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Looking back to look forward

evidence-based planning of healthy neighborhoods

Nordbø, Emma Charlott Andersson1,2; Raanaas, Ruth K.1,2

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doi: 10.11124/JBIES-20-00044
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Health-promotion efforts aimed at ensuring good health and well-being during childhood and adolescence are profoundly important because these are stages in life that provide foundations for lifelong health and resilience.1 Today, health promotion is widely recognized as a societal responsibility that extends beyond health care to also encompass the factors and conditions that influence our possibilities to participate in everyday activities.2 Attending school, spending time with friends and having opportunities to play and take part in leisure activities are vital for the health and well-being of children and adolescents. Equally important, these activities should take place in safe and suitable environments where children and adolescents are able to move around independently.3

In recent years, both researchers and policy makers have afforded greater attention to the contextual factors of the settings and surroundings where children and adolescents are involved in everyday activities.2,4 In particular, the World Health Organization has emphasized the significance of designing neighborhoods and communities that promote healthy, thriving and resilient populations.4 To achieve such objectives, more extensive use of evidence-based approaches in public health is advantageous. This involves making decisions based on the best available evidence.5

Multiple disciplines have contributed information intended to improve our understanding of how we can build healthy neighborhoods for our emerging generations. Over the past decade, the number of scientific inquiries into the impact of neighborhood contextual factors on health and well-being has increased remarkably, and a comprehensive body of evidence has been established and continues to grow.6 To increase the likelihood of yielding successful outcomes and ensuring more efficient utilization of resources, it is necessary to highlight this evidence in the development and implementation of policy changes and intersectoral public health initiatives.5 Explicit use of the existing evidence is also important to strengthen evidence-based decision-making on intersectoral public health matters. For these purposes, the availability and use of systematic reviews play a key role, which necessitates that researchers consolidate the evidence regularly and provide convenient and updated overviews.

The current issue of JBI Evidence Synthesis devotes space to a systematic review and a protocol that address the neighborhood contextual factors of children and adolescents.7,8 The systematic review conducted by Nordbø et al.7 has identified and synthesized existing evidence on built environment characteristics, such as residential density, pedestrian infrastructure, green spaces, and facilities, and their relationship to both participation in activities and well-being in childhood and adolescence. Consistent associations were found between active transport (i.e. walking and cycling to and from daily destinations) and the following built environment constructs: low traffic exposure and high safety, shorter distances to facilities, high walkability and pedestrian infrastructure for walking and cycling. These findings provide recommendations for policy development and planning practice, and aim to inform stakeholders from different sectors involved in public health.

Despite these key findings, it must be acknowledged that the causal pathways linking different built environment characteristics to health and well-being are intertwined, and operate through multiple moderators and mediators, including age, sex, socioeconomic status, personal preferences and parenting practices, to name a few. Moreover, we have only begun to scratch the surface of intriguing questions concerning how the built environment could be important for the subjective well-being of children and adolescents. This demonstrates a need for more research. In additional, there are many challenges involved in conducting systematic reviews on the complex relationship between the built environment, health, and well-being due to contextual and geographical difference, as well as heterogeneity between studies in terms of measurements and analytical approaches. One important issue concerns the large variability in how built environment constructs are measured and operationalized across studies, which leads to difficulty comparing study findings.9 However, researchers are attempting to increase the comparability of results between studies. For example, specific protocols are being developed for more consistent computation of built environment measures across diverse geographical contexts.10

Although the stated methodological challenges prevent us from drawing robust conclusions at present, the endorsements to use evidence-based strategies require that we look back to look forward. Planning practices adopted over the decades have resulted from changing ideas as to what constitutes a healthy neighborhood, and as human needs change, we must adapt to meet present and future demands. Building on previous achievements and understanding the existing neighborhood contexts, including its residents and uses, help to specify the factors shaping the relationship between the built environment and health. The best available evidence at this moment shows that focal aspects in planning healthy neighborhoods for the children and adolescents who represent the societies of tomorrow include low traffic exposure and high safety, well established pedestrian infrastructure for walking and cycling, shorter distances to facilities, and high walkability.7


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