Urban Health Indicator Tools of the Physical Environment: a Systematic Review

Abstract

Urban health indicator (UHI) tools provide evidence about the health impacts of the physical urban environment which can be used in built environment policy and decision-making. Where UHI tools provide data at the neighborhood (and lower) scale they can provide valuable information about health inequalities and environmental deprivation. This review performs a census of UHI tools and explores their nature and characteristics (including how they represent, simplify or address complex systems) to increase understanding of their potential use by municipal built environment policy and decision-makers. We searched seven bibliographic databases, four key journals and six practitioner websites and conducted Google searches between January 27, 2016 and February 24, 2016 for UHI tools. We extracted data from primary studies and online indicator systems. We included 198 documents which identified 145 UHI tools comprising 8006 indicators, from which we developed a taxonomy. Our taxonomy classifies the significant diversity of UHI tools with respect to topic, spatial scale, format, scope and purpose. The proportions of UHI tools which measure data at the neighborhood and lower scale, and present data via interactive maps, have both increased over time. This is particularly relevant to built environment policy and decision-makers, reflects growing analytical capability and offers the potential for improved understanding of the complexity of influences on urban health (an aspect noted as a particular challenge by some indicator producers). The relation between urban health indicators and health impacts attributable to modifiable environmental characteristics is often indirect. Furthermore, the use of UHI tools in policy and decision-making appears to be limited, thus raising questions about the continued development of such tools by multiple organisations duplicating scarce resources. Further research is needed to understand the requirements of built environment policy and decision-makers, public health professionals and local communities regarding the form and presentation of indicators which support their varied objectives.

Keywords: Built environment; Evidence; Healthy cities; Indicator; Indices; Policy; Social determinants of health; Urban health; Urban metrics; Urban planning.

Fig. 1

Flow of documents through the review, following PRISMA reporting style [35]

Fig. 2

Taxonomy of urban health indicator tools. H&W, health and wellbeing; PA, physical activity

Fig. 3

Change over time of proportion of UHI tools by spatial scale compared with cumulative growth of UHI tools. N.B. Missing data for 9/145 UHI tools: 7 did not report a date of publication and 2 did not report spatial scale

Fig. 4

Number of new UHI tools by spatial scale. N.B. Missing data for 9/145 UHI tools: 7 did not report a date of publication and 2 did not report spatial scale

Fig. 5

Number of UHI tools in each stated purpose categorised by those which were used beyond research and ‘unknown’

Fig. 6

Scope of indicators across UHI tool topics. PA, physical activity; H&W, health and wellbeing

Fig. 7

Date of publication of UHI tools by topic area and rate of growth. N.B. Missing data for 7/145 UHI tools which did not report a date of publication

Fig. 8

Proportion of UHI tools which display data on static and interactive maps over time, compared with the cumulative growth of all UHI tools. N.B. Missing data for 7/145 UHI tools which did not report a date of publication

Fig. 9

Location of UHI tools internationally. N.B. Tools which apply in more than one country are not shaded