Actions to address CDoH at the local authority level
Actions to address CDoH at the local authority level

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Incentives for green space and/or tree protection on private property

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  Norms
Practices:  Political practices
Mechanism:
Financial
Effect:
* (Inconclusive)
References:
Scopes:
Global, Europe, UK

Details:

Types of identified policy actions: Voluntary standard or certification (i.e., standard or certification schemes that incentivise retention of trees or discourages removal of trees); voluntary financial incentives (e.g., tax rebate or grant) financial incentives for tree retention in new developments or private residences; provision of free tree seedlings for private owners to plant.

What we know: Despite academics support for the use of incentives for green spaces and/or tree protection, there is limited evidence of the development, use or efficacy of these types of policies at the local level (Ordóñez-Barona et al., 2021). Incentive approaches could be appealing to local government considering they are less resource intensive than regulatory processes (Ordóñez-Barona et al., 2021).

Investing in and improving public transportation infrastructure

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  Norms, Power
Practices:  N/A
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK

Details:

Types of identified policies: development of bus rapid transport (BRT) systems; creation of a new bus routes; development of aerial tram infrastructure.

What we know: Investing in and improving public transportation and active transportation infrastructure is highly cost-effective and has several beneficial win-win effects for health and the environment (Gao et al., 2018; Godrich et al., 2023; McKinnon et al., 2016; Stankov et al., 2020). Travel modal shifts to public transport and/or active transport (e.g., walking or cycling) can increase physical activity (Stankov et al., 2020), greater active transport duration and numbers of trips (Stankov et al., 2020), reduce CO2 emissions (Gao et al., 2018) and protect against morbidity (DALYs) and mortality associated with air pollution, traffic-related incidents and sedentary lifestyles (Gao et al., 2018), as well as wider knock-on effects for community wellbeing like improving neighbourhood safety (Stankov et al., 2020).

Examples of implementation: In Connecticut, the creation of the L-Tower Avenue CT Transit bus route was associated with increased access to supermarkets for residents. Ridership increased over 100% in one year from 4978 passengers (Sept 2000) to 10,349 (Aug 2001) (see Hamel et al., 2015 in Godrich et al., 2023). The construction of the Metrocable aerial tram system in Medellin (Colombia) was associated with significant reductions in homicide rates in neighbouring areas (Stankov et al., 2020).

Neighbourhood and community environment modification programme to promote active transport and physical activity

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 4: Environments
Drivers:  Norms, Power
Practices:  N/A
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK, Other (Colombia)

Details:

Types of identified programmes and initiatives: Active paths development and programmes; modification of parks, construction of outdoor gyms and promotion of use; implementation and improvement of bicycle infrastructure (racks, lanes) and pedestrian paths/bridges.

What we know: Investing in and improving public transportation and active transportation infrastructure is highly cost-effective and has several beneficial win-win effects for health and the environment (Gao et al., 2018; Godrich et al., 2023; McKinnon et al., 2016; Stankov et al., 2020; White et al., 2018). Travel modal shifts to public transport and/or active transport (e.g., walking or cycling) can increase physical activity (Stankov et al., 2020), greater active transport duration and numbers of trips (Stankov et al., 2020), reduce CO2 emissions (Gao et al., 2018) and protect against morbidity (DALYs) and mortality associated with air pollution, traffic-related incidents and sedentary lifestyles (Gao et al., 2018), as well as wider knock-on effects for community wellbeing like improving neighbourhood safety (Stankov et al., 2020). Bicycle lane interventions and Bus Rapid Transit (BRT) systems with adjacent bicycle lanes have been associated with promoted physical activity and active transport (Stankov et al., 2020). Empirical and modelling evidence indicates that multi-pronged actions may be more effective than single-component interventions for influencing health (Stankov et al., 2020).

Examples of implementation: Stankov et al., (2020) presents several empirical and modelling-based studies that have local level examples of active transport interventions and their actual or estimated impacts. Within the UK, included examples came from studies of developed public and active transport infrastructure in Cambridge (England), which included cycle paths, multi-use trails and BRT and studies in Southampton (England), Cardiff and Kenilworth (Wales), which featured new riverside footpaths/boardwalks and traffic-free bridges (Stankov et al., 2020).

Free access to publicly-operated leisure facilities (e.g., council-run gyms)

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 4: Environments
Drivers:  Norms, Power
Practices:  N/A
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
References:
Scopes:
UK

Details:

What we know: Providing free access to publicly-operated leisure facilities has positive benefits for health but it is not the most cost-effective in terms of operational costs (White et al., 2018).

Examples of implementation: Birmingham (UK) provided free access to their council gyms as part of their 'Be Active' programme. Despite the less cost-effective nature of this type of intervention, the Birmingham Be Active programme continued due to its social value which provided a 'net benefit' to society (White et al., 2018).

Provision of demand-responsive transport (DRT) options

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 4: Environments
Drivers:  Norms, Power
Practices:  N/A
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK, Other (Italy)

Details:

Definition: Demand-responsive transport (DRT) provides transportation options that employ dynamic, semi-fixed, or fixed routes with users and can be pre-booked or operated on-demand. They are often mostly used by elderly persons or those with disabilities even if available to the whole community (Butler et al., 2020).

What we know: Publicly funded and socially delivered demand-responsive transport (DRT) services demonstrate beneficial effects, with evidence suggesting they can be aligned with public transport service networks so as to improve first- and last-mile access to public transportation and provide connections to major transportation hubs, which can ultimately increase public transportation ridership (Butler et al., 2020). Shared DRT services can also present an opportunity for increased social interaction and reduced feelings of isolation, particularly among older users (Butler et al., 2020). Effort needs to be made to improve education and awareness of available DRT services as research suggests users who could benefit the most from DRT services are often confused or uncertain about how to use them (Butler et al., 2020).

Examples of implementation: Within Italy, most regions and autonomous provinces offer accompanying and social transport services for older persons to facilitate easier access to health, social, educational, recreational and public services (Barbabella et al., 2022).

'Healthy Places’ policies

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 2: Regulatory approaches and upstream policies
Drivers:  N/A
Practices:  Political practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

Types of identified policies: Columbus (Ohio, USA) Healthy Places; Healthy Together Geelong (Victoria, Australia); Healthy Auckland Together (New Zealand); Amsterdam (Netherlands) 'Healthy Weight Programme'; Healthy Living Cambridge Kids (Massachusetts, USA); Seinajoki (Finland) Health in All Polices approach.

What we know: Integrating health into policymaking efforts via multi-component and systems-level action (i.e., ‘Health in All Policies’) has been demonstrated with the successful implementation of ‘Healthy Places’ policies (Danielli et al., 2021). These 'Healthy Places' policies aim to link public health and urban planning have been implemented globally in several cities and have been associated with positive health effects such as reductions in childhood obesity.

Examples of implementation: Philadelphia (USA) developed its 'Get Healthy Philly' programme which served as a multi-component and multi-level approach to improve local nutrition, physical activity and tobacco environments. An evaluation of the programme determined that they achieved a 6.5% reduction in childhood obesity rates and larger reductions among children of colour (African Americans and Asians) than white children, which at the time was the only city in the US reaching that outcome (Danielli et al., 2021). Adoption of a health in all policies approach in Seinajoki (Finland) led to multi-sectoral actions across various settings (maternity clinics, day care centres, primary schools and after school clubs and community clubs) and was associated with reductions in odds of overweight or obesity from 1 in 6 five-year-olds (2009) to 1 in 10 (2015) (Danielli et al., 2021). Chicago (USA) developed 'A Recipe for Health Places', which had six strategies with actions linking health and sustainability outcomes including a focus on building healthier neighbourhoods through involving public health professionals in community planning efforts and embedding health impact assessments into local planning and development as well as investment in urban agriculture initiatives and incentives for health food enterprises (Barbour et al., 2022, S6).

Open Streets (aka Play Streets) programmes

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  Norms, Power
Practices:  N/A
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
Scopes:
Global, Europe, UK

Details:

Definition: Open streets or play street programmes are initiatives that temporarily close streets to vehicles for pedestrian access, recreational activities or play for children.

What we know: Open streets programmes have been implemented in several cities globally (Danielli et al., 2021) and have showed positive cost-benefit ratios (McKinnon et al., 2016).

Examples of implementation: A review from McKinnon et al., (2016) identified four Ciclovia (Open Streets) programmes in Bogotá (Colombia), Medellín (Colombia), Guadalajara (Mexico) and San Francisco (California, USA). Each of the programmes had a positive cost benefit ratio (Bogotá: 3.23–4.26; Medellín: 1.83; Guadalajara: 1.02–1.23; and San Francisco: 2.32) (McKinnon et al., 2016, Appendix Table 1).

Strategy of combined fabric, ventilation, fuel switching and behavioural change in housing stock

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 3: Sectoral public policies
Drivers:  N/A
Practices:  Supply chain and waste practices
Mechanism:
Physical environment
Effect:
+ (Beneficial effect)
References:
Scopes:
Global, Europe, UK

Details:

What we know: Evidence from a review by Gao et al., (2018) indicates that taking a multi-component strategy of combined fabric, ventilation, fuel switching and behaviour change in housing stock has beneficial effects, by leading to estimated significant reductions in CO2 emissions and avoidance of DALYs associated with air pollution (Gao et al., 2018).

Increase availability and accessibility of shared mobility services

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 4: Environments
Drivers:  Norms, Power
Practices:  N/A
Mechanism:
Physical environment
Effect:
+/- (Mixed effect)
Scopes:
Global, Europe, UK, Other (North America)

Details:

Types of identified shared mobility services: car rentals, public transport, taxis, bike sharing, ride-sharing (e.g., Uber).

What we know: The potential effects of shared mobility services depend on the type and form, with more beneficial effects noted for those related to public transport and active travel (i.e., bike sharing) and neutral and/or inequitable effects for others like private ridesourcing/sharing (Gao et al., 2018; McKane et al., 2023). Bike shares have been estimated to significantly reduce emissions and increases in physical activity, leading to greater avoidance of deaths annual compared to car users (Gao et al., 2018). Private ridesourcing and car-sharing options could potentially contribute to widening transport disadvantage, as these private services are more likely to be operating in centralised, denser areas where more demand is present and thus higher possible profit (Butler et al., 2020). Private ridesourcing also has limited evidence to support claims that it reduce emissions and pollution, with other evidence suggesting that this private option could disrupt existing public transportation networks and taxi users away from more sustainable public and active transport options (McKane et al., 2023).

Examples of implementation: Journeys associated with the bike sharing programme in Barcelona (Spain) - Bicing - have been estimated to have reducing annual CO2 emissions by 9062 MT (Gao et al., 2018). In Australia, the unchecked introduction of the private ridesourcing platform Uber in 2015 led to issues including the overnight loss of value to taxi licenses, concerns around underpayment of workers and later oversaturation of the market (McKane et al., 2023).

Development of business improvement districts (BIDs)

Area of Interest:
Built Environment
Lancet Model:
Level:  Level 1: Political and economic system
Drivers:  N/A
Practices:  Political practices
Mechanism:
Physical environment
Effect:
+/- (Mixed effect)
References:
Scopes:
Global, Europe, UK

Details:

Three identified aims of BID-style policies: economic regeneration, urban regeneration, community development, and/or safety.

What we know: The widespread development strategy of 'business improvement districts (BIDs)' has been criticised for being a demonstration of neoliberal urbanisation that commonly prioritises private financial interests over that of the local community residents (Fell and Mattsson, 2021; Guimaraes et al., 2021). This approach also can come at the expense of stigmatising the most disadvantaged citizens (Fell and Mattsson, 2021) and exacerbating existing economic and social exclusion (Guimaraes et al., 2021). There is limited evidence evaluating health effects associated with BIDs, with mixed effects reported on by Naik et al., (2019), who found one review citing reductions in self-reported wellbeing post-implementation of an urban regeneration programme but also small reductions in overall mortality rate.

Examples of implementation: The Scottish Government sought to develop a BID strategy that would privilege community-based intervention over economic (Guimaraes et al., 2021). In other cases, BIDs have been re-branded into other designations like 'community improvement districts' in Georgia (USA), but their prioritisation for economic goals remains (Guimaraes et al., 2021). Malmo (Sweden) implemented a BID to improve resident living conditions and address crime rates, though no conclusions on effectiveness of preventing crime of increasing safety were drawn (Guimaraes et al., 2021).