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December 19, 2023

Built Environment and Public Health: More Than 20 Years of Progress

Rollings, K. A., Dannenberg, A. L., Frumkin, H., & Jackson, R. J. (2024). Built Environment and Public Health: More Than 20 Years of Progress. American Journal of Public Health (1971), 114(1), 27-.

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Early BEH research addressed influences of toxic environmental exposures, zoning laws, building codes, and healthy housing and communities on asthma, injury, violence, healthy and unhealthy food consumption, mental health, social capital, and health inequities.1 Awareness increased regarding the benefits of denser, more walkable, and less automobile-dependent settings, as well as the accessibility, mobility, and livability needs of the growing aging population. Work on automobile dependence, traffic safety, walking and biking, commuting, and sedentary time was primarily driven by the Robert Wood Johnson Foundation's Active Living Research initiative to promote active living via environment, policy, and practice improvements3,4 Research linked specific building and community features to health outcomes, enabling more effective interventions such as appealing stairways, ample sidewalks, and vibrant activity centers.5 The business case for health promoting, walkable places was documented.6 Unintended consequences, including gentrification and displacement, of interventions aimed at improving health among people from racial and ethnic minority groups and of lower incomes were increasingly recognized, resulting in more research focused on how to mitigate these risks.7 The history of structural racism, segregation, redlining, neighborhood disinvestment, health inequities, and disparities in walkability, housing, and green space access was only recently widely acknowledged.8 Numerous books (Table E, available as a supplement to the online version of this article at and dozens of BEH measures (e.g., walkability [https://www.wal kscore. com], access to parks [https://www.tpl. org/ParkScore], livability [http://www.], and brain health [https://cognability.isr.umich. edu]) were also published, reflecting the growth and maturation of the field. The effects of these evolving technologies on land use, housing, economic and community development, traffic patterns, transportation planning and infrastructure, air quality, and associated health outcomes require further research and evaluation (Table G, reference 3).10 PRACTICE Professional organizations across disciplines established BEH committees and working groups (Table F, available as a supplement to the online version of this article at, promoting healthy building and community design through conferences, reports, training, and advocacy (e.g., https://www. Health impact assessments (HIAs) were used to consider potential health impacts of proposed projects and programs and identify disproportionately affected populations as well as how to mitigate adverse effects9,11,12 HIAs improved collaboration, amplified community member voices, increased awareness of health issues, and informed decision makers, but the time and resources required to complete HIAs limited their success.12 Cross-disciplinary public health, planning, policy, real estate, architecture, engineering, transportation, and public-private partnership efforts, along with Complete Streets approaches ( complete-streets), improved pedestrian infrastructure and safety.