The Built Environment and Impacts on Health

April 20, 2021

Yanelle Cruz Bonilla
MPhil in Evidence-Based Social Intervention and Policy Evaluation
University of Oxford
On behalf of the Oxford COVID-19 Evidence Service Team

Correspondence to

The impact of the COVID-19 pandemic in densely populated, urban areas has inspired questions around what actions can be taken to ensure a healthy and just recovery that will eventually lead to a more sustainable built environment, generating a positive balance between public health, and important social, economic, and environmental aspects. Analysis conducted earlier in the pandemic found that some of the temporary measures adopted ­— such as improved HVAC and ventilation systems, larger pedestrian pathways, and improved open access to public spaces — could become permanent solutions that will change built environments, and improve quality of life.

The built environment in which we live and work in can have a significant impact on our physical and psychological health. A case study in South Africa, found that living in an isolated and segregated neighbourhood, with limited access to economic opportunities and inadequate options for safe physical activity, or access to healthy food can lead to a higher risk of non-communicable diseases, depression and stress. Greater local accessibility and access to active travel, such as walking, cycling, and transit infrastructure have been associated with more physical activity, reduced body weight and reduced blood pressure.

Source: Marcin Jozwiak

Research across various locations in the United States found that for certain activities, combined with the awareness of related facilities — such as active commuting, recreational walking, residential land use types, and the presence of nature trails or running tracks nearby —led to participants in the study having lower Body Mass Indices (BMI). Conversely, urban areas with low walkability, a high presence of fast food and dessert destinations, and a lack of green spaces led to higher BMI for participants. While the relationship between the built environment and BMI is complex, this study does suggest that having certain positive conditions in one’s neighbourhood can lead to a healthier lifestyle.

The built environment can also severely affect psychological health, and mental well-being. A study in the United Kingdom found that among different urban environment contexts, living in areas with terraced housing, greater mixed land use, and better opportunities for walking, were all associated with lower risks of psychological distress in older men. A separate study focusing on older adults, found that many aspects of the indoor environment — such as illuminance levels, glare control, a supply of fresh air, and adequate ventilation systems — can pose challenges to the provision of care and well-being for those with dementia.

Source: Ryutaro Tsukata

Building design is an important aspect of health and wellbeing. A study in a cluster of care homes in the United Kingdom found that design features that promote independence, control, and a social environment could reduce feelings of depression in residents. Additionally, they found access to outdoor space alone was not enough to improve health overall, because residents felt constraints due to the lack of even or accessible paths, suitable seating in the garden, and restrictive requirements to gain staff permission to go outside. This shows that simply having certain conditions, such as outdoor space, might not be enough to improve well-being. More attention to detail is required when evaluating existing built environments and implementing changes, particularly when it comes to issues of limited mobility or safety of older individuals, in order for these changes to be inclusive.

Urban design matters not only for residential space, but also for the places where we work. A study in Australia found that a new office design which consisted of various changes, particularly the addition of a central staircase, led to a decrease in sedentary behaviour, and an increase in light physical activity around the building. A survey conducted in Singapore and Hong Kong found that the presence of green or planted terraces, public plazas, and other types of open spaces within workplaces contribute to better health perceptions for workers.

A growing body of research seeking to determine the cost-benefit analysis of making changes to the built environment has shown that it can be beneficial to localities. A case study in the United States found that when making pavements fully accessible to all residents, the combined benefits from increased physical activity and reduced emissions were estimated to be around US$99 million per year for that county. Similarly, an analysis in Australia found that the greatest economic gains can be accrued from increasing destinations, walkability and attributes of design within the neighbourhood area. These results show that while initial investments may be required to implement these changes, there is a capital gain that comes from these improvements that can benefit localities.

Another major takeaway from existing literature on the subject is that governments and urban planners can begin to modify the built environment with initial small changes. A study in Manchester found that small-scale, low-cost improvements to local public spaces led to an increase in usage of the public space, longer durations of stay, and more well-being activities observed in the community. The installation of more park benches particularly stood out as a valuable resource for older individuals and families living in the community. In a survey conducted in the United States, 30% of the respondents said they would walk more often if more benches and water fountains were available. While larger, sustainable changes to existing environments should be the end goal, studies show that even small changes have a positive impact and can be an important first step towards improving quality of life.

However, an important consideration for governments and planners contemplating these changes should be to find ways to integrate efforts to fight against the effects of climate change. A study in the United States found that when comparing high and low walkability urban neighbourhoods, health benefits from increased physical activity were potentially offset by health risks from air pollution exposure. As a result, researchers concluded all individuals, regardless of physical activity levels, experience changes in air pollution exposure. Therefore, the challenge is not solely to create built environments that are conducive to more active lifestyles. Urban planners and designers must also grapple with environmental factors that can offset any potential benefits that an enhanced built environment can provide.

Yanelle Cruz Bonilla is studying an MPhil in Evidence-Based Social Intervention and Policy Evaluation. She holds a Bachelor of Arts in Sociology from Tufts University.

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