Influence Of The Urban Built Environment On Residents' Health And Its Pathways

The rapid urbanization has brought people ample medical resources and welldeveloped infrastructure,and thereby has led to improvements of people's health.However,the rapid changes in the living environment and lifestyle brought about by urbanization also compel urban residents to face a series of health challenges such as obesity,chronic diseases,and mental health problems.To achieve “Healthy China 2030” blueprints,it is of great importance to explore the way of improving people's health by means of optimizing the built environment.New Urbanism believes that compact neighborhoods can help foster healthy behaviors which could improve residents' health.Nevertheless,some scholars doubt whether this theory derived from the context of Western countries could be applied to Chinese cities that are densely populated.Additionally,there are three shortcomings within the existing empirical studies,which explored the impacts of the built environment on health: mixed results with the lack of controlling for the impact of health attitudes,the lack of identifying comprehensive influential paths from the built environment to health,and neglect of age heterogeneity.Based on the questionnaire survey conducted in Shanghai in 2018,multivariate regression models were employed to explore the influence of the elements(density,land use diversity,street design,destination accessibility,and distance to transit)in the built environment on health outcomes(obesity,chronic diseases,and mental health).Furthermore,structural equation models with multiple mediators were applied to analyze the mediating effects of health behaviors(walking,exercise,social interactions,and healthy eating).In addition,the difference in the influence and pathways of the built environment on health between middle-aged adults and young adults is explored.The results show that the built environment has significant effects on health,and health behaviors act as important mediators.Moreover,the influence of the built environment on health and its pathways are different between middle-aged adults and young adults.Specifically,three conclusions are drawn as follows:First,the built environment has significant effects on health,even if health attitude is controlled.More bus stops,denser road network,and the presence of parks and squares improve residents' health,while higher population density has negative effects on health.After controlling for health attitude,the impacts of the built environment on physical health(obesity and chronic diseases)do not alter,but the impacts of the built environment on mental health are weakened.The impacts of health attitude are different among obesity,chronic diseases,and mental health.It reduces chronic diseases and improves mental health,but it is not associated with obesity.Second,health behaviors act as significant mediators between the built environment and health outcomes.On one hand,denser road network improves health through increasing walking time during commute and social cohesion.The presence of parks and squares improve health via increasing walking time during commute,exercise duration,social cohesion,and fruit and vegetable consumption.More bus stops improve health by boosting social cohesion.On the other hand,higher population density has negative effects on health mediated by lowering social cohesion,and the proximity to the city center deteriorate health through reducing walking time during commute and social cohesion.Other built environment elements have both positive and negative influential pathways to health.Land use diversity improves health by increasing exercise duration,but harms health by hurting social cohesion.The proximity to subway stations improves health by increasing walking time during commute and more fruit and vegetable consumption,whereas it worsens health via reducing exercise duration.Third,the influence of the built environment on health and its pathways are different between middle-aged adults and young adults.On one hand,land use diversity has positive effects on young adults' health,but it has both positive and negative impacts on middle-aged adults' health.On the other hand,for both middle-aged adults and young adults,higher road density,the presence of parks and squares,and more bus stops have positive effects on health,while the proximity to the city center has negative effects on health,and higher population density and the proximity to subway stations have both positive and negative influential pathways to health.The influential directions of these built environment elements on health are the same for middle-aged adults and young adults,but their influential pathways are different between these two groups.These results can deepen our understanding of the relationship between the built environment,health behaviors and health outcomes in the Chinese context,and provide new knowledge and evidence to develop the relevant theory in the field of urban geography and health geography.The conclusions have important policy implications for planning healthy cities and realizing “Health China 2030” blueprints.First,urban planners need to recognize the importance of the built environment to promote health conditions of the residents by providing facilities and resources encouraging health behaviors.Second,since the impacts of the built environment on health and its pathways differ between middle-aged adults and young adults,the building of healthy cities needs to meet the needs of residents of different ages.Third,the government should strengthen health education and improve people's health literacy,because health attitudes are related to health.