Neighbourhood characteristics and health: advancing research and practice
Authors: Melanie Lowe, Sarah Foster
Journal: The Lancet Public Health (2021)

It has long been understood that neighbourhoods impact on the health of residents.1Duncan DT Kawachi I Neighbourhooods and health: a progress report.in: Duncan DT Kawachi I Neighborhoods and health. Oxford University Press, Oxford, UK2018Google Scholar In The Lancet Public Health, Mika Kivimäki and colleagues2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar assessed the impact of modifications in some residential neighbourhood characteristics on a wide range of health outcomes. The authors pooled individual-level data from two large prospective cohort studies (comprising 114 786 community-dwelling adults in Finland) with 14 years follow-up of electronic health records, and found that favourable neighbourhood-level changes in green space, education levels, income, and employment rate after about 5 years, were associated with reduced risk of specific cardiometabolic, infectious, and orthopaedic conditions and improvements in selected health behaviours. The large sample size and inclusion of 79 health outcomes in the study by Kivimäki and colleagues reflects a comprehensive analysis, using a data-driven approach. The resulting open-access database reporting all prospective associations aligns with increasing calls for open data sharing3Zhu Y Open-access policy and data-sharing practice in UK academia.J Inf Sci. 2020; 46: 41-52Crossref Scopus (9) Google Scholar and is likely to be a useful reference for future research on health effects of residential neighbourhoods. Since the majority of previous literature in this field has been cross-sectional,4Giles-Corti B Vernez Moudon A Reis R et al.City planning and population health: a global challenge.Lancet. 2016; 388: 2912-2924Summary Full Text Full Text PDF PubMed Scopus (444) Google Scholar, 5Kawachi I Subramanian SV Neighbourhood influences on health.J Epidemiol Community Health. 2007; 61: 3-4Crossref PubMed Scopus (92) Google Scholar this study makes a valuable contribution to evidence of longitudinal associations between four neighbourhood characteristics and health. A key contribution of this study is the analysis emulating non-randomised neighbourhood modification trials. The authors examined favourable changes (from disadvantaged to advantaged neighbourhoods) and unfavourable changes (from advantaged to disadvantaged neighbourhoods) in neighbourhood exposures and health outcomes in a subgroup of participants who did not move during the 5-year exposure period, compared with reference groups who lived in areas with stable neighbourhood characteristics.2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar This analysis method distinguishes the study from conventional observational studies comparing different neighbourhoods or people moving between neighbourhoods, which can be prone to bias due to health-related self-selection.1Duncan DT Kawachi I Neighbourhooods and health: a progress report.in: Duncan DT Kawachi I Neighborhoods and health. Oxford University Press, Oxford, UK2018Google Scholar The strengths of this study design could be applied to assess the health impacts of a wider range of neighbourhood characteristics, and closer investigation of effect pathways. In addition to their focus on neighbourhood-level demographic characteristics, Kivimäki and colleagues2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar assessed green space via satellite images, and included a small number of other built environment covariates (eg, size and type of residence, rural vs urban residential location). Future studies emulating non-randomised neighbourhood modification trials could be used to examine other built and social environment factors, such as public open space access and quality (distinct from satellite-derived green space, which does not distinguish between private and public space), levels of housing density, public transport access, walkability, food and alcohol environments, social isolation, and crime. These are known determinants of health4Giles-Corti B Vernez Moudon A Reis R et al.City planning and population health: a global challenge.Lancet. 2016; 388: 2912-2924Summary Full Text Full Text PDF PubMed Scopus (444) Google Scholar, 6Badland H Whitzman C Lowe M et al.Urban liveability: emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health.Soc Sci Med. 2014; 111: 64-73Crossref PubMed Scopus (130) Google Scholar and might interact with neighbourhood-level demographic characteristics in complex ways. Potential associations exist between the neighbourhood characteristics examined by Kivimäki and colleagues.2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar For example, a population with higher educational attainment or greater income or wealth might participate in creating green spaces in their neighbourhood (eg, through tree planting) or successfully advocate for more public parks.7Luck GW Smallbone LT O'Brien R Socio-economics and vegetation change in urban ecosystems: Patterns in space and time.Ecosystems. 2009; 12: 604-620Crossref Scopus (180) Google Scholar Conversely, increases in green space might attract a more educated and higher-income population, leading to demographic change.8Pandit R Polyakov M Tapsuwan S Moran T The effect of street trees on property value in Perth, Western Australia.Landscape and Urban Planning. 2013; 110: 134-142Crossref Scopus (66) Google Scholar Although Kivimäki and colleagues2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar suggest mechanisms that could underlie their observations, closer examination of effect pathways in future research would help to clarify targets for policy intervention.1Duncan DT Kawachi I Neighbourhooods and health: a progress report.in: Duncan DT Kawachi I Neighborhoods and health. Oxford University Press, Oxford, UK2018Google Scholar Detailed investigation of the drivers of local neighbourhood change, could also assist communities, planners, and decision makers to design and implement policies and programmes to prevent or reduce inequities within and between neighbourhoods, and the associated health effects. To enhance the policy impact of research, consideration should also be given to the exposure measures applied in public health studies so that they are framed in terms that are meaningful to planners and policy makers.9Giles-Corti B Sallis J Sugiyama T Frank L Lowe M Owen N Translating active living research into policy and practice: One important pathway to chronic disease prevention.J Public Health Policy. 2015; 36: 231-243Crossref PubMed Scopus (86) Google Scholar Levels of change in neighbourhood characteristics required to improve population health should be highlighted. Natural experiments can help to monitor neighbourhood-level effects of policies over time,9Giles-Corti B Sallis J Sugiyama T Frank L Lowe M Owen N Translating active living research into policy and practice: One important pathway to chronic disease prevention.J Public Health Policy. 2015; 36: 231-243Crossref PubMed Scopus (86) Google Scholar but study timeframes must consider the slow pace of change in some built and social environment variables in practice,10Giles-Corti B Bull F Knuiman M et al.The influence of urban design on neighbourhood walking following residential relocation: Longitudinal results from the RESIDE study.Soc Sci Med. 2013; 77: 20-30Crossref PubMed Scopus (208) Google Scholar and the appropriate spatial scale of measurement for capturing health-promoting and policy-relevant distances to services and infrastructure. Although improving neighbourhood conditions for health should be a key aim, considering the negative impacts of living in disadvantaged neighbourhoods, ways to build community resilience to unfavourable conditions or changes in neighbourhoods should also be explored. Neighbourhoods are an important context for health promotion, as shown by Kivimäki and colleagues2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar and numerous previous studies.1Duncan DT Kawachi I Neighbourhooods and health: a progress report.in: Duncan DT Kawachi I Neighborhoods and health. Oxford University Press, Oxford, UK2018Google Scholar It is not just the composition of the population, but also neighbourhood environments, and their complex interactions, which determine health behaviours and outcomes. Kivimäki and colleagues2Kivimäki M Batty GD Pentti J et al.Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study.Lancet Public Health. 2021; 6: e396-e407Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar reinforce the existing evidence base by identifying longitudinal associations between changes in selected neighbourhood characteristics and health, and share their data-driven findings in an open-access database. This study is part of the growing trend towards longitudinal studies and natural experiments in this field.1Duncan DT Kawachi I Neighbourhooods and health: a progress report.in: Duncan DT Kawachi I Neighborhoods and health. Oxford University Press, Oxford, UK2018Google Scholar Such study designs strengthen causal inference and have the potential to yield useful information for public health action to reduce health disparities between neighbourhoods. However, this requires identification of the pathways by which neighbourhood disadvantage and advantage leads to health behaviours and outcomes. SF reports research grants from the Australian Research Council and Healthway; honoraria as a Senior Assistant Editor of Environment & Behavior, and from the International Association of People-Environment Studies; and travel expenses from the Department of Planning Lands and Heritage (Government of Western Australia). ML declares no competing interests. Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort studyFavourable modifications to residential neighbourhoods showed robust, longitudinal associations with a range of improvements in health outcomes, including improved health behaviours and reduced risk of cardiometabolic, infectious, and orthopaedic conditions. Full-Text PDF Open Access