Category Archives: Built Environment

Food environments around schools: what historical data might reveal about current obesity patterns

Life course, environments & health

We know that factors throughout life influence our health and well-being in older age. Childhood poverty, early life education, difficult life events and many other factors have been shown to be strongly related to subsequent health outcomes. Yet almost all of this work has focused on our individual circumstances, and there have been few attempts to consider whether a wider set of factors – such as those at the community or neighbourhood level – affect our health over the life course. This is perhaps a surprise given the evidence that features of our local environment – such as air pollution, green space, and high numbers of retailers selling fast food, alcohol or cigarettes – are often associated with current health status. If these factors are causally related to health then there may be a number of policy opportunities (e.g. see our recent post on alcohol retail licensing). Continue reading Food environments around schools: what historical data might reveal about current obesity patterns

Alcohol-related health is worse in Scottish neighbourhoods with more alcohol outlets

By Elizabeth Richardson

Alcohol-related death rates in Scottish neighbourhoods with the most alcohol outlets are more than double those in neighbourhoods with the fewest, even once socioeconomic deprivation is taken into account, according to a CRESH report published today.  The research is being presented today at Alcohol Focus Scotland‘s National Licensing Conference.  This blog summarises the background to the research, the key findings, and what this means for reducing further alcohol-related harm. Continue reading Alcohol-related health is worse in Scottish neighbourhoods with more alcohol outlets

Watch CRESH seminar on YouTube: Why is urban health so unequal?

Why is urban health so unequal?

CRESH member Prof Jamie Pearce recently contributed to an event jointly organised by the  Global Environment and Society Academy (GESA) and the Global Health Academy to deliver a public seminar series exploring the complex relationships between environment and health.  The seminar series marks The Year of  Environment and Health and will examine key issues such as urbanisation, population growth, extreme weather, pollution and  ecosystem services through the lens of global environmental change. You can watch the public lecture here:


Does deindustrialisation explain low levels of physical activity in the UK?

by Esther Rind

In the UK, as in many other affluent countries, levels of physical activity have been declining in recent decades. In many areas with a history of heavy manual employment levels of physical activity are particularly low. This has been linked to a considerable reduction in work-related activities, coupled with a generally more sedentary life-style and the development of  broader environmental factors unconducive to physical activity (e.g. increased traffic makes walking and cycling less safe and attractive). Furthermore, previous research has highlighted that participation in leisure-time physical activity is relatively low across those employed in physically demanding industries. Low levels of recreational physical activity in combination with a considerable loss of work activity would therefore result in particularly low activity levels in the former manual workforce. Continue reading Does deindustrialisation explain low levels of physical activity in the UK?

Will the new point of sale legislation in Scotland influence young people’s knowledge and attitudes of tobacco products?

By Jamie Pearce & Catherine Tisch

Smoking remains one of the most significant public health challenges in Scotland and is implicated in one in every five Scottish deaths.  Each year, around 15,000 young Scottish people start smoking and many go on to become regular smokers.  Since the introduction of the Tobacco Advertising and Promotion Act in 2005, most forms of tobacco advertising and sponsorship in the UK have been banned. One of the few ways the tobacco industry can legitimately promote their products (often by elaborate and prominent means) is via point of sale (POS) tobacco displays.  A recent systematic review showed that POS displays increased children’s susceptibility to smoking, experimentation and initiation into smoking. Continue reading Will the new point of sale legislation in Scotland influence young people’s knowledge and attitudes of tobacco products?

Alcohol and tobacco environments and adolescents’ health behaviours: future talk on CRESH research in Edinburgh

Title: Alcohol and tobacco environments in Scotland and their relationship with adolescent behaviour

Presenter: Dr Niamh Shortt
Date: Thursday 25th July 2013
Time: 11:00 am
Venue: Seminar Room, Scottish Collaboration for Public Health Research and Policy (SCPHRP), 20 West Richmond Street, Edinburgh, EH8 9DX (next door to the Mackenzie Medical Centre) Continue reading Alcohol and tobacco environments and adolescents’ health behaviours: future talk on CRESH research in Edinburgh

Tobacco and Alcohol Outlet Density and Adolescent Behaviours

Image courtesy of mack2happy /
Image courtesy of mack2happy / 

Tobacco and alcohol use pose significant global public health challenges and are major determinants of preventable morbidity and mortality.  Preventing tobacco and alcohol misuse in adolescence before habits are formed is an important policy goal. Previous research into the relationship between tobacco outlet density and smoking prevalence has resulted in mixed findings. Whilst some have reported increased smoking prevalence with a higher density of retail outlets around the home and school others have reported no significant associations.  For alcohol a positive association between drinking and alcohol outlet density has been reported around the home for adults, adolescents and around Universities for college students. Despite this there have been several calls for a policy response to address the tobacco retail environment, primarily by ‘restricting the number of retailers around child spaces’. We received seed funding from the Scottish Collaboration for Public Health Research and Policy (SCPHRP) to examine the density of tobacco and alcohol retail outlets in Scotland and their association with the prevalence of drinking and smoking behaviours in school aged children. Continue reading Tobacco and Alcohol Outlet Density and Adolescent Behaviours

Joint Seminar CRESH & PAHRC

Date: 12 noon – 1 pm, Tuesday 23 April 2013

Speaker: Esther Rind (CRESH)

Title: Industrial restructuring and physical activity

Venue: Physical Activity for Health Research Centre (PAHRC), Moray House School of Education, Room 2.35 (here), The University of Edinburgh, St Leonard’s Land, Holyrood Road, Edinburgh EH8 8AQ

Abstract: Industrial restructuring and physical activity in England –                             Towards a better understanding of geographical variations in physical activity

In recent decades, the prevalence of physical activity has declined considerably in many high-income countries which has been linked to rising levels of obesity and several weight-related medical conditions such as coronary heart disease, diabetes and cancer. This is in part related to the progressive development of obesogenic environments to which those at the lower end of the socio-economic strata are unequally more exposed than others. This presentation highlights the importance of a range of factors which contribute to a better understanding of observed geographical variations in levels of physical activity in adults. The research presented applied a mixed methods approach using GIS techniques, multilevel modelling and qualitative research interviewing. Results emphasise the plausible impact of inherited cultures and regional identities on health related behaviours as well as the importance of considering socio-cultural and historical dimensions for the development of physical activity interventions within communities with a particular industrial past.

Greenwash: have the benefits of green space been exaggerated?


Greenwash” is sometimes used to describe exaggerated or otherwise misleading claims made about a product or company’s environmental benefits.  People are understandably becoming more and more cynical about environmental friendliness claims – but the danger is that genuine environmental benefits are rejected along with the greenwash, which “threatens the whole business rationale for becoming more environmentally friendly” (Futerra 2008). 

I am concerned that the green space and health research agenda is at risk of being overtaken by a form of greenwash, as ironic as that may sound.  Green spaces – also known as natural/vegetated/open spaces – clearly have some social, environmental and economic benefits.  The research of CRESH and many other groups has demonstrated this.  But these benefits are not experienced everywhere, or by everyone.  The same wooded park may be a valued jogging or walking area for some people, but a terrifying no-go area for others.  There is much important research to be done to understand and address the barriers that prevent different groups benefitting from green spaces.  CRESH researchers are among many jointly trying to bridge this knowledge gap.

The greenwash that concerns me is the mantra that ‘green space is good’ – end of story.  At a recent GreenHealth Conference (11th March 2013, Edinburgh) the fascinating results from a four-year Scottish Government funded research programme were presented.  CRESH’s own Rich Mitchell presented on the topic “More green = better health?” and concluded that this is not always the case (see blog post).  Nonetheless, in one of the afternoon discussions one attendee called for less research and more action “because we know green space is good already”.  Additionally, some important Greenspace Scotland work – showing that investment in ten community green space projects across Scotland provides good social, environmental and economic value for money – has been misleadingly reported elsewhere as “Greenspace is good… fact!”  This is greenwash.  It is also an example of a factoid – an assumption or speculation that is reported and repeated until it is considered true (see Cummins and Macintyre’s 2002 paper on how “food deserts” made it into UK policy by such a pathway).  Policy-making based on assumptions is dangerous: Cummins and Macintyre urge policy makers to look at the facts more critically.

Jane Jacobs – the influential American writer on urban planning – wrote about the greenwash surrounding green spaces (or ‘grass fetishes’ as she called it) more than 50 years ago.  In The Death and Life of Great American Cities (1961, Random House, NY) she wrote that “In orthodox city planning, neighbourhood open spaces are venerated in an amazingly uncritical fashion…” (p.90).  She qualifies that, while ”parks can and do add great attraction to neighbourhoods that people find attractive for a great variety of other uses”, they may also “exaggerate the dullness, the danger, the emptiness” (p.111).  If the barriers to green space use are not identified and addressed local people cannot be expected to use and benefit from them, regardless of the intentions of well-meaning city planners.  Informing people that ‘green space is good’ won’t help.  The danger is that when their touted benefits don’t materialise, green spaces may fall out of favour, when in truth, and with greater attention to what the evidence tells us, they may have been a great public health resource.  Instead of less research we urgently need to strengthen the evidence base and publicise our findings more widely.  Watch this space.

Author: Liz Richardson

Improving the evidence for place effects on (children’s) health

Four members of the CRESH team attended a two-day ‘Good Places, Better Health for Scotland’s Children’ conference (November 27th and 28th 2012, at Murrayfield, Edinburgh; @gpbhscotland and #gpbhconf).  Good Places Better Health (GPBH) is the Scottish Government’s strategy on health and the environment.  The conference reported on the first phase (2008-2011), which addressed how places can help to deliver improvements in four key health challenges facing children under 9 years old in Scotland: obesity, asthma, unintentional injury, mental health and wellbeing.  In 2012 the GPBH team published the recommendations that have arisen from the work programme.

The conference started by outlining how health and place ‘intelligence’ had been brought together to inform the recommendations.  The first step involved developing a conceptual model within which each of the issues and their influences could be framed (see Scottish Government report for more info).  Subsequently, evidence for place effects on health and wellbeing was brought together from scientific literature and workshops with scientific experts, practitioners, and communities.  The need to value and learn from the ‘anecdotes’ from the workshops as well as the ‘hard science’ from the literature reviews was stressed.  When reviewing the evidence gathered the GPBH team noted that (a) the absence of evidence did not equate with absence of possible effect, and that (b) the social, economic, cultural and physical components of places influence our health in complex and intertwined ways that are very difficult to disentangle.

Interestingly, and importantly, the evidence from literature, experts and practitioners varied.  In the case of childhood obesity, experts rated the strongest scientific evidence for the influence of place as being for ‘downstream’ influences on diet (portion size, snacking, fast food and soft drinks), and determinants of sedentary behaviour and of physical activity in schools and nurseries.  But practitioners (e.g., health care, police, and councils) ranked neighbourhood attributes most highly: unattractive, unsightly and unsafe neighbourhoods were 1st, and neighbourhoods without accessible play and sports facilities were 2nd.

Community engagement approaches were used to assess how communities saw and experienced things – as ‘on-the-ground’ experts.  When asked how place impacted upon their children’s health, parents and carers concurred with the practitioners.  They highlighted mainly negative neighbourhood attributes: anti-social behaviour, dog fouling, junkies, drug dealers, hooligans, drug paraphernalia, vandalism, and the lack of appropriate neighbourhood facilities.  There was a strong sense from these meetings that what researchers often label ‘low-level incivilities’ – things like dog mess, litter and graffiti – can cause a very high level of distress and potential health detriment.  These personal insights should inform and direct our investigations of neighbourhood influences on health.

When bringing the evidence together the team noted that the evidence was mainly for downstream determinants of health, such as displaying sweets at shop tills, and that the much-needed evidence for upstream drivers (the economic, social and political driving forces) would remain elusive until we were ‘permitted’ to randomise society and conduct controlled experiments!  Fortunately for all concerned this is unlikely to happen.  But the difficulties involved in evidencing the impacts of these wider determinants are clear.

What will help are neat approaches to working with pre-existing data that have been collected for individuals or populations over time – e.g., longitudinal survey datasets such as the British Household Panel Survey, repeated cross-sectional surveys such as the Scottish Health Survey, or national death records.  These provide us with a cost-effective means of assessing how wider changes to the upstream drivers of health might influence our health and health behaviours, by exploiting what are often referred to as ‘natural experiments’.  Here we can assess how health or behaviour changed either side of a particular ‘event’ (e.g., introduction of a policy to create smoke-free public buildings: see Jamie Pearce’s work in New Zealand) without needing to establish costly monitoring programmes that might not last long enough to show any effect.  Evidence from natural experiments can be even more robust if, in addition to ‘before and after’ data, we can also identify ‘treatment and control’ sites.  In the UK we have the opportunity of survey data that include both treatment and control nations: for example smoking was banned in public places in Scotland one year before it was in England, Wales or Northern Ireland.

If we remain fixated on the idea that ‘randomised controlled trials’ are the only evidence that counts (see Rich Mitchell’s blog post for discussion) we risk seeing public health policies being made on little or no research evidence (see Dunn and Bobak).  Alternatively, accepting the value of what we can learn from natural experiments and other longitudinal study designs will enable us to provide policy-makers with evidence for how upstream drivers influence our health.   The wealth of already-collected data available in the UK and elsewhere gives us a great opportunity to ‘add value’ to these investments and uncover important lessons about environment and health relationships.  We should continue to utilise these data, improve our use of them, and support the continuation of their collection.

Author: Elizabeth Richardson

What if neighbouring areas are very different?

Waldo Tobler’s first law of geography is that “everything is related to everything else, but near things are more related than distant things.” This is an important idea for many aspects of spatial science, but it’s taken particularly seriously by people who draw maps and do statistics to investigate how and why disease rates vary from place to place.

If Tobler’s first law holds,  we should expect the characteristics of people and places who are close together (including their health) to be similar. So, in general, the folk who live in your neighbourhood should be more like you than the folk who live on the other side of town.

This matters when we are researching if and how environment affects health. We know that people’s health can be affected by a huge range of things. If we are to reveal the health impacts that environment has, we need to try and allow for as many of those other influences as possible. However, we know that it’s very hard to account for all of them. This means some of the relationship between environment and health we see in our analyses may actually be due to these ‘unmeasured’ influences, a problem we call ‘residual confounding’. Now, if Tobler’s law is right, it is also likely that these unmeasured influences are also more similar when they are closer together. When this happens, it’s called residual spatial confounding. If we don’t allow for it, we run the risk of making mistakes in assessing the strength of relationships between the characteristics of environments and the health of the people who live there.

The good news is that these problems have long been known about and there are a range of techniques to try and deal with them. They include ways to statistically ‘smooth’ maps showing how risk of a disease varies from area to area, and to adjust measurements of risk for how close together they are in geographic space.

The bad news is that Tobler’s first law is not always true! It’s not always the case that neighbouring areas do have similar characteristics or environments. Often areas that are right next to each other contain very different types of people and have a very different environment. You have probably experienced this when walking around a town or city. You cross a road, the housing changes dramatically, and the streets ‘feel’ different. Those statistical techniques assume that kind of sudden change doesn’t happen.

Dr Duncan Lee and Prof Rich Mitchell have just finished an ESRC funded research project (RES-000-22-4256) trying to improve the way we handle this situation in our research. We have successfully created, and published techniques that can spot when two neighbourhood areas are so different that we need to alter our statistical assessment of the relationships between health and environment. One technique, published in Biostatistics, can be used when we have data that tell us something about the characteristics of the people or the neighbourhoods, such as house prices or smoking rates. The other can be used when all we have is information about health in the areas (now in press with Journal of the Royal Statistical Society Series C) .

Here’s an example of our results. The map below (click it to view full size) shows 271 areas that make up the Greater Glasgow and Clyde Health Board (for the geeks, the areas are intermediate geography zones). We obtained data on the risk of admission to hospital with a primary diagnosis of respiratory disease, from the Scottish Neighbourhood Statistics database ( The map is shaded so the colour of each area denotes its disease risk, with a value of 1.0 representing an average risk across the whole health board. Values above 1.0 represent high risk areas (for example a value of 1.10 indicates a 10% higher risk), while values below 1.0 represent low risk areas (for example a value of 0.85 indicates a 15% reduced risk). The red lines show boundaries between neighbouring areas that contain populations at very different risk of hospital admission for respiratory disease. These are the areas in which the conventional techniques would make mistakes. There are 173 of them… that’s 25% of all the boundaries in the map.


map of respiratory admissions

Data and boundaries © Crown Copyright. All rights reserved 2010.

We have created a free software package that will allow anyone to apply our techniques. It’s called CARBayes and is for the statistical software R. You can read about it and get it from here.

There has also been an interesting spin off from this research. Within Glasgow, we found a lot of neighbourhoods that were right next to each other but were very different in social and economic terms. We called these between-neighbourhood differences ‘social cliffs’. It prompted us to ask how such social cliffs occur. One idea is that they may be made more likely by physical barriers between the neighbourhoods, such as rivers, main roads or railways.The map below (click it to view full size) shows the kinds of physical features we’ve been looking at (note, our data are for the period before the new M74 motorway was opened).



Map based on data that are © Crown Copyright/database right 2012. An Ordnance Survey/EDINA supplied service.

Our research is now complete and we’re writing it up for publication. It seems that two kinds of physical feature are especially important. Where one or both of them lie along a neighbourhood boundary, it’s much more likely that the neighbourhoods will be very different socially, and economically. Which two do you think they are?


16th Emerging New Researchers in the Geographies of Health & Impairment (ENRGHI) conference


The 16th Emerging New Researchers in the Geographies of Health & Impairment (ENRGHI) conference took place in London at the beginning of September, jointly organised by University College London and Queen Mary’s University College London.

ENRGHI is a conference run for and by post graduate and early career researchers and provides an innovative and supportive forum for presenting and sharing ideas.  The conference consisted of two days of posters and presentations, as well as opportunities for networking, socialising and a careers Q&A session.

CRESH PhD student Anna Kenyon presented on the socio-spatial distribution of environments that are likely to support walking throughout urban Scotland, concluding that there is little evidence of inequality in the distribution of good walking environments in relation to area deprivation.

The talk sparked debate about which features of urban environments are the most important to include in measures of area walkability. This led to a wider discussion about the balance, when measuring environmental determinants of health behaviours, between the benefits of using a large study area, such as urban Scotland, and the inevitable technical constraints this places on the specificity of measures used.

Other delegates made presentations on a diverse range of topics and attendees voted for the presentation they thought was the best.  Topics of the winning presentations were: Women’s detention and mental health, Environmental and socio economic factors associated with leishmaniasis outbreaks in Saudi Arabia, and Inequalities in the provision of treatment for chronic kidney disease in the UK.

Dr. Maurzio Gibin (Birkbeck University of London) gave a plenary speech on geovisualisation techniques and presenting geographic data to non-expert audiences as well as ingenious methods of presenting geographic data.  Prof. Steve Cummins (Queen Mary University of London) presented on the benefits of using of natural experiments in geography.  Prizes for the best three delegate presentations were presented by Dr Jim Dunn, deputy editor of the Journal of Epidemiology and Community Health.

Postgraduates and postdoctoral researchers travelled from countries including Canada, France, Australia and the Netherlands as well as throughout the UK to attend the conference.

Details of the next ENRGHI conference as well as including photos of the event, posters and prizes from this year can be viewed on the ENRGHI website:


Anna Kenyon

October 2012

London 2012: inspiring a generation and regenerating East London?

Immediately following the Olympics, Prime Minister David Cameron announced that government funding to support Team GB athletes would increase up to the Rio 2016 Games. “The motto of these Games has been ‘Inspire a generation’. Nothing has been more inspirational than seeing our elite athletes win Gold this summer. There’s a direct link between elite success and participation in sport” he said.

This link between the inspiration of elite athletes and wider public participation in physical activity was a key claim made for the London Olympics from the start. The London 2012 Candidate file, part of the initial bid for the Games, stated that the Olympics would: “…inspire a new generation to greater sporting activity and achievement, helping to foster a healthy and active nation.”

Furthermore, the Government’s Legacy Action Plan published in 2008 promised that the Olympics would “transform the heart of East London” the home of the Olympics Park by “turning one of London’s most deprived areas into a world-class district for living, leisure, business and sport, with safe and sustainable neighbourhoods, new parkland, new homes, jobs, and social and leisure facilities for generations to come.”

So, what is the evidence regarding the impacts of large scale sporting effects on public participation in sport and area regeneration?

A review of research into the impact of mass sporting events on physical activity among the wider population by Murphy and Bauman (2007) suggested a lack of evidence for a public health benefit. A systematic review of the health and socioeconomic impacts of major multi-sport events published in 2010 by McCartney and colleagues found that few studies looked at health outcomes and concluded similarly: “The available evidence is not sufficient to confirm or refute expectations about the health or socioeconomic benefits for the host population of previous major multi-sport events.”

Sport is not the only way that London 2012 might affect health and wellbeing. Huge amounts of construction and regeneration in East London have already taken place or are planned. Yet the impacts of that are also uncertain. A review by Davies (2010) of sport and economic regeneration also highlighted that “…no comprehensive longitudinal post-event study has ever been undertaken on the economic regeneration impacts of the Olympic Games”.

The impacts of regeneration for London 2012 are being closely watched. A longitudinal study of the health and social impacts of the London Olympics upon families in East London is already underway. The Olympic Regeneration in East London (ORiEL) Study, led by Professor Steven Cummins at Queen Mary, University of London, is a five-year study, following approximately 1,800 school children and their parents in Tower Hamlets, Hackney, Newham and Barking and Dagenham. It will assess their health and well-being over time. The results of this study should demonstrate whether claims that have been confidently made for the long term public benefits of the 2012 London Olympic games, and the regeneration accompanying them, prove to be true.

By Helena Tunstall

Stigma, environments and health inequalities: why should we be interested?

In recent years there has been a great deal of interest amongst health researchers in the role of social stigma in affecting health. Social stigma can be articulated as a majority view that works to spoil the identity of others on the basis of a discriminating characteristic such as race, gender or class. The social stigma associated with some minority groups has been shown to have health salience in terms of providing an obstacle to gaining access health care, housing provision, welfare, employment and other underlying factors affecting health. Groups that have been the subjects of research include disabled, homeless and itinerant populations and this body of work has revealed the multitude of interpersonal and institutional factors linking discrimination with health. Stigma has also been adopted as a deliberate strategy in health promotion initiatives, most notably in tobacco control with recent work beginning to question whether the denormalisation and stigmatisation of smoking (and the smoker) has reached its limit as a public health goal.

Given the long tradition of work on stigma and health, and the importance of stigma for establishing and perpetuating health inequalities, it is perhaps surprising that few researchers have considered the potential significance of place and the environment in establishing, perpetuating and mediating social stigma. In a recent commentary* on a Japanese paper on place-based discrimination published in the journal Social Science and Medicine, I argue that geographers (and others with interests in place, space and health) could productively consider the role of spatial stigma in affecting the health of local residents. Spatial stigma arises in places with notoriety in the public discourse, and that are constructed as ‘no-go zones’ or ‘sink estates’ that require constant policing.  Neighbourhoods such as Toxteth in Liverpool, South Central in Los Angeles or the French banlieues have for instance been prejudiced by deep-rooted geographical discrimination.  Key to the argument in the commentary is that there are a range of consequences for population health of residing in a highly stigmatised community. Yet very few empirical studies have tested the salience of spatial stigma in affecting population health.

So why should researchers with interests in the environment and spatial inequalities in health be concerned with place-based stigma? In the Social Science and Medicine commentary, I suggest that health might be compromised by spatial stigma through a series of (non-mutually exclusive) individualised and institutional pathways, which in turn can exacerbate geographical inequalities in health. These include:

1. Being ‘looked down on’ because of residing in a stigmatised community can detrimentally affect a number of life chances such as education and training opportunities, employment prospects and the prospects of developing interpersonal relationships. These factors have all been implicated in studies of health.

2. Stigma relating to particular places may act as ‘badge of dishonour’ that results in local residents taking actions such as concealing their address, avoiding receiving visitors or providing excuses to others for where they live. These feelings of shame can work to spoil, manipulate and mediate individual identities and social relations and affect health (e.g. health behaviours or mental health).

3. Place-based stigma affects the levels investment and disinvestment of public and private resources put into the local community. Progressive social policy is undermined by the lack of investment in the local infrastructure, housing and other services that provide the opportunities for healthy living.

4. Social networks, community social bonds and collective efficacy are affected by residents’ withdrawal from the public realm in response to the perceived threats associated with spatial stigma (e.g. crime). The breakdown of these community ties is detrimental to physical and mental health outcomes of local populations.

In short, there is plenty of evidence from the urban sociology and urban geography literature that through a variety of intersecting pathways place-based stigmatisation is harmful to the life chances of local residents. The population health consequences of place-based stigma are however less well established; understanding these pathways is an important challenge for researchers with an interest in the environment and health. This challenge is particularly important during a period of austerity with major reductions in state investment in a range of health related infrastructure. A likely consequence of this retrenchment is the heightened stigmatisation of many socially disadvantaged communities with potentially disastrous implications for public health and health inequalities.

Jamie Pearce, August 2012

 *Library access required; if you are unable to get hold of the paper then I’d be please to email you a copy ( .

Neighbourhood built environment related to transport and leisure physical activity

A new study involving CRESH researchers on neighbourhood built environments and  transport and leisure physical activity has recently been published in the journal Environmental Health Perspectives. The New Zealand study collected data on the urban built environment (destination access, street connectivity, dwelling density, land-use mix and streetscape quality) and surveyed 2,033 adults who lived in 48 New Zealand neighbourhoods. The findings suggested associations of neighbourhood destination access, street connectivity, and dwelling density with self-reported and objectively measured PA were moderately strong.  You can find the paper here:

CRESH gets new grant to look at risk to kids from alcohol and tobacco outlets

The CRESH team, led by Niamh Shortt, has been awarded a grant from the MRC/CSO Scottish Collaboration for Public Health Research and Policy. The research will examine whether the density of tobacco and alcohol outlets around schools and homes affects smoking and drinking behaviours among 13 and 15 year olds, in Scotland. The grant begins in early 2011 and we’ll be looking to recruit staff soon. Watch our website for more details.

Mental health and the environment symposium: some thoughts

The CRESH symposium on mental health and the environment was one of those (quite rare) conference days that worked incredibly well. I’m not sure what it was that made the day so interesting and exciting. Perhaps it was the unusual mix of academics, practitioners, policy makers and GPs in the audience, all of whom seemed keen and willing to engage and debate. Perhaps it was the variety of interesting presentations. Whatever the magic ingredients, I came away from the day inspired and full of thoughts. I’d like to share two of them

1) There was much discussion during the day about the nature of ‘evidence’ for the influence of environment on health. There was a clear tension between the desire for evidence from ‘intervention / evaluation’ type studies, which hold the promise of identifying causal mechanisms and offer a higher standard of ‘proof’ about whether environment does or does not hold influence over health (especially if the studies are controlled in some way), and the bulk of existing evidence which stems from observational designs. It certainly feels like the balance of funding available for health research is shifting rapidly to favour study designs which are more experimental than observational. Colleagues of mine have recently had funding requests turned down because of their observational study design, and we have had papers rejected from leading medical journals specifically because of an observational design. This pressure is, rightly or wrongly, asking scientists to work further up the hierarchy of study designs. What concerns me is the extent to which we are ignoring the weakness of experimental / evaluation study designs, especially in a) the extent to which they have external validity (i.e. can we really learn anything about how the wider world works from the controlled and unusual situations that experimental studies either create or exploit) and b) the extent to which we are tempted to believe that what are often relatively short-term studies can really tell us much about how social and physical environments really influence population health and health inequalities. This is a topic to which we intend to return in the next CRESH event. What is the right balance between experimental and observational studies in a portfolio, or mixed economy, of evidence? Is it all over for observation?

2) Critical thinking is essential to the progress of science. If we don’t ask how, and for whom, our results or conclusions might not hold, our work is weaker. If we don’t question how and why we think and research in the way we do, our approaches will not develop. In one area CRESH researches, the health effects of contact with green spaces or natural environments, we frequently encounter land managers, policy makers and planners who adhere to a general orthodoxy that ‘green space is good for you’. The value of critical science is that it makes us aware that not everyone feels comfortable walking in the woods or the park, and that some people even feel threatened by open spaces in the their neighbourhoods. There is plenty of evidence from qualitative and quantitative studies that this is true.

One of the weaknesses of critical thinking in the field at the moment however is that the critique seems to stop at ‘not everyone benefits from green space’. My question is, what do we do with that knowledge? If we can understand how and for whom benefits are not realised, that could help adjust expectations about what green space can deliver, and also help us think through how benefits could be brought to a wider range of people. Perhaps the real value of critical approaches to thinking about environment and health is that they pose these questions.

News about the next CRESH symposium will appear on the site soon. In the meantime, if any attendees want to post their thoughts on the mental health and environment day, please use the form below.

This is a personal post, written by Rich Mitchell. It doesn’t represent the views of ‘CRESH’

Fast food outlets cluster around schools

New CRESH research has found that fast food outlets tend to cluster around schools. The work published in the American Journal of Preventive Medicine demonstrated that fast food vendors are five times more likely to cluster around New Zealand schools than in other areas. Using data from four cities, the authors found that outlets are also more likely to be situated in poorer neighbourhoods. The results suggest that the geographical distribution of fast food outlets may be one factor in explaining the increase in obesity rates amongst youths, and its social distribution.

The work has been covered in the New Zealand media. See:


The academic paper can be found here: