October 30 | 2017
Healthy Cities of Tomorrow: the Case for Large Scale Built Environment-Health Studies.
J Urban Health. 2017 Feb;94(1):4-19. DOI: 10.1007/s11524-016-0122-1
EXCERPT FROM INTRODUCTION: New scientific evidence generated over the past decade points to a significant role played by a myriad of attributes of our cities’ built environments (BE) in shaping human behaviour, health and well-being [3, 4, 5, 6]. This has resulted in a renaissance of interest in an environmentalmodel of public health, comprising interventions specific to physical and social environments [7, 8]. We view this as similar to the wave of public health interest that gave birth to modern town planning in the mid to late twentieth century. Non-clinical environmental interventions in the form of health-specific planning and design of neighbourhoods and cities have been scientifically shown to have significant potential in playing a role in creating healthy cities of tomorrow. In addition to enabling healthier lifestyles, such interventions can produce higher cost effectiveness ratios in health service provision and can thus play a part in reducing future health expenditures [9]. The creation of healthy cities will entail a much closer integration and synergy between the disciplines of public health, epidemiology, transport planning, urban planning and design.
In the recent years several ongoing projects have emerged that aim specifically to measure health-specific components of urban environments at a large scale. The ultimate objective is to eventually link them with existing health cohorts enabling interdisciplinary collaborations and evidence generation towards creation of healthy cities. The Place, Health and Liveability project is one such national-level study aiming to create neighbourhood-level spatial measures of urban liveability across seven domains of employment, food, housing, public open space, social infrastructure, transport and walkability in Australia [10]. Algorithms measuring weighted street distance of individual dwellings to amenities and public transit have been developed to produce composite Walk Scores and Transit Scores in most US cities and some Canadian and Australian cities at the level of individual properties [11]. These are being linked with existing health cohorts to decipher associations with individual’s active travel behaviours [12]. Furthermore, there are many large scale health studies being conducted around the world, including the UK Biobank study (described in the subsequent section), 45 and Up Study in New South Wales, Australia1 (N = 250,000 participants); EpiHealth Study, Sweden2 (N = 300,000); China Kadoorie Biobank, China3 (N = 500,000); Million Death Study, India4 (N = 1,000,000) and Hong Kong FAMILY Cohort5 (N = 46,000) to name just a few. These present us (BE and urban planners and designers, epidemiologists, health economists, public health researchers and policy makers) with a well-timed opportunity to join expertise and resources for an integrated and multi-disciplinary global consortium to model and create national-level BE-health databases that can be turned into fine-tuned professional decision support and guidance systems. In the remaining part of this paper, we shall discuss some of the key issues and challenges in creation of healthy cities and ways to overcome them through interdisciplinary evidence generation on a large scale, planning and forecasting.