BA Geography student, University of Oxford
As part of my internship with GCHU, I helped to extract data for a systematic scoping review on urban health interventions for the Commission on Creating Healthy Cities. My focus was on social and environmental interventions. This experience provided me with real insight regarding the importance and challenges of synthesising research. Many of these challenges were in the variation of reporting methodologies; some studies followed a clear protocol, provided detailed evidence for their methods, and assessed risks of bias, whereas other studies failed to even list the number of included studies, or produce novel results.
I reviewed 13 studies with exposures ranging from green space (Barnes et al., 2019; Hunter et al., 2019) and urban regeneration (Thomson et al., 2006) to social capital (Pridmore et al., 2017) and community-based social innovations (Ghiga et al, 2020). Health outcomes were just as varied, which, coming from a geographical, not medical background, surprised me. These included mental health outcomes, from general wellbeing to specific conditions like depression, and physical health outcomes, communicable vector-borne diseases (Bermudez-Tamayo et al., 2016), non-communicable diseases such as asthma (DePriest and Butz, 2017), mortality rates, birth outcomes and, most interestingly, intimate partner violence (Beyer, Wallis, & Hamberger, 2015).
Across the studies, there were inconsistent definitions and measurements. Moreover, some studies reported environmental variables that other studies reported as health outcomes and vice versa. For example, Salgado et al. (2020) used access to health services and alcohol consumption as independent not dependent variables. Conversely, Thomson et al. (2006) used employment status as a proxy for health outcomes rather than an exposure. Thus, considering both issues of quality and complexity, it was difficult to summarise the overall impact of interventions and exposures of the studies.
The epistemological tensions between the medical and social sciences were evident. This was reflected in the strength of the evidence, especially concerning causal mechanisms, an area where there was hesitancy in sociological linking of urban interventions to health outcomes.
Clear and reproducible outcomes are important for progressing health and have critical implications for policy-making. The generalisability of findings were lacking in most reviews. However, I would add that there might be a difference between generalisable findings and generalisable policy implementations. Whilst policy recommendations may need to be more context-specific, the complexity of findings does not mean that there are no associations to be found between the urban environment and health outcomes.
The conclusion of the majority of authors was the need for clearer and more consistent methods and concepts surrounding the intersection between health and urban areas. The overarching recommendation from most authors was the need for holism at both research and policy-making stages. Indeed, as Thomson et al. (2006) put it, uncertainty in this area of research is not a cause for inaction. Rather it is a call to action for bridging interdisciplinary boundaries.
Barnes, M. R., et al. (2019). Characterizing Nature and Participant Experience in Studies of Nature Exposure for Positive Mental Health: An Integrative Review. Frontiers in psychology, 9, 2617. https://doi.org/10.3389/fpsyg.2018.02617
Bermudez-Tamayo, C., et al. (2016). Priorities and needs for research on urban interventions targeting vector-borne diseases: rapid review of scoping and systematic reviews. Infectious diseases of poverty, 5(1), 104. https://doi.org/10.1186/s40249-016-0198-6
Beyer, K., Wallis, A. B., & Hamberger, L. K. (2015). Neighborhood environment and intimate partner violence: a systematic review. Trauma, violence & abuse, 16(1), 16–47. https://doi.org/10.1177/1524838013515758
DePriest, K., & Butz, A. (2017). Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas. The Journal of school nursing : the official publication of the National Association of School Nurses, 33(1), 8–17. https://doi.org/10.1177/1059840516674054
Ghiga, I., et al. (2020). The effectiveness of community-based social innovations for healthy ageing in middle- and high-income countries: a systematic review. Journal of health services research & policy, 25(3), 202–210. https://doi.org/10.1177/1355819619888244
Hunter, R. F., et al. (2019). Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis. Environment international, 130, 104923. https://doi.org/10.1016/j.envint.2019.104923
Pridmore, P., et al. (2007). Social capital and healthy urbanization in a globalized world. Journal of urban health : bulletin of the New York Academy of Medicine, 84(3 Suppl), i130–i143. https://doi.org/10.1007/s11524-007-9172-8
Salgado, M., et al. (2020). Environmental determinants of population health in urban settings. A systematic review. BMC public health, 20(1), 853. https://doi.org/10.1186/s12889-020-08905-0
Thomson, H., et al. (2006). Do urban regeneration programmes improve public health and reduce health inequalities? A synthesis of the evidence from UK policy and practice (1980-2004). Journal of epidemiology and community health, 60(2), 108–115. https://doi.org/10.1136/jech.2005.038885