Built environment and health

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.

The built environment interacts with 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

Economic development and technological advances have brought with them a range of benefits such as a higher average standard of living, which can influence health outcomes positively. Cities and the number of cars have also grown with economic development, increasing convenience and economic opportunity. There are also costs associated with the growth of cities; these costs can be mitigated to an extent through effective urban planning (Grant et al. 2017).

The shape, size, population density and layout of a city is known as the urban form. In 2020, 90% of the Australian population lived in Major cities or Inner regional areas (ABS 2021). 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 (Frumkin 2021). 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 dependence, 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 pollutants, including PM2.5 (see Glossary), reducing air quality in built-up areas
• loss of natural areas and agricultural land, which reduces areas for biodiversity conservation and food production
• 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 results in 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 (see Glossary) affects health through its impact on physical activity and social capital (see Glossary) (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. 2016).

Participating in 30 minutes of walking on average a day can lower the risk of heart disease, stroke, and diabetes (National Heart Foundation 2019). The health benefits increase with increased levels of activity and intensity, with up to 30–40% reduction of risk for some conditions at the higher levels of activity (Hamer and Chida 2008; Williams and Thompson 2013). Adding 15 minutes of brisk walking, 5 days each week, could reduce disease burden due to physical inactivity by about 13% (AIHW 2017). If this time increased to 30 minutes, the burden could be reduced by about 26% and benefits would extend to all ages, particularly people aged 65 and over (AIHW 2017).

A ‘walkability index’ has been created by the Centre for Urban Research, which combines dwelling density (see Glossary), 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 et al. (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 one 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 regularly walk to school.

Green space

Green space (see Glossary) includes areas of public and private land such as nature reserves, public parks, residential gardens and sporting facilities. It is important for both physical and mental health (AIHW 2011; Sugiyama et al. 2008). 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 research examining the association between green space and health outcomes indicated that:

• There was a three-fold increase in the likelihood of doing any moderate-vigorous physical activity if more than 95% of dwellings in the suburb were within 400m 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 space, particularly tree canopy, has also been associated with a range of health benefits such as reduced cardiovascular disease and lower psychological distress (Astell-Burt and Feng 2019, 2020). However, available research that examines the association between access to green spaces and health outcomes shows mixed findings (Frumkin et al. 2017; Hartig et al. 2014). This is largely due to differences in methodology and definitions of measures. Additionally, factors other than access to green spaces may be associated with their use. For example, lower socioeconomic areas tend to perceive quality, neighbourhood aesthetics and safety of green spaces to be lower than those from higher socioeconomic areas (Sugiyama et al. 2015).

Green space also provides places for social interaction, both planned and incidental, and facilitates 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; Mavoa et al. 2019).

Well-planned green space supports biodiversity, improves air quality, and reduces noise pollution and temperatures in urban areas (Kent and Thompson 2019). Contact with the natural environment may also benefit our immune system (WHO and SCBD 2015). Conversely, the loss of green space, particularly tree canopy coverage, can increase temperatures in urban areas (Government of South Australia 2019).

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 (see Glossary), or negatively influence health through traffic accidents and sedentary behaviour. Transport systems can also:

• negatively affect human health through air pollutants such as PM2.5
• contribute to greenhouse gas emissions (see Glossary) and global climate change
• increase environmental noise
• lead to the reduction of natural environments (Infrastructure Australia 2019; Kent and Thompson 2019).

Car dependence

The great majority of Australians depend on their cars for transport. While cars allow for increased mobility and convenience, and technology has led to cars that are less polluting, a high level of dependence on cars for transport has a range of implications for human and environmental health (Infrastructure Australia 2019). Car-dependent suburbs tend to have poor access to public transport, employment services and shops. Car dependence also:

• increases traffic congestion, commuting times and air and noise pollution
• can 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)
• is associated with sedentary lifestyles and growing rates of overweight and obesity (Sugiyama et al. 2020).

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 et al. 2004; Dodson and Sipe 2008; 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 about 1,100 deaths due to road traffic crashes in 2020. The number and population rate of road deaths decreased over the decade from 2011 to 2020 (by 13% and 25% respectively). Comparable data for road crash hospitalisations are available only for the period 2013–2016 and show the number and population rate of hospitalised injuries has increased (by 11% and 6.2% respectively) (BITRE 2021).

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 one 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 (400–800m) 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 night 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

Diet is a factor that can be modified and aspects of a person’s diet can influence the extent to which they are at risk of, or protected against, a range of chronic conditions as well as overweight and obesity. See Diet and Overweight and obesity. The food environment plays a role in the food and drinks we choose to buy and consume through factors such as availability, accessibility, affordability and marketing of healthy and unhealthy food options. Additional factors within the food environment including living in areas of greater socioeconomic disadvantage or living in rural and remote areas, are also associated with more limited access to healthy food choices (Dutko et al. 2012; Fleischhacker et al. 2011; Lewis and Lee 2016; Thornton et al. 2016). A range of indicators are used to estimate how healthy the Australian food environment is in the Australia’s Food Environment Dashboard (Australia’s Food Environment Dashboard 2022).

The National Preventive Health Strategy has described the following food environment factors as being associated with having either a protective or adverse effect on Australian’s health and wellbeing (Department of Health 2021).

The relationship between the food environment and dietary intake is complex, largely due to an interplay of a variety of factors and behaviours as well as inconsistencies in methods and measured outcomes (Mahendra et al. 2017; Ni Mhurchu et al. 2013). Therefore, improvements to standardisation of measures and further research to better understand the relationship between availability of food, individual food choices and health outcomes in Australia are needed.

Housing

Housing has 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 one million Australians live in housing regarded as being in poor condition – according to the Household Income and Labour Dynamics in Australia survey which used a five-point scale to rate external dwelling condition as very good–excellent; good; average; poor; or very poor-derelict (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 2021a). 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 2019) – see Determinants of health for Indigenous Australians. 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 the appropriate 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:

• Health and the environment: a compilation of evidence
• Department of the Environment and Energy Australia: state of the environment 2016: built environment
• Infrastructure Australia Australian Infrastructure Audit 2019: social infrastructure
• Heart Foundation Blueprint for an Active Australia
• Australia’s Food Environment Dashboard.