Evidence is mounting to suggest a causal relationship between the built environment and people’s physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status. A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted. Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost. Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.
Background: In 2008, the World Health Organization (WHO) Member States passed a World Health Assembly resolution that identified the following five priority areas for research and pilot projects on climate change and human health: health vulnerability, health protection, health impacts of mitigation and adaptation policies, decision-support and other tools, and costs of health protection from climate change. Objectives: To assess the extent to which recently published research corresponds to these priorities, we undertook a scoping review of original research on climate change and human health. Scoping reviews address topics that are too broad for a systematic review and commonly aim to identify research gaps in existing literature. We also assessed recent publication trends for climate change and health research. Methods: We searched for original quantitative research published from 2008 onward. We included disease burden studies that were specific to climate change and health and included intervention studies that focused on climate change and measured health outcomes. We used MEDLINE, Embase, and Web of Science databases and extracted data on research priority areas, geographic regions, health fields, and equity (systematic differences between advantaged and disadvantaged social groups). Discussion: We identified 40 eligible studies. Compared with other health topics, the number of climate change publications has grown rapidly, with a larger proportion of reviews or editorials. Recent original research addressed four of the five priority areas identified by the WHO Member States, but we found no eligible studies of health adaptation interventions, and most of the studies focused on high-income countries. Conclusions: Climate change and health is a rapidly growing area of research, but quantitative studies remain rare. Among recently published studies, we found gaps in adaptation research and a deficit of studies in most developing regions. Funders and researchers should monitor and respond to research gaps to help ensure that the needs of policymakers are met.
The transport system influences everyone’s wellbeing on a daily basis. These impacts are both positive and negative and are borne directly and indirectly at a range of spatial and temporal scales and across different groups in society. Furthermore, they are often distributed unfairly and the people who are least able to use transport networks frequently bear the greatest costs. People also have various transport needs and these needs change throughout their lives. Due to these complexities, there is no straightforward answer as to how we should provide transport fairly. Policies and actions to decarbonise the transport system are urgently needed, but their equity effects are also important. We give a brief overview of distributive justice and equity in transport literature. We then develop a conceptual framework of distributive justice and a set of four principles to guide the application of the framework to transport policy. We then apply these to recent transport policies in Aotearoa/New Zealand, a country that shares common features with most highly motorised countries. We apply the Capabilities Approach to transport policy in a novel way that conceptualises transport policy as a social conversion factor which influences people’s ability to convert resources and opportunities into the things (‘beings and doings’) that they have reason to value. The consideration of transport policy as a conversion factor, rather than focusing on a specific capability, emphasises the role of transport policy as a promoter of a wide range of capabilities and highlights the inequitable distribution of positive and negative effects on people’s health and wellbeing. It also illuminates issues of power structures and procedural fairness in transport policy that are otherwise not covered by distributive justice approaches. Taking a broader view of distributive justice theory in transport provides a clearer picture of the impacts of transport on wellbeing and provides theory-based guidance on the actions to improve transport justice that can be readily integrated into existing policy institutions.
1 April 2013 in Australian and New Zealand Journal of Public Health
Efforts to improve health equity should be informed by the best available evidence. However, equity-related research is inconsistently indexed, and uses a variety of terms to describe key concepts, making it difficult to reliably identify all relevant studies. We report the development and validation of a search strategy for studies investigating whether the effects of interventions differ by ethnicity or socio-economic status, using the field of transport and health as an example. Adapting previously described methods, we followed four steps: generation of a test set of eligible studies, search strategy development, search strategy validation, and documentation. Drawing from 12 systematic reviews, supplemented by additional studies identified by experts and colleagues, we identified a test set of 11 studies that met our eligibility criteria. We assigned five studies to a development set, which we used to develop and refine our search strategy. We assigned the remaining six studies to a validation set, against which we tested our final search strategy. The final search strategy identified all studies in both validation and development sets. The validated search strategy derived in this study facilitates the conduct of systematic reviews and other literature searches investigating whether the effects of interventions differ by ethnicity or socio-economic status and may be further developed in future for other equity-focused searches and reviews.