The Moving to Health (M2H) approach to natural experiment research: A paradigm shift for studies on built environment and health

Abstract

Improving the built environment (BE) is viewed as one strategy to improve community diets and health. The present goal is to review the literature on the effects of BE on health, highlight its limitations, and explore the growing use of natural experiments in BE research, such as the advent of new supermarkets, revitalized parks, or new transportation systems. Based on recent studies on movers, a paradigm shift in built-environment health research may be imminent. Following the classic Moving to Opportunity study in the US, the present Moving to Health (M2H) strategy takes advantage of the fact that changing residential location can entail overnight changes in multiple BE variables. The necessary conditions for applying the M2H strategy to Geographic Information Systems (GIS) databases and to large longitudinal cohorts are outlined below. Also outlined are significant limitations of this approach, including the use of electronic medical records in lieu of survey data. The key research question is whether documented changes in BE exposure can be linked to changes in health outcomes in a causal manner. The use of geo-localized clinical information from regional health care systems should permit new insights into the social and environmental determinants of health.

Obesity and the Built Environment: A Reappraisal

“…Current studies on obesity and the BE owe much to the development of geographic information systems (GIS) and the widespread use of global positioning system (GPS) devices . Elements of the neighborhood BE tend to be categorized into the food environment and the physical activity (PA) environment . The food environment is conceptualized in terms of physical access to local supermarkets, groceries, fast food restaurants, or convenience stores .…”

“…Elements of the neighborhood BE tend to be categorized into the food environment and the physical activity (PA) environment . The food environment is conceptualized in terms of physical access to local supermarkets, groceries, fast food restaurants, or convenience stores . The PA environment refers to area walkability, greenness, blue water, land use mix, and access to recreational facilities .…”

“…Much of the work on health and the BE, conducted over the past 2 decades, has focused on neighborhood‐level BE features and their likely impact on poor diet, lack of exercise, and higher obesity prevalence . Most studies have been home‐centric, meaning that the density of or distances to destinations of interest were measured in relation to the individuals’ homes .…”

“…By contrast, measures of diet quality, PA, and health have not followed suit. Standard methods of dietary intake assessment, such as food recalls or food frequency questionnaires, have generally not been used . Instead, the frequency of consuming “healthy” and “unhealthy” foods per day has been one proxy for diet quality .…”

“…The almost exclusive focus on quantifying BE exposure, together with cross‐sectional study designs , has limited the ability to draw causal inferences regarding potential links between BE exposure and obesity . Furthermore, there seems to be a conceptual disconnect between current measures of BE exposure and the long‐term trajectories of body weight.…”