Strategies for inclusive, equitable and sustainable places
The Global Centre for Healthcare and Urbanisation at Kellogg College, University of Oxford held a public seminar on healthy cities. I spoke about reframing our understanding of healthy urban environments, focusing on the need to improve the design quality of new development in England.
Nørrebro, one of the most densely populated, diverse, and disadvantaged neighbourhoods in Copenhagen, is home to Folkets Park (literally, “People’s Park”). It is a small urban park with a rich history as a place associated with local grassroots activism.
Residents created the park in 1971 on the site of a burned down building as a place for children to play. The adjacent Folkets Hus community centre was the site of local activism between the 1960s and 1980s, largely focused on disagreement over urban renewal. In the decades following there was not much municipal intervention in the park, but this shifted after a violent crime in 2012 that spurred the need for a re-design process focused on safety and inclusion.
The 2013 renovation of Folkets Park aimed to create a public space where all users could feel safe and comfortable. Perceived safety and the provision of public greenspace were the main determinants of health for this project. Another key aspect of this project was the aspiration to embed an inclusive and collaborative approach throughout the design process. As explained in guidance by the Gehl Institute, this exemplary project demonstrates how “when designing healthy places, inclusion can be a goal, a process, and a result”.(1)
This project is featured as one of our healthy urban development case studies and this case study was written by Elizabeth Cooper.
Continue reading “Folkets Park”
The UniverCity Childcare Centre at Simon Fraser University (SFU) was the first childcare centre in the world to obtain the Living Building Challenge (LBC) standard. It was an early adopter of the LBC standard, which originated in British Columbia. The Centre is linked to the SFU Faculty of Education for research on the provision of innovative childcare. After the building was completed and in operation, university researchers engaged with staff at the Childcare Centre in a community of practice model to study and inform the use of the building itself as part of the children’s ‘play-based holistic learning’ about sustainability.(1)
The design process was informed by sustainable building practices and the Childcare Centre’s adoption of the Reggio Emilia pedagogical three ‘teachers’ model whereby educators are considered to be the more than teaching staff, but also the environment in which the children learn and the community in which they live. Inclusive design processes helped the project team understand how children and staff wanted to use the space to support education and development.
This project is featured as one of our healthy urban development case studies.
Continue reading “UniverCity Childcare Centre”
The Queen Elizabeth Olympic Park (QEOP) is large-scale, master planned urban regeneration project on the site of the 2012 London Olympic and Paralympic Games. The vision of the project was to use the opportunity of the London 2012 Games to create a dynamic new metropolitan centre for London and an inspiring place where people want to – and can afford to – live, work and visit.
Totalling 560 acres (226 hectares), the QEOP includes plans for up to 6,800 new homes and 91,000 square metres of new commercial space around substantial green and blue infrastructure. The open space includes ‘35km of pathways and cycleways, 6.5km of waterways, over 100 hectares (ha) of land capable of designation as Metropolitan Open Land, 45ha of Biodiversity Action Plan Habitat, 4000 trees, playgrounds and a Park suitable for year-round events and sporting activities’ (1). There are five residential neighbourhoods led by different private sector partners, in addition to East Village (the former Athletes’ Village), including Chobham Manor, East Wick, Sweetwater, Marshgate Wharf and Pudding Mill.
QEOP borders four East London boroughs, Hackney, Tower Hamlets, Newham and Waltham Forest, each with high levels of deprivation and comparatively poor health outcomes. Regeneration plans in each borough aimed to transform the site’s post-industrial landscape and create better living conditions for residents. The London Legacy Development Corporation (LLDC) is the official planning authority of the Olympic Park and was established in 2012 as a mayoral development corporation under the power of the Localism Act 2011. All the planning applications submitted within the boundaries of the Growth Area are processed by the LLDC instead of the local boroughs. This mechanism ensures an integrated approach to the ongoing development in a way which aims to be responsive and accountable to local concerns while reflecting the area’s strategic significance for London.
This project is featured as one of our healthy urban development case studies.
Continue reading “Queen Elizabeth Olympic Park”
The Via Verde project was a response to several challenges for the South Bronx community of New York City: lack of high-quality affordable housing and high rates of asthma and obesity. Delivered through a public-private partnership with a complex financing model, Via Verde offers affordable high-quality homes for a broad range of income levels. Based on existing case study reports, its most successful features are the health-focused amenities and sustainable design, alongside the project’s value in changing perceptions about high-rise housing in America.
Green roofs and food gardens are planted on the rooftops of each building – the organising design feature behind the project’s name, Via Verde, meaning green way in Spanish. The project was the winning design in the New Housing New York Legacy Project (NHNY) competition. The multi-award-winning project is hailed as ‘a model for affordable, green, and healthy urban living’ by the Urban Land Institute.(1)
This project is featured as one of our healthy urban development case studies.
Continue reading “Via Verde”What do exemplar healthy urban developments look like? With the growing interest in ‘healthy’ buildings and places, we wanted to understand what could be considered best practice. This research involved a large review of published case studies, using professional organisations, newspaper reports, published academic research and other sources.
Our summary of each case study will be published incrementally in Spring 2022.
In publishing these projects, we are not endorsing them as ‘best practice’ or making any claims about whether they are good for health and wellbeing. We are hoping to learn about what the wider industry and professionals perceive ‘healthy’ development to look like.
Each case study was selected because it met our selection criteria:
We extracted information about each project from multiple sources and entered this into a template. The template included general project details (project size, location, type of development, etc.) and information specifically related to health.
We used the THRIVES framework as a way to consider how health and wellbeing were supported in each project. In reporting each project we explain how it relates to THRIVES through three scales of health impact (planetary, ecosystem and local) and the core principles (inclusion, equity and sustainability).
This project was funded by Guy’s and St Thomas’ Foundation, an urban health charity in London. The research team includes Helen Pineo, Gemma Moore, Karla Barrantes Chaves, Elizabeth Cooper, Vafa Dianati, Kay Forster and Isobel Braithwaite.
Policy-making is complex and contested, and health is only one goal among many to be achieved through implementing urban planning policy. We researched the complexity of this process using a systems thinking approach, mapping out the value of urban health indicators in two case studies.
In this research of activities in Melbourne (Australia) and San Francisco (USA), urban health indicator tools were a form of evidence that influenced local urban planning policy and decision-making when they were embedded in policy processes, networks and institutions.
This research used systems thinking to map out participants’ mental models of how indicators were used in planning policy and decision-making. The image below is one of the causal loop diagrams produced in the research. It shows how inter-sectoral relationships led to increased urban planning policy that would be health-promoting.
References
(1) Pineo, H., Zimmermann, N. and Davies, M. (2020) Integrating health into the complex urban planning policy and decision-making context: a systems thinking analysis. Palgrave Communications. 6 (1), pp. 1–14. https://doi.org/10.1057/s41599-020-0398-3
Measuring whether we have achieved certain project goals is an important way for public and private sector organisations to demonstrate their success. In the property sector, professionals will already be familiar with key performance indicators (KPIs) that show outputs from buildings and infrastructure. KPIs may be about sales values, carbon footprint or cost per square metre, among other factors.
Using metrics to inform the healthy design, construction and maintenance of new development is new to most property and built environment professionals. Consultants may support this task, but everybody involved in the project can benefit from a basic understanding.
There are general factors to think about when choosing indicators, including: scale, purpose, cost, priorities and collaboration.
Understanding the local context: As with other site investigations, you can use local public health data to understand key environmental exposures and health issues in the area. This may form part of a health impact assessment (HIA). For example, it may be possible to find local air pollution concentrations and rates of hospital admissions for asthma. Site surveys using indicators can be conducted with and without local residents to identify assets or hazards in the area. There are many healthy development checklists that can be used to support this process.
Set targets for the development: The developer and other stakeholders may set targets for how the development will seek to improve (or not harm) health through design and planning strategies. Existing standards are available (such as certification systems like WELL, Fitwel, LEED, and BREEAM) or a design team may develop their own set of targets. The database of 300 indicators may help with the selection of appropriate metrics. If indicators are used, there will be a need to specify current and target levels. Especially on large projects, early agreement on these targets will help all professions to ensure their contribution supports the health goals.
Monitor progress and results: If baseline measures have been taken, it will be possible to understand how the development has impacted the local environment in ways that support (or harm) health and wellbeing.
For short-term exposures such as noise and air pollution created during construction, it will be important to regularly monitor these and ideally to publicly report the results. If problems arise, mitigation measures can be taken to avoid harm.
For long-term benefits, such as increasing residents’ physical activity or wellbeing, developers could use public health indicators to determine impact. However, a few limitations should be noted:
As a simple evaluation, developers (or other stakeholders) could pay for a survey of residents’ behaviours and self-reported health pre- and post-development.
Many of healthy urban environment guidance documents include useful monitoring indicators.
There are many benefits to using indicators that others have developed. If the indicator was developed by a public health agency, it is likely to have an evidence-based link to health. By using indicators that are reported elsewhere, you can compare data that you gather with other locations.
The database below is a selection of nearly 300 indicators across 22 categories. You can download the file or filter/search in the columns below. These are small selection of 8006 indicators that we identified in our review of urban health indicator tools.
The indicators below have been selected to show typical metrics under the available categories. We also provide examples that are relevant for inclusion, equity and sustainability. For further details on the source see this table.
| General category | Indicator | Index/tool |
|---|---|---|
| Air quality | Annual average air concentration estimates | Environmental Public Health Tracking Network Indicators |
| Air quality | Proportion of people who are either very or mostly satisfied with air quality in their neighbourhood | Liveability Assessment Tool |
| Air quality | % of the urban population exposed to small or fine urban particulates (PM10 or PM2·5 [particles with a diameter of ≤10 or ≤2·5 micrometres]) in concentrations exceeding WHO Air Quality Guidelines | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Air quality | Estimated burden of disease from urban ambient air pollution. | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Air quality | Evidence of cooking with wood/charcoal in kitchens (h) | Proxy Environmental Health Indicators for Accra |
| Air quality | Emissions of Pb, primary PM10, NOx and benzene in urban areas | WHO Environmental Health Indicators |
| Air quality | Proportion of residences having a moisture problem, visible mould or mould odour | WHO Environmental Health Indicators |
| Air quality | Proportion of residences exceeding indoor air radon concentration of 200 Bq/m3 | WHO Environmental Health Indicators |
| Air quality | Capability to implement indoor air quality (IAQ) management | WHO Environmental Health Indicators |
| Behaviours | % of preschoolders (3-4) who meet physical activity recommendations | Active Transportation and Health Indicators |
| Behaviours | Percent eating 2+ fruits per day | American Fitness Index |
| Behaviours | Percent eating 3+ vegetables per day | American Fitness Index |
| Behaviours | Percent obese | American Fitness Index |
| Behaviours | Adequate Physical Exercise: The % of people who undertook sufficient physical activity to confer a health benefit in the previous week | Community Indicators Victoria |
| Behaviours | Smoking Status: % of people who are current smokers | Community Indicators Victoria |
| Behaviours | Volunteering: People who do Voluntary Work for Organisations or Groups. | Community Indicators Victoria |
| Behaviours | % of people who would participate in a community garden | Liveability Assessment Tool |
| Behaviours | Proportion of people who have used neighbourhood footpaths in the last month | Liveability Assessment Tool |
| Behaviours | % of population who get more than 6 hours of sleep | Wellbeing Index |
| Behaviours | % who see their friends and relatives less than once a month | Wellbeing Index |
| Behaviours | % who spend leisure time outside less than once a week | Wellbeing Index |
| Behaviours | % who live within a five minute walk of goods and services | Wellbeing Index |
| Crime and safety | Violent crime Rate/100,000 | American Fitness Index |
| Crime and safety | % respondents who think street litter is a problem | Bristol Quality of Life Indicators |
| Crime and safety | % respondents who agree anti-social graffiti is a problem | Bristol Quality of Life Indicators |
| Crime and safety | % respondents whose day to day life is affected by fear of crime | Bristol Quality of Life Indicators |
| Crime and safety | Level of cleanliness and building maintenance | CANVAS (Computer-Assisted Neighborhood Visual Assessment System) |
| Crime and safety | Hate Crime By Type of Offense | Communities Count |
| Crime and safety | Perceived Safety: Race, Ethnicity, Country of Birth, Language | Communities Count |
| Crime and safety | Sidewalks, parks, and parking areas in the neighborhood are well lit to enhance safety at night. | Community Healthy Living Index |
| Crime and safety | Perceptions of Safety: People Who Feel Safe or Very Safe Walking Alone in Local Area During the Day | Community Indicators Victoria |
| Crime and safety | Perceptions of Safety: People Who Feel Safe or Very Safe Walking Alone in Local Area at Night | Community Indicators Victoria |
| Economy | Rate of communities with primary schools within 500 meters | 2011 Livable City Index |
| Economy | Rate of communities with middle schools within 500 meters | 2011 Livable City Index |
| Economy | Percent high school graduate or higher | American Fitness Index |
| Economy | % respondents with no educational or technical qualifications | Bristol Quality of Life Indicators |
| Economy | Proximity to high-quality early childhood education centers | Child Opportunity Index |
| Economy | Number of child care centers per 100,000 children | Community Well-being Index (A) |
| Economy | Proportion of students who travel less than 15 minutes to school | Liveability Assessment Tool |
| Economy | Barriers to using active or public transport as the main means to travel to school | Liveability Assessment Tool |
| Economy | perception of cost of living within the city | Quality of Life Indicators for Galway |
| Economy | Proportion of population within ½ mile of a savings bank or credit union | San Francisco Indicator Project |
| Economy | Minority and women owned Local Business Enterprises | San Francisco Indicator Project |
| Economy | Distribution of green businesses | San Francisco Indicator Project |
| Economy | Completion of primary education: Completion of primary education, expressed as a % | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Economy | Physical, social, emotional readiness levels for kindergarten | Wellbeing Index |
| Economy | % who feel confident, cooking a meal, doing basic repairs, or using the internet | Wellbeing Index |
| Employment and income | Percent of households below poverty level | American Fitness Index |
| Employment and income | Jobs to labor force Ratio: The Ration of the number of jobs to the number of workers in an NPU | ANQoLHP Neighborhood Quality of Life Index |
| Employment and income | % respondents who say that financial circumstances prevents them from leaving their house when they want to | Bristol Quality of Life Indicators |
| Employment and income | Proximity to employment. Definition: Average number of employees in ZIP Codes within 5 miles of the census tract centroid (geographic center) | Child Opportunity Index |
| Employment and income | Employment Rate: People Who Are Employed: expressed as a % of people aged 15 years and over. | Community Indicators Victoria |
| Employment and income | Unemployment: People Who Are Unemployed, expressed as a % of the labour force. | Community Indicators Victoria |
| Employment and income | Food Insecurity Rate | Kansas Health Matters |
| Employment and income | Access to jobs by transit: Number of jobs accessible within a 45-minute transit commute: measured at the neighborhood scale, higher values are better | Livability Index |
| Employment and income | Income inequality: Gini coefficient (the gap between rich and poor): measured at the county scale from 0 to 1, lower values are better | Livability Index |
| Employment and income | Jobs per worker: Number of jobs per person in the workforce: measured at the metro area scale, higher values are better. Jobs are capped at 1.0 job per person. | Livability Index |
| Employment and income | Index of Multiple Deprivation IMD Score | Local Health |
| Employment and income | Income Deprivation: % living in income deprived households | Local Health |
| Employment and income | Child poverty: % aged 0-15 living in income deprived households | Local Health |
| Employment and income | Unemployment: % of working age population claiming out of work benefits | Local Health |
| Employment and income | Long term unemployment: crude Rate per 1000 working age population who have been claiming for more than 12 months | Local Health |
| Employment and income | Older people in deprivation: % aged 60 or over living in pension credit households | Local Health |
| Employment and income | Jobs paying wages greater than or equal to the self-sufficiency wage | San Francisco Indicator Project |
| Employment and income | Women in workforce: Participation of women in the workforce, expressed as a % | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Employment and income | % of residents who report at least one economic worry | Wellbeing Index |
| Employment and income | How satisfied are you with your capacity for work? | WHO Quality of Life (WHOQOL-BREF) |
| Food environment | Rate of residential areas with supermarkets within 1,000 meters | 2011 Livable City Index |
| Food environment | Farmers’ markets/1,000,000 | American Fitness Index |
| Food environment | Food access: the % of no vehicle households living beyond 0.9 mile radial distance of a supermarket or superstore | ANQoLHP Neighborhood Health Index |
| Food environment | Fast Food Outlet Density (per 1,000 Residents) | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Food environment | % respondents who eat food grown by themselves or by people they know | Bristol Quality of Life Indicators |
| Food environment | Water fountain present | CANVAS (Computer-Assisted Neighborhood Visual Assessment System) |
| Food environment | Rate of healthy food outlets per 10,000 residents | Colorado Health Indicators |
| Food environment | Percent who agree or strongly agree it is easy to purchase healthy foods in their neighborhood | Colorado Health Indicators |
| Food environment | Rate of fast food restaurants per 10,000 residents | Colorado Health Indicators |
| Food environment | Number of reported outbreaks of foodborne illness | Colorado Health Indicators |
| Food environment | % of population who are low income and do not live close to a grocery store | Community Health Status Indicators |
| Food environment | Neighborhood parks (public or private) offer on-site gardens and/orfarmers markets. | Community Healthy Living Index |
| Food environment | Average walking time to healthy food retailers | Healthy Resources Index |
| Food environment | Children with Low Access to a Grocery Store | Kansas Health Matters |
| Food environment | People 65+ with Low Access to a Grocery Store | Kansas Health Matters |
| Food environment | Access to grocery stores and farmers' markets: Number of grocery stores and farmers’ markets within a half-mile: measured at the neighborhood scale, higher values are better | Livability Index |
| Food environment | % of people who travel less than 15 min to shops | Liveability Assessment Tool |
| Food environment | % of people who travel less than 15 min for fruit and vegetables | Liveability Assessment Tool |
| Food environment | Food and drink | Liveable Cities Index |
| Food environment | Fast Food Density: The number of fast food restaurants per 10,000 residents | Neighborhood Health Profile Reports |
| Food environment | Carryout Density: The number of carry-out restaurants per 10,000 residents | Neighborhood Health Profile Reports |
| Food environment | Corner Store Density: The number of corner stores per 10,000 residents | Neighborhood Health Profile Reports |
| Food environment | Supermarket Proximity: The estimated travel time in minutes to the nearest supermarket using different modes oftransportation from the most populated area | Neighborhood Health Profile Reports |
| Food environment | Food sold near drains (c) | Proxy Environmental Health Indicators for Accra |
| Food environment | Food sold near public toilets (c) | Proxy Environmental Health Indicators for Accra |
| Food environment | Percent of residential area within ½ mile of a supermarket/grocery store that accepts EBT (food stamps) and WIC | Seattle Healthy Living Assessment |
| Food environment | Access to healthy foods | Truckee Meadows Tomorrow |
| Food environment | Incidence of human zoonoses | WHO Environmental Health Indicators |
| Food environment | Dioxins and PCBs levels in human milk | WHO Environmental Health Indicators |
| Food environment | Incidence of animal zoonoses | WHO Environmental Health Indicators |
| Food environment | Rate of official food control | WHO Environmental Health Indicators |
| Food environment | Progress in implementation of HACCP system | WHO Environmental Health Indicators |
| Food environment | Population awareness of food safety rules in households | WHO Environmental Health Indicators |
| Health and social services | Ratio of population to dentists in a county | County Health Rankings |
| Health and social services | Ratio of population to mental health providers in a county | County Health Rankings |
| Health and social services | Proportion of people who had difficulty accessing a community health service when needed within the last 12 months | Liveability Assessment Tool |
| Health and social services | Public health facilities with “good” and “very good” transit resource scores | San Francisco Indicator Project |
| Health and social services | Number of inhabitants per practising primary health care practitioner | WHO Healthy City Indicators |
| Health and social services | Number of inhabitants per nurse | WHO Healthy City Indicators |
| Health and social services | % of population covered by health insurance | WHO Healthy City Indicators |
| Health and social services | How satisfied are you with your access to health services? | WHO Quality of Life (WHOQOL-BREF) |
| Health outcomes | Number of injured pedestrians admitted to hospital | Active Transportation and Health Indicators |
| Health outcomes | Number of pedestrians killed in road traffic accident | Active Transportation and Health Indicators |
| Health outcomes | Pedestrian injury demographics by age and gender | Active Transportation and Health Indicators |
| Health outcomes | % respondents who say that disability prevents them from leaving their house when they want to | Bristol Quality of Life Indicators |
| Health outcomes | % respondents who say that poor health prevents them from leaving their house when they want to | Bristol Quality of Life Indicators |
| Health outcomes | Incidence of gastrointestinal disease | Caya Hueso Urban Ecosystem Health Indicators |
| Health outcomes | Incidence of asthma attacks | Caya Hueso Urban Ecosystem Health Indicators |
| Health outcomes | Incidence of respiratory infection in children | Caya Hueso Urban Ecosystem Health Indicators |
| Health outcomes | Incidence of home injuries | Caya Hueso Urban Ecosystem Health Indicators |
| Health outcomes | Diarrhoea mortality Rate in children aged 04 years | Children's Environmental Health Indicators |
| Health outcomes | Prevalence of insectborne diseases in children aged 014 years | Children's Environmental Health Indicators |
| Health outcomes | Subjective Wellbeing: Australian Unity Personal Wellbeing Index: completely dissatisfied = 0; completely satisfied = 100. | Community Indicators Victoria |
| Health outcomes | Life Expectancy: Life Expectancy at Birth: in years, for males and females sepaRately | Community Indicators Victoria |
| Health outcomes | Obesity: % of people who are obese according to a Body Mass Index (BMI) of 30 or greater | Community Indicators Victoria |
| Health outcomes | years of potential life lost (YPLL) as its measure of premature death, based on all deaths occurring before the age of 75 | County Health Rankings |
| Health outcomes | % of the adult population that has a body mass index greater than or equal to 30. | County Health Rankings |
| Health outcomes | Asthma in household | Environmental Health Basic Exposure Survey |
| Health outcomes | Carbon Monoxide Poisoning Emergency Department Visits | Environmental Public Health Tracking Network Indicators |
| Health outcomes | Heat stress emergency department visits | Environmental Public Health Tracking Network Indicators |
| Health outcomes | Heat-Related Mortality | Environmental Public Health Tracking Network Indicators |
| Health outcomes | Rate of Childhood Lead Poisoning (per 10,000 children under 6) | Health Indicators Dashboard |
| Health outcomes | Number of fire related deaths per 100 000 population (core indicator) | ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life |
| Health outcomes | Chronic Obstructive Pulmonary Disease (COPD) Hospital Admission Rate | Kansas Health Matters |
| Health outcomes | Limiting long term illness or disability: % with limiting long term illness or disability | Local Health |
| Health outcomes | Obese children (year 6) | Local Health |
| Health outcomes | Incidence of all cancer | Local Health |
| Health outcomes | Number and Rate of falls of adults aged 65 years and over per 10,000 population aged 65 years and over (2002/2003 to 2004/2005) | New Zealand Quality of Life Project |
| Health outcomes | Rate of Motor Vehicle Collisions with Pedestrians and Bicyclists with Children within One-Half Mile of a School per 10,000 Children | Plan for a Healthy LA Health Atlas/Health Profiles |
| Health outcomes | Mortality and morbidity attributed to household air pollution | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Health outcomes | % of population who report being stressed all or most of the time | Wellbeing Index |
| Housing | % respondents who are satisfied with the state of repair of their home | Bristol Quality of Life Indicators |
| Housing | % of houses with inadequate ventilation | Caya Hueso Urban Ecosystem Health Indicators |
| Housing | Housing stress - % of housing with one or more housing conditions | Community Health Status Indicators |
| Housing | Housing Affordability: Households with Housing Costs 30% or More of Gross Income | Community Indicators Victoria |
| Housing | Housing Affordability: Median House Price | Community Indicators Victoria |
| Housing | Housing Affordability: Occupied Private Dwellings which are Government-Owned Rental Dwellings | Community Indicators Victoria |
| Housing | Mold or mildew in home | Environmental Health Basic Exposure Survey |
| Housing | Proportion of household with no form of heating | Environmental Health Indicators New Zealand (EHINZ) |
| Housing | % of houses which have sunshine at least 5 hours a day | Health Determinants Indicators |
| Housing | Number of homeless per 100 000 population | ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life |
| Housing | Basic passage: % of housing units with extra-wide doors or hallways, floors with no steps between rooms, and an entry-level bedroom and bathroom | Livability Index |
| Housing | Availability of subsidised housing: Number of subsidized housing units per 10,000 people | Livability Index |
| Housing | % of households with central heating | Local Health |
| Housing | % of households with 1 or more rooms too few | Local Health |
| Housing | Proportion of homes judged unfit to live in | London's Health StRategy High Level Indicators |
| Housing | Dwelling condition: Dwellings in need of major repair | Peg Well-being Indicators |
| Housing | % of urban households living in durable structures (as per the MDG-era defi nition of housing: sited away from hazardous locations; a permanent structure offering protection from climatic extremes of rain, heat, cold, and humidity; and built in compliance with local building codes). | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Housing | % of households using modern fuels or technologies, as defined by WHO guidelines, for all cooking, heating, and lighting activities | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Housing | % of population with hand-washing facilities at home | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Housing | Health and building code violations for housing and habitability | San Francisco Indicator Project |
| Housing | Secure tenure: % of households with access to secure tenure (owned or rented) | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Housing | Slum population: Proportion of urban population living in slum households | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Housing | Number of women given land rights/housing tenure by City Council | Urban Health Equity Indicators for Mathare Informal Settlement |
| Housing | % of renters paying over 30% of income to rent | Wellbeing Index |
| Land use | Density and Land-Use Mix: Population density by neighbourhood | Active Transportation and Health Indicators |
| Land use | Density and Land-Use Mix: % of land used for commercial purposes by neighbourhood | Active Transportation and Health Indicators |
| Land use | Density and Land-Use Mix: Combined Commercial & Residential Density-Mix Ranking | Active Transportation and Health Indicators |
| Land use | Density and Land-Use Mix: relationship between density (both commercial and residential) and Rates of active transportation (both walking and biking) | Active Transportation and Health Indicators |
| Land use | population density per square kilometre of residential area | Activity-Friendly Index |
| Land use | density of all retail services per 10,000 population | Activity-Friendly Index |
| Land use | Living near highways - % of population living within 150 meters of a Highway | Community Health Status Indicators |
| Land use | Proximity to derelict sites | Glasgow Indicators Project |
| Land use | Diversity of destinations: Mix of jobs within a mile: measured at the neighborhood scale, higher values are better | Livability Index |
| Land use | Activity density: Combined number of jobs and people per square mile: measured at the neighborhood scale, higher values are better | Livability Index |
| Land use | Near-road pollution: % of the population living within 200 meters of a high-traffic road with more than 25,000 vehicles per day: measured at the neighborhood scale, lower values are better | Livability Index |
| Land use | There are many places to go within easy walking distance of my home. | Neighborhood Environment Walkability Scale (NEWS) |
| Land use | % Reduction of Low-Income Residents and People of Color Living within 500 Feet of a Major Truck/Traffic Route | Richmond Health Equity Indicators |
| Land use | Retail floor area Ratio; the retail building floor area footprint divided by retail land floor area footprint | Walkability Index |
| Land use | Intersection density measured the connectivity of the street network, represented by the Ratio between the number of true intersections (three or more legs) to the land area of the block group in acres | Walkability Index |
| Land use | Land use mix, or entropy score, indicated the degree to which a diversity of land use types were present in a block group. For this project, the mix measure considered five land use types: residential, retail (excluding region-serving or ‘‘big box’’ uses of approximately 91 440 m2 (300 000 square feet) or larger), entertainment (including restaurants), office and institutional (including schools and community institutions). | Walkability Index |
| Leisure and culture | Dog parks/100,000 | American Fitness Index |
| Leisure and culture | Park playgrounds/10,000 | American Fitness Index |
| Leisure and culture | Number of Public Murals | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Leisure and culture | Public Art per 1,000 Residents | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Leisure and culture | % respondents satisfied with activities for children and young people | Bristol Quality of Life Indicators |
| Leisure and culture | % respondents satisfied with the range and quality of outdoor events in Bristol | Bristol Quality of Life Indicators |
| Leisure and culture | % of people who participate in cultural and social activities | Caya Hueso Urban Ecosystem Health Indicators |
| Leisure and culture | Access to libraries: Number of libraries located within a half-mile: measured at the neighborhood scale | Livability Index |
| Leisure and culture | Cultural, arts, and entertainment institutions: Number of performing arts companies, museums, concert venues, sports stadiums, and movie theaters per 10,000 people | Livability Index |
| Leisure and culture | % of residents who feel the city has the arts and cultural opportunities they want | Wellbeing Index |
| Local democracy | % respondents who agree they can influence decisions that affect their local area | Bristol Quality of Life Indicators |
| Local democracy | Diversity of elected officials | City of Winnipeg Quality-of-Life Indicators |
| Local democracy | Participation in Citizen Engagement: People Who Participated in Citizen Engagement Activities in the Last 12 Months: expressed as a % of the adult population. | Community Indicators Victoria |
| Local democracy | Voter participation: % of eligible voters who voted in the most recent local/national elections | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Local democracy | % who feel they can influence city decisions | Wellbeing Index |
| Natural environment | % of investment on mangement of the environment | 2011 Livable City Index |
| Natural environment | Percent of Area Covered by Trees | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Natural environment | % respondents who are very concerned about the impact of climate change in the UK | Bristol Quality of Life Indicators |
| Natural environment | % respondents who think that their neighbourhood will be affected by climate change | Bristol Quality of Life Indicators |
| Natural environment | Per capita public green area/m2 | City Ecosystem Health Index |
| Natural environment | Number of Extreme Heat Days | Environmental Public Health Tracking Network Indicators |
| Natural environment | 2. Dates of Extreme Heat Days | Environmental Public Health Tracking Network Indicators |
| Natural environment | Health of key indicator species | Indicators of Urban Ecosystem Health |
| Natural environment | Ecological footprints and land productivity per resident (2003 to 2004) | New Zealand Quality of Life Project |
| Natural environment | Net change in natural/semi-natural habitats | Quality of Life Counts (Local) |
| Natural environment | Percent of open space that is a designated natural area | San Francisco Indicator Project |
| Natural environment | % of the city that is parkland or beach | Wellbeing Index |
| Noise | % respondents who think noise from neighbours is a problem | Bristol Quality of Life Indicators |
| Noise | Noise: % data zone area (population-weighted) within 100 m of a major road or rail route | South Lanarkshire Index of Multiple Environmental Deprivation (SLIMED) |
| Noise | Number of people exposed to noise levels above standard (L day/evening/night) in noise-levels categories | WHO Environmental Health Indicators |
| Noise | Number of people at working place exposed to noise levels (8 hr) > 80 dB(A) | WHO Environmental Health Indicators |
| Pollutants | Percent of Lead Violations per 1,000 Residential Units | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Pollutants | Pesticide-free communities | British Colombia Atlas of Wellness |
| Pollutants | Proximity to toxic waste release sites. Definition: Distance (in meters) to the nearest toxic waste and release site from the census tract centroid (geographic center) | Child Opportunity Index |
| Pollutants | Volume of nearby toxic release. Definition: Aggregated toxic release volume (in pounds), based on the proportion of the census tract area that overlays a two-mile buffer around any toxic release sites nearby | Child Opportunity Index |
| Pollutants | Greenhouse gas emissions measured in tonnes per capita (core indicator) | ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life |
| Pollutants | Perceived Safety from Environmental Hazards | Richmond Health Equity Indicators |
| Pollutants | proximity to solid waste disposal sites | Vulnerability Indices |
| Public open space | Parkland as a percent of city land area | American Fitness Index |
| Public open space | Acres of parkland/1,000 | American Fitness Index |
| Public open space | Number of Community Managed Open Spaces | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Public open space | % respondents satisfied with quality of parks and green spaces | Bristol Quality of Life Indicators |
| Public open space | The neighborhood’s parks, roads, and trails are free of significant airpollution, noise pollution, litter, and physical disorder. | Community Healthy Living Index |
| Public open space | Parks and recreation facilities (public or private) are provided for people of all ages in the neighborhood. | Community Healthy Living Index |
| Public open space | Average walking time to parks andschoolyards | Healthy Resources Index |
| Public open space | Access to parks: Number of parks within a half-mile | Livability Index |
| Public open space | Proportion of people who have used neighbourhood parks, picnic areas, playgrounds or reserves in the last month | Liveability Assessment Tool |
| Public open space | % of the Population within One-Half Mile Walking Distance of a Park | Plan for a Healthy LA Health Atlas/Health Profiles |
| Public open space | Children with Easy Access to a Park or Playground | Think Health LA! Indicators |
| Services & utilities | Rate of Clogged Storm Drain Reports per 1,000 Residents | Baltimore Neighborhood Indicators Alliance, Vital Signs |
| Services & utilities | % of water supply, street light networks, street infrastructure needing replacement | Caya Hueso Urban Ecosystem Health Indicators |
| Services & utilities | Children aged 014 years living in households without basic services for water supply, sanitation and hygiene | Children's Environmental Health Indicators |
| Services & utilities | Episodes of flooding inside households | Core Environmental Health Indicators in Lucknow and Calcutta |
| Services & utilities | Total residential electrical energy use per capita (kWh/year) (core indicator) | ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life |
| Services & utilities | Energy consumption of public buildings per year (kWh/m²) (core indicator) | ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life |
| Services & utilities | The % of total energy derived from renewable sources, as a share of the city’s total energy consumption (core indicator) | ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life |
| Services & utilities | Proportion of people with access to public internet facilities | Liveability Assessment Tool |
| Services & utilities | Number of energy cut-offs per 10,000 households each month | Neighborhood Health Profile Reports |
| Services & utilities | Annual average utility bills | Places Rated Almanac |
| Services & utilities | % of urban households with access to ‘modern’ energy sources for heating, cooking, and lighting, as defined by WHO indoor air quality guidelines for household fuel combustion (new indicator). | Proposed Indicators linking health and sustainability in the post-2015 development agenda |
| Services & utilities | Evidence of flood risks within community (c) | Proxy Environmental Health Indicators for Accra |
| Services & utilities | % of population with access to improved sanitation | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Services & utilities | % of households served by municipal solid waste management system | Urban Health Equity Assessment and Response Tool (Urban HEART) |
| Social networks | % of adults 18 years and over who report not receiving sufficient social-emotional support | Community Health Status Indicators |
| Social networks | % of adults who report ever experiencing discrimination, been prevented from doing something or been hassled or made to feel inferior because of their race, ethnicity or color | Healthy Chicago 2.0 |
| Social networks | Proportion of people who either agree or strongly agree with feeling they belong to their neighbourhood | Liveability Assessment Tool |
| Social networks | Proportion of people who either agree or strongly agree with the belief that their neighbours would help them in an emergency | Liveability Assessment Tool |
| Social networks | % of residents who feel they can count on their neighbours | Wellbeing Index |
| Transport | Age and Gender: Share of trips being made by cycling per demographic group | Active Transportation and Health Indicators |
| Transport | Income and Spending: Transportation expenditures by income quintile | Active Transportation and Health Indicators |
| Transport | Vehicle Ownership: % of households owning zero, 1, 2 or 3+ vehicles | Active Transportation and Health Indicators |
| Transport | Percent using public transportation to work | American Fitness Index |
| Transport | Percent bicycling or walking to work | American Fitness Index |
| Transport | Walk Score® | American Fitness Index |
| Transport | % respondents satisfied with the bus service | Bristol Quality of Life Indicators |
| Transport | Crosswalk timing (seconds) | Built Environment Assessment Tool |
| Transport | Condition and quality of curb cut/ramp | Built Environment Assessment Tool |
| Transport | Bench or covered shelter at the transit stop present | Built Environment Assessment Tool |
| Transport | Number of trees within 5 feet of either side of the sidewalk/pathway | Built Environment Assessment Tool |
| Transport | High Frequency Transit Service | Community Health and Equity Index |
| Transport | The neighborhood has a network of walkable sidewalks that are unobstructed, well maintained, and level. | Community Healthy Living Index |
| Transport | Estimated total hours that the average commuter spends in traffic each year | Livability Index |
| Transport | Average speed limit (MPH) on streets and highways | Livability Index |
| Transport | % of transit stations and vehicles that are ADA-accessible | Livability Index |
| Transport | Sidewalk Width: < 4 feet, Between 4 and 8 feet, > 8 feet | Pedestrian Environment Data Scan (PEDS) |
| Transport | Sidewalk connectivity to other sidewalks/crosswalks | Pedestrian Environment Data Scan (PEDS) |
| Transport | Are there wayfinding aids? | Pedestrian Environment Data Scan (PEDS) |
| Transport | Illegal parking | Residential Environment Assessment Tool |
| Transport | % of residents who drive to work alone | Wellbeing Index |
| Transport | Average distance of bike lane per person | Wellbeing Index |
| Urban design | % respondents who think the quality of new developments has got better | Bristol Quality of Life Indicators |
| Urban design | Observation of pleasant hardscape features such as fountains, sculptures, or art (public or private) | Built Environment Assessment Tool |
| Urban design | Amount of buildings with blank walls | CANVAS (Computer-Assisted Neighborhood Visual Assessment System) |
| Urban design | Amount of benches on segment | CANVAS (Computer-Assisted Neighborhood Visual Assessment System) |
| Urban design | There are attractive buildings/homes in my neighborhood. | Neighborhood Environment Walkability Scale (NEWS) |
| Urban design | Residents’ rating of sense of pride in the way their city looks and feels | New Zealand Quality of Life Project |
| Waste management | % Municipal Solid Waste to Waste-to-Energy | Environment Health Sustainability (EHS) Index |
| Waste management | Proportion of people who recycle all or most recyclable waste | Liveability Assessment Tool |
| Waste management | Proportion of people who compost some or all of their household food waste | Liveability Assessment Tool |
| Waste management | Mounds of uncollected garbage within community (c) | Proxy Environmental Health Indicators for Accra |
| Waste management | Indiscriminate dumping of garbage in community (c) | Proxy Environmental Health Indicators for Accra |
| Waste management | Evidence of children playing around waste-dumps and/or scavenging in them | Proxy Environmental Health Indicators for Accra |
| Waste management | Evidence of animals scavenging on waste-dumps and spreading the litter (c) | Proxy Environmental Health Indicators for Accra |
| Waste management | Annual per capita solid waste disposal | San Francisco Indicator Project |
| Water quality | Number of public water systems where the average annual or maximum concentrations of disinfection byproducts (TTHM and HAA5), nitrates and arsenic were above the EPA maximum contaminant level (MCL) | Colorado Health Indicators |
| Water quality | Percent of the population who report bottled water as their primary home drinking water source | Colorado Health Indicators |
| Water quality | Condition of Natural Streams and Waterways: Index of stream condition | Community Indicators Victoria |
| Water quality | Faecal coliforms in freshwater | Health and Environmental Sustainability Indicators |
| Water quality | % of the population getting water from public water systems with at least one health-based violation during the past year | Livability Index |
| Water quality | Proportion of people who are either very or mostly satisfied with the water quality of rivers, lakes and creeks in their neighbourhood | Liveability Assessment Tool |
| Water quality | Pools of stagnant water (cesspools) (c) | Proxy Environmental Health Indicators for Accra |
| Water quality | Number of days of beach closure in San Diego County | Quality of Life Indicator Program for San Diego-Tijuana Metropolitan Region |
| Water quality | % of population with sustainable access to an improved water source | Urban Health Equity Assessment and Response Tool (Urban HEART) |
The indicator tools set up by public health teams in San Francisco (USA) and Victoria (Australia) have been widely used for built environment purposes. These projects provide useful lessons for organisations that are considering developing a new set of indicators.
Key findings about indicator use in these case studies (1):
Inter-sectoral relationships were important: In the cases analysed, creating and using urban health indicator tools increased inter-sectoral relationships, which supported actors to better understand each other’s opportunities and constraints. These relationships spurred new advocates for health in diverse organisations, supporting health-in-all-policies and whole-of-society approaches.
Community involvement helped overcome constraints: When using urban health indicator tools to advocate for a healthier environment, there can be challenges. In these case studies constraints to health-promoting policy and implementation included those which were legal, political and economic in nature. Community involvement developing and using the indicators helped to overcome these constraints and supported advocacy.
Pitfalls of indicator projects: A number of factors reduced the perceived relevance and authority of indicator tools, including: a high number of available indicators, lack of neighbourhood scale data and poor-quality data.
These indicator tools were used as a form of evidence that influenced local urban planning policy and decision-making when they were embedded in policy processes, networks and institutions.
Beyond the two examples above, does the time and effort put into developing indicators, pay off?
Looking across the published literature, here are the key findings about the use of indicators by built environment policy-makers (2).
Who creates the tools matters: Both expert-led and participatory indicator projects can be underpinned by research evidence and residents’ knowledge. Participatory UHI tools with community involvement were generally more effective at supporting “health in all policies” and “whole-of-society” approaches to governing healthy cities than expert-led processes.
Indicator use in policy-making is not linear: Studies highlighted a number of technical, organisational, political, knowledge, and contextual factors that affect their use.
Quality matters: Some indicator tool features, such as availability of neighbourhood-scale data, were influential in the use of indicators by built environment policy- and decision-makers.
References
(1) Pineo, H., Zimmermann, N., Davies, M., 2020. Integrating health into the complex urban planning policy and decision-making context: a systems thinking analysis. Palgrave Communications 6, 1–14. https://doi.org/10.1057/s41599-020-0398-3
(2) Pineo, H., Glonti, K., Rutter, H., Zimmermann, N., Wilkinson, P. and Davies, M. (2018b) Urban Health Indicator Tools of the Physical Environment: a Systematic Review. Journal of Urban Health. 95 (5), pp. 613–646. https://doi.org/10.1007/s11524-018-0228-8
Further information
Bhatia, R., 2014. Case Study: San Francisco’s Use Of Neighborhood Indicators To Encourage Healthy Urban Development. Health Affairs 33, 1914–22. http://dx.doi.org.libproxy.ucl.ac.uk/10.1377/hlthaff.2014.0661
Davern, M.T., Gunn, L., Giles-Corti, B., David, S., 2017. Best Practice Principles for Community Indicator Systems and a Case Study Analysis: How Community Indicators Victoria is Creating Impact and Bridging Policy, Practice and Research. Soc Indic Res 131, 567–586. https://doi.org/10.1007/s11205-016-1259-8
Farhang, L., Bhatia, R., Scully, C.C., Corburn, J., Gaydos, M., Malekafzali, S., 2008. Creating Tools for Healthy Development: Case Study of San Franciscoʼs Eastern Neighborhoods Community Health Impact Assessment. Journal of Public Health Management and Practice 14, 255–265. https://doi.org/10.1097/01.PHH.0000316484.72759.7b