State of the Evidence Review on Urban Health and Healthy Weights

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Raine, Kim and Spence, John C. and Church, John and Boulé, Normand and Slater, Linda and Marko, Josh and Gibbons, Karyn and Hemphill, Eric (2008) State of the Evidence Review on Urban Health and Healthy Weights. Project Report. CIHI, Ottawa.


This review revealed that evidence exists for associations between aspects of the urban environment and behaviours contributing to obesity. Economic environments—For individuals, a lower socio‐economic status (education level, income, employment) was often associated with increased obesity among both adults and children. For instance, lower personal income affects affordability of food, which demonstrates the most consistent influence on food consumption. Similarly, individuals living in middle‐income to high‐income neighbourhoods are more likely to be physically active than their counterparts in lower‐income neighbourhoods. Lower‐income neighbourhoods are also more likely to contain greater access to sources of energy‐dense foods (for example, fast foods) and lower access to supermarkets or other stores stocking healthy foods. What this means is that interventions aimed at improving the income and educational status of individuals and families within urban environments may help address disparities in obesity. Also, improving access to healthy foods and recreation opportunities in lowerincome neighbourhoods may help to create a “healthy weight” friendly environment. School environment—Although schools are not specific to urban areas, studies from interventions performed in schools (for example, availability of healthy choices in vending machines or point‐of‐purchase nutrition information) showed evidence for improving eating behaviours. All studies had at least some positive effects on food intake, either increasing healthy food choices or decreasing unhealthy alternatives, though no school interventions significantly affected body weights. However, it should be noted that some studies that have assessed the impact of school‐based programs on body weights may not have been included in this review because they did not specify an urban setting. What this means is that comprehensive school food policies or educational interventions that promote healthy food choices are likely to have beneficial effects on children’s eating habits. Built environment—The most consistent environmental associations observed for physical activity were elements of the built environment. Hallmarks of walkability (for example, increased residential density, mixed‐use zoning and street connectivity) and access to recreational facilities are associated with healthy body weights. People’s perceptions of their built environment are also key. What this means is that walkability of neighbourhoods and access to recreational facilities in and around neighbourhoods may assist in promoting healthy weights. Lack of intervention evidence—Very little evidence exists for the effectiveness of interventions in achieving healthy weights in an urban context. More evaluations are needed to take into account natural experiments in urban environments (for example, does the proliferation of bicycle lanes increase cycling?).