Built environment and health

The built environment is a determinant of health due to its ability to affect health outcomes through activity levels, access to nutritious food and clean water, the houses we live in, where we work, contact with nature and the spaces we have for social interactions (see What are determinants of health?). It also affects the air we breathe and the water we drink and shelters us from the weather.

Urban form

The shape, size, population density and layout of a city is known as the urban form. This is characterised by components constructed by humans, including buildings and public places, as well as natural elements such as rivers and coastlines (Hill et al. 2021). In 2022–23, 90% of the Australian population lived in Major cities or Inner regional areas (ABS 2024). Despite Australian cities being highly urbanised, they have unusually low population densities by international standards (Hill et al. 2021). 

Although many Australian cities are being developed for higher density living, particularly inner-city areas, new suburbs continue to be developed on the outer areas of cities contributing to urban sprawl (see glossary). These suburbs are characterised by low densities and having, on average, greater distances to travel to services, amenities and work (Coleman 2017).

Walkability

Neighbourhood walkability (see glossary) affects health through its impact on physical activity and social connectedness (see glossary) (Kaczynski and Glover 2012). People are more likely to walk for transport, recreation or exercise if they live in neighbourhoods that are perceived as safe, are within a walkable distance of destinations (such as public transport services), have well-designed footpaths and safe pedestrian crossings, and higher residential densities (Gebel et al. 2009; Kamruzzaman et al. 2016; Larranaga et al. 2019; Majumdar et al. 2021). Lower neighbourhood walkability has been associated with increased risk of obesity, type 2 diabetes and high blood pressure (Chandrabose et al. 2019).

Participating in 30 minutes of walking on average a day can lower the risk of heart disease, stroke, and diabetes (Heart Foundation 2019). The health benefits increase with increased levels of activity and intensity (Hamer and Chida 2008; Williams and Thompson 2013). Adding 15 minutes of brisk walking, 5 days each week, could reduce disease burden due to insufficient physical activity by about 13% in Australia (AIHW 2017).

A ‘walkability index’ has been created by the Centre for Urban Research, which combines dwelling density, street connectivity (see glossary) and access to daily living destinations, such as public transport and a supermarket (Arundel et al. 2017). Using this index, only a minority of Australians living in cities live in walkable communities, and these are generally concentrated in the inner (and some middle) suburbs. However, there are some exceptions where the implementation of policies has resulted in highly walkable outer suburbs, such as in Perth and Canberra (Arundel et al. 2017). The Liveable Neighbourhoods operational policy created by The Western Australian Planning Commission in 1997 provides guidance and requirements for the design of urban areas (WAPC 2015). A study by Bull et al. (2015) found that increased compliance with policy was associated with increased likelihood to walk within their neighbourhood.

Public open space

Public open space includes a variety of green and blue spaces (see glossary) in the urban environment such as parks, nature reserves, gardens, plazas, beaches and riverbanks that are accessible by the public. They are important for recreation, enjoyment and social connection purposes, as well as enhancing the environmental quality of neighbourhoods and providing a cooling effect (AIHW 2022a; Rozek et al. n.d.; UN-Habitat 2018). 

In 2021, data from the Australian Urban Observatory showed variation in the proportion of dwellings that were within 400m of a public open space of at least 1.5 hectares in size, across Australian capital cities. Canberra had the highest proportion (72%) and Hobart had the lowest (40%). For all remaining capital cities, around half of dwellings were within 400m of a public open space 1.5 hectares or greater in size (Gunn et al. 2020).

A recent AIHW report using data from the Australian Bureau of Statistics’ (ABS) 2017–18 National Health Survey (NHS), examined whether the distance between where people lived and public open spaces was associated with the prevalence of health risk factors, including obesity and insufficient physical activity, by socioeconomic area. Data showed that living closer to public open spaces did not account for the inequalities in health risk factors often observed for people living in the lowest socioeconomic areas (AIHW 2022b). Further work is required to examine how the quality and safety of public open spaces influences usage of these spaces, and associated effects on health risk factors.

Green space

Green space (see glossary) includes areas of public and private land that feature some form of vegetation, such as nature reserves, public parks, residential gardens and outdoor sporting facilities (AIHW 2011). Green space has various positive impacts on physical and mental health (AIHW 2022a; Sugiyama et al. 2008; White et al. 2019).

Australian research examining the association between green space and health outcomes indicated that:

• there was a three-fold increase in the likelihood of doing any moderate-vigorous physical activity if more than 95% of dwellings in the suburb were within 400m of a park (Mavoa et al. 2016)
• access to a larger park within 1.6 km of home increased the likelihood of recreational walking for 150 minutes or more in a week (equivalent to the Physical activity and exercise guidelines for all Australians, specifically for adults) (Sugiyama et al. 2010).

Green space, particularly tree canopy, has also been associated with a range of health benefits such as reduced cardiovascular disease and lower psychological distress (Astell-Burt and Feng 2019, 2020). Additionally, factors other than access to green spaces may be associated with their use. For example, research has shown that lower socioeconomic neighbourhoods are less likely to have green space availability and hence fewer opportunities to use these spaces (Astell-Burt et al. 2014). The quality of available green spaces is often poorer in these areas, when compared with high socioeconomic areas. This is due to factors such as reduced safety, maintenance, cleanliness and aesthetics (Ghanem and Edirisinghe 2022).

Well-planned green space supports biodiversity, improves air quality, and reduces noise pollution and temperatures in urban areas (Kent and Thompson 2019). Contact with the natural environment may also benefit our immune system (Frumkin et al. 2017; Kuo 2015). Green space also mitigates against urban heat islands (see glossary) and extreme heat. Urban areas are susceptible to increasing temperatures and frequencies of heatwaves, due to reductions in urban green space, increasing urban densification and built environment infrastructure such as roads and buildings. As a result, this is likely to become more prominent with climate change, as average annual temperatures continue to increase (AIHW 2022a; Hill et al. 2021; NSW Government n.d.b). 

Transport

An easily accessible, reliable and affordable transport system is an essential part of a healthy built environment. It enables access to employment, education, health care, social events, leisure activities and fresh food shops. Transport systems can positively influence health by promoting active travel (see glossary) and subsequently reducing sedentary behaviour, or negatively influence health and the environment (EEA 2014, 2022; Infrastructure Australia 2019; Mihaylova 2021; Williams et al. 2021).

Shorter commuting distances are generally associated with lower prevalence of health risk factors. Self-reported data from the 2017–18 NHS show that living in an area with an average commuting distance to work of between 5 and 10 km was associated with lower prevalence of obesity (26%) and insufficient physical activity (48%), compared with living in an area with an average commuting distance of 20km or more (38% and 55%, respectively) (AIHW 2022b).

In 2020, one notable change to commuting practices was the introduction of working from home. This was driven by COVID-19 lockdowns which in some regions required people to work from home and changed employment practices allowing for greater flexibility in workplace arrangements (AIHW 2023a). Between September 2020 and February 2021 during the pandemic, 26%–31% of people worked from home. Following COVID-19, working from home is likely to remain in some capacity into the future, with 30% of people in April 2022 working from home on all or most days of the week in the last 4 weeks – twice as many as pre-pandemic levels (AIHW 2023a). Many people are opting for a mixed model of both working from home and in the office each week (AIHW 2023a). With trends of increasing working from home, it will be important to monitor how these impact physical activity levels in future. For more information, see Changing patterns of work.

Car dependence

The majority of Australians depend on their cars for transport (ABS 2020). While cars allow for increased mobility and convenience, and technology is leading to cars that are less polluting, a high level of dependence on cars for transport has a range of implications for human and environmental health (Infrastructure Australia 2019). Car-dependent suburbs tend to have poor access to public transport and as a result, less access to employment, education and other social infrastructure (Infrastructure Australia 2018). Car dependence can also:

• increase traffic congestion, greenhouse gas emissions, and air and noise pollution (Climate Council 2017; EEA 2014; Infrastructure Australia 2019)
• lead to an increase in traffic accident injuries (AIHW 2023c)
• affect respiratory and cardiovascular health, as well as mental health and life satisfaction (BITRE 2016; Giles-Corti et al. 2016)
• be associated with poor health-related behaviours such as sedentary lifestyles, reduced sleep, higher odds for smoking and growing rates of obesity (Ding et al. 2014; Sugiyama et al. 2020).

Poor air quality due to traffic emissions tends to concentrate around major road corridors and can be harmful to both human health and the ecosystem (Infrastructure Australia 2019). Traffic emissions are reduced with the use of electric vehicles. In 2023, electric cars made up 8.4% of all new car sales in Australia compared with 3.8% in 2022 (Electric Vehicle Council 2023). Despite this substantial increase, Australia is still overall slower with the uptake of electric vehicles when compared with other countries such as Europe and the UK (DCCEEW 2023). The National Electric Vehicle Strategy, released in 2023, provides a framework for increasing electric vehicle uptake, to assist in achieving Australia’s emissions reduction goals and improve wellbeing of Australians. New initiatives within the strategy include the introduction of a Fuel Efficiency Standard for new light vehicles, to encourage increased supply of affordable and accessible electric vehicles in Australia, and a focus on preparation for recycling, reuse and stewardship for electric vehicle batteries (DCCEEW 2023). It is anticipated that this will have positive impacts such as cheaper running costs and reducing road transport emissions (DCCEEW 2023).

Car dependence can have a larger effect on those from lower socioeconomic areas, who often have less choice in housing location and may have to live in outer suburbs due to housing affordability. This results in a higher proportion of their household income being spent on car-related expenses, and increased vulnerability to changes in fuel prices and mortgage stress (Dodson and Sipe 2008; Infrastructure Australia 2019). 

Traffic accidents

Traffic-related accidents are a major public health issue and can result in injury, disability or death. Road traffic accidents result from a multitude of factors relating to the elements of the built environment, such as population density, land use mix, road design and signage (Ewing and Dumbaugh 2009). For more information, see Transport accidents. 

Active travel

Active travel is the process of being physically active (usually walking or cycling) while moving from one place to another and can include multiple modes of transport in one trip. The health benefits of active travel include:

• increased physical activity which can subsequently benefit physical, mental and social health
• reductions in greenhouse gas emissions and traffic congestion and less noise and air pollution (Burke et al. 2019).

Living in close proximity to a mix of destinations, such as public transport stops and shops, was associated with higher levels of active transport across all age groups (Boulange et al. 2017; McCormack et al. 2008; Sallis et al. 2012). Other factors associated with increased active travel include well-lit streets and footpaths which contribute towards improved traffic safety (Sallis et al. 2012).

Food environments

Diet is a factor that can be modified, and aspects of a person’s diet can influence the extent to which they are at risk of, or protected against, a range of chronic conditions as well as overweight or obesity. The food environment plays a role in the food and drinks we choose to buy and consume through factors such as availability, accessibility, affordability and marketing of healthy and unhealthy food options. Additional factors within the food environment including living in areas of greater socioeconomic disadvantage or living in rural and remote areas, are also associated with more limited access to healthy food options (Dutko et al. 2012; Fleischhacker et al. 2011; Lewis and Lee 2016; Whelan et al. 2018). A range of indicators are used to estimate how healthy the Australian food environment is in the Australia’s Food Environment Dashboard (Australia’s Food Environment Dashboard 2022).

The relationship between the food environment and dietary intake is complex, largely due to an interplay of a variety of factors and behaviours as well as inconsistencies in methods and measured outcomes (Mahendra et al. 2017; Ni Mhurchu et al. 2013). Therefore, improvements to standardisation of measures and further research to better understand the relationship between availability of food, individual food choices and health outcomes in Australia, are needed. 

For more information, see Diet and Overweight and obesity.

Housing

Access to housing that is affordable, sustainable and appropriate can influence people’s health and wellbeing. Housing provides shelter, safety, security and privacy, enabling people to participate in the social, economic and community aspects of their lives (Moreland City Council 2020). Housing construction and design and the social and neighbourhood environment can affect various aspects of physical and mental health and quality of life of the inhabitants (Giles-Corti et al. 2012).

However, affordable housing is often located further away from city centres and employment areas. This can compound socioeconomic health inequalities, as people living in these areas may have longer travel times, increased travel costs, and decreased time to engage in healthy behaviours such as physical activity (Christian 2012; Daley et al. 2018; Trubka et al. 2010).

In Australia, building design codes regulate the design of insulation, ventilation, room sizes, ceiling heights and access to sunlight of dwellings (National Construction Code 2022). However, the built environment has not adapted to the changing Australian climate, particularly extreme heat events (DCCEEW 2022; NSW Government n.d.a).

The 2019–20 ABS Housing Mobility and Conditions survey found that 4.2% of households reported being dissatisfied/very dissatisfied with their current dwelling, of which almost half (49%) reported poor condition of the dwelling as being the most common reason (ABS 2022b). Poor-quality housing is associated with greater psychological distress (Giles-Corti et al. 2012) and lower self-assessed general and physical health (Baker et al. 2016). Frequent moves, renting, and being in financial housing stress are associated with impacts on children’s social and emotional wellbeing (Dockery et al. 2013).

In cities, housing affordability and homelessness are major challenges. On Census night in 2021, around 122,000 people were experiencing homelessness (ABS 2023), and in 2019–20 around 1 million low-income households were in financial housing stress (ABS 2022c; AIHW 2023b). For more information, see Housing affordability and Homelessness and homelessness services.

As people spend, on average, 87% of their time indoors (69% in residential environments) the indoor environment is important for health (Klepeis et al. 2001). Of particular concern is indoor air quality (WHO 2021). Indoor air pollution is generated from a wide range of sources, including wood fire heaters, gas appliances, chemicals, tobacco smoke, and mould (Emmerson and Keywood 2021). Infectious diseases can also be present in indoor air-borne particles (Morawska et al. 2022). Many factors can influence indoor air quality, including building location and quality, ventilation, personal behaviours and outdoor air pollution levels (Emmerson and Keywood 2021; Seguel et al. 2017). Health impacts of poor indoor air quality include respiratory diseases, allergies, asthma, cancer and cardiovascular disease (Kumar et al. 2023; WHO 2021). Children, the elderly and people with existing conditions, such as asthma are particularly at risk of harmful effects (Bentayeb et al. 2015; Maung et al. 2022). In Australia, there are currently no specific national performance standards or controls for indoor air, other than in certain workplace situations, in accordance with Safe Work Australia (DCCEEW 2021; Morawska et al. 2022).

Living in appropriately sized housing that isn’t overcrowded is an important determinant of physical and mental health. Overcrowding can affect education and health outcomes, and increases the spread of infectious diseases, such as COVID-19 and acute rheumatic fever (Baker et al. 2013; Ghosh et al. 2021; Infrastructure Australia 2019; Jaine et al. 2011). Many population groups are particularly vulnerable to household overcrowding, such as Aboriginal and Torres Strait Islander (First Nations) people and those who are socioeconomically disadvantaged (AIHW 2019; Buckle et al. 2020; Dockery et al. 2022). 

For more information, see Determinants of health for First Nations people, Housing circumstances of First Nations people, Social determinants of health, Health of people experiencing homelessness, and Housing assistance in Australia.

Water resources

Reliable and safe drinking water and wastewater services are vital for the wellbeing and long-term sustainability of communities. In metropolitan areas, water infrastructure includes drinkable supply and wastewater services; many rural and remote areas rely on small, localised or onsite systems (Infrastructure Australia 2019). Features of the built environment that can affect water quality include urban stormwater runoff, household wastewater, and by-products of industry and agriculture. Extreme weather events, such as floods, storms, drought and bushfires also impact the quality and availability of water resources and can contribute to waterborne diseases (Smith et al. 2011; van Vliet et al. 2023).

Use of contaminated water for drinking or for food preparation practices such as washing fruit and vegetables, or food containers can lead to illness. In addition, use of contaminated water for irrigation of food-based crops is a potential source of food-borne diseases (Bhagwat 2019; Steele and Odumeru 2004).

While most Australians have access to good quality drinking water, research has shown that water quality in rural and remote communities is commonly of lower quality than in metropolitan areas (Wyrwoll et al. 2022). This is likely due to water and wastewater infrastructures being poorly maintained, routinely failing, or failing to provide services to the appropriate standard (Infrastructure Australia 2019). Additionally, bore and rain water, which is often used in rural and remote communities, is prone to contamination with heavy metals, chemicals, microbes, organic matter and dust (Doble et al. 2023).

The increasing demand for water due to population and economic growth, as well as greater expected frequency of severe droughts, is likely to challenge the available water supply and quality over the coming years (Green and Moggridge 2021).

Where do I go for more information?

For more information on the built environment and health, see:

• AIHW: Health and the environment: a compilation of evidence
• AIHW: Climate change and environmental health indicators: reporting framework
• Department of Climate Change, Energy, the Environment and Water: Australia’s State of Environment Report 2021
• Infrastructure Australia: Australian Infrastructure Audit 2019: An Assessment of Australia’s Future Infrastructure Needs
• Heart Foundation: Blueprint for an Active Australia