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This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research.

Measuring and monitoring the spatial distribution of liveability is crucial to ensure that implemented urban and transport planning decisions support health and wellbeing. Spatial liveability indicators can be used to ensure these decisions are effective, equitable and tracked across time. The 2018 Australian National Liveability Study datasets comprise a suite of policy-relevant health-related spatial indicators of local neighbourhood liveability and amenity access estimated for residential address points and administrative areas across Australia's 21 most populous cities. The indicators and measures encompass access to community and health services, social infrastructure, employment, food, housing, public open space, transportation, walkability and overall liveability. This national 'baseline' liveability indicators dataset for residential address points and areas can be further linked with surveys containing geocoded participant locations, as well as Census data for areas from the Australian Statistical Geography Standard. The datasets will be of interest to planners, policy makers and researchers interested in modelling and mapping the spatial distribution of urban environmental exposures and their relationship with health and other outcomes.

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities.

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

This paper explores neighborhood-built environment features related to ‘better than expected’ and ‘as expected’ early childhood development outcomes (ECD) in 14 Australian disadvantaged communities. This paper draws from mixed methods data collected in the Kids in Communities Study – an Australian investigation of community effects on ECD – in communities across five states and territories. In total, 93 interviews and 30 focus groups were conducted with service providers and parents, and geographic information systems were used to create built environment measures for each local community. Housing factors (e.g. better affordability, tenure, less high-density public housing) were consistently related to disadvantaged local communities with ‘better than expected’ ECD outcomes. Physical access to services and public transport, living in a walkable area, having high-quality public open space, and a mix of local destinations was perceived to be consistently important by community members in disadvantaged communities regardless of ECD outcomes. Findings may help policymakers to consider neighborhood features that contribute to better ECD outcomes.

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km2, 100 intersections per km2, and 25 public transport stops per km2 were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.

Interrelationships between neighborhood walkability, area disadvantage, and crime may contribute to the inconsistent associations between crime and walking. We examined associations between crime and walking, and tested for differences by neighborhood disadvantage while addressing these additional complexities. Participants ( n = 6,680) from 200 neighborhoods spanning the most and least disadvantaged in Brisbane, Australia, completed a questionnaire and objective measures were generated for the individual-level 1,000-m neighborhood. Multilevel models examined associations between crime (perceived and objective) and walking (recreational and transport), and interactions tested for differences by neighborhood disadvantage. High perceived crime was associated with reduced odds of transport walking, whereas high objective crime was associated with increased odds of transport walking. Patterns did not differ by neighborhood disadvantage. In disadvantaged neighborhoods, the “negative” criminogenic attributes were insufficient to outweigh the “positive” walkability attributes, producing similar walking patterns to advantaged neighborhoods where residents were dislocated from local destinations but buffered from crime.

Recognition is increasing globally that urban planning interventions to improve neighbourhood liveability enable healthy sustainable lifestyles and assist in the prevention and management of chronic disease. We present the spatial urban liveability index (ULI) as a tool to inform localised interventions that would create healthier, more sustainable cities and examine its associations with cardiometabolic and wellbeing-related health outcomes. The ULI and associated indicators were calculated for Melbourne address points and spatially linked with health outcomes for participants from the 2014 Victorian Population Health Survey. Residing in higher liveability areas was found to be positively associated with a more physically active lifestyle and negatively associated with BMI—more so than for a comparable walkability index. Although walkable neighbourhoods underpin a liveable city, areas with diverse ‘community, culture and leisure’ destinations displayed strongest beneficial associations with cardiometabolic health outcomes, suggesting that access to diverse local destinations may encourage more active sustainable living.

Pedestrian accessibility is an important factor in urban transport and land use policy and critical for creating healthy, sustainable cities. Developing and evaluating indicators measuring inequalities in pedestrian accessibility can help planners and policymakers benchmark and monitor the progress of city planning interventions. However, measuring and assessing indicators of urban design and transport features at high resolution worldwide to enable city comparisons is challenging due to limited availability of official, high‐quality, and comparable spatial data, as well as spatial analysis tools offering customizable frameworks for indicator construction and analysis. To address these challenges, this study develops an open source software framework to construct pedestrian accessibility indicators for cities using open and consistent data. It presents a generalized method to consistently measure pedestrian accessibility at high resolution and spatially aggregated scale, to allow for both within‐ and between‐city analyses. The open source and open data methods developed in this study can be extended to other cities worldwide to support local planning and policymaking. The software is made publicly available for reuse in an open repository.

There is increasing international interest in place-based approaches to improve early childhood development (ECD) outcomes. The available data and evidence are limited and precludes well informed policy and practice change. Developing the evidence-base for community-level effects on ECD is one way to facilitate more informed and targeted community action. This paper presents overall final findings from the Kids in Communities Study (KiCS), an Australian mixed methods investigation into community-level effects on ECD in five domains of influence-physical, social, governance, service, and sociodemographic. Twenty five local communities (suburbs) across Australia were selected based on 'diagonality type' i.e. whether they performed better (off-diagonal positive), worse (off-diagonal negative), or 'as expected' (on-diagonal) on the Australian Early Development Census (AEDC) relative to their socioeconomic profile. The approach was designed to determine replicable and modifiable factors that were separate to socioeconomic status. Between 2015-2017, stakeholder interviews (n = 146), parent and service provider focus groups (n = 51), and existing socio-economic and early childhood education and care administrative data were collected. Qualitative and quantitative data analyses were undertaken to understand differences between 14 paired disadvantaged local communities (i.e. on versus off-diagonal). Further analysis of qualitative data elicited important factors for all 25 local communities. From this, we developed a draft set of 'Foundational Community Factors' (FCFs); these are the factors that lay the foundations of a good community for young children.

BACKGROUND: The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs. OBJECTIVES: To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations. METHODS: An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes. RESULTS: In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant. CONCLUSIONS: The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health s

Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The 2012 Australian Early Development Census (AEDC), a population-wide measure of early childhood development, and the Australian Bureau of Statistics Socio-economic Index for Areas Index of Relative Socio-economic Disadvantage were used to select fourteen disadvantaged local communities in five Australian states and territories based on those performing better (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their socio-economic profile. Between 2015–2017, qualitative and quantitative housing data were collected in the local communities. In total, 87 interviews with stakeholders, 30 focus groups with local service providers and parents, and Australian Census dwelling information were analysed. A comparative case study approach was used to examine differences in housing characteristics (e.g., public housing, density, affordability, and tenure) between disadvantaged local communities performing ‘better than expected’ and ‘as expected’ on early childhood development. Perceived better housing affordability, objectively measured housing tenure (ownership) and perceived and objectively measured lower-density public housing were housing characteristics that emerged as points of difference for disadvantaged local communities where children had relatively better early childhood development outcomes. These characteristics are potential modifiable and policy sensitive housing levers for reducing early childhood development inequities.

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

BACKGROUND: Designing healthy, liveable cities is a global priority. Current liveability indices are aggregated at the city-level, do not reflect spatial variation within cities, and are often not aligned to policy or health. OBJECTIVES: To combine policy-relevant liveability indicators associated with health into a spatial Urban Liveability Index (ULI) and examine its association with adult travel behaviours. METHODS: We developed methods to calculate spatial liveability indicators and the ULI for all residential addresses in Melbourne, Australia. Associations between the address-level ULI and adult travel behaviours from the 2012-2014 Victorian Integrated Survey of Travel and Activity (VISTA) (n = 12,323) were analysed using multilevel logistic regression. Sensitivity analyses to evaluate impact of methodological choices on distribution of liveability as assessed by the ULI and associations with travel mode choice were also conducted. RESULTS: Liveability estimates were calculated for 1,550,641 residential addresses. ULI scores were positively associated with active transport behaviour: for each unit increase in the ULI score the estimated adjusted odds ratio (OR) for: walking increased by 12% (95% Credible Interval: 9%, 15%); cycling increased by 10% (4%, 17%); public transport increased by 15% (11%, 19%); and private vehicle transport decreased by 12% (- 9%, - 15%). CONCLUSIONS: The ULI provides an evidence-informed and policy-relevant measure of urban liveability, that is significantly and approximately linearly associated with adult travel behaviours in the Melbourne context. The ULI can be used to evaluate progress towards implementing policies designed to achieve more liveable cities, identify spatial inequities, and examine relationships with health and wellbeing.

BACKGROUND: Most research on walking for transport has focused on the walkability of residential neighborhoods, overlooking the contribution of places of work/study and the ease with which destinations outside the immediate neighborhood can be accessed, referred to as regional accessibility. OBJECTIVES: We aimed to examine if local accessibility/walkability around place of work/study and regional accessibility are independently and interactively associated with walking. METHODS: A sample of 4,913 adult commuters was derived from a household travel survey in Melbourne, Australia (2012-2014). Local accessibility was measured as the availability of destinations within an 800-m pedestrian network from homes and places of work/education using a local living index [LLI; 0-3 (low), 4-6, 7-9, and 10-12 (high) destinations]. Regional accessibility was estimated using employment opportunity, commute travel time by mode, and public transport accessibility. Every individual's potential minutes of walking for each level of exposure (observed and counter to fact) were predicted using multivariable regression models including confounders and interaction terms. For each contrast of exposure levels of interest, the corresponding within-individual differences in predicted walking were averaged across individuals to estimate marginal effects. RESULTS: High LLI at home and work/education was associated with more minutes walking than low LLI by 3.9 [95% confidence interval (CI): 2.3, 5.5] and 8.3 (95% CI: 7.3, 9.3) min, respectively, in mutually adjusted models. Across regional accessibility measures, an independent association with walking and an interactive association with LLI at work/education was observed. To take one example, the regional accessibility measure of "Jobs within 30 min by public transport" was associated with 4.3 (95% CI: 2.9, 5.7) more mins walking for high (≥30,000 jobs) compared with low (<4,000 jobs) accessibility in adjusted models. The estimated difference for

Background Population densities of many cities are increasing rapidly, with the potential for impacts on cardiovascular health. This longitudinal study examined the potential impact of population-density increases in urban areas (urban densification) on cardiovascular risk markers among Australian adults. Methods and Results Data were from the Australian Diabetes, Obesity and Lifestyle Study, in which adult participants' cardiovascular risk markers were collected in 3 waves (in 1999-2000, 2004-2005, and 2011-2012). We included 2354 participants with a mean age of 51 years at baseline who did not change their residence during the study period. Outcomes were 12-year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2-hour postload plasma glucose, high-density lipoprotein cholesterol, and triglycerides. The exposure was neighborhood population densification, defined as 12-year change in population density within a 1-km radius buffer around the participant's home. Multilevel linear growth models, adjusting for potential confounders, were used to examine the relationships. Each 1% annual increase in population density was related with smaller increases in waist circumference (b=-0.043 cm/y; 95% CI, -0.065 to -0.021 [P<0.001]), weight (b=-0.019 kg/y; 95% CI, -0.039 to 0.001 [P=0.07]), and high-density lipoprotein cholesterol (b=-0.035 mg/dL per year; 95% CI, -0.067 to -0.002 [P=0.04]), and greater increases in diastolic blood pressure (b=0.032 mm Hg/y; 95% CI, -0.004 to 0.069 [P=0.08]). Conclusions Our findings suggest that, at least in the context of Australia, urban densification may be protective against obesity risk but may have adverse effects on blood lipids and blood pressure. Further research is needed to understand the mechanisms through which urban densification influences cardiovascular health.

OBJECTIVE: The World Health Organization calls upon local government worldwide to play a greater role in improving public health by improving the social determinants of health. This research aimed to determine how local governments in Victoria, Australia, conceptualised their organisational efficacy to address public health with reference to their statutory obligations. METHODS: Sixteen in-depth interviews were conducted with Victorian local government health planners. Thematic analysis was used to determine the importance of state health priorities and the perceived organisational efficacy of local government to address health via social determinants. RESULTS: While there were disparities between state and local priorities for health, local government believes it can make an important contribution to improving health through 'upstream' approaches. CONCLUSIONS: Victorian local government has strongly adopted the socio-ecological model of health and is aware of the important role that its diverse policy and program areas play in creating healthy communities. The Victorian State Government's priorities, which adopted a more 'downstream' approach, were less influential. Implications for public health: State governments' priority settings should be responsive to local governments' unique local knowledge of health priorities. There is value in legislating a social determinants role for local government, provided it is supported by state and national government policies that facilitate public health.

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

BACKGROUND: A consensus is emerging in the literature that urban form can impact health by either facilitating or deterring physical activity (PA). However, there is a lack of evidence measuring population health and the economic benefits relating to alternative urban forms. We examined the issue of housing people within two distinct types of urban development forms: a medium-density brownfield development in an established area with existing amenities (e.g. daily living destinations, transit), and a low-density suburban greenfield development. We predicted the health and economic benefits of a brownfield development compared with a greenfield development through their influence on PA. METHODS: We combined a new Walkability Planning Support System (Walkability PSS) with a quantitative health impact assessment model. We used the Walkability PSS to estimate the probability of residents' transport walking, based on their exposure to urban form in the brownfield and greenfield developments. We developed the underlying algorithms of the Walkability PSS using multi-level multivariate logistic regression analysis based on self-reported data for transport walking from the Victorian Integrated Survey of Transport and Activity 2009-10 and objectively measured urban form in the developments. We derived the difference in transport walking minutes per week based on the probability of transport walking in each of the developments and the average transport walking time per week among those who reported any transport walking. We then used the well-established method of the proportional multi-cohort multi-state life table model to translate the difference in transport walking minutes per week into health and economic benefits. RESULTS: If adult residents living in the greenfield neighbourhood were instead exposed to the urban development form observed in a brownfield neighbourhood, the incidence and mortality of physical inactivity-related chronic diseases would decrease. Over the l