Category: Indicators

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.

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.

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.

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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.

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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

Selecting indicators is about balancing priorities with available data.

There are many free and publicly available indicator sets. Here are some points to consider before you start choosing specific metrics:

Scale: Indicators about health and the built environment are available at many scales, from individual buildings, neighbourhoods, cities and beyond. This is important if you want to be able to compare your project or area to another. You can choose metrics to measure in a building or neighbourhood based on what is available at comparable scales or for the whole city.

Purpose: The metrics that you choose will have limitations, so be clear about what purpose the information will serve. If you want to show that one area is disadvantaged compared to others, you will need comparisons with other places (see above). Perhaps you want to see how something changes over time. In this case, the data will need to be gathered periodically. Setting a clear purpose helps to narrow down which indicators can be used.

Cost: Collecting data can be expensive, but there are many freely available datasets that report useful indicators. If these sources are likely to keep reporting over time (this is a big challenge), then you may be able to rely on such public data. Consider who will pay for data collection, which could include environmental monitoring or residents’ surveys.

Priorities: It may be true that we should ‘measure what matters’, but it is also true that ‘what gets measured matters’. There can be a tension between choosing the most important indicators for urban health and available data. This can result in many datasets reporting readily available data that may not be the most important issues for a particular community. It is worth considering which indicators are most important and reflective of local values and health priorities (see ‘Collaboration’ and ‘Don’t start from scratch’ below).

Collaboration: Selecting indicators is often a process that surfaces disagreements among built environment stakeholders. For example, gathering data may reveal problems that damage public or private sector organisations reputations. It can be useful to involve a wide range of stakeholders in choosing indicators to ensure that all parties have a chance raise concerns and solutions.

Don’t start from scratch

We conducted a review of global urban health indicator sets and found 145 internationally, so there is probably an indicator dataset available near you.(1) This means you don’t have to start from scratch. Check for the country-specific or international indicator sets using the link below.

If you want to develop your own indicator set for a specific project or place, you still don’t have to start from scratch. We’ve produced an indicator database with roughly 300 examples of published urban health indicators. You can search the database on this website (e.g. for air quality or waste) or download a copy to explore in detail.

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References

(1) 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

Urban health indicators focus on the health impact of cities, including the physical urban environment.

There are many metrics about our quality of life, wellbeing and health. These measures can be used to understand the current status, set targets and judge progress.

We can use indicators for any of the following (1):

• understand a place and its impact on health to inform the development, monitoring and adjustment of urban policies
• compare places or success of policy programmes (e.g. within a city, across cities or internationally)
• support funding bids and/or decisions
• involve the community in agreeing priorities.

The value of indicators for communication

Here are a few examples where a headline figure helps to communicate a key challenge or opportunity.

Highlighting a problem

The first two examples show how indicators can highlight problems with the current state or proposed changes in the built environment.

<13% of new homes were located within walking distance of a railway, light rail or metro station

Royal Town Planning Institute (2016)

An analysis of planning permissions for new residential development in 12 city regions in England included data for 165,000 planned new homes.(2) Less than 13% were located within walking distance of a railway, light rail or metro station. Only 46% were located in an existing built-up area. This is likely to mean that many new homes are spatially disconnected from shops, schools, local services and convenient public transport. Residents of these new developments will probably rely on cars for the majority of their daily trips.

43% of British people are living in homes which do not meet the Living Home Standard.

Shelter

Shelter’s Living Home Standard highlighted the condition of housing in the UK. The standard looks at affordability, space, stability, decent conditions and neighbourhood – all of which are important for health. The charity has a dashboard that reports the percentage of homes that fail to meet the standard across different tenures and occupants’ characteristics (e.g. age, income, etc.).(3)

Measures of impact

The next few example shows how indicators can measure impact. The first is about the financial value of walkable neighbourhoods.

$4k – $34k Increased value of homes in highly walkable communities in USA

Cortright (2009)

A study of American cities found that houses with high walkability scores sold at values of $4,000 to $34,000 higher than homes with average walkability scores.(4) The walkability scores were measured by a tool called ‘Walk Score’ which is based on a combination of population density, access to services and street layout. 

Finally, this last example looks at the physical activity levels of residents in a new development, which is important for health.

40-50 min/week more physical activity since moving to the new development

Kramer et al. (2014)

A master-planned community called Mueller in Austin, Texas included 5,700 homes. The new community was studied by researchers who found that residents in early phases increased their physical activity levels by 40-50 minutes per week.(5)

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References

(1) Pineo, H., Zimmermann, N., Cosgrave, E., Aldridge, R.W., Acuto, M. and Rutter, H. (2018a) Promoting a healthy cities agenda through indicators: development of a global urban environment and health index. Cities & Health. 2  (1), pp. 27–45. https://doi.org/10.1080/23748834.2018.1429180

(2) Royal Town Planning Institute, 2016. The location of development: Mapping planning permissions for housing in twelve English city-regions.

(3) http://www.shelter.org.uk/livinghomestandard

(4) Cortright, J., 2009. Walking the walk: How walkability raises home values in US cities. CEOs for Cities

(5) Kramer, A., Lassar, T.J., Federman, M., Hammerschmidt, S., 2014. Building for Wellness: The Business Case. Urban Land Institute, Washington DC.