Abstract
BackgroundThe built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport.MethodsA structured search was conducted for quantitative systematic reviews and stakeholder reviews published between January 2005 and April 2016. Seven databases and the websites of 15 relevant and respected stakeholder organisations known to publish review-level documentation were searched. Searches were limited to English-language publications and duplicate references were removed. Evidence quality and strength was appraised using validated techniques. Findings were used to develop a diagram for each topic area, illustrating relationships between built and natural environment planning principles and health-related outcomes.ResultsA total of 117 systematic reviews and review-level documents were eligible for inclusion. The quality of evidence was mixed; much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between built environment exposures and health-related impacts and outcomes. Fourteen actionable planning principles associated with positive health-related outcomes were identified across the five topic areas. For example, neighbourhoods that enhanced walkability, were complete and compact in design, and those which enhanced connectivity through safe and efficient infrastructure were associated with better health-related outcomes relating to physical activity, social engagement, mental health, perceptions of crime, and road traffic collisions. Evidence for the effectiveness of planning principles across different topic areas and on reducing health inequalities was sparse and inconclusive.ConclusionsFindings provide an up-to-date overview of relationships between the built and natural environment and health and present logical, evidence-based messages to aid communication between public health and planning professionals.
Highlights
The built and natural environment and health are inextricably linked
Findings relevant to each topic area were extracted separately and this resulted in the following breakdown of eligible reviews for each category: neighbourhood design (N = 32), housing (N = 23), healthier food environment (N = 20), natural and sustainable environment (N = 49), and, transport (N = 29)
The quality of evidence was mixed as much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between specific built and natural environment principles and features and health-related outcomes: one review included original empirical studies deemed to be high quality (1%), 11 reviews contained evidence of moderate-to-high quality (9%), 25 of moderate quality (25%), 14 of low-to-moderate quality (12%), 9 of low quality (8%), and for 52 reviews the quality of evidence from original empirical studies was not reported by review authors (45%)
Summary
There is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport. The broadly cross-sectional nature of the evidence base means it is often difficult to determine cause and effect relationships between built environment exposures and health-related impacts and outcomes, and the potential effectiveness of interventions [2, 4]. It has been acknowledged that evidence for the effectiveness of built environment interventions on tackling health inequalities is limited and unclear [2]
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