Technical Paper 1:
Obesity in Australia: a need for urgent action

4.6.4 - Town planning and building design

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While interventions based on improved nutrition and increased physical activity can be effective in addressing overweight and obesity in individuals, shifting the population distribution of obesity requires interventions that target elements of the environment that promote or support weight gain. Solutions to address the obesity-promoting environment such as changes in transport infrastructure and urban design can be more difficult and expensive than interventions targeting groups, families or individuals. However, these kinds of strategies are more likely to support and encourage healthy eating choices and physical activity among the greatest number of people in the population in the long term.[33]

Urban planning approaches influence community levels of physical activity and driving behaviours, and are also associated with health outcomes.[115]

Meta-analyses have quantified the effects of environment on physical activity.[116] For example:

• Good community-scale urban design and land use policies and practices in promoting physical activity are associated with higher levels of physical activity (for example, proximity of residents to shops and schools, connectivity of streets, population density, green spaces).
• Good urban design and land use at a street level increase physical activity levels by 35% (improved lighting, ease and safety of street crossings, pathway continuity, presence of traffic calming structures, aesthetic enhancements).
• Having access to places for physical activity increases physical activity by 48.4% (trails, facilities, parks, safety, affordability).

The urban environment also has significant association with some health outcomes. For example, a large US study across more than 400 counties found that people living in more sprawling counties (i.e. a widely dispersed population in low-density residential developments; the rigid separation of homes, shops and workplaces; a lack of thriving distinct activity hubs such as town centres; and a network of roads with large blocks and poor access between places) were less likely to walk during leisure time, weighed more and had a greater prevalence of hypertension, after demographic and behavioural covariates were taken into account.[115]

In Australia, a national planning guide is being developed that addresses the relationship between people’s health and the built environment. The planning group includes the Australian Local Government Association, the National Heart Foundation of Australia and the Planning Institute of Australia.¹¹

The ‘Healthy Spaces and Places Project’, with funding assistance from the Department of Health and Ageing, aims to promote ongoing development and improvement of built environments to facilitate lifelong active living and promote good health outcomes for Australians. Long-term planning, policy and infrastructure measures are required to address the urban obesity-promoting environment. This requires reorientation of transport policy to prioritise and enable walking, cycling and public transport options, and the development of policies to support increased urban density. At a neighbourhood level there is a need to build new, and redevelop existing neighbourhoods to provide infrastructure and services for recreational physical activity, including accessibility for pedestrians and cyclists to shops, workplaces, public transport and services. It is also important that there are high-quality and usable public open spaces that cater for different target groups such as children, adolescents, adults and older Australians. These spaces should enable walking as well as active recreation and sport.
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A number of reviews have shown that access to neighbourhoods characterised by higher density, mixed-use zoning, interconnected streets and access to public transport increases walking.[169, 170] There is also reasonably strong evidence of an association between parks and open spaces and walking. While having access to public open spaces is associated with walking as a form of transportation and achieving recommended levels of walking, it also appears necessary to have good communication and promotion of available facilities; access alone does not guarantee improved outcomes.[117, 118] Young people who live in more walkable, pedestrian-friendly neighbourhoods, with reduced exposure to traffic, are also more likely to walk.[119]

Evidence-based recommendations on how to improve the physical environment to encourage and support physical activity, based on effectiveness and cost-effectiveness studies, are available from the UK National Institute for Health and Clinical Excellence (2008).[120]

Facilitate the adoption of consistent town planning and general building design that encourage greater levels of physical activity, and reorient urban obesity-promoting environments through appropriate infrastructure investments. For example, develop state and municipal plans to re-orient public transportation and increase urban density, support farmers’ markets, build bicycle paths and footpaths, and protect open spaces.

¹¹See www.healthyactive.gov.au/internet/healthyactive/publishing.nsf/Content/healthy-spaces-index

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