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Background Population surveys across the world have examined the impact of the COVID-19 pandemic on mental health. However, few have simultaneously examined independent cross-sectional data with longitudinal data, each of which have different strengths and weaknesses and facilitate the investigation of distinct research questions. This study aimed to investigate psychological distress and life satisfaction during the first and second lockdowns in the state of Victoria, Australia, and the social factors that may be affected by lockdowns and could affect mental health. Methods The VicHealth Victorian Coronavirus Wellbeing Impact Study included two 20-min opt-in online panel surveys conducted in May and September 2020 in Victoria, each with a sample of 2000 adults aged 18 + . A two-part study design was used: a repeated cross-sectional study of respondents who participated in Survey One and Survey Two, followed by a longitudinal nested cohort study. The primary exposures were social solidarity, social connectedness and staying connected with family and friends. Using logistic regression modelling, we explored the associations between our exposures and primary outcomes of psychological distress and life satisfaction with and without adjustment for covariates, both cross-sectionally and longitudinally. The results from the multivariable models were summarised using adjusted Odds Ratios (aOR), 95% Confidence Intervals (CI). Results Cross-sectional results indicated that the percentage of participants with low life satisfaction was significantly higher in the second survey sample (53%) compared to the first (47%). The percentage of participants with high psychological distress was higher but not significantly different between the two survey samples (14% first survey vs 16% second survey). Longitudinal study results indicated that lower social connectedness was significantly associated with higher psychological distress (aOR:3.3; 95% CI: 1.3–8.4) and lower life satisfaction (aOR:0.2; 95% CI: 0.1–0.4). Younger adults had higher psychological distress compared to older adults (aOR:6.8; 95% CI:1.5–31.1). Unemployment at the time of the first survey was significantly associated with lower life satisfaction at the second survey (aOR:0.5; 95% CI: 0.3–0.9). Conclusion This study supports the findings of other international studies. It also highlights the need to promote increased social connection and maintain it at times of isolation and separation, particularly amongst younger adults.

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Objective:Higher neighbourhood walkability would be expected to contribute to better health, but the relevant evidence is inconsistent. This may be because residents’ dietary attributes, which vary with socio-economic status (SES) and influence their health, can be related to walkability. We examined associations of walkability with dietary attributes and potential effect modification by area-level SES.Design:The exposure variable of this cross-sectional study was neighbourhood walkability, calculated using residential density, intersection density and destination density within 1-km street-network buffer around each participant’s residence. The outcome variables were dietary patterns (Western, prudent and mixed) and total dietary energy intake, derived from a FFQ. Main and interaction effects with area-level SES were estimated using two-level linear regression models.Setting:Participants were from all states and territories in Australia.Participants:The analytical sample included 3590 participants (54 % women, age range 34 to 86).Results:Walkability was not associated with dietary attributes in the whole sample. However, we found interaction effects of walkability and area-level SES on Western diet scores (P < 0·001) and total energy intake (P = 0·012). In low SES areas, higher walkability was associated with higher Western dietary patterns (P = 0·062) and higher total energy intake (P = 0·066). In high SES areas, higher walkability was associated with lower Western diet scores (P = 0·021) and lower total energy intake (P = 0·058).Conclusions:Higher walkability may not be necessarily conducive to better health in socio-economically disadvantaged areas. Public health initiatives to enhance neighbourhood walkability need to consider food environments and socio-economic contexts.

Globally there is increasing interest in making cities more liveable for all, a concept which aligns strongly with the UN Sustainable Development Goals. However, existing tools for tracking progres...

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km 2, 100 intersections per km 2, and 25 public transport stops per km 2 were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.

Spatial and area-level socioeconomic variation in urban liveability (access to social infrastructure, public transport, open space, healthy food choices, local employment, street connectivity, dwelling density, and housing affordability) was examined and mapped across 39,967 residential statistical areas in Australia's metropolitan (n = 7) and largest regional cities (n = 14). Urban liveability varied spatially, with inner-city areas more liveable than outer suburbs. Disadvantaged areas in larger metropolitan cities were less liveable than advantaged areas, but this pattern was reversed in smaller cities. Local data could inform policies to redress inequities, including those designed to avoid disadvantage being suburbanised as cities grow and gentrify.

We examined associations between neighbourhood built environment features and early childhood development (ECD), and tested the contribution of the built environment to associations between neighbourhood disadvantage and ECD.Spatial neighbourhood built environment measures were linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children ∼5 years old living in Australia's 21 most populous cities. The 2015 AEDC contains teacher-reported national data on five key child development domains for children in their first year of formal full-time schooling (approximately five years old). AEDC scores were classified as 'developmentally vulnerable' (≤10th centile). Using multilevel modelling, 44 built environment measures were tested with developmental vulnerability on at least one domain of the AEDC, adjusting for socioeconomic factors and neighbourhood disadvantage.The dataset consisted of 205,030 children; 89.2% living in major cities. In major cities, children with more early childhood education and care services (OR 0.997) and preschool services (OR 0.991) exceeding Australian standards, and access to more healthier food outlets within 3,200m of their home (OR 0.999) had decreased odds of developmental vulnerability, controlling for socioeconomic factors and neighbourhood disadvantage. Neighbourhood disadvantage remained significantly associated with developmental vulnerability after adjustment for child/family variables and neighbourhood built environment characteristics.The neighbourhood built environment had small effects on the neighbourhood disadvantage - ECD relationship at the national level. Few built environment measures were associated with ECD. Small effects at the population level may have wide-ranging impacts; modifying the built environment at scale are promising levers for supporting good child outcomes.

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities. BG-C was supported by an RMIT Vice-Chancellor's Fellowship. CH was supported through an NHMRC Centre for Research Excellence in Healthy Liveable Communities grant (number 1061404) and The Australian Prevention Partnership Centre (number 9100003). DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. EC's research was supported by the Australian Catholic University. SL was supported by the experiential fellowships from College of Social Science and Humanities, Northeastern University. JFS was supported by Australian Catholic University. DS was supported by Washington University in St Louis (MO, USA), Center for Diabetes Translation Research (number P30DK092950 from the US National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institute of Health) and by the Cooperative Agreement Number U48DP006395 from the US Centers for Disease Control and Prevention. SB was supported by an Australian Research Council Linkage Grant (LP160100324) and European Union's Horizon 2020 research and innovation programme under grant agreement #730426 (Urban GreenUP). We would like to thank Belinda Nemec and Judy Boyce. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

Focus of presentation Through the UN’s Sustainable Development Goals (SDGs), there is a major commitment from cities to prioritise health and wellbeing, reduce poverty, support environmental resilience, and increase liveability. Existing tools for tracking progress towards liveable, equitable cities have been developed primarily for high-income country contexts. This project is a collaboration led by RMIT University (Australia), partnering with the Bangkok Metropolitan Administration (BMA) (Thailand), the UN Global Compact - Cities Programme, and the Victorian Department of Health and Human Services (Australia). It aims to provide a proof-of-concept spatial indicators system using open access and local spatial data to monitor progress towards the SDGs in Bangkok. Findings Approximately 50 spatial indicators aligned to the SDGs have been generated for Bangkok. These are available in a range of formats, including a bi-lingual online-portal, and static and interactive maps. The BMA have identified three Bangkok districts for deeper interrogation, and on-going workshops shape the capacity building activities. Conclusions/Implications This partnership has enhanced understandings of liveability within the SDG framework including: i) providing indicators for monitoring liveability in a low-to-middle income city context; ii) developing an international liveability network and deeper understanding of challenges; and iii) creating opportunities for capacity building and reciprocal learning. Key messages There has been little ‘liveability’ guidance for cities in low- or middle-income country contexts. This project contributes to the global SDG agenda to enhance health and wellbeing through the built environment in diverse contexts.

The UN Global Compact – Cities Programme sponsors cross-sectoral partnerships to further the Sustainable Development Goals and the New Urban Agenda at the local level. The paper situates urban live...

Background Designing healthy, liveable cities is a global priority. Current liveability indices are aggregated at the city-level, do not reflect spatial variation within cities, and are often not aligned to policy or health. Objectives To combine policy-relevant liveability indicators associated with health into a spatial Urban Liveability Index (ULI) and examine its association with adult travel behaviours. Methods We developed methods to calculate spatial liveability indicators and the ULI for all residential addresses in Melbourne, Australia. Associations between the address-level ULI and adult travel behaviours from the 2012–2014 Victorian Integrated Survey of Travel and Activity (VISTA) (n = 12,323) were analysed using multilevel logistic regression. Sensitivity analyses to evaluate impact of methodological choices on distribution of liveability as assessed by the ULI and associations with travel mode choice were also conducted. Results Liveability estimates were calculated for 1,550,641 residential addresses. ULI scores were positively associated with active transport behaviour: for each unit increase in the ULI score the estimated adjusted odds ratio (OR) for: walking increased by 12% (95% Credible Interval: 9%, 15%); cycling increased by 10% (4%, 17%); public transport increased by 15% (11%, 19%); and private vehicle transport decreased by 12% (− 9%, − 15%). Conclusions The ULI provides an evidence-informed and policy-relevant measure of urban liveability, that is significantly and approximately linearly associated with adult travel behaviours in the Melbourne context. The ULI can be used to evaluate progress towards implementing policies designed to achieve more liveable cities, identify spatial inequities, and examine relationships with health and wellbeing. Electronic supplementary material The online version of this article (10.1186/s12942-019-0178-8) contains supplementary material, which is available to authorized users.

Cities are widely recognised as important settings for promoting health. Nonetheless, making cities more liveable and supportive of health and wellbeing remains a challenge. Decision-makers’ capacity to use urban health evidence to create more liveable cities is fundamental to achieving these goals. This paper describes an international partnership designed to build capacity in using liveability indicators aligned with the UN Sustainable Development Goals (SDGs) and social determinants of health, in Bangkok, Thailand. The aim of this paper is to reflect on this partnership and outline factors critical to its success. Partners included the Bangkok Metropolitan Administration, the UN Global Compact—Cities Programme, the Victorian Government Department of Health and Human Services, the Victorian Health Promotion Foundation, and urban scholars based at an Australian university. Numerous critical success factors were identified, including having a bilingual liaison and champion, establishment of two active working groups in the Bangkok Metropolitan Administration, and incorporating a six-month hand-over period. Other successful outcomes included contextualising liveability for diverse contexts, providing opportunities for reciprocal learning and knowledge exchange, and informing a major Bangkok strategic urban planning initiative. Future partnerships should consider the strategies identified here to maximise the success and longevity of capacity-building partnerships.

Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks, are associated with a range of health and wellbeing outcomes across the life course, but evidence with early years’ outcomes is still emerging. Data linkage techniques were used to assemble a dataset of spatial (objectively-measured) neighbourhood-built environment (BE) measures linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children living in the 21 most populous urban and regional Australian cities (n = 235,655) to help address this gap. This paper describes the methods used to develop this dataset. This linked dataset (AEDC-BE) is the first of its kind worldwide, enabling opportunities for identifying which features of the built environment are associated with ECD across Australia at scale, allow comparisons between diverse contexts, and the identification of where best to intervene. National data coverage provides statistical power to model real-world complexities, such as differences by city, state/territory, and remoteness. The neighbourhood-built environment can be modified by policy and practice at scale, and has been identified as a way to help reduce inequitable early childhood development outcomes.

Pedestrian accessibility is an important factor in urban transport and land use policy and critical for creating healthy, sustainable cities. Developing and evaluating indicators measuring inequalities in pedestrian accessibility can help planners and policymakers benchmark and monitor the progress of city planning interventions. However, measuring and assessing indicators of urban design and transport features at high resolution worldwide to enable city comparisons is challenging due to limited availability of official, high quality, and comparable spatial data, as well as spatial analysis tools offering customizable frameworks for indicator construction and analysis. To address these challenges, this study develops an open source software framework to construct pedestrian accessibility indicators for cities using open and consistent data. It presents a generalized method to consistently measure pedestrian accessibility at high resolution and spatially aggregated scale, to allow for both within- and between-city analyses. The open source and open data methods developed in this study can be extended to other cities worldwide to support local planning and policymaking. The software is made publicly available for reuse in an open repository.

Social infrastructure requires a consistent and measurable definition and more evidence is needed to demonstrate why it is important to health, wellbeing and the liveability of a community. In this paper, social infrastructure is defined as life-long social service needs related to health, education, early childhood, community support, community development, culture, sport and recreation, parks and emergency services. These services are needed to promote health and wellbeing and underinvestment and poor planning of social infrastructure has been linked to area-based health inequities. Current methods used to plan infrastructure delivery in communities were analysed and a new conceptual framework of social infrastructure developed and empirically tested using geocoded health survey data linked to spatial social infrastructure measures. Both accessibility and mix of social infrastructure were associated with higher Subjective Wellbeing. Residents were most likely to have close access to childcare services, dentists, doctors and sport facilities and least likely to have access to services of culture and leisure including cinemas, theatres, libraries, museums and art galleries. Results provide evidence of direct associations between social infrastructure planning and public health, the need for alternative social infrastructure urban planning methods and policies, and areas for future research.

Background Creating ‘liveable’ cities has become a priority for various sectors, including those tasked with improving population health and reducing inequities. Two-thirds of the world’s population will live in cities by 2050, with the most rapid urbanisation in low- and middle-income countries (LMIC). However, there is limited guidance about what constitutes a liveable city from a LMIC perspective, with most of the evidence relating to high-income countries, such as Australia. Existing liveability frameworks include features such as public transport, affordable housing, and public open space; however, these frameworks may not capture all of the liveability considerations for cities in LMIC contexts. Objectives This case study formed a multi-sectoral partnership between academics, policymakers (Bangkok Metropolitan Administration, Victorian (Australia) Department of Health and Human Services), and a non-government organisation (UN Global Compact – Cities Programme). This study aimed to: 1) conceptualise and prioritise components of urban liveability within the Bangkok, Thailand context; 2) identify alignment to or divergence from other existing liveability tools; and 3) identify potential indicators and data sources for use within a Pilot Bangkok Liveability Framework. Methods The Urban Liveability Workshop involving technical leaders from the Bangkok Metropolitan Administration and a rapid review of liveability literature informed the conceptualisation of liveability for Bangkok. The Bangkok Metropolitan Administration Working Group and key informants in Bangkok provided input into the liveability framework. Indicators identified for Bangkok were mapped onto existing liveability tools, including the UN Global Compact CityScan. Results Findings revealed commonalities with the Australian liveability definition, as well as new potential indicators for Bangkok. The resulting Pilot Bangkok Liveability Framework provides a structure for measuring liveability in Bangkok that can be implemented by the Bangkok Metropolitan Administration immediately, pending appropriate data acquisition and licensing. The Bangkok Metropolitan Administration Working Group and key informants identified core issues for implementation, including limited spatial data available at the district-level or lower. Conclusions This study conceptualised urban liveability for Bangkok, a city in a LMIC context, with potential for adjustment to other cities. Future work should leverage opportunities for using open source data, building local capacity in spatial data expertise, and knowledge sharing between cities. Electronic supplementary material The online version of this article (10.1186/s12992-019-0484-8) contains supplementary material, which is available to authorized users.

Introduction Planning policies support the development of healthy, liveable cities. Yet, recent research suggests they may not offer enough detail to provide on-the-ground delivery of social and transport infrastructure that supports and impacts healthy, active behaviours and the subjective wellbeing of residents in new developments and growth areas. Methods Three analyses were conducted. First, planning policies were reviewed using a content analysis to identify environmental features known to support healthy and active behaviours. Then, for two growth area estates located in Melbourne, Australia (Allura and Selandra Rise), the on-the-ground delivery of these planning policies were evaluated using spatial data of key destinations (e.g., shops, schools, and transport) and geographic information systems analysis. Finally, the health and subjective wellbeing of adult residents from these two estates combined (n = 352) was assessed using survey methodology. This included asking residents about the importance and satisfaction with access to transport and key destinations. Results We found that many built environment features were mentioned in the policy documents; however policy standards for dwelling density remain low at 15 dph and distances for accessing activity centres too long at 1 km to adequately support the walkability of new growth areas. We found generally, that average distances to key destinations were longer and more variable in growth areas in comparison to inner city areas and Greater Melbourne overall. For residents, satisfaction with access to destinations differed between the two case study areas. Residents in Allura, where destination and transport access was generally poorer were less satisfied, whilst those in the more walkable and established Selandra Rise area were more satisfied. Conclusions Although planning policies support the development of active transport and healthy, liveable cities they are insufficient for influencing healthy behaviours when not well implemented. Early delivery of social and transport infrastructure and services must occur early in the development cycle of new growth areas to support healthier and more sustainable behaviours.

Creating healthy, liveable cities is a common policy aspiration globally. However, little research has explored the capacity of urban policies to deliver this aspiration, or levels of policy implementation. This study aimed to develop policy-relevant indicators, to detect within- and between-city inequities in the implementation of Australian state government policy targets related to urban liveability. Seventy-three government policies were reviewed across Australia's four largest cities to identify measurable spatial policies that contribute to creating healthy, liveable neighbourhoods. Spatial indicators based on these policies were developed to assess and map levels of policy implementation at the metropolitan and sub-metropolitan level. Measurable spatial policies were identified for only three out of seven policy domains: walkability, transit access, and public open space. While there was significant variation between cities, policies were often inconsistent with evidence about how to achieve liveability. No Australian city performed well on all liveability domains. Even modest policy targets were often not achieved, and there were significant spatial inequities in policy implementation. With few exceptions, people living in outer suburbs had poorer access to amenities than inner-city residents. This study demonstrates the benefits and challenges of measuring urban policy implementation. Evidence-informed targets are needed in urban, transport and infrastructure policies designed to create healthy, liveable cities, to enable levels of (and inequities in) policy implementation to be assessed. Consistent standards for government spatial data would enable development of comparable indicators and cities to be directly compared.

Background:Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed.Methods:Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011–2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively.Results:One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia.Conclusions:An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.

Adequate and affordable housing is a major social determinant of health; yet no work has attempted to conceptually map and spatially test area-level measures of housing with selected health and wellbeing outcomes. Sourcing data from 7,753 adults from Melbourne, Australia, we tested associations between area-level measures of housing density, tenure, and affordability with individual-level measures of neighbourhood safety, community satisfaction, and self-rated health. Compared with the reference groups, the odds of: feeling unsafe was higher for residents living in areas with less affordable housing; community dissatisfaction was ~30% higher in those living in areas with >36% residential properties assigned as rentals, and was significantly higher in the least affordable areas (OR =1.57). Compared with the reference groups, as dwelling density, proportion of rental properties, and housing unaffordability increased, the odds of reporting poorer self-rated health increased; however these associations did not always reach statistical significance. This work highlights the benefits of evidenced-based planning spatial measures to support health and wellbeing.