Reconnecting urban planning with health: a protocol for the development and validation of national liveability indicators associated with noncommunicable disease risk behaviours and health outcomes November 2014, Volume 25, Issue 1

Introduction

Recognition that city design impacts public health was established in the 19th century in response to outbreaks of infectious disease.¹ Recently, there have been calls for public health and planning disciplines to reconnect¹ to ‘create healthy cities’ that facilitate healthier lifestyles, which in turn might contribute to reducing the risk of noncommunicable disease.² Urban form that promotes walking, cycling and public transport is now being recommended by multiple sectors, including public health³, transport⁴ and planning^5,6, and the creation of ‘liveable and sustainable’ communities is a priority within state⁷, national⁸ and international⁹ urban policies. For example, Plan Melbourne⁶ and the draft Metropolitan Strategy for Sydney⁵ encourage active travel (e.g. walking, cycling) as innovative metropolitan planning approaches to transition to more sustainable cities. Similarly, in Western Australia, the Liveable Neighbourhoods Guidelines, first trialled in 1998, replace conventional design codes to facilitate the development of more sustainable suburban communities.¹⁰

From a population health perspective, a ‘liveable’ community is one that is safe, attractive, affordable, and environmentally and economically sustainable; socially cohesive; has good access to public open space, employment, education, shops and services; and has effective public transport and walking and cycling infrastructure. As such, many liveable attributes are features of the built environment.¹¹

A number of recent reviews and studies demonstrate the association between built environment attributes and various health outcomes, suggesting that community design affects travel mode choices, physical activity levels and vehicle kilometres travelled.^3,4,12,13 Thus, creating safe, pedestrian-friendly and cycle-friendly neighbourhoods with access to local amenities and well-designed public open spaces benefits health through increased physical activity and reduced levels of obesity.¹⁴ Furthermore, liveable communities have the potential to promote mental health¹⁵, including reducing the incidence of depression and social isolation, by creating a sense of community and social support.^16,17 These communities also facilitate access to healthier food options to encourage healthy eating^18,19, and minimise access to alcohol and gambling outlets²⁰⁻²³, thereby limiting exposure to, and engagement in, behaviours that damage health.

Liveable communities create conditions that can optimise health and wellbeing outcomes in residents by influencing various social determinants of health²⁴ through provision of supportive infrastructure: walkable neighbourhoods, public transport, public open space, local amenities, and social and community facilities. The notion of the health benefits of liveable communities is consistent with initiatives such as the World Health Organization’s Healthy Cities Movement that, for more than two decades, has promoted the creation of health-enhancing cities.²⁵ Yet, until recently, limited systematic research has examined the influence of these ‘upstream’ factors on health outcomes²⁴, and even less attention has been paid to how best to measure them within a policy context. To our knowledge, no research has examined how these factors impact people with differing levels of disadvantage, so there is limited understanding about how urban environments can deliver and equitably distribute health benefits.

Over two years, the National Liveability Study, funded through The Australian Prevention Partnership Centre (TAPPC), aims to develop and validate a national set of spatially derived built environment liveability indicators that impact on noncommunicable disease risk behaviours and/or health outcomes. The work will be done in collaboration with a team recently established through a National Health and Medical Research Council (NHMRC) Centre for Research Excellence (CRE) in Healthy, Liveable Communities, and the Australian Urban Research Infrastructure Network (AURIN). Liveability indicators will be (a) aligned with state and federal urban policy, (b) developed using national data (where available), (c) standard and consistent over time, (d) suitable for monitoring progress towards creating more liveable, equitable and sustainable communities, (e) validated as being associated with selected noncommunicable disease risk behaviours and/or health outcomes, and (f) developed to provide a practical mechanism for local through to national organisations to measure the impact of activities in their relevant jurisdiction.

This paper describes the protocol for the study. Details of the project can be found on the CRE for Healthy, Liveable Communities website at the University of Melbourne’s McCaughey VicHealth Centre for Community Wellbeing.

Method

Geographic information systems (GISs) can process spatially referenced, multilayered spatial data to create objective exposure measures of the built environment, and are increasingly being used in public health research.^26–28 Using a GIS, we propose to develop, trial and validate spatial metrics appropriate for urban environments in metropolitan city regions and major towns across Australia.

The selection of appropriate liveability indicators will be informed by the ongoing work of the Place, Health and Liveability research team (University of Melbourne) at the McCaughey VicHealth Centre, which has recently reviewed the evidence on conceptualising and measuring liveability from a public health perspective.^11,29 Our starting point for measurement will be based on acquiring and deriving data for the five domains of liveability that are potentially associated with chronic disease outcomes (Table 1). We will review relevant plans and policies of selected Australian state and territory governments for each domain, and then create a set of liveability indicators based on the policies and data available.

Table 1. Built environment domains to be considered in this project

Source: Badland et al.¹¹

A national advisory group comprised of stakeholders in state and federal government, federal nongovernment organisations and state-based technical working groups located in the ACT, Victoria, NSW, Queensland and WA will provide advice during the project. State-based technical working groups will review previously used indicators identified from the literature across the physical activity, urban planning and transportation fields, as well as current urban planning policy, and present their recommendations to the national technical team, which will agree on appropriate spatial measures for each indicator. Each state-based technical working group will then identify and source relevant state-level and national-level spatial data to develop and validate each indicator.

Validating the indicators

Three approaches will be taken to validate and assess the feasibility of the liveability indicators:

1. Examining the association of the indicators with a range of health behaviours and, where available, noncommunicable disease outcomes

State-based indicators of liveability will be linked to state-based (and where available, national) health behaviour and health outcome data, and cross-sectional associations will be examined.

2. Comparing indicators developed using national data with finer-grained, state-level data

Generally, data available at a national scale are less sensitive than the finer-grained data available at city and state levels. Consequently, we will compare indicators developed using national-level data (coarser-grained) with indicators developed using state-level information (finer-grained). For example, previous work by our group reported associations between physical activity and public open space access indicators, developed using nationally available land use data (sourced from the Australian Bureau of Statistics ‘mesh block’ dataset, which contains broad land use classes).³⁰ These national-level measures will be compared with public open space indicators developed using finer-grained, state-level datasets, such as POS Tool in WA, allowing assessment of the validity of using national-level mesh block data to calculate an indicator of public open space. Once the validity of each data source is confirmed, the national-level GIS indicators will be finalised.

3. Exploring the potential for creating a national database of built environment spatial indicators that can be used (a) for state and national research, (b) to inform local planning to improve infrastructure access and reduce noncommunicable disease and inequalities, and (c) to monitor changes in urban policy and planning

The final stage of this project will be to scope the feasibility of developing and maintaining a national built environment spatial database from which liveability indicators could be applied to state and national-level health studies. This will be informed by stakeholder consultation and ongoing national database initiatives such as AURIN³¹, the Australian National Development Index, Research Data Australia and Australian Government datasets.

Conclusion

The National Liveability Study aims to build the capacity for systems research relating to the built environment and health, and to develop a set of national indicators that can be used to monitor progress towards creating healthy and liveable communities. It builds on research involving the development of built environment GIS indicators and validation with health behaviours and outcomes conducted by our team and collaborators. Such a program of work requires involvement from many stakeholders and disciplines: an approach well aligned with the shared objectives and aspirations of TAPPC and the CRE in Healthy, Liveable Communities.

Through a national advisory group, stakeholders (such as state and local government, nongovernment organisations, and policy and planning practitioners) will co-create and integrate this research into their practice and monitoring. The national advisory group will provide guidance to assist in the development of the liveability indicator database, as well as being end users of this resource. To facilitate research translation and application, the study results will be disseminated to stakeholders using a range of methods, including policy briefs, and regional (e.g. regional management forums), state and national (e.g. Planning Institute of Australia) planning and policy meetings and workshops, with the intention that the indicators are used in these agencies’ regular reporting and monitoring frameworks.

The liveability indicators developed by this study will also be made available to end users, including (but not limited to) the Community Indicators Victoria program (housed in the Place, Health and Liveability Program, McCaughey VicHealth Centre, University of Melbourne), the Sax Institute in NSW, the University of Western Australia’s Centre for the Built Environment and Health, the ACT’s University of Canberra and the national AURIN portal. Using existing infrastructure and stakeholder partnerships maximises the likelihood that the indicators will be used in regional and national urban planning policy and related monitoring.

Acknowledgements

The National Liveability Study is supported by The Australian Prevention Partnership Centre, which is funded by the NHMRC, the Australian Government Department of Health, NSW Ministry of Health, ACT Health and the HCF Research Foundation. It is administered and hosted by the Sax Institute, and co-hosted by the Centre for Excellence in Intervention and Prevention Science. An NHMRC Principal Research Fellowship (#1004900) supports BGC. An NHMRC Senior Research Fellowship (#10037100) supports GT. We would also like to acknowledge the contributions and feedback from our Systems Investigators and Advisory Group members, including James Collett and Anne Hurni (Department of Infrastructure and Regional Development), John Miller (Hames Sharley),Kirsty Kelly (Planning Institute of Australia), Louise Sylvan (Australian National Preventive Health Agency (functions transferred to Department of Health), Shelley Bowen (Department of Health, Victoria) and Ross O’Donoughue (ACT Health). The contributions to the conceptual work underlying this project made by collaborators at McCaughey VicHealth Centre’s Place, Health and Liveability Program, and the NHMRC Centre for Excellence in Healthy, Liveable Communities (#1061404), are also gratefully acknowledged. Finally, Dr Iain Butterworth from the Victorian Department of Health North and West Metropolitan (NW) Region is gratefully acknowledged as the initiator of the Place, Health and Liveability Program, which is a partnership between the Victorian Department of Health NW Region and the McCaughey VicHealth Centre.

Copyright:

© Giles-Corti et al. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.