About this Article: This study describes a systematic literature review undertaken to examine the effectiveness of various interventions on the built environment to improve health outcomes. A discussion of interventions that have shown success, is presented along with recommendations for further research. Interventions aimed at improving safety, mental health, physical activity and household air quality were examined.
About This Series: The É/Exchange working paper series is designed to facilitate sharing of results and to encourage discussion of concepts, practices, and policies in applied health. This series provides a way to disseminate well-written, but not yet published, reports of research. It is also a way to make research conducted by affiliated community members accessible to a wider readership. The series is co-sponsored by The Population Health Improvement Research Network (PHIRN), Réseau de recherche appliquée sur la santé des francophones de l'Ontario (RRASFO); and the Ontario Health Human Resources Research Network (OHHRRN).
The Public Health Agency of Canada defines the built environment as “part of our physical surroundings” which “includes the buildings, parks, schools, road systems and other infrastructure that we encounter in our daily lives.” A recent systematic review by Dobbins and Tirilis sought to identify and summarize research findings on the effectiveness of built environment interventions on health; and of associations of features of the built environment with health. This information will support efforts to improve health by directing decision makers toward interventions with proven effectiveness.
The review was limited to studies of strong methodological quality and the search for topic related literature indentified 37 systematic reviews, meta-analyses and narrative reviews, 27 of which were relevant to this synthesis. Topics examined included interventions and associations aimed at improving injury rates, safety, mental health, physical activity; and household air quality.
Injuries and Safety
A number of interventions were shown to impact health:
- Home visit parenting programs and paediatric practice-based interventions lower the risk of home related injuries, burns, and scratches among children. Parental education improved the likelihood of putting safety measures in place, but the provision of low cost or free equipment to do so did not result in fewer actual injuries among children in the home.
- Workplace injury and illness prevention programs reduce falls, prevent back injuries among nurses working on high risk floors, prevent eye injuries, and prevent hearing loss when hearing protection is mandatory, but do not prevent logger injuries, hearing loss and use of substances. The evidence is inconclusive regarding attempts to reduce repetitive strain disorder.
- Encouraging nurses with back injuries to engage in specific exercises reduces daily reported pain.
- While few studies were adequately controlled, the use of red light cameras appears to reduce total casualty crashes but did not reduce right angle casualty crashes, total crashes or red light violations.
- Street lighting improvements can reduce total crashes and total injury crashes.
- Rehousing, refurbishment, and relocation may be associated with improved mental and physical health outcomes in the longer term (18 months), although the majority of studies were not of high quality.
- Being born in an urban centre is associated with developing schizophrenia, while living in sparsely populated areas is associated with higher suicide rates among males.
- Poor neighbourhood or housing quality, may be associated with poorer mental health, while access to green spaces appears to be associated with better mental health
- Witnessing crime or being a victim of crime, and neighbourhood disorder are also associated with poorer mental health,
- Road traffic noise increases the risk of anxiety but not depression in adults.
To some extent the results illustrate that many population health and public health programs are associated with benefit to various populations, particularly related to outcomes such as physical activity and mental health
Household Air Quality
- Education about allergen exposure and the provision of allergen reduction equipment reduces physician diagnosed asthma in children, and number of days ill, but not asthma symptoms such as wheezing and lung function.
- Programs targeting children’s exposure to environmental tobacco smoke, particularly in the home, are effective to some degree.
- The provision of mite impermeable bedding covers appears to reduce dust mite load, but not household dust levels.
- Self-reported walking can be increased in the short term by face-to-face counselling provided in the workplace; by clinicians or exercise specialists in primary care; via telephone and internet messaging to individuals; and by group contact through lay mentored meetings, led walks and educational sessions; and by pedometer use.
- Worksite incentives (i.e., subsidy of employees who choose not to drive) appear to have a positive impact on travel behaviour.
- The effectiveness of community level interventions to promote walking is aided by substantial mass media campaigns.
- Street lighting and infrastructure projects that increase the ease and safety of street crossing; ensure sidewalk continuity, address traffic calming; enhance street area aesthetics, and introduce point-of-decision prompts that encourage people to use the stairs, can increase physical activity.
- Promotion of cycling rather than driving, along with educational activities and improving the cycle route network, increase the proportion of people who cycle, the number of times they do so and their cycling distance. Social marketing and mass media campaigns did not increase the population prevalence of cycling.
- Transportation and travel policies and practices which focus on improving pedestrian, transit and light rail access to increase pedestrian and cyclist activity and safety, reduce car use and improve air quality have not changed physical activity behaviour.
- Workplace interventions to reduce sitting have not been able to change workday sitting behaviour.
Built environment interventions have been indentified as priority topics for Ontario. This systematic review has identified some promising interventions, along with some to remove from consideration.
Reference: Dobbins, M., Tirilis, D. Diet and Nutrition: A Synthesis of Review Evidence. An overview of systematic review evidence on the effectiveness of community-based interventions to promote healthy diet and nutrition. Exchange Working Paper Series, PHIRN S1 Issue 3. University of Ottawa, Ottawa, Canada. Available at rrasp-phirn.ca.