Association between Built Environment Policy and Good Health Status

Abstract

ABSTRACT Introduction/Purpose Access to a high-quality built environment may help improve resident health status. However, city-level evidence regarding the health benefits of community assets is lacking. Thus, we aimed to examine the association between environmental indicators of cities and health statuses of residents. Methods This panel study used the American Fitness Index® data reported annually between 2018 and 2022 for the 100 most populous US cities. The study outcome was self-reported good health status of residents, and exposures were environmental factors: parks per 10,000 residents, percentage of walking distance parks, Walk Score®, air quality index, Bike Score®, Complete Streets policy, park expenditure per resident, and physical education requirement. We applied crude and multivariable-adjusted linear mixed and general models in our analyses. Results Among the 100 largest US cities, 84 increased in percentage of good health status from 2018 to 2022, but the increase was at most 13.1%. Furthermore, the maximum percentage with good health status was only between 60% and 70% in most fit cities, and the gap in good health status between most and least fit cities was approximately 40%. Good health status of residents was significantly (in the positive direction) associated with walking distance parks, Walk Score®, Bike Score®, and Complete Streets policy. The baseline percentage for walking distance parks, Walk Score®, and Complete Streets policy were each significantly associated with higher percentages of good health status of residents over the follow-up period. Conclusion Our study shows room for improvement in environments in all cities. Findings furthermore suggest that environmental factors, such as availability of parks within walking distance, walkability, bikeability, and Complete Streets policy, have the potential to impact the general health status of residents of the largest US cities.