Healthy Urban Design

Evidence

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There is considerable literature about area socioeconomic advantage, physical activity, and health. There is only some consideration of variation in the built and social environment by area socioeconomic advantage (a key focus of this module). This review - undertaken by researchers at the University of Canberra's Health Research Institute - primarily includes research from urban and residential areas of Australia, Europe, Asia and the United States of America.

The below content summarises the evidence about:

Variation in the built and social environments by area socioeconomic advantage
The built environment:
Public open space including greenspace
Community facilities
Buildings
Destinations
Movement networks
Housing diversity
Healthy food
The social environment:
sense of place
Other factors impacting physical activity in areas of low socioeconomic advantage

Variation in the built and social environments by area socioeconomic advantage

Providing access to a well-designed built environment with thoughtful design features encourages people to be physically active and healthy. Built environment design features and the social environment (including sense of place) can vary with area socioeconomic advantage and subsequently impact levels of physical activity and health outcomes.

The built environment

The built environment, ‘the human-made surroundings where people live, work and recreate’, plays an important role in shaping everyday life. ² Despite this importance, not all built environments are designed equal, with variation existing in built environment design qualities between areas, including differences based on area socioeconomic advantage.

The below evidence provides a broad overview of the variation in built environment design qualities that tend to exist between areas of different socioeconomic advantage. In providing this broad overview, it is beneficial to keep in mind that built environment urban design features vary across each unique neighbourhood and the tendencies described here may not be what is seen in every area of low advantage.

Public open space including greenspace

Public open space, the variety of spaces within the urban environment that are readily and freely accessible to the wider community for recreation and enjoyment including greenspace, offers a broad range of health and social benefits (see Public Open Space for more information). However, areas of lower socioeconomic advantage may have lower availability of (ie: amount within an area) and accessibility to (ie: distance/proximity to) public open space, as well as public open space of lower quality. Evidence from Australia suggests that areas of lower socioeconomic advantage tend
to have:

smaller amounts of public open space than areas of higher socioeconomic advantage. ^54,55
on average, greater distance from place of residence to public open space than areas of higher socioeconomic advantage. ^54,56 Although this is not always the case, as was shown in Melbourne, where those living in the most disadvantaged areas were closer to all types of public open spaces ⁵⁷ and
public open space of lower quality than areas of higher socioeconomic advantage, with public open space sometimes being of smaller size, poorer maintenance and safety, and having fewer amenities and/or features, such as picnic tables, drinking fountains, water features, walking and cycling paths, lighting, signage, and playgrounds. ^20,55,57-60

Community facilities

Community facilities, public places where members of a community gather for recreational, educational, artistic, social or cultural activities (eg: schools, libraries, community centres, places of worship, and sport and recreation facilities) that are co-located with housing, preferably within walking or cycling distance, provide opportunities for physical activity as well as community interaction and social cohesion (see Community Facilities for more information).

Areas of low socioeconomic advantage may be under-served by urban infrastructure such as community facilities as compared with areas of higher advantage. ^27,61 While Australian outer suburban areas generally tend to be poorly served by local amenity and infrastructure, ²⁶ the picture appears to be slightly more nuanced.

Socioeconomic inequities are more likely in larger cities such as Melbourne, Sydney and Perth where the most disadvantaged areas are mostly concentrated in the outer suburban/middle level areas and under-served by urban infrastructure. However, in smaller metropolitan and regional cities, areas of high socioeconomic advantage are often located in outer-suburban areas, and neighbourhoods of low socioeconomic advantage appear to have significantly higher liveability (including access to community facilities) than the most advantaged areas. ⁶²

Buildings

Buildings, which include a roof and walls and are generally located permanently in one place, provide people with sheltered, secure and comfortable places in which to live, work and learn and can, if designed cleverly, promote incidental physical activity. For example, buildings can be serviced with nearby public transport, provide bike racks and other facilities to promote active travel to the building, as well as encourage stair use for incidental activity within the building (see Buildings for more information).

While there is little research focusing on variation in commercial build quality by area advantage, considerable evidence exists of a socioeconomic gradient in housing, where lower income populations tend to live in poorer quality housing ⁶³ and housing quality tends to be worse in socioeconomically disadvantaged neighbourhoods. ^63,64 This may, however, be influenced by local building standards and market forces. For example, while one recent Australian study found apartments in areas of low socioeconomic advantage in Perth performed worst on most design quality measures (eg: having smaller internal areas and private outdoor spaces), there was little evidence that the design quality of apartments was worse in areas of low socioeconomic advantage within Sydney and Melbourne. ⁶⁵

Destinations

Local access to destinations, such as places of employment, places of education, retail, healthcare, and leisure and recreational facilities, is a key component of the built environment that supports daily living (see Destinations for more information). Neighbourhoods that are compact and mixed-use support local access to destinations.

Generally, evidence from Australia and the United States suggests that, when compared with more socioeconomically advantaged areas, areas of lower socioeconomic advantage may:

have fewer goods and/or services within easily accessible distances; ^26,62
have fewer leisure and recreational facilities and public open spaces within easily accessible distances; ^56,66-68
have fewer places offering employment and education opportunities locally, requiring further travel distances to access these opportunities; ^26,62 and
be located further away from central business districts and have longer travel times. ^62,69,70

The area-level socioeconomic differences that can be seen in access to destinations are often linked to locational disadvantage, whereby lower socioeconomically advantaged areas are generally located in middle to outer suburban areas. ⁶²

Movement networks

Movement networks, the interconnected system of paths, streets, and roads within and between areas, can influence how people traverse and perceive their local environment (see Movement Networks for more information). Ideally movement networks should be safe and well connected between residences and potential destinations and include quality, maintained foot (or cycle) paths, lighting, street trees and the occasional bench.

The evidence from Australia, New Zealand, and the United Kingdom suggests inequality in elements of movement networks may exist between areas of different socioeconomic advantage, with areas of lower socioeconomic advantage generally having:

poorer walkability, including lower street connectivity, lower residential density, and lower land use mix. ⁷¹ This is more prevalent for disadvantaged areas located in outer suburban fringes. However, some disadvantaged areas can be more walkable than more advantaged areas; ^71,72
poorer walkability in neighbourhoods surrounding disadvantaged schools; ^73,74
lower presence and/or quality of pedestrian infrastructure including minimal buffers between pedestrians and cars, fewer and/or poorer continuity of footpaths and cycleways, more poorly maintained footpaths and cycleways (eg: broken/uneven), and less traffic calming infrastructure; ^75-77
less public transit infrastructure, requiring longer travel distances to access public transit, and more time spent commuting to destinations. ^26,62,71,78 Although, areas of lower socioeconomic advantage in Brisbane had better transit access than more advantaged areas; ⁷²
increased exposure to high volumes of traffic, lower traffic safety and higher road traffic injuries, and poorer traffic- and industrial-related air quality; ^72,79-82
poorer streetscape aesthetics, with lower cleanliness, higher signs of physical incivilities
(eg: litter/graffiti/vandalism), poorer street lighting, and fewer trees on streets and in private gardens; ^75,83-86 and
lower perceived safety, with greater perceived fear and/or risk of being a victim of crime. ^75,87

Housing diversity

Housing diversity, the range of housing types and lot sizes in a development or neighbourhood, can assist to create a local population large enough to support a vibrant community and a broader range of services within walking or cycling distance, thereby encouraging physical activity (see Housing Diversity for more information). Having a range of housing options can support a diversity of residents and household types across the lifespan (eg: young families, professionals, retirees, people with disability).

Higher density design, particularly close to the neighbourhood centre (eg: shops and services) as well as near public open spaces, means key local resources will be accessible, ideally by walking or cycling.

Greater residential density has been linked to physical activity and better health. Whilst overall it is considered that higher density designs are beneficial, careful consideration of other factors is needed in order to avoid negative outcomes. Dwellings should be designed to maximise natural light, provide clean air ventilation (ie: avoiding car and other exhausts as inputs, and avoiding internal dampness and mould), adequate insulation, heating and cooling, and address noise management (see Housing Diversity).

Focusing on housing diversity and density within less socioeconomically advantaged areas, evidence suggests that these areas tend to:

have lower dwelling density; ⁷¹
be less walkable; ⁷¹ and
have a locational disadvantage being further from the city centre and related resources, with less advantaged areas typically located from middle suburbia to areas out on the urban fringe. ^62,88 Transport options to these areas are often limited and support services more difficult to access. ⁶² This may be due, in part, to areas of lower socioeconomic advantage generally having lower social capital, ⁸⁹ and consequently, less community capacity to advocate for better service provision. Additionally, locational disadvantage is more prevalent in larger cities than smaller or regional urban centres. ⁶²

Some Australian studies, such as the HABITAT study in Brisbane, reported no association between less area advantage and dwelling density, and found other walkability factors (street connectivity and land use mix) were actually higher in less advantaged areas. ³² This highlights variability in the design principles such as dwelling density, street layout, and land mix between Australian cities as well as within Australian capital cities. Cities, and areas within cities, reflect the design principles of the time they were first built, and these principles change over time. This can be seen when comparing older cities (eg: Sydney) with newer cities (eg: Canberra) in terms of overall city plan as well as within area plans. Cities also grow and change over time with areas closest to the central business district (CBD) often the oldest, and newer builds (applying more recent design principles) often further from the CBD. However, cities also undergo in-fill and urban renewal reshape dwelling density and land use mix within areas – for example transforming a less advantaged area relatively close to the CBD that was once an industrial area into new housing which also typically changes the level of area advantage from low to higher.

The age of a city and where areas are within this renewal process impacts the distribution of areas of disadvantage across the city (along with geographical factors such as pleasant views) and consequently the relationship between area disadvantage and dwelling density. ^90-92

Regarding housing diversity (beyond density) and quality, there is a lack of research focused on variation in these by area advantage. However, individuals who are less socioeconomically advantaged tend to live in less advantaged areas and are more likely to reside in a poorer quality residence ⁶⁴ or have at least one major structural problem with their residence. ⁹³

Healthy food

The built food environment, that is the density and variety of local food outlets, can influence health and dietary behaviour (see Healthy Food for more information). Variations in the built food environment can exist between areas of different socioeconomic advantage. International evidence, primarily from the United States, indicates that less socioeconomically advantaged areas tend to have poorer access to healthy food outlets (eg: supermarkets/greengrocers) compared to areas of higher socioeconomic advantage. ^48,94,95

Within Australia, the evidence is less clear, ⁴⁸ with some studies reporting poorer access to healthy food outlets in socioeconomically disadvantaged areas, ^96-98 and other studies reporting no differences or better access in disadvantaged areas. ^99,100 There is, however, consensus that areas of lower socioeconomic advantage have greater access to, and density of, unhealthy foods outlets (eg: fast food) than more socioeconomically advantaged areas. ^98,101-104

The evidence from Australia also suggests that areas of lower socioeconomic advantage, compared to those of higher advantage, may have:

poorer availability, poorer quality, and less varieties of fruit and vegetables in local outlets.105,106 However, there is some evidence indicating no differences exist between areas of high and low socioeconomic advantage; ^107-110
lower costs of healthy food baskets, including fruit and vegetables.105,108 Although, some studies have reported no difference in cost; ^107,110
higher exposure to unhealthy food outlets around schools. ^101,111 For example, disadvantaged schools in Adelaide had 1.6 times and 9.5 times greater risk of exposure to fast food within 1000m and 1500m respectively; ¹¹¹ and
more advertisements for unhealthy food items. ¹¹²

The social environment: Sense of place

Sense of place, how a person feels about a place and their relationship with that place, can be influenced positively by a well-designed area that enables residents to know their neighbours and other locals (see Sense of Place for more information).

Urban design features have been linked to sense of place, and a positive sense of place is in turn associated with better mental health and wellbeing. ¹¹³ In brief, key design factors that support the development of a positive sense of place include being pedestrian friendly with appealing destinations such as cafes and parks, and services, as well as accessible transport options. Areas should be attractive, feel safe, clean and comfortable, and promote social connection through deliberate as well as chance encounter. ¹¹⁴

The previous sections have already summarised important urban design features and highlighted the variation we see in these features based on area-level socioeconomic advantage. Here we will focus more on variation in the neighbourhood social environment, in particular, the relationships between and within the local social groups, and social processes among residents of the neighbourhood. ¹¹⁵

Health and physical activity differences based on area socioeconomic disadvantage have been attributed to less positive social environments in terms of social capital, social cohesion, sense of community, safety, social incivilities, and physical disorder. ^115,116 Few Australian studies have directly assessed variation in the social environment by area deprivation. However, the available Australian evidence generally seems to align with the above statement. For example, one Victorian study reported less socioeconomically advantaged neighbourhoods were negatively associated with various aspects of neighbourhood safety such as social incivilities (eg: public drinking, evident drug use, criminality, vandalism, and conflict) and physical disorder (neglected properties, derelict buildings, graffiti and dirty streets). ¹¹⁷ Similarly, a Brisbane-based study reported residents of the most disadvantaged neighbourhoods perceived their neighbourhoods to be less safe from crime than residents of more advantaged neighbourhoods. ⁸⁷

Many of the above factors are likely influenced by residential mobility with higher turn-over of local residents negatively impacting the local social environment. ¹¹⁸ Importantly, the above information on variation in the social environment by area advantage is a generalisation of the research and will not be the case in all neighbourhoods.

Other factors impacting active living in areas of low socioeconomic advantage

Greater vulnerability of disadvantaged areas and individuals to inadequate local environmental design features

As highlighted above, less advantaged areas may have less supportive design features thus impacting opportunity for active living and related health outcomes for local residents. ^51,119 Socioeconomically disadvantaged areas and individuals may, in addition, be more vulnerable to inadequate local environmental design features. ^51,119

Living in less advantaged neighbourhoods can be particularly detrimental to individuals with lower socioeconomic backgrounds because they tend to be more reliant on the local services and amenities (sometimes lacking in areas of low socioeconomic advantage), while individuals with relatively more disposable income have capacity to overcome local barriers to active living and health. ^120,121 For example, car ownership and the ability to pay to access a fitness centre can reduce the impact of the lack of freely available quality physical activity resources in the local area, but individuals with less fiscal resources (and no car) may be unable to access wider facilities and therefore be more vulnerable to the impact of an unsupportive local environment (deprivation amplification). ^4,121

Complex interplay between design features, local sociodemographic factors and local social environment factors

Several factors can influence the extent to which individuals engage in physical activity within their neighbourhood, including:

opportunity (time spent there, availability of free time and transport);
personal drivers and motivations to use (perceptions and awareness of environment, including safety); and
ease of use/interaction (practicalities and safety from hazards eg: fast traffic, uneven footpaths, crime). ¹²²

The interplay between design features and local sociodemographic factors (which influence opportunity and personal drivers and motivations), local social environment factors and other design features (both of which influence personal drivers and motivations and ease of use/interaction) creates a level of complexity that warrants careful consideration.

Local sociodemographic factors, built environment and physical activity

Local sociodemographic factors such as ethnicity and cultural background, age, socioeconomic background, and family structures including child status influence the value different groups place on different design features within their neighbourhood, ¹²² and the likelihood of engaging in physical activity. For example:

perceived barriers and perceptions of the suitability of the environment for physical activity (eg: safety and aesthetics of the built environment; adequacy of public recreation facilities) have been shown to vary between cultural groups (older Italian, Vietnamese and Anglo-Celtic women in the Western region of Melbourne) ¹²³ (although Australian studies are lacking);
middle aged adults are less sensitive to greenspace provision than younger and older groups ^124,125 - hypothesised to be because middle-aged adults are at work, whereas the younger and older groups are spending more time in the neighbourhood and are therefore more reliant on the resources within it; ¹²⁶
individuals from lower socioeconomic backgrounds tend to benefit more from greenspace, ¹²⁷ and walk more for transport, particularly if they lack access to a motor vehicle and the built environment is conducive to walking; ^32,128 and
a family with young children might prefer smaller areas of greenspace with play, toilet and parking facilities, while a jogger running solo may want a large green space with quiet paths. ^129,130

Local social environment factors, built environment and physical activity

Social environment factors such as crime rates and cultural and social attitudes and cohesion can impact personal drivers and motivations to be in the built environment as well as its ease of use. ¹²² For example, high crime rates (real or perceived) are likely to discourage people from being outside, ¹²² and busy roads with fast traffic and derelict housing are likely to discourage active travel to destinations, including for physical activity such as greenspace or parks. ¹³¹

Cultural, social and personal attitudes to use of the outdoors and physical activity, while harder to quantify, are also likely to be important, with the concept of accessibility (ie: being easy to access) strongly shaped by these. Indeed, the social perceptions of accessibility along with the social meaning attached to greenspace may be more important drivers of health than having physical access to built environment design features that are supportive of physical activity. ^122,132

Interplay between multiple built environment factors and physical activity

The interaction between multiple built environment factors can impact personal drivers and motivations, and the ease with which residents are able to utilise features within neighbourhoods of lower socioeconomic advantage. For example, free to use public greenspace is likely to be of particular benefit for people living in high density apartments without private gardens, private residential tree coverage or the time or money to travel for physical activity ^84,122 and is associated with enhanced life satisfaction benefits for people living in more densely populated areas. ¹³³ Minimal buffers between pedestrians and cars (eg: footpath being right next to the road), poor footpath quality (or absence of footpaths altogether) and (as mentioned above) busy roads with fast traffic are also likely to impact active travel. ¹³¹

The unique characteristics of each neighbourhood of lower socioeconomic advantage will lead to variations in the interplay between design features, sociodemographic features and social environment factors with the result that a needs-based approach to the optimal configuration of the neighbourhood will likely be warranted.

Insights from workshops in three Australian Communities of lower socioeconomic advantage

The previous sections on this Evidence page have outlined differences in physical activity and health between residents of areas of low and high advantage as well as variation in the built environment. In developing the mobilisation strategies and checklist for this module we also conducted a series of workshops in three communities of lower socioeconomic advantage to understand their lived experiences, including what enables active living and their perceptions of what barriers exist.

What we did

Six face-to-face workshops of approximately 2 ½ hours each were conducted in three communities (two workshops per community) of lower socioeconomic advantage, one with government representatives including council staff and local industry practitioners (Friday afternoon), and one with local community members (Saturday morning). This research received approval from the University of Canberra Human Research Ethics Committee (13741).

How we chose the communities

Three socioeconomically disadvantaged council areas were selected based on Australian Bureau of Statistics’ (ABS) Socio-Economic Indexes for Advantage Index for Relative Socioeconomic Disadvantage rankings (SEIFA), ⁵ current physical activity and health and wellbeing initiatives, and regionality: George Town, Tasmania (regional); Fairfield, New South Wales (outer suburban); and Mirrabooka, Western Australia (inner city).

Recruitment of participants

Government representatives at each of the three councils were identified through their roles and positions within community development, planning and development and other related fields. Recruitment of community members occurred through collaboration with the local council, Heart Foundation walking programs, relevant local community organisations and local businesses. A digital flyer (along with print copy version) was provided to the Councils and community organisations to assist with promotion, and interested people invited to contact the researchers if they wished to know more. The Heart Foundation also supported each of the three local councils to promote the community workshops through their community communication channels.

How we ran the workshops

Workshops consisted of a short introduction to the session, presenting the purpose of the workshop and key background information such as the importance of physical activity to health and ways in which the built environment can impact and/or support this. We then asked participants to tell us about current initiatives in their area, and to identify local barriers and enablers to active living in their community. Following this, as a group and using a consensus approach, ¹³⁴ workshop participants were asked to rate the identified barriers based on their i) importance to active living, and ii) feasibility to change. Barriers identified as both important and feasible to change were noted as potential focus points for intervention within those communities. These are summarised below.

Key findings

The workshops were well attended with 56 participants across the six workshops: 31 Council staff, stakeholders and practitioners (10 men and 21 women); and 25 community members (7 men and 18 women).

Active living enablers

Workshop participants identified a range of things that enabled (or would enable) active living in their neighbourhood, including:

clear activated destinations, facilitated by way-finding signage and maps (on-line and in-print) that outline continuous lines of travel and curb cuts through the central neighbourhood;
multi-use destinations (eg: sports fields with playgrounds, show grounds with soccer fields and walking paths; places with multiple social services and recreation/other opportunities: markets, dancing and food);
connected places (supported through regular identification of missing links/snail trails and resulting establishment of new walking infrastructure/footpaths) and connection to place;
access to attractive natural environments (eg: beach, rivers and mountains), including through extended recreational walking tracks;
free (or lower cost) access to bikes and bike-riding lessons, mountain bike trails, park gyms, basketball courts, skate parks, parkour ranges, dance classes, youth and leisure centres and swimming facilities; and self-organised social and fitness groups (including walking groups operating in local shopping centres);
community and library facilities that provide information and activities for culturally diverse communities; and
a built environment and parks that support dogs walking their humans (including off-leash).

Opportunities to meet with friends, a sense of community and community leadership and ownership, and support from planners, developers and businesses were also seen as essential to maintaining and growing a local built and social environment supportive of active living.

Barriers to active living

Workshop discussions identified a range of built environment design elements as well as local social issues as barriers to active living (summarised below). Overall, these findings align with the literature as presented in the Heart Foundation’s Healthy Active by Design design features and elsewhere in this module.

Public open space, movement networks, and sense of place tended to be the focus of workshop discussions:

For public open space, workshop participants noted the need for parks to be locally available and accessible, attractive, appropriately maintained, with quality paths/trails, and to feature key amenities such as toilets, BBQs, water, shade, and lighting. The need for at least one large multiuse park within walking distance of a place of residence to support different types of users and activities was also highlighted.
Regarding movement networks, key issues related to the quality and connectivity of footpaths (and cycleways) with a lack of connectivity between key destinations (public open space, shops/services), as well as generalised path issues of missing or discontinuous sections, paths only on one side of the road, and difficulties with crossing roads (eg: lack of crosswalks).
Variation in public transport was noted between communities, with one having no public transport, one having various local options though with a variety of issues such as safety concerns and connectivity/time in routing, and the third community being well connected by public transport but with some safety concerns. This variation highlights how every community is unique.
Sense of place was an important discussion topic, particularly in two of the communities. Complex social issues that were identified included:
negative impacts of high transient rates on sense of ownership and community, social connections, and neighbourhood pride;
evidence of vandalism/dumping/litter and lack of community sense of empowerment to notify authorities or take action;
tensions between cultural groups (and a lack of understanding, appreciation and awareness of different cultural norms and behaviours);
a lack of appreciation of gender-norms within some cultural groups (and thus lack of provision of appropriate spaces reflecting these cultural needs);
lack of trust in government/authority;
the impact of historical issues and related safety and stigma which all together contributed to a general sense of feeling unsafe in some areas; and
the impacts of external perceptions of an area as a source of community stress and resulting lack of external, private investment.
Sense of place was also negatively impacted by physical environment changes such as land being cleared and remaining vacant for extended periods of time with a resulting lack of birds and wildlife and the creation of heat islands and generally unpleasant areas.