Folkets Park

New playground at Folkets Park. Image: Kenneth A. Balfelt.

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.

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UniverCity Childcare Centre

Playground at UniverCity Childcare. Image: Martin Tessler

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.

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Queen Elizabeth Olympic Park

Open space and surrounding residential blocks in East Village.

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.

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Via Verde

Via Verde Housing Complex, Bronx, NY - Designed by Grimshaw Architects and Dattner Architects.

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.

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Healthy urban development case studies

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.

Are the projects ‘best practice’?

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:

  1. Describes an urban development project that explicitly aimed to promote or safeguard human health and/or wellbeing (including the related term of liveability)
  2. Urban development cases are recent, built after 2000
  3. Substantive data are available
  4. Data are available from sources that are not solely marketing material
  5. Design measures or processes are described (related to health and wellbeing)

How were the projects analysed?

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).

Acknowledgements

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.

How are indicators used in urban planning?

Engineers drawing on whiteboard

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.

Key findings

  • Creating and using urban health indicator tools increased inter-sectoral relationships, which supported different stakeholders to better understand each other’s opportunities and constraints.
  • Relationships among stakeholders spurred new advocates for health in diverse organisations, supporting health-in-all-policies and whole-of-society approaches.
  • Constraints to health-promoting policy and implementation (e.g. legal, political and economic in nature), were overcome through community involvement in urban health indicator tools and advocacy effectiveness.
  • Some characteristics of indicator tools reduced their perceived relevance and authority, such as: a high number of available indicators, lack of neighbourhood scale data and poor-quality data.

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.

Systems thinking approach

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.

Detailed view of the causes and effects of inter-sectoral relationships (arrow colours denote diverse participants’ perspectives: orange for producers, green for users, blue for both and grey for the researcher), from Pineo et al. (2020).

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

New Development

Post-its

Indicators can be used to improve a new development’s impact on health and wellbeing.

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.

Pointers for using health indicators on new developments

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:

  1. Whose health? The people living in the area before and after development are not always the same, so any uplift in health may not relate to local populations. Ideally, baseline measures of local residents who may benefit from the development can be taken to show a ‘before and after’ story.
  2. What caused any changes? Any differences in the environment or local health measured before and after a new development may not have resulted from the development itself. Changes could be caused by other factors, such as national or local air pollution control policies.
  3. How long to wait before measuring? Improvements to health could be immediate (e.g. if noise or air pollution is reduced) but in many cases they will take time to detect.

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.

Indicator database

Woman with tablet

Organisations can save a lot of time and money by using existing 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.

Selection of urban health indicators

General categoryIndicatorIndex/tool
Air qualityAnnual average air concentration estimatesEnvironmental Public Health Tracking Network Indicators
Air qualityProportion of people who are either very or mostly satisfied with air quality in their neighbourhoodLiveability 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 GuidelinesProposed Indicators linking health and sustainability in the post-2015 development agenda
Air qualityEstimated burden of disease from urban ambient air pollution.Proposed Indicators linking health and sustainability in the post-2015 development agenda
Air qualityEvidence of cooking with wood/charcoal in kitchens (h)Proxy Environmental Health Indicators for Accra
Air qualityEmissions of Pb, primary PM10, NOx and benzene in urban areasWHO Environmental Health Indicators
Air qualityProportion of residences having a moisture problem, visible mould or mould odourWHO Environmental Health Indicators
Air qualityProportion of residences exceeding indoor air radon concentration of 200 Bq/m3WHO Environmental Health Indicators
Air qualityCapability to implement indoor air quality (IAQ) managementWHO Environmental Health Indicators
Behaviours% of preschoolders (3-4) who meet physical activity recommendationsActive Transportation and Health Indicators
BehavioursPercent eating 2+ fruits per dayAmerican Fitness Index
BehavioursPercent eating 3+ vegetables per dayAmerican Fitness Index
BehavioursPercent obeseAmerican Fitness Index
BehavioursAdequate Physical Exercise: The % of people who undertook sufficient physical activity to confer a health benefit in the previous weekCommunity Indicators Victoria
BehavioursSmoking Status: % of people who are current smokersCommunity Indicators Victoria
BehavioursVolunteering: People who do Voluntary Work for Organisations or Groups. Community Indicators Victoria
Behaviours% of people who would participate in a community gardenLiveability Assessment Tool
BehavioursProportion of people who have used neighbourhood footpaths in the last monthLiveability Assessment Tool
Behaviours% of population who get more than 6 hours of sleepWellbeing Index
Behaviours% who see their friends and relatives less than once a monthWellbeing 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 servicesWellbeing Index
Crime and safetyViolent crime Rate/100,000American Fitness Index
Crime and safety% respondents who think street litter is a problemBristol Quality of Life Indicators
Crime and safety% respondents who agree anti-social graffiti is a problemBristol Quality of Life Indicators
Crime and safety% respondents whose day to day life is affected by fear of crimeBristol Quality of Life Indicators
Crime and safetyLevel of cleanliness and building maintenanceCANVAS (Computer-Assisted Neighborhood Visual Assessment System)
Crime and safetyHate Crime By Type of OffenseCommunities Count
Crime and safetyPerceived Safety: Race, Ethnicity, Country of Birth, LanguageCommunities Count
Crime and safetySidewalks, parks, and parking areas in the neighborhood are well lit to enhance safety at night.Community Healthy Living Index
Crime and safetyPerceptions of Safety: People Who Feel Safe or Very Safe Walking Alone in Local Area During the DayCommunity Indicators Victoria
Crime and safetyPerceptions of Safety: People Who Feel Safe or Very Safe Walking Alone in Local Area at NightCommunity Indicators Victoria
EconomyRate of communities with primary schools within 500 meters2011 Livable City Index
EconomyRate of communities with middle schools within 500 meters2011 Livable City Index
EconomyPercent high school graduate or higherAmerican Fitness Index
Economy% respondents with no educational or technical qualificationsBristol Quality of Life Indicators
EconomyProximity to high-quality early childhood education centersChild Opportunity Index
EconomyNumber of child care centers per 100,000 childrenCommunity Well-being Index (A)
EconomyProportion of students who travel less than 15 minutes to schoolLiveability Assessment Tool
EconomyBarriers to using active or public transport as the main means to travel to schoolLiveability Assessment Tool
Economyperception of cost of living within the cityQuality of Life Indicators for Galway
EconomyProportion of population within ½ mile of a savings bank or credit unionSan Francisco Indicator Project
EconomyMinority and women owned Local Business EnterprisesSan Francisco Indicator Project
EconomyDistribution of green businessesSan Francisco Indicator Project
EconomyCompletion of primary education: Completion of primary education, expressed as a %Urban Health Equity Assessment and Response Tool (Urban HEART)
EconomyPhysical, social, emotional readiness levels for kindergartenWellbeing Index
Economy% who feel confident, cooking a meal, doing basic repairs, or using the internetWellbeing Index
Employment and incomePercent of households below poverty levelAmerican Fitness Index
Employment and incomeJobs to labor force Ratio: The Ration of the number of jobs to the number of workers in an NPUANQoLHP Neighborhood Quality of Life Index
Employment and income% respondents who say that financial circumstances prevents them from leaving their house when they want toBristol Quality of Life Indicators
Employment and incomeProximity 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 incomeEmployment Rate: People Who Are Employed: expressed as a % of people aged 15 years and over.Community Indicators Victoria
Employment and incomeUnemployment: People Who Are Unemployed, expressed as a % of the labour force.Community Indicators Victoria
Employment and incomeFood Insecurity RateKansas Health Matters
Employment and incomeAccess to jobs by transit: Number of jobs accessible within a 45-minute transit commute: measured at the neighborhood scale, higher values are betterLivability Index
Employment and incomeIncome inequality: Gini coefficient (the gap between rich and poor): measured at the county scale from 0 to 1, lower values are betterLivability Index
Employment and incomeJobs 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 incomeIndex of Multiple Deprivation IMD ScoreLocal Health
Employment and incomeIncome Deprivation: % living in income deprived householdsLocal Health
Employment and incomeChild poverty: % aged 0-15 living in income deprived householdsLocal Health
Employment and incomeUnemployment: % of working age population claiming out of work benefitsLocal Health
Employment and incomeLong term unemployment: crude Rate per 1000 working age population who have been claiming for more than 12 monthsLocal Health
Employment and incomeOlder people in deprivation: % aged 60 or over living in pension credit householdsLocal Health
Employment and incomeJobs paying wages greater than or equal to the self-sufficiency wageSan Francisco Indicator Project
Employment and incomeWomen 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 worryWellbeing Index
Employment and incomeHow satisfied are you with your capacity for work?WHO Quality of Life (WHOQOL-BREF)
Food environmentRate of residential areas with supermarkets within 1,000 meters2011 Livable City Index
Food environmentFarmers’ markets/1,000,000American Fitness Index
Food environmentFood access: the % of no vehicle households living beyond 0.9 mile radial distance of a supermarket or superstoreANQoLHP Neighborhood Health Index
Food environmentFast 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 knowBristol Quality of Life Indicators
Food environmentWater fountain presentCANVAS (Computer-Assisted Neighborhood Visual Assessment System)
Food environmentRate of healthy food outlets per 10,000 residentsColorado Health Indicators
Food environmentPercent who agree or strongly agree it is easy to purchase healthy foods in their neighborhoodColorado Health Indicators
Food environmentRate of fast food restaurants per 10,000 residentsColorado Health Indicators
Food environmentNumber of reported outbreaks of foodborne illnessColorado Health Indicators
Food environment% of population who are low income and do not live close to a grocery storeCommunity Health Status Indicators
Food environmentNeighborhood parks (public or private) offer on-site gardens and/orfarmers markets.Community Healthy Living Index
Food environmentAverage walking time to healthy food retailersHealthy Resources Index
Food environmentChildren with Low Access to a Grocery StoreKansas Health Matters
Food environmentPeople 65+ with Low Access to a Grocery StoreKansas Health Matters
Food environmentAccess 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 betterLivability Index
Food environment% of people who travel less than 15 min to shopsLiveability Assessment Tool
Food environment% of people who travel less than 15 min for fruit and vegetablesLiveability Assessment Tool
Food environmentFood and drinkLiveable Cities Index
Food environmentFast Food Density: The number of fast food restaurants per 10,000 residentsNeighborhood Health Profile Reports
Food environmentCarryout Density: The number of carry-out restaurants per 10,000 residentsNeighborhood Health Profile Reports
Food environmentCorner Store Density: The number of corner stores per 10,000 residentsNeighborhood Health Profile Reports
Food environmentSupermarket Proximity: The estimated travel time in minutes to the nearest supermarket using different modes oftransportation from the most populated areaNeighborhood Health Profile Reports
Food environmentFood sold near drains (c)Proxy Environmental Health Indicators for Accra
Food environmentFood sold near public toilets (c)Proxy Environmental Health Indicators for Accra
Food environmentPercent of residential area within ½ mile of a supermarket/grocery store that accepts EBT (food stamps) and WICSeattle Healthy Living Assessment
Food environmentAccess to healthy foodsTruckee Meadows Tomorrow
Food environmentIncidence of human zoonosesWHO Environmental Health Indicators
Food environmentDioxins and PCBs levels in human milkWHO Environmental Health Indicators
Food environmentIncidence of animal zoonosesWHO Environmental Health Indicators
Food environmentRate of official food controlWHO Environmental Health Indicators
Food environmentProgress in implementation of HACCP systemWHO Environmental Health Indicators
Food environmentPopulation awareness of food safety rules in householdsWHO Environmental Health Indicators
Health and social servicesRatio of population to dentists in a countyCounty Health Rankings
Health and social servicesRatio of population to mental health providers in a countyCounty Health Rankings
Health and social servicesProportion of people who had difficulty accessing a community health service when needed within the last 12 monthsLiveability Assessment Tool
Health and social servicesPublic health facilities with “good” and “very good” transit resource scoresSan Francisco Indicator Project
Health and social servicesNumber of inhabitants per practising primary health care practitionerWHO Healthy City Indicators
Health and social servicesNumber of inhabitants per nurseWHO Healthy City Indicators
Health and social services% of population covered by health insuranceWHO Healthy City Indicators
Health and social servicesHow satisfied are you with your access to health services?WHO Quality of Life (WHOQOL-BREF)
Health outcomesNumber of injured pedestrians admitted to hospitalActive Transportation and Health Indicators
Health outcomesNumber of pedestrians killed in road traffic accidentActive Transportation and Health Indicators
Health outcomesPedestrian injury demographics by age and genderActive Transportation and Health Indicators
Health outcomes% respondents who say that disability prevents them from leaving their house when they want toBristol Quality of Life Indicators
Health outcomes% respondents who say that poor health prevents them from leaving their house when they want toBristol Quality of Life Indicators
Health outcomesIncidence of gastrointestinal diseaseCaya Hueso Urban Ecosystem Health Indicators
Health outcomesIncidence of asthma attacksCaya Hueso Urban Ecosystem Health Indicators
Health outcomesIncidence of respiratory infection in childrenCaya Hueso Urban Ecosystem Health Indicators
Health outcomesIncidence of home injuriesCaya Hueso Urban Ecosystem Health Indicators
Health outcomesDiarrhoea mortality Rate in children aged 0­4 yearsChildren's Environmental Health Indicators
Health outcomesPrevalence of insect­borne diseases in children aged 0­14 yearsChildren's Environmental Health Indicators
Health outcomesSubjective Wellbeing: Australian Unity Personal Wellbeing Index: completely dissatisfied = 0; completely satisfied = 100.Community Indicators Victoria
Health outcomesLife Expectancy: Life Expectancy at Birth: in years, for males and females sepaRatelyCommunity Indicators Victoria
Health outcomesObesity: % of people who are obese according to a Body Mass Index (BMI) of 30 or greaterCommunity Indicators Victoria
Health outcomesyears of potential life lost (YPLL) as its measure of premature death, based on all deaths occurring before the age of 75County Health Rankings
Health outcomes% of the adult population that has a body mass index greater than or equal to 30.County Health Rankings
Health outcomesAsthma in householdEnvironmental Health Basic Exposure Survey
Health outcomesCarbon Monoxide Poisoning Emergency Department VisitsEnvironmental Public Health Tracking Network Indicators
Health outcomesHeat stress emergency department visitsEnvironmental Public Health Tracking Network Indicators
Health outcomesHeat-Related MortalityEnvironmental Public Health Tracking Network Indicators
Health outcomesRate of Childhood Lead Poisoning (per 10,000 children under 6)Health Indicators Dashboard
Health outcomesNumber 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 outcomesChronic Obstructive Pulmonary Disease (COPD) Hospital Admission RateKansas Health Matters
Health outcomesLimiting long term illness or disability: % with limiting long term illness or disabilityLocal Health
Health outcomesObese children (year 6)Local Health
Health outcomesIncidence of all cancerLocal Health
Health outcomesNumber 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 outcomesRate of Motor Vehicle Collisions with Pedestrians and Bicyclists with Children within One-Half Mile of a School per 10,000 ChildrenPlan for a Healthy LA Health Atlas/Health Profiles
Health outcomesMortality and morbidity attributed to household air pollutionProposed Indicators linking health and sustainability in the post-2015 development agenda
Health outcomes% of population who report being stressed all or most of the timeWellbeing Index
Housing% respondents who are satisfied with the state of repair of their homeBristol Quality of Life Indicators
Housing% of houses with inadequate ventilationCaya Hueso Urban Ecosystem Health Indicators
HousingHousing stress - % of housing with one or more housing conditionsCommunity Health Status Indicators
HousingHousing Affordability: Households with Housing Costs 30% or More of Gross IncomeCommunity Indicators Victoria
HousingHousing Affordability: Median House PriceCommunity Indicators Victoria
HousingHousing Affordability: Occupied Private Dwellings which are Government-Owned Rental DwellingsCommunity Indicators Victoria
HousingMold or mildew in homeEnvironmental Health Basic Exposure Survey
HousingProportion of household with no form of heatingEnvironmental Health Indicators New Zealand (EHINZ)
Housing% of houses which have sunshine at least 5 hours a dayHealth Determinants Indicators
HousingNumber of homeless per 100 000 populationISO 37120: Sustainable development of communities -- Indicators for city services and quality of life
HousingBasic passage: % of housing units with extra-wide doors or hallways, floors with no steps between rooms, and an entry-level bedroom and bathroomLivability Index
HousingAvailability of subsidised housing: Number of subsidized housing units per 10,000 peopleLivability Index
Housing% of households with central heatingLocal Health
Housing% of households with 1 or more rooms too fewLocal Health
HousingProportion of homes judged unfit to live inLondon's Health StRategy High Level Indicators
HousingDwelling condition: Dwellings in need of major repairPeg 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 activitiesProposed Indicators linking health and sustainability in the post-2015 development agenda
Housing% of population with hand-washing facilities at homeProposed Indicators linking health and sustainability in the post-2015 development agenda
HousingHealth and building code violations for housing and habitabilitySan Francisco Indicator Project
HousingSecure tenure: % of households with access to secure tenure (owned or rented)Urban Health Equity Assessment and Response Tool (Urban HEART)
HousingSlum population: Proportion of urban population living in slum householdsUrban Health Equity Assessment and Response Tool (Urban HEART)
HousingNumber of women given land rights/housing tenure by City CouncilUrban Health Equity Indicators for Mathare Informal Settlement
Housing% of renters paying over 30% of income to rentWellbeing Index
Land useDensity and Land-Use Mix: Population density by neighbourhoodActive Transportation and Health Indicators
Land useDensity and Land-Use Mix: % of land used for commercial purposes by neighbourhoodActive Transportation and Health Indicators
Land useDensity and Land-Use Mix: Combined Commercial & Residential Density-Mix RankingActive Transportation and Health Indicators
Land useDensity 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 usepopulation density per square kilometre of residential areaActivity-Friendly Index
Land usedensity of all retail services per 10,000 populationActivity-Friendly Index
Land useLiving near highways - % of population living within 150 meters of a HighwayCommunity Health Status Indicators
Land useProximity to derelict sitesGlasgow Indicators Project
Land useDiversity of destinations: Mix of jobs within a mile: measured at the neighborhood scale, higher values are betterLivability Index
Land useActivity density: Combined number of jobs and people per square mile: measured at the neighborhood scale, higher values are betterLivability Index
Land useNear-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 betterLivability Index
Land useThere 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 RouteRichmond Health Equity Indicators
Land useRetail floor area Ratio; the retail building floor area footprint divided by retail land floor area footprintWalkability Index
Land useIntersection 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 acresWalkability Index
Land useLand 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 cultureDog parks/100,000American Fitness Index
Leisure and culturePark playgrounds/10,000American Fitness Index
Leisure and cultureNumber of Public MuralsBaltimore Neighborhood Indicators Alliance, Vital Signs
Leisure and culturePublic Art per 1,000 ResidentsBaltimore Neighborhood Indicators Alliance, Vital Signs
Leisure and culture% respondents satisfied with activities for children and young peopleBristol Quality of Life Indicators
Leisure and culture% respondents satisfied with the range and quality of outdoor events in BristolBristol Quality of Life Indicators
Leisure and culture% of people who participate in cultural and social activitiesCaya Hueso Urban Ecosystem Health Indicators
Leisure and cultureAccess to libraries: Number of libraries located within a half-mile: measured at the neighborhood scaleLivability Index
Leisure and cultureCultural, arts, and entertainment institutions: Number of performing arts companies, museums, concert venues, sports stadiums, and movie theaters per 10,000 peopleLivability Index
Leisure and culture% of residents who feel the city has the arts and cultural opportunities they wantWellbeing Index
Local democracy% respondents who agree they can influence decisions that affect their local areaBristol Quality of Life Indicators
Local democracyDiversity of elected officialsCity of Winnipeg Quality-of-Life Indicators
Local democracyParticipation 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 democracyVoter participation: % of eligible voters who voted in the most recent local/national electionsUrban Health Equity Assessment and Response Tool (Urban HEART)
Local democracy% who feel they can influence city decisionsWellbeing Index
Natural environment% of investment on mangement of the environment2011 Livable City Index
Natural environmentPercent of Area Covered by TreesBaltimore Neighborhood Indicators Alliance, Vital Signs
Natural environment% respondents who are very concerned about the impact of climate change in the UKBristol Quality of Life Indicators
Natural environment% respondents who think that their neighbourhood will be affected by climate changeBristol Quality of Life Indicators
Natural environmentPer capita public green area/m2City Ecosystem Health Index
Natural environmentNumber of Extreme Heat DaysEnvironmental Public Health Tracking Network Indicators
Natural environment2. Dates of Extreme Heat DaysEnvironmental Public Health Tracking Network Indicators
Natural environmentHealth of key indicator speciesIndicators of Urban Ecosystem Health
Natural environmentEcological footprints and land productivity per resident (2003 to 2004)New Zealand Quality of Life Project
Natural environmentNet change in natural/semi-natural habitatsQuality of Life Counts (Local)
Natural environmentPercent of open space that is a designated natural areaSan Francisco Indicator Project
Natural environment% of the city that is parkland or beachWellbeing Index
Noise% respondents who think noise from neighbours is a problemBristol Quality of Life Indicators
NoiseNoise: % data zone area (population-weighted) within 100 m of a major road or rail routeSouth Lanarkshire Index of Multiple Environmental Deprivation (SLIMED)
NoiseNumber of people exposed to noise levels above standard (L day/evening/night) in noise-levels categoriesWHO Environmental Health Indicators
NoiseNumber of people at working place exposed to noise levels (8 hr) > 80 dB(A)WHO Environmental Health Indicators
PollutantsPercent of Lead Violations per 1,000 Residential UnitsBaltimore Neighborhood Indicators Alliance, Vital Signs
PollutantsPesticide-free communitiesBritish Colombia Atlas of Wellness
PollutantsProximity 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
PollutantsVolume 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 nearbyChild Opportunity Index
PollutantsGreenhouse gas emissions measured in tonnes per capita (core indicator)ISO 37120: Sustainable development of communities -- Indicators for city services and quality of life
PollutantsPerceived Safety from Environmental HazardsRichmond Health Equity Indicators
Pollutantsproximity to solid waste disposal sitesVulnerability Indices
Public open spaceParkland as a percent of city land areaAmerican Fitness Index
Public open spaceAcres of parkland/1,000American Fitness Index
Public open spaceNumber of Community Managed Open SpacesBaltimore Neighborhood Indicators Alliance, Vital Signs
Public open space% respondents satisfied with quality of parks and green spacesBristol Quality of Life Indicators
Public open spaceThe neighborhood’s parks, roads, and trails are free of significant airpollution, noise pollution, litter, and physical disorder.Community Healthy Living Index
Public open spaceParks and recreation facilities (public or private) are provided for people of all ages in the neighborhood.Community Healthy Living Index
Public open spaceAverage walking time to parks andschoolyardsHealthy Resources Index
Public open spaceAccess to parks: Number of parks within a half-mileLivability Index
Public open spaceProportion of people who have used neighbourhood parks, picnic areas, playgrounds or reserves in the last monthLiveability Assessment Tool
Public open space% of the Population within One-Half Mile Walking Distance of a ParkPlan for a Healthy LA Health Atlas/Health Profiles
Public open spaceChildren with Easy Access to a Park or PlaygroundThink Health LA! Indicators
Services & utilitiesRate of Clogged Storm Drain Reports per 1,000 ResidentsBaltimore Neighborhood Indicators Alliance, Vital Signs
Services & utilities% of water supply, street light networks, street infrastructure needing replacementCaya Hueso Urban Ecosystem Health Indicators
Services & utilitiesChildren aged 0­14 years living in households without basic services for water supply, sanitation and hygieneChildren's Environmental Health Indicators
Services & utilitiesEpisodes of flooding inside householdsCore Environmental Health Indicators in Lucknow and Calcutta
Services & utilitiesTotal 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 & utilitiesEnergy 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 & utilitiesThe % 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 & utilitiesProportion of people with access to public internet facilitiesLiveability Assessment Tool
Services & utilitiesNumber of energy cut-offs per 10,000 households each monthNeighborhood Health Profile Reports
Services & utilitiesAnnual average utility billsPlaces 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 & utilitiesEvidence of flood risks within community (c)Proxy Environmental Health Indicators for Accra
Services & utilities% of population with access to improved sanitationUrban Health Equity Assessment and Response Tool (Urban HEART)
Services & utilities% of households served by municipal solid waste management systemUrban Health Equity Assessment and Response Tool (Urban HEART)
Social networks% of adults 18 years and over who report not receiving sufficient social-emotional supportCommunity 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 colorHealthy Chicago 2.0
Social networksProportion of people who either agree or strongly agree with feeling they belong to their neighbourhoodLiveability Assessment Tool
Social networksProportion of people who either agree or strongly agree with the belief that their neighbours would help them in an emergencyLiveability Assessment Tool
Social networks% of residents who feel they can count on their neighboursWellbeing Index
TransportAge and Gender: Share of trips being made by cycling per demographic groupActive Transportation and Health Indicators
TransportIncome and Spending: Transportation expenditures by income quintileActive Transportation and Health Indicators
TransportVehicle Ownership: % of households owning zero, 1, 2 or 3+ vehiclesActive Transportation and Health Indicators
TransportPercent using public transportation to workAmerican Fitness Index
TransportPercent bicycling or walking to workAmerican Fitness Index
TransportWalk Score®American Fitness Index
Transport% respondents satisfied with the bus serviceBristol Quality of Life Indicators
TransportCrosswalk timing (seconds)Built Environment Assessment Tool
TransportCondition and quality of curb cut/rampBuilt Environment Assessment Tool
TransportBench or covered shelter at the transit stop presentBuilt Environment Assessment Tool
TransportNumber of trees within 5 feet of either side of the sidewalk/pathwayBuilt Environment Assessment Tool
TransportHigh Frequency Transit ServiceCommunity Health and Equity Index
TransportThe neighborhood has a network of walkable sidewalks that are unobstructed, well maintained, and level.Community Healthy Living Index
TransportEstimated total hours that the average commuter spends in traffic each yearLivability Index
TransportAverage speed limit (MPH) on streets and highwaysLivability Index
Transport% of transit stations and vehicles that are ADA-accessibleLivability Index
TransportSidewalk Width: < 4 feet, Between 4 and 8 feet, > 8 feetPedestrian Environment Data Scan (PEDS)
TransportSidewalk connectivity to other sidewalks/crosswalksPedestrian Environment Data Scan (PEDS)
TransportAre there wayfinding aids?Pedestrian Environment Data Scan (PEDS)
TransportIllegal parkingResidential Environment Assessment Tool
Transport% of residents who drive to work aloneWellbeing Index
TransportAverage distance of bike lane per personWellbeing Index
Urban design% respondents who think the quality of new developments has got betterBristol Quality of Life Indicators
Urban designObservation of pleasant hardscape features such as fountains, sculptures, or art (public or private)Built Environment Assessment Tool
Urban designAmount of buildings with blank wallsCANVAS (Computer-Assisted Neighborhood Visual Assessment System)
Urban designAmount of benches on segmentCANVAS (Computer-Assisted Neighborhood Visual Assessment System)
Urban designThere are attractive buildings/homes in my neighborhood.Neighborhood Environment Walkability Scale (NEWS)
Urban designResidents’ rating of sense of pride in the way their city looks and feelsNew Zealand Quality of Life Project
Waste management% Municipal Solid Waste to Waste-to-EnergyEnvironment Health Sustainability (EHS) Index
Waste managementProportion of people who recycle all or most recyclable wasteLiveability Assessment Tool
Waste managementProportion of people who compost some or all of their household food wasteLiveability Assessment Tool
Waste managementMounds of uncollected garbage within community (c)Proxy Environmental Health Indicators for Accra
Waste managementIndiscriminate dumping of garbage in community (c)Proxy Environmental Health Indicators for Accra
Waste managementEvidence of children playing around waste-dumps and/or scavenging in themProxy Environmental Health Indicators for Accra
Waste managementEvidence of animals scavenging on waste-dumps and spreading the litter (c)Proxy Environmental Health Indicators for Accra
Waste managementAnnual per capita solid waste disposalSan Francisco Indicator Project
Water qualityNumber 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 qualityPercent of the population who report bottled water as their primary home drinking water sourceColorado Health Indicators
Water qualityCondition of Natural Streams and Waterways: Index of stream conditionCommunity Indicators Victoria
Water qualityFaecal coliforms in freshwaterHealth 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 yearLivability Index
Water qualityProportion of people who are either very or mostly satisfied with the water quality of rivers, lakes and creeks in their neighbourhoodLiveability Assessment Tool
Water qualityPools of stagnant water (cesspools) (c)Proxy Environmental Health Indicators for Accra
Water qualityNumber of days of beach closure in San Diego CountyQuality of Life Indicator Program for San Diego-Tijuana Metropolitan Region
Water quality% of population with sustainable access to an improved water sourceUrban Health Equity Assessment and Response Tool (Urban HEART)

Successful examples

meeting

The San Francisco Indicators Project and Community Indicators Victoria are well-known tools that provide great lessons.

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.


Do other indicators get used in practice?

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