Measuring the Built Environment in Studies of Child Health—A Meta-Narrative Review of Associations

Abstract

Although the built environment (BE) is important for children’s health, there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative review was undertaken by a multi-disciplinary team of researchers to summarise ways in which the BE is measured, and how this links to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The most commonly addressed health-related outcomes were active travel, physical activity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (perceived) measurements of the BE. However, there was a wide variety, and sometimes inconsistency, in their definition and use. There were clear associations between the BE and children’s health. Objective physical activity and self-reported active travel, or obesity, were positively associated with higher street connectivity or walkability measures, while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Despite the high heterogeneity found in BE measures and health outcomes, the meta-narrative approach enabled us to identify ten BE categories that are likely to support children’s health and be protective against some non-communicable disease risk factors. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential unintended health consequences of making changes to the BE.

Associations between Park and Playground Availability and Proximity and Children’s Physical Activity and Body Mass Index: The BEACH Study

“…The role of the built environment on children’s health has attracted great attention in the literature during the last decade [ 1 , 2 ]. Nevertheless, there is little consensus about the impact of the built environment on health-related outcomes for children [ 1 , 3 ]. This is mainly due to the inconsistency in approaches and measures used to evaluate built environment for youth [ 1 , 3 ].…”

“…Nevertheless, there is little consensus about the impact of the built environment on health-related outcomes for children [ 1 , 3 ]. This is mainly due to the inconsistency in approaches and measures used to evaluate built environment for youth [ 1 , 3 ]. According to current evidence, a child-friendly built environment has high walkability levels (e.g., well-connected streets) and provides access to recreational facilities (e.g., parks and playgrounds), that have been positively associated with physical activity (PA), including active commuting to/from school (ACS) and recreational play [ 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“…This is mainly due to the inconsistency in approaches and measures used to evaluate built environment for youth [ 1 , 3 ]. According to current evidence, a child-friendly built environment has high walkability levels (e.g., well-connected streets) and provides access to recreational facilities (e.g., parks and playgrounds), that have been positively associated with physical activity (PA), including active commuting to/from school (ACS) and recreational play [ 1 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Furthermore, a positive built environment has a significant role in preventing non-communicable diseases reducing obesity rates, diabetes or coronary heart disease [ 1 , 4 , 12 ].…”

“…The majority of studies about the impact of built-environment attributes on children’s health come from the USA, UK, Canada, Australia and New Zealand [ 1 ]. Southern European countries, such as Spain, show the highest rates of obesity among children in Europe [ 16 ] and one of the highest levels of physical inactivity [ 17 ], hence, the importance of analyzing the built environment in relation to children’s health with the aim to design more efficient health policies.…”

“…A playground is usually an outdoor area designed for children to play and is located in public parks or other public open spaces. Globally, public parks and playgrounds can have a prominent role in reducing physical inactivity and obesity among children [ 1 ].…”