BackgroundThe burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life.MethodsPre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records.ResultsThe cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations.ConclusionsOur study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.

Abstract"Accessibility" has become commonplace in transport planning and as such there is a plethora of interpretations of what accessibility means, what constitutes a good measure of accessibility, and how this might be applied in practice. This paper presents an overview of approaches to measuring accessibility and presents a case study of Accessibility Planning in England -one approach to formalising the concept of accessibility. Results of semi-structured interviews with local authority officers are discussed to establish whether current approaches allow their desired outcomes to be met. This approach demonstrates where there might be gaps between measured or modelled accessibility and the perceptions of the individuals. Findings suggest that while the process is deemed useful in raising the profile of accessibility issues, measures of accessibility do not necessarily easily translate into quantifying benefits of those improvements that are perceived by practitioners to improve accessibility and reduce transport disadvantage.

Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of 'proportionate universalism' argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to 'need' and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving 'higher', 'medium' or 'lower' levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF-12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in 'higher investment' areas relative to 'lower investment' areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need.

BackgroundExisting research points towards physical and mental health gains from housing improvements, but findings are inconsistent and often not statistically significant. The detailed characteristics and variability of housing improvement works are problematic and studies are often small, not experimental, with short follow-up times.MethodsA quasi-experimental design was used to assess the impact on physical health and mental health (using SF-12v2 Physical and Mental health component summary scales) of four types of housing improvement works—central heating, ‘Secured By Design’ front doors, fabric works, kitchens and bathrooms—both singly and in pairwise combinations. A longitudinal sample of 1933 residents from 15 deprived communities in Glasgow, UK was constructed from surveys carried out in 2006, 2008 and 2011. Sociodemographic characteristics and changes in employment status were taken into account.ResultsFabric works had positive associations with physical health (+2.09, 95% CI 0.13 to 4.04) and mental health (+1.84, 95% CI 0.04 to 3.65) in 1–2 years. Kitchens and bathrooms had a positive association with mental health in 1–2 years (+2.58, 95% CI 0.79 to 4.36). Central heating had a negative association with physical health (−2.21, 95% CI −3.74 to −0.68). New front doors had a positive association with mental health in <1 year (+5.89, 95% CI 0.65 to 11.14) and when provided alongside kitchens and bathrooms (+4.25, 95% CI 1.71 to 6.80). Gaining employment had strong associations with physical health (+7.14, 95% CI 4.72 to 9.55) as well as mental health (+5.50, 95% CI 3.27 to 7.73).ConclusionsFabric works may provide insulation benefits and visual amenity benefits to residents. Front doors may provide important security benefits in deprived communities. Economic regeneration is important alongside property-led regeneration.

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