A global consensus has been increasingly acknowledged that the built environment, including man-made or modified structures, surfaces, facilities, and landscapes, influences human health and wellbeing (Fig. 1).1, 2, 3 Housing price, as a monetary metric to reflect the quality of the built environment regarding properties’ structural and socioeconomic attributes, locations, and neighboring amenities, is highly associated with physical and mental health from research findings in recent studies.4,5 These results unveil the underlying concerns of coincided disparities between the built environment and human health; worrisomely, this trend is expected to exacerbate along with rapid urbanization.6 The United Nations 2030 Agenda for Sustainable Development has highlighted the aspiration of making cities and human settlements inclusive, safe, resilient, and sustainable in the 11th Sustainable Development Goal.7 The current challenge is how to promote social, environmental, and economic prosperities while mitigating associated disparities (with the goal of leaving no one behind).
Fig. 1.
Conceptual diagram of the built environment impacts on human health.
Bennett and colleagues bring insights on three key questions that deepen our understanding of the association between the built environment and health outcome: 1) what is the relationship between housing price and life expectancy at a granular scale? 2) to what extent has this relationship changed over the years? and 3) how does this change covary with the structure of residential population?8 The authors integrate various datasets to conduct a fine-resolution spatiotemporal analysis to examine the relationship between housing price and life expectance from 2002 to 2019 covering 4835 local ‘neighbourhoods’ in London.8 They discover the high association between housing price and life expectancy and the increased life expectancy inequality trend from 2002 to 2019. The neighbourhoods with substantial increase in life expectancy are either those with originally high housing price or those that have experienced price boom during the period. This is attributed to the role of population displacement in shaping the different associations between changes in housing price and life expectancy over space. This study unravels the mechanism of coupled housing price and health outcome and informs multi-level implications for housing and health policies.
Given the nature of ecological studies, Bennett and colleagues' research design is susceptible to ecological fallacy without the fair capability to make causal inferences at the individual level, based on the aggregated data at the neighourhood level. However, this is one of the critical challenges in the built environment and health that requires future collective efforts for informing causality evidence. Additionally, housing price is an indirect metric to measure the quality of the built environment through its spatial distribution and the associated inequalities can reflect residential population's socioeconomic (e.g., income and infrastructure accessibility), and physical statuses (e.g., properties and nearby living environment). From this point of view, it is worthwhile to dive into the direct channels that lead to the variation of health outcomes as a spatially and temporally explicit pathway of health-facilitating or limiting (Fig. 1).
The gradient of housing price in a city and its evolutionary sorting will lead to certain segregation in inhabitants' living environments. The formed inequality in environmental exposure has the potential to translate housing inequalities into physical and mental health, thus leading to coincided disparity between the built environment and health outcomes.9 Another vital implication of Bennett and colleagues' study lies in the effect of demographic changes on the housing price.8 This aligns with the widely documented gentrification process whereby the character of a poor urban area is changed along with wealthier people moving in, improving local facilities, and establishing new businesses, ultimately displacing current residents over time as an outcome. Notably, the increasing gap between housing price and income has made housing more unaffordable and will gradually ‘turf out’ disadvantaged segments of the population. The continued gentrification will exacerbate the disparities in accessing health, education, and other socioeconomic resources, which further prevents poor residents from climbing the social ladder. This leads to a vicious cycle of urban poverty and even causes inter-generational poverty in the long run.10
In summary, more scientific evidences from cross-sectional and longitudinal studies are in need to advance our current understanding of the complex mechanisms between individual and combined built environmental factors and health outcomes, in particular the cascading effect over time. For the action side, we call for coordinated practices among policymakers, city planners, real estate developers, and landscape architects to balance land-housing supply and demand as well as optimize infrastructures and landscape arrangements for facilitating sustainable and equitable living environment.
Declaration of interests
The author declares no competing interests.
Acknowledgements
This work was supported by The University of Hong Kong HKU-100 Scholars Fund. The author would thank Professor P. Gong and Dr. S. Shi from The University of Hong Kong for discussion on drafting this commentary.
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