Skip to content

City Planning Policies to Support Health and Sustainability: An International Comparison of Policy Indicators for 25 Cities

Lowe, Melanie; Adlakha, Deepti; Sallis, James F.; Salvo, Deborah; Cerin, Ester; Moudon, Anne Vernez; Higgs, Carl; Hinckson, Erica; Arundel, Jonathan; Boeing, Geoff; Liu, Shiqin; Mansour, Perla; Gebel, Klaus; Puig-ribera, Anna; Mishra, Pinki Bhasin; Bozovic, Tamara; Carson, Jacob; Dygryn, Jan; Florindo, Alex A.; Ho, Thanh Phuong; Hook, Hannah; Hunter, Ruth F.; Lai, Poh-chin; Molina-garcia, Javier; Nitvimol, Kornsupha; Oyeyemi, Adewale L.; Ramos, Carolina D. G.; Resendiz, Eugen; Troelsen, Jens; Witlox, Frank; Giles-corti, Billie. (2022). City Planning Policies to Support Health and Sustainability: An International Comparison of Policy Indicators for 25 Cities. Lancet Global Health, 10(6), E882-E894.

View Publication

Abstract

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Keywords

Physical-activity; Population Health; Walkability

Deciphering the Impact of Urban Built Environment Density on Respiratory Health Using a Quasi-cohort Analysis of 5495 Non-smoking Lung Cancer Cases

Wang, Lan; Sun, Wenyao; Moudon, Anne Vernez; Zhu, Yong-guan; Wang, Jinfeng; Bao, Pingping; Zhao, Xiaojing; Yang, Xiaoming; Jia, Yinghui; Zhang, Surong; Wu, Shuang; Cai, Yuxi. (2022). Deciphering the Impact of Urban Built Environment Density on Respiratory Health Using a Quasi-cohort Analysis of 5495 Non-smoking Lung Cancer Cases. Science Of The Total Environment, 850.

View Publication

Abstract

Introduction: Lung cancer is a major health concern and is influenced by air pollution, which can be affected by the den-sity of urban built environment. The spatiotemporal impact of urban density on lung cancer incidence remains unclear, especially at the sub-city level. We aimed to determine cumulative effect of community-level density attributes of the built environment on lung cancer incidence in high-density urban areas. Methods: We selected 78 communities in the central city of Shanghai, China as the study site; communities included in the analysis had an averaged population density of 313 residents per hectare. Using data from the city cancer surveil-lance system, an age-period-cohort analysis of lung cancer incidence was performed over a five-year period (2009-2013), with a total of 5495 non-smoking/non-secondhand smoking exposure lung cancer cases. Community -level density measures included the density of road network, facilities, buildings, green spaces, and land use mixture. Results: In multivariate models, built environment density and the exposure time duration had an interactive effect on lung cancer incidence. Lung cancer incidence of birth cohorts was associated with road density and building coverage across communities, with a relative risk of 1middot142 (95 % CI: 1middot056-1middot234, P = 0middot001) and 1middot090 (95 % CI: 1middot053-1middot128, P < 0middot001) at the baseline year (2009), respectively. The relative risk increased exponentially with the exposure timeduration. As for the change in lung cancer incidence over the five-year period, lung cancer incidence of birth cohorts tended to increase faster in communities with a higher road density and building coverage. Conclusion: Urban planning policies that improve road network design and building layout could be important strate-gies to reduce lung cancer incidence in high-density urban areas.

Keywords

Air-quality; Pollutant Dispersion; Risk-factors; Land-use; Mortality; Exposure; Cities; Transport; Compact City; Longitudinal Analysis; Lung Cancer; Urban Planning

Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study

Cruz, Maricela; Drewnowski, Adam; Bobb, Jennifer F.; Hurvitz, Philip M.; Moudon, Anne Vernez; Cook, Andrea; Mooney, Stephen J.; Buszkiewicz, James H.; Lozano, Paula; Rosenberg, Dori E.; Kapos, Flavia; Theis, Mary Kay; Anau, Jane; Arterburn, David. (2022). Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study. Epidemiology, 33(5), 747-755.

View Publication

Abstract

Background: Neighborhoods may play an important role in shaping long-term weight trajectory and obesity risk. Studying the impact of moving to another neighborhood may be the most efficient way to determine the impact of the built environment on health. We explored whether residential moves were associated with changes in body weight. Methods: Kaiser Permanente Washington electronic health records were used to identify 21,502 members aged 18-64 who moved within King County, WA between 2005 and 2017. We linked body weight measures to environment measures, including population, residential, and street intersection densities (800 m and 1,600 m Euclidian buffers) and access to supermarkets and fast foods (1,600 m and 5,000 m network distances). We used linear mixed models to estimate associations between postmove changes in environment and changes in body weight. Results: In general, moving from high-density to moderate- or low-density neighborhoods was associated with greater weight gain postmove. For example, those moving from high to low residential density neighborhoods (within 1,600 m) gained an average of 4.5 (95% confidence interval [CI] = 3.0, 5.9) lbs 3 years after moving, whereas those moving from low to high-density neighborhoods gained an average of 1.3 (95% CI = -0.2, 2.9) lbs. Also, those moving from neighborhoods without fast-food access (within 1600m) to other neighborhoods without fast-food access gained less weight (average 1.6 lbs [95% CI = 0.9, 2.4]) than those moving from and to neighborhoods with fast-food access (average 2.8 lbs [95% CI = 2.5, 3.2]). Conclusions: Moving to higher-density neighborhoods may be associated with reductions in adult weight gain.

Keywords

Body-mass Index; Neighborhood Socioeconomic-status; New-york-city; Built Environment; Physical-activity; Food Environment; Urban Sprawl; Risk-factors; Obesity; Walking; Electronic Medical Records; Fast Foods; Population Density; Residential Density; Residential Moves; Supermarkets

Using Open Data and Open-source Software to Develop Spatial Indicators of Urban Design and Transport Features for Achieving Healthy and Sustainable Cities

Boeing, Geoff; Higgs, Carl; Liu, Shiqin; Giles-corti, Billie; Sallis, James F.; Cerin, Ester; Lowe, Melanie; Adlakha, Deepti; Hinckson, Erica; Moudon, Anne Vernez; Salvo, Deborah; Adams, Marc A.; Barrozo, Ligia, V; Bozovic, Tamara; Delclos-alio, Xavier; Dygryn, Jan; Ferguson, Sara; Gebel, Klaus; Thanh Phuong Ho; Lai, Poh-chin; Martori, Joan C.; Nitvimol, Kornsupha; Queralt, Ana; Roberts, Jennifer D.; Sambo, Garba H.; Schipperijn, Jasper; Vale, David; Van De Weghe, Nico; Vich, Guillem; Arundel, Jonathan. (2022). Using Open Data and Open-source Software to Develop Spatial Indicators of Urban Design and Transport Features for Achieving Healthy and Sustainable Cities. Lancet Global Health, 10(6), E907-E918.

View Publication

Abstract

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

Keywords

Systems; Access; Care

What Next? Expanding Our View of City Planning and Global Health, and Implementing and Monitoring Evidence-informed Policy

Giles-corti, Billie; Moudon, Anne Vernez; Lowe, Melanie; Cerin, Ester; Boeing, Geoff; Frumkin, Howard; Salvo, Deborah; Foster, Sarah; Kleeman, Alexandra; Bekessy, Sarah; De Sa, Thiago Herick; Nieuwenhuijsen, Mark; Higgs, Carl; Hinckson, Erica; Adlakha, Deepti; Arundel, Jonathan; Liu, Shiqin; Oyeyemi, Adewale L.; Nitvimol, Kornsupha; Sallis, James F. (2022). What Next? Expanding Our View of City Planning and Global Health, and Implementing and Monitoring Evidence-informed Policy. Lancet Global Health, 10(6), E919-E926.

View Publication

Abstract

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.

Residential Property Values are Associated with Obesity among Women in King County, WA, USA

Rehm, Colin D.; Moudon, Anne V.; Hurvitz, Philip M.; Drewnowski, Adam. (2012). Residential Property Values are Associated with Obesity among Women in King County, WA, USA. Social Science & Medicine, 75(3), 491 – 495.

View Publication

Abstract

Studies of social determinants of weight and health in the US have typically relied on self-reported education and incomes as the two primary measures of socioeconomic status (SES). The assessed value of one's home, an important component of wealth, may be a better measure of the underlying SES construct and a better predictor of obesity. The Seattle Obesity Study (SOS), conducted in 2008-9, was a cross-sectional random digit dial telephone survey of 2001 adults in King County, Washington State, US. Participants' addresses were geocoded and residential property values for each tax parcel were obtained from the county tax assessor's database. Prevalence ratios of obesity by property values, education, and household income were estimated separately for women and men, after adjusting for age, race/ethnicity, household size, employment status and home ownership. Among women, the inverse association between property values and obesity was very strong and independent of other SES factors. Women in the bottom quartile of property values were 3.4 times more likely to be obese than women in the top quartile. No association between property values and obesity was observed for men. The present data strengthen the evidence for a social gradient in obesity among women. Property values may represent a novel and objective measure of SES at the individual level in the US. Measures based on tax assessment data will provide a valuable resource for future health studies. (C) 2012 Elsevier Ltd. All rights reserved.

Keywords

Communities; Employment; Income; Obesity; Poisson Distribution; Probability Theory; Research Funding; Self-evaluation; Sex Distribution; Social Classes; Statistics; Surveys; Data Analysis; Educational Attainment; Cross-sectional Method; Data Analysis Software; Descriptive Statistics; Washington (state); Health Status Disparities; Health Surveys; Social Class; Socioeconomic Factors; Usa; Women; Body-mass Index; Socioeconomic-status; Aged Men; Health; Weight; Disparities; Overweight; Disease; Poverty; Height

Multistate Evaluation of Safe Routes to School Programs

Stewart, Orion; Moudon, Anne Vernez; Claybrooke, Charlotte. (2014). Multistate Evaluation of Safe Routes to School Programs. American Journal Of Health Promotion, 28, S89 – S96.

View Publication

Abstract

Purpose. State Safe Routes to School (SRTS) programs provide competitive grants to local projects that support safe walking, bicycling, and other modes of active school travel (AST). This study assessed changes in rates of AST after implementation of SRTS projects at multiple sites across four states. Design. One-group pretest and posttest. Setting. Florida, Mississippi, Washington, and Wisconsin. Subjects. Convenience sample of 48 completed SRTS projects and 53 schools affected by a completed SRTS project. Intervention. State-funded SRTS project. Measures. AST was measured as the percentage of students walking, bicycling, or using any AST mode. SRTS project characteristics were measured at the project, school, and school neighborhood levels. Analysis. Paired-samples t-tests were used to assess changes in AST. Bivariate analysis was used to identify SRTS project characteristics associated with increases in AST. Data were analyzed separately at the project (n = 48) and school (n = 53) levels. Results. Statistically significant increases in AST were observed across projects in all four states. All AST modes increased from 12.9% to 17.6%; walking from 9.8% to 14.2%; and bicycling from 2.5% to 3.0%. Increases in rates of bicycling were negatively correlated with baseline rates of bicycling. Conclusion. State-funded SRTS projects are achieving one of the primary program goals of increasing rates of AST. They may be particularly effective at introducing bicycling to communities where it is rare. The evaluation framework introduced in this study can be used to continue tracking the effect of state SRTS programs as more projects are completed.

Keywords

Transportation Of School Children; Physical Activity Measurement; Health Promotion; Cycling; Walking; School Children -- United States; Bicycling; Children; Commuting; Health Focus: Fitness/physical Activity; Manuscript Format: Research; Outcome Measure: Behavioral; Prevention Research; Research Purpose: Program Evaluation; Schools; Setting: School; Strategy: Skill Building/behavior Change, Built Environment; Study Design: Quasi-experimental; Target Population Age: Youth; Target Population Circumstances: Geographic Location; Physical-activity; Mental-health; Travel; Association; Validity; Mode; Bus

The Residential Effect Fallacy in Neighborhood and Health Studies Formal Definition, Empirical Identification, and Correction

Chaix, Basile; Duncan, Dustin; Vallee, Julie; Vernez-moudon, Anne; Benmarhnia, Tarik; Kestens, Yan. (2017). The Residential Effect Fallacy in Neighborhood and Health Studies Formal Definition, Empirical Identification, and Correction. Epidemiology, 28(6), 789 – 797.

View Publication

Abstract

Background: Because of confounding from the urban/rural and socioeconomic organizations of territories and resulting correlation between residential and nonresidential exposures, classically estimated residential neighborhood-outcome associations capture nonresidential environment effects, overestimating residential intervention effects. Our study diagnosed and corrected this residential effect fallacy bias applicable to a large fraction of neighborhood and health studies. Methods: Our empirical application investigated the effect that hypothetical interventions raising the residential number of services would have on the probability that a trip is walked. Using global positioning systems tracking and mobility surveys over 7 days (227 participants and 7440 trips), we employed a multilevel linear probability model to estimate the trip-level association between residential number of services and walking to derive a naive intervention effect estimate and a corrected model accounting for numbers of services at the residence, trip origin, and trip destination to determine a corrected intervention effect estimate (true effect conditional on assumptions). Results: There was a strong correlation in service densities between the residential neighborhood and nonresidential places. From the naive model, hypothetical interventions raising the residential number of services to 200, 500, and 1000 were associated with an increase by 0.020, 0.055, and 0.109 of the probability of walking in the intervention groups. Corrected estimates were of 0.007, 0.019, and 0.039. Thus, naive estimates were overestimated by multiplicative factors of 3.0, 2.9, and 2.8. Conclusions: Commonly estimated residential intervention-outcome associations substantially overestimate true effects. Our somewhat paradoxical conclusion is that to estimate residential effects, investigators critically need information on nonresidential places visited.

Keywords

Self-rated Health; Record Cohort; Physical-activity; Transportation Modes; Built Environment; Activity Spaces; Research Agenda; Risk-factors; Associations; Exposure

Intersections and Non-Intersections: A Protocol for Identifying Pedestrian Crash Risk Locations in GIS

Kang, Mingyu; Moudon, Anne Vernez; Kim, Haena; Boyle, Linda Ng. (2019). Intersections and Non-Intersections: A Protocol for Identifying Pedestrian Crash Risk Locations in GIS. International Journal Of Environmental Research And Public Health, 16(19).

View Publication

Abstract

Intersection and non-intersection locations are commonly used as spatial units of analysis for modeling pedestrian crashes. While both location types have been previously studied, comparing results is difficult given the different data and methods used to identify crash-risk locations. In this study, a systematic and replicable protocol was developed in GIS (Geographic Information System) to create a consistent spatial unit of analysis for use in pedestrian crash modelling. Four publicly accessible datasets were used to identify unique intersection and non-intersection locations: Roadway intersection points, roadway lanes, legal speed limits, and pedestrian crash records. Two algorithms were developed and tested using five search radii (ranging from 20 to 100 m) to assess the protocol reliability. The algorithms, which were designed to identify crash-risk locations at intersection and non-intersection areas detected 87.2% of the pedestrian crash locations (r: 20 m). Agreement rates between algorithm results and the crash data were 94.1% for intersection and 98.0% for non-intersection locations, respectively. The buffer size of 20 m generally showed the highest performance in the analyses. The present protocol offered an efficient and reliable method to create spatial analysis units for pedestrian crash modeling. It provided researchers a cost-effective method to identify unique intersection and non-intersection locations. Additional search radii should be tested in future studies to refine the capture of crash-risk locations.

Keywords

Traffic Crash; Walking; Collisions; Accidents; Models; Pedestrian Safety; Spatial Autocorrelation; Algorithm

The Economic Value of Walkable Neighborhoods

Sohn, Dong Wook; Moudon, Anne Vernez; Lee, Jeasun. (2012). The Economic Value of Walkable Neighborhoods. Urban Design International, 17(2), 115 – 128.

View Publication

Abstract

This study investigated how the benefits of a walkable neighborhood were reflected in the American real estate market by examining the economic values of urban environmental factors supporting walking activities. Property values were used as a proxy measure for economic value and analyzed in relation to land use characteristics that have been known to correlate with walking at the neighborhood scale. Four aspects of the built environment supporting walking were included in the analyses: development density, land use mix, public open space and pedestrian infrastructure. Hedonic models were employed where the property value was regressed on the measures of the four sets of correlates of walking in a neighborhood. Models were estimated for four land use types - single-family residential, rental multi-family residential, commercial and office. The findings did not support previous arguments that increasing density weakens the quality of a neighborhood. To the contrary, the positive association of higher development density with the value of single-family residential properties detected in King County suggested that high development density might increase surrounding property values. The pedestrian infrastructure and land use mix significantly contributed to increases in rental multi-family residential property values. Higher development density with higher street and sidewalk coverage were also favored by retail service uses. In relation to land use mix, mixing retail service uses and rental multi-family residential uses helped make rental housings more attractive. URBAN DESIGN International (2012) 17, 115-128. doi:10.1057/udi.2012.1; published online 4 April 2012

Keywords

Land-use; Physical-activity; Travel Behavior; Smart Growth; Mode Choice; Urban Form; Walking; Gis; Transportation; Accessibility; Mixed Land Use; Neighborhood; Urban Design