Developing indicators of public open space to promote health and wellbeing in communities
Introduction
Evidence supporting associations between the built environment and health behaviours and outcomes continues to accumulate (Koohsari, Badland, & Giles-Corti, 2013). Along with other built environment attributes (e.g., public transport infrastructure, walkability), public open space (POS) confers physical and social benefits including encouraging physical activity (Giles-Corti, Broomhall, et al., 2005), and fostering neighbourhood social cohesion (Kaźmierczak, 2013, Peters et al., 2010). Studies have linked POS with chronic conditions such as obesity (Lachowycz & Jones, 2011), cardiovascular disease (Pereira et al., 2012), diabetes (Maas, Verheij, et al., 2009), respiratory health (Maas, Verheij, et al., 2009), and mental health (e.g., stress, anxiety, depression, and attention deficit disorders) (Francis, Wood, Knuiman, & Giles-Corti, 2012). Furthermore, the provision of POS is important for mitigating health consequences (e.g., heat stress and heat-related illness) resulting from extreme ambient temperatures such as those potentially caused by climate change (Tan et al., 2007), and reducing urban heat island effects (Aniello et al., 1995, Jonsson, 2004).
POS is defined as “all open space of public value, including areas of water such as rivers, canals, lakes and reservoirs (not just land) which offer important opportunities for sport and recreation and also act as visual amenity” (Alexander, 1977). POS, such as freely-accessible parks or green spaces, have received the most attention in urban planning and public health fields, with much of the research exploring the association between POS and health and wellbeing outcomes (Bedimo-Rung et al., 2005, Giles-Corti et al., 2005a, Koohsari et al., 2013b). Consistent with this body of research, for the purposes of this paper, POS refers to green spaces.
Local access to green POS encourages walking for recreation (Sugiyama, Francis, Middleton, Owen, & Giles-Corti, 2010), walking for transport (Sugiyama & Thompson, 2008), and leisure (recreational) physical activity (Kaczynski et al., 2008, Lackey and Kaczynski, 2009). POS also provides a venue for people to socialise, interact, and gather; this contributes to social inclusion, and community social capital (Maas et al., 2009a, Wood et al., 2010). While access to POS within walking distance is necessary to facilitate physical activity, a growing body of literature suggests that proximity alone may be insufficient to entice use. Other elements such as POS quality or attractiveness (Giles-Corti et al., 2005a, Sugiyama et al., 2010) including its attributes (Cohen et al., 2006, Giles-Corti et al., 2005a, Potwarka et al., 2008), as well as its size (Paquet et al., 2013, Schipperijn et al., 2013), are also important determinants for POS use, physical activity, and mental health outcomes.
Since urban POS plays such an important role in providing space for enhancing health, the provision and access to POS is increasingly being recognised as an environmental justice issue, which aims for a fair distribution of resources to ensure vulnerable groups are not exposed to undue harm to health and wellbeing (Cutts, Darby, Boone, & Brewis, 2009). Thus, POS viewed through an environmental justice lens ensures the democratic provision and equitable access to POS for sectors of the community from different ethnic and socio-economic backgrounds (Low et al., 2009, Wolch et al., 2005). Although the evidence remains mixed (Badland, Keam, Witten, Kearns, & Mavoa, 2010), some studies show that the availability of POS disproportionately benefits more affluent communities; while others have shown more socioeconomically deprived areas and areas with high ethnic minority populations may have poorer quality POS (Crawford et al., 2008, Pearce et al., 2007, Timperio et al., 2007), which may in turn, amplify social inequalities.
The provision of POS is an important (and potentially modifiable) social determinant of health and wellbeing, and contributes to the liveability of a region. Liveability has been conceptualized as ‘safe, attractive, socially cohesive and inclusive, and environmentally sustainable; with affordable and diverse housing linked to employment, education, public open space, local shops, health and community services, and leisure and cultural opportunities; via convenient public transport, walking and cycling infrastructure’ (Lowe et al., 2013). This concept is closely aligned with the social determinants of health (SDH), which encompass the ‘circumstances in which people are born, grow up, live work, and age, and the systems put in place to deal with illness’ (World Health Organization, 2012). In addition to influencing people's health and community wellbeing, POS has broader relevance to regional and national policies, including: biodiversity protection (Sadler, Bates, Hale, & James, 2010), environmental sustainability and regeneration (Chiesura, 2004); climate change adaptation; and water management (Young, 2010).
The amount and spatial distribution of POS throughout cities is determined by state and local government urban planning policies, practices, and standards for open space planning. In the context of POS planning, three types of ‘standards’ or ‘guidelines’ are generally used: 1) Area-percentages: a specified percentage of land to be reserved for POS; 2) Population-ratios: a prescribed level of provision of POS related to the level of population (typically, per 1000 population); and 3) Catchment area: specifications for various categories of POS (typically based on size) of the ‘service area’ or maximum distances which residents should have to travel to gain access (Veal, 2013).
In Australia for example, the Victorian Planning Provision states that 95% of dwellings should have access to a local park ≤400 m from home (Victorian Planning Commission, 2006). The Western Australian Liveable Neighbourhood Guidelines, on the other hand, requires a minimum of 8–10% of gross subdivisible land area as POS as well as catchment (distance) specifications for different sized parks (Western Australian Planning Commission, January 2009 Update 02). Queensland POS guidance is different again, based on population-ratios for recreational (2.0–2.6 ha per 1000 population) and sporting space (1.8–2.4 ha per 1000 population) within specified distances, based on size, and 90% of dwellings.
Although urban design and planning literature provides a number of policy recommendations for the provision of POS, they are not necessarily spatially quantifiable and measurable. For example, an Australian review into the historical origins of POS planning guidelines revealed most of the standards are not evidence-driven, but rather derived from British or American standards, often with little rationale for their application within the Australian context (Veal, 2013). Indeed, internationally, there appears to be few evidence-based approaches to developing urban design and planning standards for the provision of POS (La Rosa, 2014). Similarly, there is no evidence about how different guidelines and recommendations impact the health and wellbeing outcomes.
To optimise health and community wellbeing outcomes, there is a need to test different policy standards and metrics to understand which measures are impactful. Identification of the best POS indicators would be useful tools to measure and monitor progress towards achieving a range of policy and health and wellbeing outcomes, as well as reducing social and health inequalities (State Government Victoria, 2014). This would further refine and inform evidence-driven planning policy standards for POS provision.
The current study aims to: 1) develop a framework conceptualising the pathways in which POS influences health and wellbeing outcomes; 2) use this conceptual framework as a guide to identify upstream policy-relevant indicators of POS that are evidence-based, specific, quantifiable, and measurable across regions; and 3) highlight methodological issues and challenges in developing these indicators. This study will use major urban regions and capital cities across Australia as a case study for the development of POS indicators, underpinned by the Australian planning policy context. However, these methods may be relevant and applicable to other developed countries, and could be modified for use in developing countries.
Section snippets
Development of a conceptual framework
In a review of urban liveability indicators (Badland et al., 2014) POS was identified as one aspect of liveability, and contributing to the SDH pathway. For each of the domains of liveability (e.g., housing, employment, transport, walkability, food, and social infrastructure), conceptual frameworks have been developed to inform the creation of indicators (Badland et al., in press).
The POS conceptual framework was developed considering adult human health and wellbeing outcomes using an SDH lens.
Conceptual framework
The ‘upstream’ POS determinants of health and wellbeing outcomes (left side of Fig. 1) focus on built environment attributes, and are informed by available evidence (Giles-Corti et al., 2005a, Paquet et al., 2013). The ‘downstream’ determinants of the framework (moving to the right of Fig. 1) are the more behavioural measures of health and wellbeing, which in turn influence intermediate and long-term health and wellbeing outcomes (to the far right of Fig. 1). For example, the quantity of POS
Discussion
Urban design and planning policies have the capacity to shape people's health and wellbeing, and influence social and health inequities. To date an evidence-based approach to developing recommendations for the provision of POS has rarely been adopted in urban design and planning practice and literature. Moreover, the use of POS indicators for the specific purpose of informing and monitoring urban planning policy and practice, is lacking. This may, in part, be due to limited understanding of
Conclusions
With over 50% of the global population living in urban environments (United Nations Development Program, 2011), it is not surprising there is increasing research and policy interest in creating indicators for liveable and healthy cities to support our rapidly growing urban population (Badland et al., 2014, State Government Victoria, 2014). POS is important for urban liveability, and has been associated with health and wellbeing. Despite key methodological challenges and our focus on the
Acknowledgements
BGC is supported by an NHMRC Principal Research Fellow Award (#1004900). KV, HB, SM, MD, and RR are in part, supported by VicHealth. Funding provided by the NHMRC Centre for Excellence in Healthy Liveable Communities (#1061404) and The Australian Prevention Partnership Centre (TAPPC) (the latter is supported by NHMRC, ACT Health, NSW Health, the Australian National Preventive Health Agency (ANPHA), the Hospitals Contribution Fund of Australia (HCF) and the HCF Research Foundation (#9100001) are
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