 10.1016/j.socscimed.2006.07.001Save Citation »Export Citation » Share Citation »

    Large sample study examining neighborhood-level impacts on resident stress levels.

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  • Sturm, R., and D. Cohen. 2004. Suburban sprawl and physical and mental health. Public Health 118.7: 488–496.

    DOI: 10.1016/j.puhe.2004.02.007Save Citation »Export Citation » Share Citation »

    Cross-sectional analysis examining linkages between urban form and both physical and mental health. Findings of this study run counter to prominent hypotheses relating to mental health.

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Built Environment Influences on Health via Social Capital

Phongsavan, et al. 2006 and Poortinga 2006 are representative examples of how perceptions of neighborhood environments are seen to relate to social capital and health. Leyden 2003 examines how one specific aspect of neighborhood environments, walkability, influences social capital. While not explicitly addressing social capital, Foster and Giles Corti 2008 is important in this context because it examines relationships between physical activity and perceptions of safety, which are reflective of the neighborhood social environment.

  • Foster, Sarah, and Billie Giles-Corti. 2008. The built environment, neighborhood crime and constrained physical activity: An exploration of inconsistent findings. Preventive Medicine 47.3: 241–251.

    DOI: 10.1016/j.ypmed.2008.03.017Save Citation »Export Citation » Share Citation »

    Highlights some of the challenges in conceptualizing and measuring relationships between perceptions of safety and physical activity. Useful for researchers considering study design.

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  • Leyden, Kevin M. 2003. Social capital and the built environment: The importance of walkable neighborhoods. American Journal of Public Health 93.9: 1546–1551.

    DOI: 10.2105/AJPH.93.9.1546Save Citation »Export Citation » Share Citation »

    Study demonstrating the importance of walkability specifically as an element of the built environment related to social capital. This paper exemplifies research on the subject and is useful as a reading for graduate students.

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  • Phongsavan, Philayrath, Tien Chay, Adrian Bauman, Robert Brooks, and Derrick Silove. 2006. Social capital, socio-economic status and psychological distress among Australian adults. Social Science & Medicine 63.10: 2546–2561.

    DOI: 10.1016/j.socscimed.2006.06.021Save Citation »Export Citation » Share Citation »

    Demonstrates relationships between social capital, including perceived neighborhood connections, and mental health, as gauged by psychological distress.

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  • Poortinga, Wouter. 2006. Social relations or social capital? Individual and community health effects of bonding social capital. Social Science & Medicine 63.1: 255–270.

    DOI: 10.1016/j.socscimed.2005.11.039Save Citation »Export Citation » Share Citation »

    Multilevel analysis of links between perceptions of the environment (including the social environment) and obesity, self-rated health, and physical activity.

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Food Access and Health

Paralleling the influences on health of transportation-related physical activity, the built environment also influences health by shaping food consumption patterns. These influences occur via the “food environment” and are summarized in Black and Macinko 2008 and Caspi, et al. 2012. Cummins and Macintyre 2006 offers a broader perspective of what environments are truly the most important in shaping behavioral and health outcomes. An earlier piece, Cummins and Macintyre 2002, argues that certain findings arising from food environment research have been misapplied in policy development, while Story, et al. 2008 takes a broader view of the application of research to policy. As with other built environment influences on health, food consumption and weight patterns follow a socioeconomic gradient, as presented in Drewnowski 2009.

Healthy Housing

As with larger-scale neighborhood environments, housing can influence health through multiple pathways. These avenues are presented in Shaw 2004, a broad, conceptually focused review. Mitchell, et al. 2007 presents a more empirically focused review of the literature, while Jacobs, et al. 2007 draws attention to policy challenges faced by US institutions in addressing indoor environmental policy. Practitioners may find useful the (Healthy Housing Reference Manual and Thomson, et al. 2001, a review of intervention studies. Both Bennett, et al. 2007 and Brugge, et al. 2003 provide examples of health issues linked specifically to public housing.

Crime Prevention through Environmental Design

The concept of “crime prevention through environmental design” (CPTED) is focused on deterring criminal activity, with multiple goals, including minimizing economic loss and increasing perceptions of safety. It also holds several potential benefits for public health. Casteel and Peek-Asa 2000 examines the effectiveness of CPTED in reducing robberies as a means of health promotion, while both Cozens 2007 and Dannenberg, et al. 2003 provide broader perspectives in considering CPTED influences on health.

  • Casteel, Carri, and Corinne Peek-Asa. 2000. Effectiveness of crime prevention through environmental design (CPTED) in reducing robberies. American Journal of Preventive Medicine 18.4 (Suppl. 1): 99–115.

    DOI: 10.1016/S0749-3797(00)00146-XSave Citation »Export Citation » Share Citation »

    Systematic review examining robbery reduction as a fundamental mechanism through which CPTED is hypothesized to positively influence health.

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  • Cozens, Paul. 2007. Public health and the potential benefits of crime prevention through environmental design. New South Wales Public Health Bulletin 18.11–12: 232–237.

    DOI: 10.1071/NB07025Save Citation »Export Citation » Share Citation »

    Overview of CPTED influences on health, focused on policy in the Australian context. Situates CPTED within the broader context of environmental influences on health and highlights multiple mechanisms through which CPTED might support public health.

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  • Dannenberg, Andrew L., Richard J. Jackson, Howard Frumkin, et al. 2003. The impact of community design and land-use choices on public health: A scientific research agenda. American Journal of Public Health 93.9 (September): 1500–1508.

    DOI: 10.2105/AJPH.93.9.1500Save Citation »Export Citation » Share Citation »

    Broadly focused commentary presenting a research agenda to address community design influences on health. Includes a brief but useful discussion of research questions relating to CPTED.

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Vulnerable Populations and Environmental Justice

Certain population groups have been identified as particularly vulnerable to built environment impacts on health, due to greater sensitivity or exposure to specific environmental influences than the broader population. These groups include youth, older adults, and low-income populations. For each of these groups, substantial research has been developed to explore influences on health-related behaviors and exposures specific to that group, such as youth walking and biking to school.


As noted in American Academy of Pediatrics 2009, the built environment has been identified as a key focus for policies aimed at addressing youth physical inactivity and weight problems. Research supporting this position is well summarized in Ding, et al. 2011 and Sirard and Slater 2008. Timperio, et al. 2006 is an example of a single study that powerfully demonstrates the application of an ecological modeling approach. Relationships between the built environment and health via air pollution exposure are demonstrated in Landrigan, et al. 2002, which also provides an example of monetary costs associated with environmental influences on health.

  • American Academy of Pediatrics, Committee on Environmental Health. 2009. The built environment: Designing communities to promote physical activity in children. Pediatrics 123.6: 1591–1598.

    DOI: 10.1542/peds.2009-0750Save Citation »Export Citation » Share Citation »

    Policy statement providing a succinct synthesis of evidence to date, with recommendations for both government officials (primarily relevant to urban planners) and pediatricians.

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  • Ding, D., J. F. Sallis, J. Kerr, S. Lee, and D. E. Rosenberg. 2011. Neighborhood environment and physical activity among youth: A review. American Journal of Preventive Medicine 41.4: 442–455.

    DOI: 10.1016/j.amepre.2011.06.036Save Citation »Export Citation » Share Citation »

    A recent, systematic review of studies that incorporates a clear presentation of previous reviews, variable by variable summary tables, and a solid discussion of policy implications. Useful primarily for researchers and practitioners.

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  • Landrigan, Philip J., Clyde B. Schechter, Jeffrey M. Lipton, Marianne C. Fahs, and Joel Schwartz. 2002. Environmental pollutants and disease in American children: Estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environmental Health Perspectives 110.7: 721–728.

    DOI: 10.1289/ehp.02110721Save Citation »Export Citation » Share Citation »

    Study examining the magnitude of health-care costs in the United States arising from exposure of children to air pollution. Informative both as a review of adverse health outcomes associated with air pollution exposure and in demonstrating the potential scale of the associated costs.

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  • Sirard, J. R., and M. E. Slater. 2008. Walking and bicycling to school: A review. American Journal of Lifestyle Medicine 2.5: 372–396.

    DOI: 10.1177/1559827608320127Save Citation »Export Citation » Share Citation »

    A review focusing on a specific subset of physical activity: walking and biking. This systematic review is a valuable resource primarily for researchers, with a strong emphasis on conceptual models.

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  • Timperio, Anna, Kylie Ball, Jo Salmon, et al. 2006. Personal, family, social, and environmental correlates of active commuting to school. American Journal of Preventive Medicine 30.1: 45–51.

    DOI: 10.1016/j.amepre.2005.08.047Save Citation »Export Citation » Share Citation »

    Good example of an ecological model–based study examining several types of correlates of youth physical activity in a single analysis: personal, family, social, and environmental correlates, including measures of perceptions and objective measures.

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Older Adults

Due in part to the rapid aging of populations across much of the developed world, and to the particular sensitivity of the elderly population to environmental conditions (e.g., relating to ease and safety of mobility), built environment–health relationships specific to older adults have been extensively studied. Theoretical aspects of these relationships are explored in Satariano 2003 and Sugiyama and Thompson 2007, while Yen, et al. 2009 presents a systematic review of the literature. Empirical studies have examined health impacts related to air pollution (Lee, et al. 2007), walking (Li, et al. 2005), and obesity (Berke, et al. 2007).

  • Berke, Ethan M., Thomas D. Koepsell, Anne Vernez Moudon, Richard E. Hoskins, and Eric B. Larsen. 2007. Association of the built environment with physical activity and obesity in older persons. American Journal of Public Health 97.3: 486–492.

    DOI: 10.2105/AJPH.2006.085837Save Citation »Export Citation » Share Citation »

    Study examining relationships between objectively measured walkability, physical activity, and body mass index of older adults.

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  • Lee, Jong-Tae, Ji-Young Son, and Yong-Sung Cho. 2007. The adverse effects of fine particle air pollution on respiratory function in the elderly. Science of the Total Environment 385.1–3: 28–36.

    DOI: 10.1016/j.scitotenv.2007.07.005Save Citation »Export Citation » Share Citation »

    Study of health impacts of exposure to fine particulate matter on respiratory health of older adults.

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  • Li, Fuzhong, K. John Fisher, Ross C. Brownson, and Mark Bosworth. 2005. Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. Journal of Epidemiology and Community Health 59.7: 558–564.

    DOI: 10.1136/jech.2004.028399Save Citation »Export Citation » Share Citation »

    Analysis of walking behavior of older adults as predicted by both individual- and neighborhood-level built environment characteristics.

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  • Satariano, W. A., and E. McAuley. 2003. Promoting physical activity among older adults: From ecology to the individual. American Journal of Preventive Medicine 25.3 (Suppl. 2): 184–192.

    DOI: 10.1016/S0749-3797(03)00183-1Save Citation »Export Citation » Share Citation »

    Valuable theoretical piece on interactions between individual and environment as potential determinants of physical activity in older adults.

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  • Sugiyama, Takemi, and Catharine Ward Thompson. 2007. Outdoor environments, activity and the well-being of older people: Conceptualising environmental support. Environment and Planning A 39.8: 1943–1960.

    DOI: 10.1068/a38226Save Citation »Export Citation » Share Citation »

    Conceptual discussion focusing on links between walking and quality of life.

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  • Yen, Irene H., Yvonne L. Michael, and Leslie Perdue. 2009. Neighborhood environment in studies of health of older adults: A systematic review. American Journal of Preventive Medicine 37.5: 455–463.

    DOI: 10.1016/j.amepre.2009.06.022Save Citation »Export Citation » Share Citation »

    Systematic review of studies examining neighborhood environment influences on health. This review is primarily applicable to researchers and graduate students, with an emphasis on methodological and theoretical considerations.

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While ethnicity is widely recognized as an influential factor in health-related behaviors, moderating influences of ethnicity on built environment–health relationships are still poorly understood, as outlined in Casagrande, et al. 2009. Such influences are complex, with interacting individual and contextual factors (Boardman, et al. 2005) as well as gender-specific relationships (Bopp, et al. 2006). Policy implications are far reaching because of the environmental justice issues that arise due to racial isolation and concentrated disadvantage (Chang, et al. 2009).

  • Boardman, Jason D., Jarron M. Saint Onge, Richard G. Rogers, and Justin T. Denney. 2005. Race differentials in obesity: The impact of place. Journal of Health and Social Behavior 46.3: 229–243.

    DOI: 10.1177/002214650504600302Save Citation »Export Citation » Share Citation »

    Multilevel study valuable for demonstrating the entanglement of individual and neighborhood contextual factors in explaining obesity rates.

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  • Bopp, Melissa, Sara Wilcox, Marilyn Laken, et al. 2006. Factors associated with physical activity among African-American men and women. American Journal of Preventive Medicine 30.4: 340–346.

    DOI: 10.1016/j.amepre.2005.11.007Save Citation »Export Citation » Share Citation »

    Demonstrates the importance of gender stratification in the study of built environment influences on non-Caucasian populations, with implications for physical activity interventions.

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  • Casagrande, Sara Stark, Melicia C. Whitt-Glover, Kristie J. Lancaster, Angela M. Odoms-Young, and Tiffany L. Gary. 2009. Built environment and health behaviors among African Americans: A systematic review. American Journal of Preventive Medicine 36.2: 174–181.

    DOI: 10.1016/j.amepre.2008.09.037Save Citation »Export Citation » Share Citation »

    A synthesis of research on built environment influences on the health of African Americans, highlighting preliminary findings and the need for more research.

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  • Chang, Virginia W., Amy E. Hillier, and Neil K. Mehta. 2009. Neighborhood racial isolation, disorder and obesity. Social Forces: A Scientific Medium of Social Study and Interpretation 87.4: 2063–2092.

    DOI: 10.1353/sof.0.0188Save Citation »Export Citation » Share Citation »

    Study examining influences of racially based residential segregation on obesity. Also considers the mediating role that neighborhood disorder plays in this relationship.

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Low Income

Diverse approaches have been adopted to assess interactions between the built environment, income, and health. Studies such as Franzini, et al. 2005, for instance, have focused on neighborhood economic conditions as influencing health outcomes. Lovasi, et al. 2009 addresses area disadvantage as a moderating effect, modifying the relationship between walkability and body mass index (BMI). Contrastingly, Cohen, et al. 2003 and Gordon-Larsen, et al. 2006 examine how inequalities in the spatial distribution of environmental characteristics (such as access to recreational amenities) potentially underlie health disparities. Transportation infrastructure development and operation has historically been widely studied for its impact on low-income populations. Forkenbrock and Schweitzer 2007 illustrates how such impacts can be assessed, while Schweitzer and Valenzuela 2004 synthesizes research on the subject. Normative research, such as that in Day 2007, has sought to identify how to shape environments to promote the health of vulnerable populations. Such research informs the work of organizations such as the Environmental Justice Resource Center at Clark Atlanta University.

  • Cohen, Deborah A., Thomas A. Farley, and Karen Mason. 2003. Why is poverty unhealthy? Social and physical mediators. Social Science & Medicine 57.9: 1631–1641.

    DOI: 10.1016/S0277-9536(03)00015-7Save Citation »Export Citation » Share Citation »

    Explores the role of environmental characteristics such as “broken windows” as mediating factors in explaining observed socioeconomic gradients in health.

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  • Day, Kristen. 2007. Active living and social justice: Planning for physical activity in low-income, black, and Latino communities. Journal of the American Planning Association 72.1: 88–99.

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    Review focused toward practicing planners, including a useful discussion of “group factors” specific to promoting physical activity in vulnerable populations.

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  • Environmental Justice Resource Center at Clark Atlanta University.

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    Valuable online resource for practitioners and researchers, with links to diverse resources and topical news items.

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  • Forkenbrock, David J., and Lisa A. Schweitzer. 2007. Environmental justice in transportation planning. Journal of the American Planning Association 65.1: 37–41.

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    Case study demonstrating an approach to explicitly assess environmental justice impacts arising from transportation infrastructure.

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  • Franzini, Luisa, Margaret Caughy, William Spears, and Maria Eugenia Fernandez-Esquer. 2005. Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: A multilevel latent variables model. Social Science & Medicine 61.6: 1135–1150.

    DOI: 10.1016/j.socscimed.2005.02.010Save Citation »Export Citation » Share Citation »

    Valuable for its conceptual model of the influence of neighborhood economic conditions on health outcomes.

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  • Gordon-Larsen, Penny, Melissa C. Nelson, Phil Page, and Barry M. Popkin. 2006. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics 117.2: 417–424.

    DOI: 10.1542/peds.2005-0058Save Citation »Export Citation » Share Citation »

    Highlights correlations between recreational facility access and neighborhood socioeconomic status.

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  • Lovasi, Gina S., Kathryn M. Neckerman, James W. Quinn, Christopher C. Weiss, and Andrew Rundle. 2009. Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and body mass index. American Journal of Public Health 99.2: 279–284.

    DOI: 10.2105/AJPH.2008.138230Save Citation »Export Citation » Share Citation »

    Explores the moderating effect of area disadvantage on relationships between walkability and body mass index.

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  • Schweitzer, Lisa, and Abel Valenzuela Jr. 2004. Environmental injustice and transportation: The claims and the evidence. Journal of Planning Literature 18.4 (May): 383–398.

    DOI: 10.1177/0885412204262958Save Citation »Export Citation » Share Citation »

    Review of research on environmental justice issues relating to transportation. Useful primarily for researchers and students.

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Disability is fundamentally intertwined with the environment, as outlined in Verbrugge and Jette 1994, the authors’ seminal work, and more recently in Iwarsson and Ståhl 2003. Mobility challenges resulting from disability have been the subject of considerable research, including Clarke, et al. 2008 and Spivock, et al. 2008. Creating accessible environments for the disabled has been the subject of universal design research and practice at institutes such as the Center for Universal Design. Principles of universal design are summarized in Story 1998.

Research Limitations and Future Directions

Much of the research in this field is quantitative, gauging how specific measurable characteristics of the environment translate into quantifiable health outcomes or behaviors. Lee and Moudon 2006 presents several alternative approaches to assessing built environment characteristics that can be linked to health-related behaviors. Challenges also arise due to the conflation of individual characteristics (such as preferences) with contextual characteristics (such as built environment features), and have themselves become the focus of substantial research. One particularly well-documented example of these challenges is the “residential self-selection” problem, addressed in Cao, et al. 2009 and Frank, et al. 2007. As the volume of research has expanded, many authors have written reviews to help synthesize and make sense of the vast body of knowledge. In reviewing these reviews, Ding and Gebel 2012 highlights several useful recommendations for future research. These include recommendations to better address causation, improve the identification and definition of place, and undertake more population-specific analyses. In response to the burgeoning research in this field, numerous tools have been developed to better incorporate health into planning, as evidenced by the application of health impact assessments, discussed in Parry and Stevens 2001.

  • Cao, Xinyu (Jason), Patricia L. Mokhtarian, and Susan L. Handy. 2009. Examining the impacts of residential self-selection on travel behaviour: A focus on empirical findings. Transport Reviews 29.3: 359–395.

    DOI: 10.1080/01441640802539195Save Citation »Export Citation » Share Citation »

    Explicitly examines residential self-selection, one of the key challenges in researching built environment influences on health.

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  • Ding, Ding, and Klaus Gebel. 2012. Built environment, physical activity, and obesity: What have we learned from reviewing the literature? Health & Place 18.1: 100–105.

    DOI: 10.1016/j.healthplace.2011.08.021Save Citation »Export Citation » Share Citation »

    As research on built environment and health has grown in depth and breadth, so has the literature reviewing this research. This paper is a review of reviews, useful both in summarizing past research (Table 1 identifies the thirty-six reviews examined) and in the insights that it presents for a future research agenda.

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  • Frank, Lawrence D., Brian E. Saelens, Ken E. Powell, and James E. Chapman. 2007. Stepping towards causation: Do built environments or neighborhood and travel preferences explain physical activity, driving, and obesity? Social Science & Medicine 65.9: 1898–1914.

    DOI: 10.1016/j.socscimed.2007.05.053Save Citation »Export Citation » Share Citation »

    Clear introduction to the self-selection issue and innovative analysis comparing individuals across walkability and neighborhood preference quadrants.

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  • Lee, Chanam, and Anne Vernez Moudon. 2006. The 3Ds+R: Quantifying land use and urban form correlates of walking. Transportation Research Part D: Transport and Environment 11.3 (May): 204–215.

    DOI: 10.1016/j.trd.2006.02.003Save Citation »Export Citation » Share Citation »

    Strongly methodologically focused paper illustrating alternative approaches to built environment measure definition, including numerous alternate measures of land use mix and destination accessibility. (3Ds+R refers to destinations, distance, density, and route.)

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  • Parry, Jayne, and Andrew Stevens. 2001. Prospective health impact assessment: Pitfalls, problems and possible ways forward. British Medical Journal 323.7322: 1177–1182.

    DOI: 10.1136/bmj.323.7322.1177Save Citation »Export Citation » Share Citation »

    Excellent introductory overview of health impact assessment, with a pointed commentary on potential limitations and ways forward.

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