Elsevier

The Lancet

Volume 388, Issue 10062, 10–16 December 2016, Pages 2936-2947
The Lancet

Series
Use of science to guide city planning policy and practice: how to achieve healthy and sustainable future cities

https://doi.org/10.1016/S0140-6736(16)30068-XGet rights and content

Summary

Land-use and transport policies contribute to worldwide epidemics of injuries and non-communicable diseases through traffic exposure, noise, air pollution, social isolation, low physical activity, and sedentary behaviours. Motorised transport is a major cause of the greenhouse gas emissions that are threatening human health. Urban and transport planning and urban design policies in many cities do not reflect the accumulating evidence that, if policies would take health effects into account, they could benefit a wide range of common health problems. Enhanced research translation to increase the influence of health research on urban and transport planning decisions could address many global health problems. This paper illustrates the potential for such change by presenting conceptual models and case studies of research translation applied to urban and transport planning and urban design. The primary recommendation of this paper is for cities to actively pursue compact and mixed-use urban designs that encourage a transport modal shift away from private motor vehicles towards walking, cycling, and public transport. This Series concludes by urging a systematic approach to city design to enhance health and sustainability through active transport and a move towards new urban mobility. Such an approach promises to be a powerful strategy for improvements in population health on a permanent basis.

Introduction

Land-use and transport policies in cities around the world are having negative effects on health, primarily through road traffic injuries, air pollution, and physical inactivity.1, 2, 3 Road traffic collisions kill and maim millions of people each year. Urban air pollution, mostly motor vehicle related, kills hundreds of thousands of people annually and contributes to climate change. Epidemic levels of physical inactivity contribute to the deaths of millions through effects on multiple non-communicable diseases (NCDs). Urban and transport planning and urban design are some of the most fundamental causes of many serious global problems.3, 4

Evidence of the health effects of land-use and transport policies needs to be used more effectively to guide the design of cities so that they enhance health and environmental sustainability. The first paper5 in this Series demonstrated that land-use and transport policies and practices can affect a wide range of health outcomes, especially NCDs and motor vehicle injuries. Eight health-promoting urban design and transport principles were identified, and evidence-informed indicators were proposed that can be used to monitor progress in the creation of health-promoting cities. In many countries, land-use and transport policies are the antithesis of healthy urban design.5 The second paper6 in this Series modelled land-use and transport policies—with an emphasis on compact cities that support a modal shift from private motor-vehicle use to walking, cycling, and public transport as a strategy for improvements in population health—and estimated the gains in population health that cities could achieve.

In this final paper of the Series, we consider the use of evidence as a tool for improved decision making in urban design and transport, and we make recommendations for improvements in the application of evidence. This paper draws on a conceptual model of research translation, summarises evidence from the knowledge transfer field, and uses a diverse set of case studies to illustrate the potential for effective research translation to facilitate health-oriented land-use and transport practices and policies. We use the terms research translation, knowledge transfer, and knowledge exchange interchangeably to refer to the process of actively working to have research-based information used in policy making. We conclude with recommendations based on the entire Series, identifying research and policy actions needed to advance the creation of healthy and sustainable cities.

Section snippets

Models and evidence to guide research translation

Research translation is a novel concept to many health researchers. Some investigators might not consider it their role to communicate research findings to decision makers, and those who would like to see research used in decision making might not have the necessary skills. Researchers need to understand policy processes to effectively promote the application of health research findings.

Case study 1: Active Living Research, USA

Active Living Research (ALR) illustrates all phases of the four-phase research translation model.13 ALR was supported by The Robert Wood Johnson Foundation with aims to build evidence about the role of environments and policies in physical activity, nurture investigative teams with members from diverse disciplines and personal backgrounds, and use research to inform policy and practice in multiple sectors.14 We describe ALR's methods of research translation for each phase of the model,13 with

Case study 2: RESIDE, Perth, WA, Australia

The Residential Environment (RESIDE) study was a longitudinal natural experiment that evaluated health impacts of the state government's Liveable Neighbourhoods design code in new suburban neighbourhoods.18 Although initiated by public-health researchers, active engagement of the Department of Planning took place before and during the study. The Chief Investigator and Department of Planning staff had collaborated on a prior study that had resulted in multiple presentations and a good working

Case study 3: SMARTRAQ, Atlanta, GA, USA

Strategies for Metropolitan Atlanta's Regional Transport and Air Quality (SMARTRAQ)20 is another example of research undertaken as a successful partnership between researchers and government that resulted in strong knowledge translation to policy. In 1997, the Atlanta, GA, region fell out of compliance with the USA's Federal Clean Air Act21 owing to its low-density sprawling urban form, which created long distances between destinations and few competitive options to the car.22

From individual studies to knowledge platforms

RESIDE and SMARTRAQ are examples of collaborations between researchers and policy makers opening channels for policy influence. However, development of a more systematic knowledge translation process for city planning and transport sectors is needed to integrate health goals and evidence. Several countries have shown progress in this area. An early example from the USA was an evidence-based report24 on active transport that was jointly produced by the Transportation Research Board and the

Conclusions about research translation

Motor vehicle-oriented land-use and transport policies in cities are contributing to global epidemics of NCDs and injuries.5, 6 The health impacts create an imperative to make use of research evidence to move city planning and transport policies in directions that are health promoting. The diverse case studies presented here demonstrate that health research can play an influential role in land-use and transport decision making. The challenge is to ensure that health research is used in a more

Series conclusions and recommendations

Land-use and transport policies are contributing to worldwide epidemics of NCDs and injuries through traffic exposure, noise, air pollution, social isolation, low physical activity, and sedentary behaviours. Motorised transport is a major cause of greenhouse gas emissions that threaten human health, especially in low-income countries.46 Traditional single-problem and single-discipline approaches to research, practice, and policy are insufficient to solve the serious inter-related problems

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