Review

. 2022 Jun;10(6):e882-e894.

doi: 10.1016/S2214-109X(22)00069-9.

City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

Melanie Lowe¹, Deepti Adlakha², James F Sallis³, Deborah Salvo⁴, Ester Cerin⁵, Anne Vernez Moudon⁶, Carl Higgs⁷, Erica Hinckson⁸, Jonathan Arundel⁷, Geoff Boeing⁹, Shiqin Liu¹⁰, Perla Mansour¹¹, Klaus Gebel¹², Anna Puig-Ribera¹³, Pinki Bhasin Mishra¹⁴, Tamara Bozovic⁸, Jacob Carson¹⁵, Jan Dygrýn¹⁶, Alex A Florindo¹⁷, Thanh Phuong Ho¹⁸, Hannah Hook¹⁹, Ruth F Hunter²⁰, Poh-Chin Lai²¹, Javier Molina-García²², Kornsupha Nitvimol²³, Adewale L Oyeyemi²⁴, Carolina D G Ramos²⁵, Eugen Resendiz⁴, Jens Troelsen²⁶, Frank Witlox²⁷, Billie Giles-Corti²⁸

Affiliations

¹ Melbourne Centre for Cities, University of Melbourne, Melbourne, VIC, Australia. Electronic address: mdlowe@unimelb.edu.au.
² Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC, USA.
³ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA.
⁴ Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA.
⁵ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
⁶ Department of Urban Planning and Design, Urban Form Lab, University of Washington, Seattle, WA, USA.
⁷ Healthy Liveable Cities Lab, RMIT University, Melbourne, VIC, Australia.
⁸ Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.
⁹ Department of Urban Planning and Spatial Analysis, Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
¹⁰ School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA.
¹¹ City Planning and Design, School of Natural and Built Environment, Queen's University Belfast, Belfast, UK.
¹² Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
¹³ Sport and Physical Activity Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Vic, Spain.
¹⁴ Healthstrong-Medibank, Mildura, VIC, Australia.
¹⁵ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA.
¹⁶ Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.
¹⁷ School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
¹⁸ Transport, Health and Urban Design Research Lab, Melbourne School of Design, University of Melbourne, Melbourne, VIC, Australia.
¹⁹ College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Department of Geography, Ghent University, Ghent, Belgium.
²⁰ Centre for Public Health, Queen's University Belfast, Belfast, UK.
²¹ Department of Geography, The University of Hong Kong, Hong Kong Special Administrative Region, China.
²² AFIPS Research Group, Department of Musical, Visual and Corporal Expression Teaching, University of Valencia, Valencia, Spain.
²³ Office of the Permanent Secretary for the Bangkok Metropolitan Administration, Bangkok, Thailand.
²⁴ Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria.
²⁵ Research Centre for Architecture, Urbanism and Design (CIAUD), Lisbon School of Architecture, University of Lisbon, Lisbon, Portugal.
²⁶ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
²⁷ Department of Geography, Ghent University, Ghent, Belgium; Department of Geography, University of Tartu, Tartu, Estonia.
²⁸ Healthy Liveable Cities Lab, RMIT University, Melbourne, VIC, Australia; School of Population Health, The University of Western Australia, Perth, WA, Australia.

PMID: 35561723
PMCID: PMC9906636
DOI: 10.1016/S2214-109X(22)00069-9

Review

City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

Melanie Lowe et al. Lancet Glob Health. 2022 Jun.

. 2022 Jun;10(6):e882-e894.

doi: 10.1016/S2214-109X(22)00069-9.

Authors

Affiliations

¹ Melbourne Centre for Cities, University of Melbourne, Melbourne, VIC, Australia. Electronic address: mdlowe@unimelb.edu.au.
² Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC, USA.
³ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA.
⁴ Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA.
⁵ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
⁶ Department of Urban Planning and Design, Urban Form Lab, University of Washington, Seattle, WA, USA.
⁷ Healthy Liveable Cities Lab, RMIT University, Melbourne, VIC, Australia.
⁸ Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.
⁹ Department of Urban Planning and Spatial Analysis, Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
¹⁰ School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA.
¹¹ City Planning and Design, School of Natural and Built Environment, Queen's University Belfast, Belfast, UK.
¹² Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
¹³ Sport and Physical Activity Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Vic, Spain.
¹⁴ Healthstrong-Medibank, Mildura, VIC, Australia.
¹⁵ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, CA, USA.
¹⁶ Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.
¹⁷ School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
¹⁸ Transport, Health and Urban Design Research Lab, Melbourne School of Design, University of Melbourne, Melbourne, VIC, Australia.
¹⁹ College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Department of Geography, Ghent University, Ghent, Belgium.
²⁰ Centre for Public Health, Queen's University Belfast, Belfast, UK.
²¹ Department of Geography, The University of Hong Kong, Hong Kong Special Administrative Region, China.
²² AFIPS Research Group, Department of Musical, Visual and Corporal Expression Teaching, University of Valencia, Valencia, Spain.
²³ Office of the Permanent Secretary for the Bangkok Metropolitan Administration, Bangkok, Thailand.
²⁴ Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria.
²⁵ Research Centre for Architecture, Urbanism and Design (CIAUD), Lisbon School of Architecture, University of Lisbon, Lisbon, Portugal.
²⁶ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
²⁷ Department of Geography, Ghent University, Ghent, Belgium; Department of Geography, University of Tartu, Tartu, Estonia.
²⁸ Healthy Liveable Cities Lab, RMIT University, Melbourne, VIC, Australia; School of Population Health, The University of Western Australia, Perth, WA, Australia.

PMID: 35561723
PMCID: PMC9906636
DOI: 10.1016/S2214-109X(22)00069-9

Abstract

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

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Conflict of interest statement

Declaration of interests BG-C reports Senior Principal Research Fellowship (GNT1107672) and grant (number 1061404) support from National Health and Medical Research Council during the conduct of the study. CH was also supported by National Health and Medical Research Council through the Centre for Research Excellence in Healthy Liveable Communities (grant number 1061404). GB reports grants from the Public Good Projects, during the conduct of the study. JFS reports personal fees from Sports, Play, and Active Recreation for Kids (SPARK) physical activity programmes of Gopher Sport, and travel support from Rails to Trails Conservancy, outside the submitted work. JFS also has a copyright on SPARK physical activity programmes with royalties paid by Gopher Sport. DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. SL was supported by the experiential fellowships from the College of Social Science and Humanities, Northeastern University, Boston, MA, USA. EC and JFS were supported by the Australian Catholic University, Melbourne, VIC, Australia. AAF is supported by a research fellowship from the Brazilian National Council for Scientific and Technological Development (CNPq) (#309301/2020-3). TB was supported by a Doctoral Scholarship from Auckland University of Technology, Auckland, New Zealand. AP-R was supported by the Centre for Health and Social Care Research at the University of Vic-Central University of Catalonia, Vic, Spain, and funding was provided by the Barcelona Provincial Council, Barcelona, Spain and City Council of Vic, Vic, Spain. CDGR is supported by the Portugal National Funds through Fundação para a Ciência e a Tecnologia, Instituto Público, Lisbon, Portugal, under the Research Fellowship (UI/BD/152231/2021). DS was supported by Washington University in St Louis, Center for Diabetes Translation Research, St Louis, MO, USA (P30DK092950 from National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health) and by the Cooperative Agreement Number U48DP006395 from the Centers for Disease Control and Prevention. RFH was supported by the UK Research and Innovation—National Health and Medical Research Council (project reference MR/T038934/1). The content of this article is solely the responsibility of the authors and does not represent the official views of any of the funding agencies supporting this work. Funding sources had no role in writing the manuscript or in the decision to submit for publication. All other authors report no competing interests.

Figures

**Figure 1**
Presence of key city planning policies associated with health AUS=Australia. NZL=New Zealand. CHE=Switzerland. DNK=Denmark. AUT=Austria. DEU=Germany. BEL=Belgium. GBR=United Kingdom. ESP=Spain. PRT=Portugal. CZE=Czech Republic. HKG=Hong Kong. MEX=Mexico. BRA=Brazil. THA=Thailand. VNM=Vietnam. NGA=Nigeria. IND=India. *National and subnational policies were treated as separate components of these measures, so were each scored out of 0·5.

**Figure 2**
Presence of measurable and evidence-consistent city planning policies associated with health Separate measures are listed in the table. AUS=Australia. NZL=New Zealand. CHE=Switzerland. DNK=Denmark. AUT=Austria. DEU=Germany. BEL=Belgium. GBR=United Kingdom. ESP=Spain. PRT=Portugal. CZE=Czech Republic. HKG=Hong Kong. MEX=Mexico. BRA=Brazil. THA=Thailand. VNM=Vietnam. NGA=Nigeria. IND=India. *National and subnational policies were treated as separate components of these measures, so scores are divided by two (out of -1·5 or 1·5 each).

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City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

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City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

Authors

Affiliations

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Conflict of interest statement

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