The built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport. A structured search was conducted for quantitative systematic reviews and stakeholder reviews published between January 2005 and April 2016. Seven databases and the websites of 15 relevant and respected stakeholder organisations known to publish review-level documentation were searched. Searches were limited to English-language publications and duplicate references were removed. Evidence quality and strength was appraised using validated techniques. Findings were used to develop a diagram for each topic area, illustrating relationships between built and natural environment planning principles and health-related outcomes. A total of 117 systematic reviews and review-level documents were eligible for inclusion. The quality of evidence was mixed; much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between built environment exposures and health-related impacts and outcomes. Fourteen actionable planning principles associated with positive health-related outcomes were identified across the five topic areas. For example, neighbourhoods that enhanced walkability, were complete and compact in design, and those which enhanced connectivity through safe and efficient infrastructure were associated with better health-related outcomes relating to physical activity, social engagement, mental health, perceptions of crime, and road traffic collisions. Evidence for the effectiveness of planning principles across different topic areas and on reducing health inequalities was sparse and inconclusive. Findings provide an up-to-date overview of relationships between the built and natural environment and health and present logical, evidence-based messages to aid communication between public health and planning professionals.
Objectives To assess whether speed cameras reduce road traffic collisions and related casualties. Design Systematic review. Data sources Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials, Medline, Embase, Social Science Citation Index, TRANSPORT database, ZETOC, the internet (including websites of road safety and motoring organisations), and contact with key individuals and organisations. Main outcome measures Road traffic collisions, injuries, and deaths. Inclusion criteria Controlled trials and observational studies assessing the impact of fixed or mobile speed cameras on any of the selected outcomes. Results 14 observational studies met the inclusion criteria; no randomised controlled trials were found. Most studies were before-after studies without controls (n = 8). All but one of the studies showed effectiveness of cameras up to three years or less after their introduction; one study showed sustained longer term effects (4.6 years after introduction). Reductions in outcomes across studies ranged from 5% to 69% for collisions, 12% to 65% for injuries, and 17% to 71% for deaths in the immediate vicinity of camera sites. The reductions over wider geographical areas were of a similar order of magnitude. Conclusions Existing research consistently shows that speed cameras are an effective intervention in reducing road traffic collisions and related casualties. The level of evidence is relatively poor, however, as most studies did not have satisfactory comparison groups or adequate control for potential confounders. Controlled introduction of speed cameras with careful data collection may offer improved evidence of their effectiveness in the future.
Several studies have investigated the impact of neighbourhood design on health and wellbeing, yet there are limited reviews investigating the quality of the evidence and the most effective interventions at a population level. This systematic review aims to clarify the impact of the neighbourhood design on health and wellbeing and evaluate the quality of the evidence underpinning such associations. Eight electronic databases were searched for studies conducted between 2000 and 2016. Additional searches were conducted on Google to identify potentially eligible grey literature. A total of 7694 studies were returned from the literature search, and a final selection of 39 studies were deemed eligible for inclusion. Quality appraisal was conducted using the Quality Assessment Tool for Quantitative Studies. Findings from the studies showed important associations between neighbourhood design principles such as walkability, access to green space and amenities on health and wellbeing. Findings from this review also highlight areas with inconsistent findings and gaps in the evidence for future research.
Older adults from Black and Minority Ethnic (BME) groups experience a relatively higher burden of physical inactivity compared with their counterparts from non-BME groups. Despite the increasing number of qualitative studies investigating the barriers and facilitators of physical activity among older adults from BME backgrounds in the UK, there is very limited review-level evidence. The aim of this review is to undertake a synthesis of existing qualitative studies, using a meta-ethnographic approach, to explore the barriers and opportunities for physical activity among adults and older adults from BME communities in the UK. Studies conducted between January 2007 and July 2017 were eligible if they met the following criteria: employed any qualitative method; included participants identified as being BME, aged 50 and above, and living in the UK. In total, 1036 studies were identified from a structured search of six electronic databases combined with hand searching of reference bibliographies. Ten studies met the inclusion criteria for the review and were included. Six key themes emerged from the data: awareness of the links between physical activity and health, interaction and engagement with health professionals, cultural expectations and social responsibilities, suitable environment for physical activity, religious fatalism and practical challenges. There was a substantial gap in research among Black African groups. Interventions aimed at improving physical activity participation among older adults should be acceptable and accessible to minority groups. Further research is needed to investigate the barriers and facilitators of physical activity among older adults from African backgrounds.
Secondary sources of information indicate that the proportion of child deaths due to injuries is increasing in Nepal. This study aimed to describe the epidemiology of unintentional injuries in children, explore risk factors and estimate the burden faced by families and the community in the Makwanpur district. We conducted a household survey in Makwanpur, covering 3441 households. Injuries that occurred during the 12 months before the survey and required treatment or caused the child to be unable to take part in usual activities for three or more days were included. We identified 193 cases of non-fatal unintentional child injuries from 181 households and estimated an annual rate of non-fatal injuries of 24.6/1000 children; rates for boys were double (32.7/1000) that for girls (16.8/1000). The rates were higher among the children of age groups 1–4 years and 5–9 years. Falls were the most common cause of non-fatal child injuries followed by burns in preschool children and road traffic injuries were the most likely cause in adolescence. Mean period of disability following injury was 25 days. The rates and the mechanisms of injury vary by age and gender. Falls and burns are currently the most common mechanisms of injury amongst young children around rural homes.
This paper describes the development, conceptualization, and implementation of a transdisciplinary research pilot, the aim of which is to understand how human and planetary health could become a priority for those who control the urban development process. Key challenges include a significant dislocation between academia and the real world, alongside systemic failures in valuation and assessment mechanisms. The National Institutes of Health four‐phase model of transdisciplinary team‐based research is drawn on and adapted to reflect on what has worked well and what has not operationally. Results underscore the need for experienced academics open to new collaborations and ways of working; clarity of leadership without compromising exploration; clarification of the poorly understood “impacts interface” and navigation toward effective real world impact; acknowledgement of the additional time and resource required for transdisciplinary research and “nonacademic” researchers. Having practitioner‐researchers as part of the research leadership team requires rigourous reflective practice and effective management, but it can also ensure breadth in transdisciplinary outlook as well as constant course correction toward real‐world impact. It is important for the research community to understand better the opportunities and limitations provided by knowledge intermediaries in terms of function, specialism, and experience.