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J Urban Health. 2003 December; 80(4): 556–568.
PMCID: PMC3456215

Sorting out the connections between the built environment and health: A conceptual framework for navigating pathways and planning healthy cities


The overarching goal of this article is to make explicit the multiple pathways through which the built environment may potentially affect health and well-being. The loss of close collaboration between urban planning and pulic health professionals that characterized the post-World War II era has limited the design and implementation of effective intervention and policies that might translate into improved health for urban populatons. First, we present a conceptual model that developed out of previous research called Social Determinants of Health and Environmental Health Promotion. Second, we review empirical research from both the urban planning and public health literature regarding the health effects of housing and housing interventions. And third, we wrestle with key challenges in conducting sound scientific research on connections between the built environment and health, namely: (1) the necessity of dealing with the possible health consequences of myriad public and private sector activities; (2) the lack of valid and reliable indicators of the built environment to monitor the health effects of urban planning and policy decisions, especially with regard to land use mix; and (3) the growth of the “megalopolis” or “super urban region” that requires analysis of health effects across state lines and in circumscribed areas within multiple states. We contend that to plan for healthy cities, we need to reinvigorate the historic link between urban planning and public health, and thereby conduct informed science to better guide effective public policy.

Keywords: Urban planning, Public health, Population health, Urban health, Built environment, Land use, Transportation

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Selected References

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1. Sclar E, Northridge ME. Property, politics, and public health. Am J Public Health. 2001;91:1013–1015. [PubMed]
2. United Nations Human Settlements Programme (UN-HBITAT). Available at: Accessed June 1, 2003.
3. Northridge ME, Sclar E. A jont urban planning and public health framework; contributions to health impact assessment. Am J Public Health. 2003;93:118–121. [PubMed]
4. Schulz AJ, Williams DR, Israel BA, Lembert LB. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Q. 2002;20(4):677–707. doi: 10.1111/1468-0009.00028. [PubMed] [Cross Ref]
5. Schulz A, Northridge ME. Social determinants of health and environmental health promotion. Health Educ Behav. In press. [PubMed]
6. Hebbert M. A city in good shape: town planning and public health. Town Planning Rev. 1999;70:433–453.
7. Greenberg M, Popper F, West B, Krueckeberg D. Linking city planning and public health in the United States. J Plann Lit. 1994;8:235–239.
8. Dannenberg AL, Jackson RJ, Frumkin H, et al. The impact of community design on public health: a scientific research agenda. Am J Public Health. 2003;93:1500–1508. [PubMed]
9. Srinivasan S, O’Fallon LR, Dearry A. Creating healthy communities, healthy homes, healthy people: initiating a research agenda on the built environment and public health. Am J Public Health. 2003;93:1446–1450. [PubMed]
10. Jackson RJ. The impact of the built environment on health: An emerging field. Am J Public Health. 2003;93:1382–1384. [PubMed]
11. Killingsworth R, Earp J, Moore R. Supporting health through desing: Challenges and opportunities. Am J Health Promotion. 2003;18:1–2. doi: 10.1093/heapro/18.1.1. [PubMed] [Cross Ref]
12. Krieger N, Northridge ME, Gruskin S, et al. Assessing health impact assessment: multidisciplinary and international perspectives. J Epidemiol Community Health. 2003;57:659–662. doi: 10.1136/jech.57.9.659. [PMC free article] [PubMed] [Cross Ref]
13. Frank LD. Land use and transportatiion interactiion: implications on public health and quality of life. J Plann Educ Res. 2000;20:6–22. doi: 10.1177/073945600128992564. [Cross Ref]
14. Sclar E. A metropolitan nation. Am J Public Health. In press.
15. US Bureau of the Census. Available at: Table?ds_name=DEC_2000_SF1_U&geo_id=0100US&_box_head_nbr=GCT-PH1-R&format=US-10S. Accessed December 21, 2002.
16. Health and Environment: Partners for Life. Ottawa, Ontario: Health Canada; 1997. Report available at
17. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;spec no:80’94. [PubMed]
18. Brenner MH. Fetal, infant, and maternal mortality during periods of economic instability. Int J Health Serv. 1973;3:145–159. [PubMed]
19. Sclar ED. Community economic structure and individual well-being: a look behind the statistics. Int J Health Serv. 1980;10:563–579. [PubMed]
20. Krieger N. Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective. Am J Public Health. 2003;93:194–199. [PubMed]
21. Glass TA, Dym B, Greenberg S, Rintell D, Roesch C, Berkman LK. Psychosocial intervention in stroke: Families in Recovery from Stroke Trial (FIRST) Am J Orthopsychiatry. 2000;70:169–181. [PubMed]
22. Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges, and interdisciplinary perspectives. Int J Epidemiol. 2002;31:285–293. doi: 10.1093/ije/31.2.285. [PubMed] [Cross Ref]
23. Pond MA. Role of the public health service in housing and urban life. Public Health Reports. 1968;83:101–107. [PMC free article] [PubMed]
24. Sclar ED. Homelessness and housing policy: a game of musical chairs. Am J Public Health. 1990;80:1039–1040. [PubMed]
25. Northridge ME, Sclar ED. Housing and health. Am J Public Health. 2002;92:701–701. [PubMed]
26. Northridge ME, Jean-Louis B, Shoemaker K, Nicholas S. Advancing population health in the Harlem Children Zone Project. Soz Praventiv Med. 2002;47:201–201. [PubMed]
27. Newfield J. How the other half still lives: in the shadow of wealth, New York’s poor increase. The Nation, March 17, 2003:11–17.
28. Thomson H, Pettricrew M, Douglas M. Health impact assessment of housing improvements: incorporating research evidence. J Epidemiol Community Health. 2003;57:11–16. doi: 10.1136/jech.57.1.11. [PMC free article] [PubMed] [Cross Ref]
29. Curtis C, Cave B, Coutts A. Is urban regeneration good for health? Perceptions and theories of the health impacts of urban change. Environ Plann C: Gov Policy. 2002;20:517–534. doi: 10.1068/c02r. [Cross Ref]
30. Somerville M, Mackenzie I, Owen P, et al. Housing and health: does installing heating in the home improve the health of children with asthma? Public Health. 2000;114:434–440. doi: 10.1016/S0033-3506(00)00383-8. [PubMed] [Cross Ref]
31. McGonigle G, Kirby J. Poverty and Public Health. London, England: Gillencz; 1936.
32. Halpern D. Mental Health and the Built Environment: More Than Bricks and Mortar. London, England: Taylor and Francis; 1995.
33. Dalgard O, Tambs K. Urban environment and mental health: a longitudinal study. J Psychiatry. 1997;171:530–536. doi: 10.1192/bjp.171.6.530. [PubMed] [Cross Ref]
34. Collard A. Settling Up: Towards a Strategy for Resettling Homeless Families. London, England: Homeless Forum; 1997.
35. Saegert SC, Klitzman S, Freudenberg N, Cooperman J, Nassar S. Healthy housing: a structured review of published evaluations of U.S. interventions to improve health by modifying housing in the United States, 1990–2001. Am J Public Health. 2003;93:1471–1477. [PubMed]
36. Prindle RA. Health aspects of the urban environment. Public Health Rep. 1968;83:617–621. [PMC free article] [PubMed]
37. Parker T. The Land Use Air Quality Linkage: Hour Land Use and Transportation Affect Air Quality. Sacramento: California Air Resources Board; 1994.
38. Handy S. Understanding the link between urban form and network travel behavior. J Plann Educe Res. 1996;15:183–198.
39. Handy S. Regional versus local accessibility: neo-traditional development and its implications for non-work travel. Built Environ. 1992;18:253–267.
40. Maantay J. Zoning, equity and public health. Am J Public Health. 2001;91:1033–1041. doi: 10.2105/AJPH.91.7.1033. [PubMed] [Cross Ref]
41. Rodwin VG, Gusmano MK. The World Cities Project: rationale, organization, and design for comparison of megacity health systems. J Urban Health. 2002;79:445–463. [PMC free article] [PubMed]
42. Nelson DE, Naimi TS, Brewer RD, Bolen, J, Wells HE. Metropolitan area estimates of binge drinking in the United States. Am J Public Health. In press. [PubMed]
43. Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inqeualities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? The Public Health Disparities Geocoding Project. Am J Epidemiol. 2002;156:471–482. doi: 10.1093/aje/kwf068. [PubMed] [Cross Ref]
44. Weiss J. Boston Globe Magazine. October 27, 2002:4.
45. Barra X. Fear of epidemics: the engine of urban planning. Plann Pract Res. 2000;15:7–16.
46. Wirth L. Urbanism as a way of life. In: LeGates RT, Stout F, editors. The City Reader. 2nd ed. London, England: Routledge; 2000. pp. 97–105.
47. Independent Inquiry Into inequalities in Health: Report. London, England: Stationary Office; 1998.
48. Israel BA, Schulz AJ, Parker A, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202. doi: 10.1146/annurev.publhealth.19.1.173. [PubMed] [Cross Ref]
49. Gilpin A. Environmental Impact Assessment (FIA): Cutting Edge for the Twenty-First Century. Cambridge, England: Cambridge University Press; 1995.
50. Krieger N. Theories for social epidemilogy in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30:668–677. doi: 10.1093/ije/30.4.668. [PubMed] [Cross Ref]
51. Gruskin S, Tarantola D. Health and human rights. In: Detels R, McEwen J, Beaglehole R, Tanaka K, editors. The Oxford Textbook of Public Health. 4th ed. New York, NY: Oxford University Press; 2001. pp. 311–335.
52. Kriebel D, Tickner J, Epstein P, et al. The precautionary principle in environmental health. Environ Health Perspect. 2001;109:871–876. [PMC free article] [PubMed]
53. Quinn MM, Kriebel D, Geiser K, Moure-Eraso R. Sustainable production: a proposed strategy for the work environment. Am J Ind Med. 1998;34:297–304. doi: 10.1002/(SICI)1097-0274(199810)34:4<297::AID-AJIM1>3.0.CO;2-Q. [PubMed] [Cross Ref]

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