Elsevier

Health & Place

Volume 7, Issue 4, December 2001, Pages 283-292
Health & Place

Measuring the built environment: validity of a site survey instrument for use in urban settings

https://doi.org/10.1016/S1353-8292(01)00019-3Get rights and content

Abstract

There are few reliable measures of place with which to study the effects of socio-economic context on health. We report on the development and inter-rater reliability of a 27-item observer-rated built environment site survey checklist (BESSC). Across eleven ‘housing areas’ (defined as areas of homogeneity in housing form) and two raters, kappa coefficients were ⩾0.5 for fifteen categorical items, and intra-class correlation coefficients exceeded 0.6 for a further three continuous measures. Ratings on several BESSC items were associated to a statistically significant degree with the prevalence of depression and residents’ dissatisfaction with ‘their area as a place to live’. BESSC items may prove to be valuable descriptors of the urban built environment in future studies.

Introduction

As the evidence for inequalities in morbidity and mortality by occupational social class and wealth has become irrefutable (Acheson, 1998; Marmot and Wilkinson, 1999), attention has turned to geographical variations in health, and to the effects of context (MacIntyre, 1997; Ecob and MacIntyre, 2000). Despite the importance currently attached to building ‘healthy communities’ (Department of Health, 1999); National Strategy for Neighbourhood Renewal, 2000), it is still not known which aspects of the social, economic and physical environments have the greatest effects on health (Sloggett and Joshi, 1994; Lynch et al., 2000). This is partly because most previous research on the geographies of health has been based on studies of the aggregated socio-economic characteristics of people living in particular areas (measures of ‘social composition’), rather than ‘contextual’ characteristics of the places where people live (MacIntyre, 1997; Ecob and MacIntyre, 2000).

There is an extensive literature on the associations between poor housing and worse physical and mental health (Wilkinson, 1999; Dunn, 2000), but most of this is based on cross-sectional studies, which are unable to distinguish between causal associations and those due to social selection or recall bias. Furthermore, most previous research into the effects of housing on health has been concerned with tenure (Lewis et al., 1998; Weich and Lewis, 1998), and the effects of structural problems, such as damp or infestation (Platt et al., 1990; Hopton and Hunt, 1996; Smith and Mallinson, 1997; Acheson, 1998; Weich and Lewis, 1998; Marsh et al., 2000). There have been very few studies of the associations of the effects of the wider environment outside the home. One exception was a survey of a random sample of residents in West Central Scotland, which identified three ‘psychosocial benefits’ associated with the home: the home as haven, as a locus of autonomy and as a source of status (Kearns et al., 2000). Statistically significant associations were found between all three dimensions and respondents’ perceptions of the ‘area environment’ (such as litter, vandalism and crime), and the ‘people in the area’ (including noise, other types of disturbance, and ‘neighbourhood reputation’). However, only the latter remained statistically significant after adjusting for housing tenure and problems associated with the dwellings themselves, such as damp.

There is also evidence that those living in urban areas experience worse physical and mental health than those living in rural or suburban areas (Lewis and Booth, 1994; Meltzer et al., 1995; Dorling, 1997). The mechanisms underlying this association remain poorly understood, although there is now little support for the once-popular notion of geographical drift (Lewis et al., 1992; Verheij, 1996). It is not yet known, however, to what extent higher rates of morbidity and mortality in urban areas are explained by individual-level socio-economic deprivation, such as low income or unemployment (Sloggett and Joshi, 1994; Dunn, 2000).

One important aspect of life in urban areas is the built environment. Defined broadly, the built environment includes many characteristics of places that cannot be reduced to the characteristics of the people who live there, such as housing form, roads and footpaths, transport networks, shops, markets, parks and other public amenities, and the disposition of public space. The built environment is likely to affect important aspects of the environment in which people live in both direct ways, such as effects on traffic, noise and air pollution, and in less tangible ways, by influencing the sense of community and ‘social capital’ in an area (Dunn, 2000). Evaluating associations between the built environment and health is therefore highly challenging, particularly when attempting to elucidate the mechanisms that might link these. Two previous studies of the effects of urban regeneration on mental health assessed the impact of improvements in the built environment that were intended to increase security and community participation, even though both were primarily ‘bricks and mortar’ interventions. Although both treated urban regeneration as a ‘black box’ intervention, both found that improvements in the built environment were associated with lower levels of anxiety and depression (Halpern, 1995; Dalgard and Tambs, 1997). Both studies were, however, limited by measures of the built environment that relied on residents’ perceptions, and may therefore have been prone to recall bias.

The dearth of empirical research into the effects of specific features of the built environment on health may be partly due to the absence of reliable and valid ‘objective’ measures. One notable exception was the study of young married women living on a housing estate in south–east London (Birtchnell et al., 1988). In this study, Birtchnell and his colleagues rated several aspects of the built environment including housing form, density, accessibility, entrance type and position, and control over the ‘buffer zone’ between private and public space, using a 15-item scale of ‘design variables’. Although this scale was based on previously published research, the authors did not report its psychometric properties. Birtchnell and his colleagues (1988) found that, compared with non-depressed controls, depressed women were significantly more likely to be living in blocks with raised walkways than in brick or concrete houses, or in tower blocks.

The present study was conducted prior to an evaluation of the effects of an urban regeneration programme on the mental health of local residents in an electoral ward in north London. The main initial thrust of the regeneration programme was external refurbishment, and improving the quality of the built environment. We hypothesised that improvements in the built environment would be associated with a reduction in the prevalence of depression. The aim of the present study were twofold; first, to evaluate the psychometric properties of a set of ‘objective’ measures of the built environment, and second, to validate this by evaluating associations with the prevalence of depression, among residents in two inner city electoral wards in north London.

Section snippets

Methods

The present study was conducted as a preliminary to a prospective cohort study, comparing changes in mental health over three years among individuals living in two electoral wards in north London. One of these wards was the site of a programme of improvements to the built environment, as part of the Capital Challenge scheme, while the other was selected as a control, for the purposes of evaluation. The control ward was chosen on the basis of its similarity to the intervention ward in

Inter-rater reliability of BESSC items

Table 1 shows the degree of inter-rater reliability for the full list of categorical items in BESSC, across the 11 housing areas surveyed for the reliability study. Low kappa coefficients were found when comparing the rankings used to rate the division of space within each housing area (BESSC item 7, Appendix A), the highest of which was 0.46 (SE 0.23) (p=0.02), for shared garden/open space. Table 2 shows the intra-class correlation coefficients for the estimated distances from the centre of

Discussion

It is still not known whether, or how, the built environment affects health, independent of individuals’ material circumstances. The present study represents a preliminary attempt to develop a set of reliable measures of the characteristics of the built environment in urban settings, with which to further address these questions. There was relatively little published empirical evidence to guide the choice of items, and consequently we opted for items with the greatest face validity, and those

Conclusions

Our findings suggest that it is both possible and feasible to rate the characteristics of the built environment in an urban setting independent of residents’ subjective perceptions. Most items, excluding those that required researchers to rank the use of land, showed at least moderate inter-rater reliability. Although further work is now required to refine and validate the measures described in this paper, in other independent areas, they may well prove useful in the further study of the

Acknowledgements

We would like to thank Ken Brodie and Juliet Matthews for collecting the site survey data, and Haroula Baladimou for collating it. We are also grateful to David Walker, of the London Borough of Camden, for providing us with demographic data about the two study wards.

References (41)

  • A.T.F Beekman et al.

    Criterion validity of the Center for Epidemiologic Studies Depression scaleresults from a community-based sample of older subjects in the Netherlands

    Psychological Medicine

    (1997)
  • I Bentley et al.

    Responsive EnvironmentA Manual for Designers

    (1985)
  • J Birtchnell et al.

    Depression and the physical environmenta study of young married women on a London housing estate

    British Journal of Psychiatry

    (1988)
  • A Coleman

    Utopia on TrialVision and Reality in Planned Housing

    (1985)
  • O.S Dalgard et al.

    Urban environment and mental health

    British Journal of Psychiatry

    (1997)
  • Department of Health, 1999. Reducing Health Inequalities: An Action Report. TSO,...
  • Department of the Environment, 1994. Housing Attitudes Survey. HMSO,...
  • D Dorling

    Death in Britain How Local Mortality Rates have Changed: 1950s to 1990s.

    (1997)
  • J.R Dunn

    Housing and health inequalitiesreview and prospects for research

    Housing Studies

    (2000)
  • R.R Frerichs et al.

    Prevalence of depression in Los Angeles County

    American Journal of Epidemiology

    (1981)
  • Cited by (82)

    • A systematic review of the relationship between objective measurements of the urban environment and psychological distress

      2016, Environment International
      Citation Excerpt :

      Typically, a census tract in the US has 4000 to 6000 people, and a CCD has an average of 255 dwellings. Seven studies defined their own neighbourhoods using a variety of different definitions, including: (1) a housing area that was geographically bounded and in which the majority of the housing was homogeneous in form and character (Weich et al., 2001; Weich et al., 2002), (2) buffer zones, such as a 0.25 km (Downey and Van Willigen, 2005), 100 m, 500 m and 1000 m (Berke et al., 2007), 1 km and 3 km (Maas et al., 2009) radius around a participant's home), and 3) street block, such as approximately ten small contiguous streets (Araya et al., 2007) or another definition requiring four streets and eight street sides (Mair et al., 2010). Two methods were used to measure the urban environment objectively; namely independent observational measures and Geographic Information System (GIS).

    • Urban Health Systems: Overview

      2016, International Encyclopedia of Public Health
    View all citing articles on Scopus
    View full text