408 Research Group | Health England: Five Elements of Health-oriented Spatial Planning
The following article comes from environmental design research, written by the Ministry of Public Health of England.

Environmental design research
Urban design research exchange platform based on [408 Research Group]


author
English Ministry of Public Health
Andre Pinto; Jacy McGaw-Césaire;
Carl Petrokofsky,; Paul Pilkington
University of the West of England
Emma Bird; Janet lge; Jilla Burgess-Allen
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Meng dancheng and tan yuxing, master students of Tongji university, 408 research group
According to the literature review of the impact of built environment on health, this report draws a series of practical charts to explore the relationship between built environment and natural environment and health results. Based on the literature review of the University of the West of England, this report was summarized by the British Ministry of Public Health in 2017.
http:/eprints.uwe.ac.uk/31390/
brief introduction
Built and natural environment are the key environmental determinants of health and happiness. In this report, "built and natural environment" refers to the physical environment where people live, work and play, including: schools, workplaces, families, communities, parks/entertainment areas, green spaces (i.e. visible grasslands, trees and other vegetation) and waters.
The relationship between health and man-made and natural environment has long been established, and the role of environment in shaping the social, economic and environmental environment that determines health is increasingly recognized and understood. More and more studies show that the environment in which we live is inextricably linked with our health all our lives. For example, the design of our community can affect the level of physical activity, travel mode, social contact, physical and mental health and happiness results. However, it must be recognized that the causal relationship between built environment and health is often complicated, because they are influenced by many factors and sometimes contradictory.

Health map-based on Barton, H. and Grant, M. (2006).
Content summary
This assessment mainly focuses on five aspects of the built and natural environment:

These five aspects of completion and natural environment are considered to be the main aspects affected by local planning policies. These aspects can be designed and shaped by planners to promote health.
I. Neighborhood Design
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Principles of building a healthy neighborhood

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1. Strengthen the walkability of the neighborhood:
Characteristics of pedestrian-friendly blocks: good street connectivity, mixed land use and compact residential design.
There is evidence that walkable communities can encourage travel and promote physical activity.
Improving recreational and non-recreational destinations (such as grocery stores, schools and other facilities) can also have a positive impact on the social interaction of the elderly.
The improvement of infrastructure can encourage all ages to travel and increase the level of physical activity.
2. Build a complete and compact community:
In communities with higher street connectivity, the grid pattern design is more detailed, which is conducive to mixed land use, improved residential density and non-motorized transportation.
Improving facilities can improve the mobility and social participation of the elderly. Giving priority to the development of schools, recreation centers and social facilities can increase the sports activities of children, teenagers and the elderly.
3. Strengthen interconnection with safe and efficient infrastructure:
Providing infrastructure for walking and cycling and improving public transport can enhance the connectivity of streets.
Improvements in the public sphere. The improvement of the overall environment may reduce the fear of crime. If street lighting is provided in residential areas, traffic accidents will be reduced and pedestrian activities will be increased.
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case
Case 1: Vibrant Street Pedestrians

The "Vibrant Street Pedestrian" project (2008-2012) aims to improve specific walking routes and promote walking in 12 regions of 5 regions in England. The level of community sports activities in these areas is low and the obesity rate is high. Taking Bolton as an example, with the help of local schools, on the way from two residential areas to towns and schools, the project team upgraded the road signs and artistic design to improve the walking route.
Community participation is advocated in the work of living streets; Experience shows that contact with local residents is the best way to understand the problems they live in.
Case 2: Pedestrian block

Lack of exercise is associated with diabetes, heart disease and some cancers. Participants in this study came from 14 cities in 10 countries and surrounding areas.
The communities sampled in this study are different in socio-economic status and walkability. This study uses Geographic Information System (GIS) to measure the density of residents, street connections, public transport stations, the number of parks, mixed land and the nearest public transport points. Researchers wear a small electronic device called an accelerometer around their waist for a week to record every minute of exercise.
The overall survey results of all 14 cities are as follows:
Characteristics of activity-friendly community: residential density, number of public transport parking spots, number of street connections, etc.
Adults living in the most active and friendly communities exercise 48 to 89 minutes more every week than those living in the least active and friendly communities.
These beneficial characteristics are related to sports activities independently. The relationship with physical activity is also linear; For example, the higher the level of residential density. The higher the level of physical activity.
In different cities, the relationship between community characteristics and residents’ sports activities is usually similar.
There is no significant relationship between mixed land use and the nearest public transportation point and the level of physical activity.

Impact on public health and planning professionals:
Similar findings in different cities and different socio-economic groups show that changing the built environment is a solution that can be used to improve international health.
This study strengthens the previous call to prevent major chronic diseases by changing policies in urban planning, public transportation, developing parks and recreational facilities, and increasing sports activities.
In order to keep healthy, adults are advised to do 150 minutes of physical activity every week, and living in an activity-friendly community can provide 32-59% of it.
Because the relationship between activity-friendly community characteristics and sports activities is linear, it means that no matter whether the starting point of urban residents is high or low, the improvement of the built environment is expected to increase sports activities.
The great difference in sports activities between participants living in the most suitable community and those living in the least suitable community provides a strong reason for public health institutions to cooperate with other institutions to create a healthier city, especially urban planning, parks and entertainment, and transportation departments.
Making cities more conducive to activities may be an important part of solving the global problems of death and disease.
A comprehensive method is needed to add as many walking functions as possible to design an activity-friendly community.
Second, the residential design
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Principles of building healthy housing

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1. Improve the quality of housing
There is evidence that living in a warm and energy-saving property can improve general health outcomes, reduce breathing conditions, improve mental health and reduce mortality. Renovation to improve housing temperature and energy efficiency may help reduce health inequality among low-income groups, especially the elderly and those with chronic acquired diseases.
High-quality housing can also reduce the risk of accidental injury or death. For example, interventions to improve residential lighting and reduce indoor hazards can improve social outcomes. Reduce the injuries caused by falls of the elderly.
There is evidence that house renovation, including moistureproof, re-roofing and installation of new windows, is related to the improvement of overall health outcomes.
The impact of fuel poverty on health is beyond the scope of research. However, in a report, fuel shortage has been proved to be related to excessive death in winter, increased prevalence of chronic diseases and poor mental health.
However, this review has not found any reliable evidence related to sunlight, ventilation and health results, that is, there is a link between poor indoor air quality and diseases.
2. Increase the supply of affordable housing and diversified housing:
Providing various forms and types of housing is related to increasing physical activity.
The attached conditions of mixed land use and affordable housing are closely related to improving the safety perception nearby. Especially individuals from low-income groups. However, the impact of this housing supply on improving health outcomes and reducing health inequalities is unclear.
3. Increase the provision of affordable housing for groups with specific needs:
Providing housing for vulnerable groups, including adults with mental retardation and adult drug users, may improve social, behavioral and health-related outcomes.
Provide safe and affordable housing for those with chronic diseases, such as AIDS; This can increase participation in health care services.
In addition, the provision of affordable housing and affordable housing has also been proved to reduce participation in risky health-related behaviors.
Providing affordable housing for the homeless can increase participation in medical services, improve the quality of life and increase employment. It has also been proved to help improve mental health.
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case
Case 1: improving housing and childhood asthma
One in 11 children in Britain suffers from asthma, which is the most common long-term disease in childhood. The NHS spends about 1 billion pounds a year on treating and caring for asthma patients. The Kalisma project aims to improve the living conditions of children with moderate and severe asthma in Rexham and improve their asthma health and quality of life. The study evaluating the project investigated the effect and cost-effectiveness of strengthening indoor ventilation in the homes of 177 children with "moderate" or "severe" asthma in Rexham.
Housing officials of the local government visited each child’s house, and they assessed the areas that needed improvement. The ventilation system is installed in the roof space of the house. The central heating system is improved to reach a certain standard; If the new system does not exist, install the new system. These improvements are free for these families.
After tailor-made ventilation and heating transformation, the proportion of children in the intervention group who changed from "severe" asthma to "moderate" asthma was 17%, while that in the control group was 3%, with an average cost of 1,718 pounds per child. However, the plan has no obvious impact on the cost of medical services. At each point, the specific scale of asthma improvement is 234 pounds, and this measure is considered to be a cost-effective resource use. The analysis shows that there are differences in cost-effectiveness between children with severe asthma and children with mild asthma. Therefore, improving the housing situation of children with "severe" asthma is even more convincing than improving the housing situation of children with "moderate" asthma.
Iii. Food environment
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Principles of building a healthy food environment

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1. Provide healthy and affordable food for the general public:
Provide more healthy and affordable food for the general population. It also shows that improving eating behavior, such as increasing the consumption of fruits and vegetables, is related to increasing the access to healthy and affordable vegetables.
The increase of access to unhealthy food retail stores is related to the increase of the weight of the general population, the obesity of children living in low-income areas and the increase of unhealthy eating behavior.
Increasing retail channels to sell healthier food is related to improving eating behavior and adult weight.
2. Strengthen community food infrastructure:
There is a positive relationship between urban agriculture and the improvement of people’s attitude towards healthier food, the increase of sports activities and social contact opportunities, and the increase of fruit and vegetable consumption.
The impact of providing and obtaining allocation funds and adequate garden space on health is beyond the scope of this all-inclusive review. However, the findings of a recent non-systematic literature review show that gardening may have a lot of positive physical and mental health-related effects and results in the distribution environment in Britain.
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case
Case 1: Garden of Life

The Women’s Environmental Network (WEN) was entrusted by the Ministry of Public Health in Lai Ci, Tauerham, London, to help build 15 community gardens in this area. This 15-month project (April 2014 to July 2015) aims to help improve residents’ well-being by providing more healthy food, and to create community cohesion through joint efforts and develop planting space with the support of Wen’s community garden coordinator.
Fifteen community gardens were successfully established by using two gardening coordinators, who employed 4,485 residents of Tower Hamlets. 178 residents actively participated in gardening activities, mainly growing food, and were supported by training courses, which covered practical and theoretical topics such as base planning, garden design, organic food planting, healthy eating and cooking, and tailored each workshop according to the needs of the group.
The "Garden of Life" project shows that more than half (59%) of the participants (12.5%) have improved their happiness. "Life Garden" provides people with new opportunities to meet their neighbors and build a sense of community around the garden itself. The project has successfully promoted these five ways of happiness; By learning new skills, sharing their achievements with friends and family, and increasing their sports activities, including contact, activity, concern, continuous learning and giving. The project provides local food and encourages healthy eating. Personal feedback highlights a lot of community interests and how gardens help build social capital.
IV. Natural and sustainable environment
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Guidelines for natural and sustainable environment

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1. Reduce exposure to environmental hazards
Living in areas with fresh air will have a positive impact on people’s health behavior. The improvement of air quality is related to the increase of physical activities of the elderly.
Exposure to air pollutants has obvious adverse effects on the health of all people. Poor air quality will increase the risk of heart disease and develop into a chronic disease. Such as neonatal complications, cancer, worsening respiratory outcome and child mortality, and so on. It is worth noting that there is consistent evidence that exposure to particulate matter (PM2.5 and PM10) will have adverse effects on health.
Exposure to excessive noise is associated with poor mental health outcomes, especially among the elderly and children. It is also related to the higher anxiety level of adults.
Floods will affect people’s physical and mental health, including increased risk of mental illness and chronic diseases.
In case of flood/disaster, the risk of carbon monoxide poisoning and mental health problems increases.
2. Contact and participation in the natural environment:
Contact and participation in the natural environment are related to many positive health outcomes, including improving physical and mental health. Reduce the risk of cardiovascular disease, death and other chronic diseases.
There is consistent evidence that there are recreational facilities. For example, parks and playgrounds can reduce the risk of obesity among teenagers and increase physical activities. Living near green spaces, such as parks and other open spaces, can improve health.
The improvement of aesthetic parks can increase the visits of children and the elderly and improve physical activities. There is also evidence that improving the appearance of parks can increase the use of children and the elderly and increase physical activity.
Taking part in sports activities in natural environment can improve mental health results more than taking part in sports activities in indoor environment.
3. Adaptation to climate change:
Evidence shows that greening (planting trees) has a cooling effect on the environment, and urban parks are about 1 degree Celsius lower than non-green sites. Empirical research shows that the implementation of green infrastructure may have the ability to reduce the urban heat island effect.
The effects of high temperature and severe cold on health are beyond the scope of this review. However, the UK Climate Change Risk Assessment (CCR, 2017) lists the health risks of extreme temperatures unique to the UK, and these extreme temperatures are likely to increase due to climate change. Extreme heat and cold are associated with potentially fatal diseases, such as heatstroke or hypothermia, and increased death from cardiovascular and respiratory diseases. The rising temperature indicates that there will be more heat waves in Britain. However, due to the aging population, extra deaths caused by cold weather will still be challenging.
Additional findings show that stagnant weather can reduce air quality and have a negative impact on health by trapping warm air and cold air, leading to smog.
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case
Case 1: Would you prefer living in a green urban area?
This study uses large national representative data from the longitudinal survey of British households. The survey contacted the same people at regular intervals (up to 18 consecutive times) and asked them a series of questions every time, including their current work, marital status, address, income and happiness.
The focus of the analysis is those who have moved between different cities in England for 18 years (or less). What researchers want to know is whether they are "happy" (with greater life satisfaction and fewer symptoms of anxiety and depression). In the same period, understand how many green spaces they live in urban areas, the income changes after the changes in their lives, and their marital status.
Even considering other changes in personal life (such as income, employment and marital status), people have higher life satisfaction and fewer symptoms of anxiety and depression when they live in urban areas with better greening. For individuals who migrate from low to high green urban areas, this growth is immediate and lasts for at least three years (the longest post-migration time we can explore). For those who move from high green areas to low green areas, this pattern is not so clear, probably because their motives for moving are more diverse (for example, to get a better job).
Case 2: Mortality of Urban Heat Island Effect during West Midlands Heat Wave

Average temperature model of West Midlands from August 1 to 10, 2003.
W = wolverhampton wanderers, B= Birmingham, C= Coventry.
The researchers established a regional climate model with a resolution of 1 km, covering most areas of the West Midlands. The model includes the urban surface and buildings in the West Midlands, so it can visualize the spatial distribution of temperature in the whole area and quantify the UHI intensity. By deleting the regional model of urban surface and comparing two maps with different temperatures, we can estimate the local temperature of urban surface, and then use the relationship between temperature and mortality to estimate the impact of mortality caused by high temperature on heat island and estimate the increase of temperature caused by climate change.
Health impact assessment is applicable to the whole modeling area, and includes the whole population (about 5 million people) in the area. In the heat wave in 2003, people in the most developed areas were most likely to be affected by heat, and they were most vulnerable to UHI. Older African National Congress (anc) people who have diseases are the most vulnerable to the threat of high temperature. Some housing types (such as loft apartments) will also increase this risk.
Impact on public health and planning professionals: The high-resolution spatial modeling demonstrated here can help highlight the spatial vulnerability of built-up areas. Health impact assessment using rough climate models to assess future temperature impacts may underestimate the mortality associated with high temperatures. In this case, if the urban impact is not included, the health impact assessment will only capture 50% of the mortality rate, and UHI is included. Planners should consider the extra warming caused by UHI effect. And the potential impact on health when planning future infrastructure. Measures such as green space, green roof, blue space or high albedo surface should be considered to reduce these health effects, and the same model is being used for research.
V. Transportation
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Principles of healthy traffic

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1. Provide active tourism infrastructure:
Investing in infrastructure to support walking can increase the level of physical activity and improve the mobility of children. Adults and the elderly. By investing in bicycle infrastructure, giving priority to active travel can bring a lot of health benefits. For example, the implementation of new bicycle lanes can improve the cardiovascular status and weight status of children, adults and the elderly.
2. Provision of public transportation:
Evidence shows that combining public transport with other forms of activities such as walking and cycling can improve cardiovascular health. Providing high-quality public transportation for children is related to high-level activities.
Active travel in low pollution areas is related to the increase of physical activity of the elderly. The perception of air pollution seems to constitute an obstacle to participating in outdoor sports activities and active traffic activities.
3. Give priority to active travel and road safety:
Giving priority to pedestrians and cyclists by changing infrastructure is related to positive behavior and health outcomes. For example, separating bicycle and pedestrian infrastructure from road traffic can encourage people to travel actively.
Traffic calming measures, including deceleration and speed limit meter.
Improvements in public areas, such as street lighting, have been proved to increase the participation of other adults in sports activities and reduce the incidence of road traffic collisions.
4. Mobility for all ages and activities:
The architectural environment strategy to promote sports activities can have a positive impact on participating in sports activities.
The positive relationship between active school or work travel and improving cardiovascular outcomes.
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case
Case 1: Improve the connectivity of local walking and cycling routes.

Connect2 is a major new project to promote walking and cycling by improving local walking and cycling routes in 79 locations in the UK. The travel physical activity and carbon emission impact of Connect2 project are mainly evaluated by three case study projects in Cardiff, Kenilworth and Southampton, and residents within 5km.
Each Connect2 base includes a key project to overcome physical obstacles (a bridge in Cardiff Bay, a bridge in Kenilworth’s two lanes, and a boardwalk along the river in Southampton), plus the improvement of the signed roads and feeder roads, leading to key projects. The projects are tailor-made for individual locations, but they all reflect the desire to create new routes for "every day". Travel by foot or bike to schools, shops, parks and villages.
Living near the new route can’t predict the change of activity level after one year. But with those who live far away (walking and cycling for 15.3 minutes more every week, each kilometer is closer; The extra time for total strength activities per week is 12.5 minutes). The new route may replace walking or cycling in the short term, but it will produce new trips in the long term, especially for those who can’t travel to distant destinations by car. These findings support the potential of walking and cycling infrastructure to promote sports activities.
Case 2: Cambridge University Taxi

Improving transportation infrastructure and supporting walking and cycling on the way to and from work may help promote physical activity and improve the health of the population. The commuting and health research of Cambridge University aims to assess whether the investment in new high-quality transportation infrastructure is related to the increase of active commuting; The broader impact of tourism behavior changes on health; Determinants of active commuting land absorption; And how the changes in travel behavior are distributed among the population and related to the broader social background. These goals are achieved through an experimental cohort study, which studies commuters who live within 30 kilometers from Cambridge and work in Cambridge, and combines interesting and supplementary in-depth quantitative and qualitative research.
Guided bus lanes in Cambridgeshire were opened in 2011, including a new bus network, 22km long guided lanes (dedicated bus tracks) and a free road for pedestrians and cyclists.
Commuting practice is complicated and is influenced by various changeable social and environmental factors. Walking and cycling are often included in the long commuting distance, mainly by car or public transport. In the three-year follow-up survey, living closer to the bus line is more likely to greatly increase the proportion of commuting trips involving any active travel, greatly reduce the proportion of completely driving trips, and increase the weekly commuting time. There is a mixed effect model at the individual level, and intervention provides a more positive commuting environment for some people, but not for others. There is evidence that this effect is most obvious among those who report that they do not commute actively at baseline, and the observation results show that there is a link between active commuting, greater overall physical activity, improved health and weight status. These findings provide new empirical support and direction for reconfiguring transportation system to improve population health and reduce health inequality.
conclusion
This review summarizes the evidence of the relationship between built and natural environment and health. The five key aspects of built and natural environment are neighborhood design, housing, healthy food, natural and sustainable environment and transportation. In this paper, all fields of built and natural environment are studied, and the evidence shows that there is an inseparable relationship between built and natural environment and health.
The environment in which people live has a far-reaching impact on health and happiness. In addition to the direct health benefits. The completion and improvement of the natural environment will affect people’s attitude, behavior and perception of the environment. For example, reducing air pollution can improve people’s safety awareness and promote outdoor sports activities and social interaction. That is, to solve the main obstacles to a healthy life and improve the environment that produces unhealthy behaviors. It is essential to establish communication between environmental and health professionals. By incorporating health needs and impacts into the concept, design and planning of infrastructure projects, decision makers, planners and building professionals can promote the development of sustainable communities.
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Original title: 408 Research Group | Health England: Five Elements of Health-oriented Spatial Planning













