The built environment influences our health in many ways, including activity levels, access to nutritious food, the houses we live in, where we work, contact with nature and the spaces we have for social interactions. It also affects the air we breathe and the water we drink, and shelters us from the weather.

What is the built environment?

The built environment refers to the human-made surroundings where people live, work and recreate. It includes buildings and parks as well as supporting infrastructure such as transport, water and energy networks (Coleman 2017).

The built environment affects the natural environment through its use of land, water and energy resources, and the waste and emissions produced. Conversely, extreme weather events such as floods, cyclones, bushfires and heatwaves are considered the largest risk to the built environment and people who live in it. See Natural environment and health.

Urban form

The shape, size, population density and layout of a city is known as the urban form. In 2018, over 90% of the Australian population lived in Major cities and Inner regional areas (ABS 2019). Australian cities have unusually low population densities compared with cities in other developed countries with similar population sizes (Coleman 2017). Australia’s cities are also characterised by:

  • small, dense cores with large, low population density outer suburbs
  • segregated land use that separates where people live from where they work, often by great distances (Coleman 2017).

Urban form and population density may play a role in the spread and transmission of communicable diseases, such as COVID-19, as it may be easier for people to maintain physical distance from one another in areas of low population density. However, there are many other environmental, social and economic impacts from this type of urban form, with flow-on effects to human health, including:

  • increased car use, which decreases physical activity and increases the risk of chronic disease and its risk factors including obesity and hypertension, as well as increasing the risk of injury from accidents (Chandrabose et al. 2019). Road transport also increases the level of greenhouse gas emissions, reducing air quality in built-up areas
  • loss of agricultural land and green spaces, which reduces areas for food production, recreation, exercise and community gathering, and affects biodiversity. The loss of green spaces, particularly tree canopy coverage, can also increase temperatures in urban areas (Government of South Australia 2019)
  • socioeconomic inequality, as more affordable housing is often found further away from city centres and employment areas, which requires longer travel times, increased travel costs, and reduced time available to engage in healthy behaviours such as physical activity (Christian 2012; Daley et al. 2018; Trubka et al. 2010).

Walkability

Neighbourhood walkability (how conducive an area is to walking) affects health through its impact on physical activity and social capital (Giles-Corti et al. 2010). People are more likely to walk for recreation or exercise if they live in neighbourhoods that are within a walkable distance of destinations (including public transport services), have well connected streets and higher residential densities (Gebel et al. 2009; Kamruzzaman et al. 2014). Participating in 30 minutes of walking on average a day can lower the risk of heart disease, stroke, and diabetes by 30–40% (National Heart Foundation 2019).

A ‘walkability index’ has been created by the Centre for Urban Research, which combines dwelling density, daily living destinations and street connectivity (Arundel et al. 2017). Using this index, only a minority of Australians living in cities live in walkable communities, and these are generally concentrated in the inner (and some middle) suburbs. However, there are some exceptions where the implementation of policies has resulted in highly walkable outer suburbs, such as in Perth and Canberra (Arundel et al. 2017). The Liveable Neighbourhoods operational policy created by The Western Australian Planning Commission in 1997 provides guidance and requirements for the design of urban areas (WAPC 2015). A study by Bull and others (2015) found that for every 10% increase in compliance with the policy, participants were:

  • 53% more likely to walk within their neighbourhood
  • 40% less likely to feel unsafe
  • 14% more likely to have better mental health.

The study also found that:

  • people living within 1.6 km of a convenience store, shopping centre or newsagent were 2 times more likely to walk regularly
  • people with access to parks and well-connected footpaths were 2.5 times more likely to walk for more than 1 hour each week
  • children living closer to school and having highly connected street networks and low traffic volumes were nearly 4 times more likely to walk or cycle to school.

Green and public open spaces

Green and public spaces are areas of public and private land such as nature reserves, public parks, residential gardens, sporting facilities, beachfronts and waterways. They are important for both physical and mental health (Sugiyama et al. 2008; WHO 2019). Spending 2 hours or more in natural environments over the week is associated with higher levels of self-reported good health and wellbeing compared with those who spend no time in them (White et al. 2019).

Australian studies show that:

  • people were 3 times more likely to do any moderate or vigorous physical activity if they lived within 400 metres of a park (Mavoa et al. 2016)
  • access to a larger park within 1.6 km of home increased the likelihood of walking for 150 minutes or more in a week (equivalent to Australia’s Physical Activity and Sedentary Behaviour Guidelines for adults) (Sugiyama et al. 2010).

Green spaces also provide places for social interaction, both planned and incidental, and facilitate community connections and wellbeing (Infrastructure Australia 2019). This is important for feelings of safety, neighbourhood satisfaction and positive mental health, and can help to reduce social isolation (Giles-Corti et al. 2010; Mahmoudi Farahani 2016).

Well-planned green spaces support biodiversity, improve air quality, and reduce noise pollution and temperatures in urban areas (Kent & Thompson 2019). Contact with the natural environment may also benefit our immune system (WHO & SCBD 2015).

Transport

An effective transport system is an essential part of a healthy built environment. It provides access to the resources and facilities people need for a healthy life, such as employment, health care and nutritious food. Transport systems can positively influence health by promoting active travel, or negatively influence health through car dependence, traffic accidents and sedentary behaviour. Transport systems can also affect greenhouse gas emissions and climate change, air pollutants, environmental noise, and lead to the reduction of natural space (Kent & Thompson 2019).

How do Australians commute to work?

On the day of the 2016 Census of Population and Housing (Census), 9.2 million people travelled an average of 16.5 km to their workplace:

  • 79% travelled by private vehicle
  • 14% took public transport
  • 5.2% either cycled or walked.

The average distance travelled was shortest for those living in the Greater Darwin area (13 km), and greatest for those living in regional areas of Western Australia (21 km) (ABS 2018a).

Car dependence

The great majority of Australians depend on their cars for transport. Car-dependent suburbs tend to have poor access to public transport, employment services and shops. Car dependence increases traffic congestion, commuting times and air and noise pollution. It can also lead to an increase in traffic accidents and affect respiratory and cardiovascular health, as well as mental health and life satisfaction (BITRE 2016; Giles-Corti et al. 2016). It contributes to sedentary lifestyles and growing rates of overweight and obesity (AIHW 2011).

Poor air quality due to traffic emissions can be harmful to both human health and the ecosystem, and tends to concentrate around major road corridors (Infrastructure Australia 2019). Car dependence can have a larger effect on those from lower socioeconomic areas, who often have less choice in housing location and may have to live in outer suburbs due to housing affordability. This results in a higher proportion of their household income being spent on car-related expenses (and less available for health needs), and increased vulnerability to changes in fuel prices and mortgage stress (Dodson & Sipe 2008; Dodson et al. 2004; Infrastructure Australia 2019).

Traffic accidents

Traffic-related accidents are a major public health issue and can result in injury, disability or death. In Australia, there were 1,145 deaths due to road traffic crashes in 2018. The number and rate of road deaths decreased over the decade from 2009 to 2018 (by 23% and 33% respectively). Comparable data for road crash hospitalisations are available only for the period 2013–2016, and show the number and rate of hospitalised injuries has increased (by 11% and 6.2% respectively) (BITRE 2019).

Active travel

Active travel is the process of being physically active (usually walking or cycling) while moving from one place to another, and can include multiple modes of transport in 1 trip. The health benefits of active travel include:

  • increased physical activity
  • social and psychological benefits from incidental interactions with other people
  • reductions in greenhouse gas emissions and traffic congestion and less noise and air pollution.

Living in close proximity (400–800 m) to a mix of destinations is associated with higher levels of active transport across all age groups (Boulange et al. 2017; McCormack et al. 2008; Sallis et al. 2012). Other factors associated with increased active travel include safety from traffic, well-lit streets and footpaths (Sallis et al. 2012).

On Census day in 2016, of those who commuted to work 5.2% walked or cycled (ABS 2018a). People who walked or cycled to work generally had the shortest commuting distance.

Food environments

The built environment influences food choices, either by enabling healthy food options or by providing exposure to unhealthy options. Diet is a modifiable risk factor for many chronic conditions as well as overweight and obesity. See Diet and Overweight and obesity.

Some evidence links an increased density of fast food outlets with overweight and obesity in people and conversely, closer proximity to supermarkets with a higher intake of fruit and vegetables and a higher quality of diet (Allender et al. 2012; Levy 2012). The density of alcohol outlets has also been associated with alcohol-related harm in Australia and internationally (Livingston et al. 2015).

In Australia, the Australian Bureau of Statistics (ABS) National Health Survey 2017–18 included information about the proximity of major supermarket and fast food chain outlets to survey participants (ABS 2018c). Just over half (56%) of Australians lived within 1,500 m of a supermarket, and less than half (44%) within 1,500 m of a fast food outlet. However, the estimates showed no difference for adults in consumption of sweetened drinks, fruit or vegetables by proximity to supermarkets or fast food outlets. This was despite a greater proportion of people from areas of relatively greater disadvantage living within 1,500 m of a supermarket or fast food outlet.

Access to urban agriculture and community gardens is associated with greater consumption of fruit and vegetables. Other health benefits include more active lifestyles, and the mental health and social capital benefits of engagement with other people in natural spaces (Townshend et al. 2015).

More research is needed to better understand the relationship between availability of food, individual food choice and health outcomes in Australia.

Housing

Housing is a very important influence on health and wellbeing. It provides shelter, safety, security and privacy. The availability of affordable, sustainable and appropriate housing enables people to better participate in the social, economic and community aspects of their lives. Housing construction and design and the social and neighbourhood environment can affect various aspects of physical and mental health and quality of life of the inhabitants (Giles-Corti et al. 2012).

In Australia, building design codes regulate the insulation, ventilation, room sizes, ceiling heights and access to sunlight of dwellings. However, the built environment is slow to adapt to increases in extreme heat events, and heat-related deaths are expected to increase over time (Coleman 2017).

It has been estimated that almost 1,000,000 Australians live in housing regarded as being in poor condition (Baker et al. 2016). Poor-quality housing is associated with greater psychological distress (Giles-Corti et al. 2012) and lower self-assessed general and physical health (Baker et al. 2016).

Frequent moves, renting, and being in financial housing stress are associated with negative children’s physical health outcomes (Dockery et al. 2013).

In cities, housing affordability and homelessness are major challenges. On Census night in 2016, an estimated 116,000 people were homeless (ABS 2018b), and in 2017–18 more than 1 million low-income households were in financial housing stress (AIHW 2019b). See Health of people experiencing homelessness.

In remote areas, inadequate supply and poor conditions of social housing can lead to housing overcrowding, particularly for Aboriginal and Torres Strait Islander people (AIHW 2019a)—see Social determinants and Indigenous health. Overcrowding can affect health and education outcomes, and reduce employment opportunities (Infrastructure Australia 2019).

Water resources

Reliable and safe drinking water and wastewater services are vital for the wellbeing and long-term sustainability of communities. In metropolitan areas, water infrastructure includes drinkable supply and wastewater services; many rural and remote areas rely on small, localised or onsite systems (Infrastructure Australia 2019).

Water quality in urban areas of Australia is generally good, however some parts of regional Australia do not meet drinking water standards (Coleman 2017). In some remote communities, water and wastewater infrastructures are poorly maintained, routinely fail, or fail to provide services to their designed standard (Infrastructure Australia 2019).

With the increasing population, and longer and more severe droughts expected, maintaining water supply and quality will become increasingly challenging (Coleman 2017).

Where do I go for more information?

For more information on the built environment and health, see:

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