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      The relationship between buildings and health: a systematic review

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          Abstract

          Background

          The built environment exerts one of the strongest directly measurable effects on physical and mental health, yet the evidence base underpinning the design of healthy urban planning is not fully developed.

          Method

          This study provides a systematic review of quantitative studies assessing the impact of buildings on health. In total, 7127 studies were identified from a structured search of eight databases combined with manual searching for grey literature. Only quantitative studies conducted between January 2000 and November 2016 were eligible for inclusion. Studies were assessed using the quality assessment tool for quantitative studies.

          Results

          In total, 39 studies were included in this review. Findings showed consistently that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. Prioritization of housing for vulnerable groups led to improved wellbeing. However, the quality of the underpinning evidence and lack of methodological rigour in most of the studies makes it difficult to draw causal links.

          Conclusion

          This review identified evidence to demonstrate the strong association between certain features of housing and wellbeing such as adequate heating and ventilation. Our findings highlight the need for strengthening of the evidence base in order for meaningful conclusions to be drawn.

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          Most cited references40

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          Moving to opportunity: an experimental study of neighborhood effects on mental health.

          The health consequences of neighborhood poverty are a public health problem. Data were obtained to examine links between neighborhood residence and mental health outcomes. Moving to Opportunity was a randomized, controlled trial in which families from public housing in high-poverty neighborhoods were moved into private housing in near-poor or nonpoor neighborhoods, with a subset remaining in public housing. At the 3-year follow-up of the New York site, 550 families were reinterviewed. Parents who moved to low-poverty neighborhoods reported significantly less distress than parents who remained in high-poverty neighborhoods. Boys who moved to less poor neighborhoods reported significantly fewer anxious/depressive and dependency problems than did boys who stayed in public housing. This study provides experimental evidence of neighborhood income effects on mental health.
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            Effect of insulating existing houses on health inequality: cluster randomised study in the community.

            To determine whether insulating existing houses increases indoor temperatures and improves occupants' health and wellbeing. Community based, cluster, single blinded randomised study. Seven low income communities in New Zealand. 1350 households containing 4407 participants. Installation of a standard retrofit insulation package. Indoor temperature and relative humidity, energy consumption, self reported health, wheezing, days off school and work, visits to general practitioners, and admissions to hospital. Insulation was associated with a small increase in bedroom temperatures during the winter (0.5 degrees C) and decreased relative humidity (-2.3%), despite energy consumption in insulated houses being 81% of that in uninsulated houses. Bedroom temperatures were below 10 degrees C for 1.7 fewer hours each day in insulated homes than in uninsulated ones. These changes were associated with reduced odds in the insulated homes of fair or poor self rated health (adjusted odds ratio 0.50, 95% confidence interval 0.38 to 0.68), self reports of wheezing in the past three months (0.57, 0.47 to 0.70), self reports of children taking a day off school (0.49, 0.31 to 0.80), and self reports of adults taking a day off work (0.62, 0.46 to 0.83). Visits to general practitioners were less often reported by occupants of insulated homes (0.73, 0.62 to 0.87). Hospital admissions for respiratory conditions were also reduced (0.53, 0.22 to 1.29), but this reduction was not statistically significant (P=0.16). Insulating existing houses led to a significantly warmer, drier indoor environment and resulted in improved self rated health, self reported wheezing, days off school and work, and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions.
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              Associations between active school transport and physical activity, body composition, and cardiovascular fitness: a systematic review of 68 studies.

              The impact of active school transport (AST) on daily physical activity (PA) levels, body composition and cardiovascular fitness remains unclear. A systematic review was conducted to examine differences in PA, body composition and cardiovascular fitness between active and passive travelers. The Medline, PubMed, Embase, PsycInfo, and ProQuest databases were searched and 10 key informants were consulted. Quality of evidence was assessed with GRADE and with the Effective Public Health Practice Project tool for quantitative studies. Sixty-eight different studies met the inclusion criteria. The majority of studies found that active school travelers were more active or that AST interventions lead to increases in PA, and the quality of evidence is moderate. There is conflicting, and therefore very low quality evidence, regarding the associations between AST and body composition indicators, and between walking to/from school and cardiovascular fitness; however, all studies with relevant measures found a positive association between cycling to/from school and cardiovascular fitness; this evidence is of moderate quality. These findings suggest that AST should be promoted to increase PA levels in children and adolescents and that cycling to/ from school is associated with increased cardiovascular fitness. Intervention studies are needed to increase the quality of evidence.
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                Author and article information

                Contributors
                Role: Research Associate in Public Health
                Role: Senior Lecturer in Public Health
                Role: Professor of Public Health and Sustainability
                Role: Research Associate Air Quality [climate change and carbon management]
                Role: Research Associate Air Quality [climate change and carbon management]
                Role: CEO db+a
                Role: Head of the WHO Collaborating Centre for Healthy Urban Environments
                Role: Honorary Professor of Public Health, University of Bristol
                Journal
                J Public Health (Oxf)
                J Public Health (Oxf)
                pubmed
                Journal of Public Health (Oxford, England)
                Oxford University Press
                1741-3842
                1741-3850
                June 2019
                18 August 2018
                18 August 2018
                : 41
                : 2
                : e121-e132
                Affiliations
                [1 ]Department of Health and Social Sciences, University of the West of England, Bristol, UK
                [2 ]Air Quality Management Resource Centre, University of the West of England, Bristol, UK
                [3 ]Daniel Black + Associates | db+a, Bristol, UK
                [4 ]WHO Collaborating Centre for Healthy Urban Environments, University of the West of England, Bristol, UK
                Author notes
                Address correspondence to Janet Ige, E-mail: Janet.Ige@ 123456uwe.ac.uk
                Author information
                http://orcid.org/0000-0001-6639-0011
                Article
                fdy138
                10.1093/pubmed/fdy138
                6645246
                30137569
                1f625b54-74be-4afb-a837-6696c2d82f47
                © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 November 2017
                : 04 April 2018
                Page count
                Pages: 12
                Funding
                Funded by: Wellcome Trust 10.13039/100010269
                Award ID: 106857/Z/15/Z
                Categories
                Original Article

                Public health
                buildings,health,housing
                Public health
                buildings, health, housing

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