Sorting Out the Connections Betweenthe Built Environment and Health:
A Conceptual Framework for NavigatingPathways and Planning Healthy Cities
Mary E. Northridge, Elliott D. Sclar, and Padmini Biswas
ABSTRACT The overarching goal of this article is to make explicit the multiple pathways
through which the built environment may potentially affect health and wellbeing.
The loss of close collaboration between urban planning and public health professionals
that characterized the post–World War II era has limited the design and
implementation of effective interventions and policies that might translate into improved
health for urban populations. First, we present a conceptual model that developed
out of previous research called Social Determinants of Health and Environmental
Health Promotion. Second, we review empirical research from both the urban planning
and public health literature regarding the health effects of housing and housing
interventions. And third, we wrestle with key challenges in conducting sound scientific
research on connections between the built environment and health, namely: (1) the
necessity of dealing with the possible health consequences of myriad public and private
sector activities; (2) the lack of valid and reliable indicators of the built environment
to monitor the health effects of urban planning and policy decisions, especially with
regard to land use mix; and (3) the growth of the “megalopolis” or “super urban
region” that requires analysis of health effects across state lines and in circumscribed
areas within multiple states. We contend that to plan for healthy cities, we need to
reinvigorate the historic link between urban planning and public health, and thereby
conduct informed science to better guide effective public policy.
