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Grasser, G.
Walkability and Public Health. Development of GIS-based indicators of walkability for surveillance and planning purposes in the city of Graz.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medical University of Graz; 2014. pp. 234
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- Authors Med Uni Graz:
- Advisor:
- Stronegger Willibald
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- Abstract:
- The built environment is considered to be one determinant of health. Walkability measured by geographic information systems (GIS) was associated with physical activity, especially walking. Little is known about the association between walkability and health-related outcomes in Europe, and especially in Austria. Furthermore, GIS-based walkability has the potential to be used for surveillance and planning, since it is based on routine data and simple measures. Therefore the research question was: which GIS-based measures of residential neighbourhood walkability in the city of Graz are consistently associated with health-related outcomes among adults and are therefore relevant to public health surveillance and planning? A cross-sectional study was undertaken. Based on both representative and secondary survey data from the Radfreundliche Stadt (n=843) and geodata, the association between walkability (defined as gross-population density, household-unit density, entropy-index, proportion of mixed-land use, three-way intersection density and four-way intersection density, respectively, IPEN walkability index and Graz walkability index) and health-related outcomes was investigated. Health-related outcomes were defined as walking for transport, general walking, cycling for transport, active modes of transport, BMI, self-rated health, and mean neighbourhood satisfaction, as well as neighbourhood satisfaction with social environmental quality, social cohesion and infrastructure. Covariates were sex, age, socio-economic status and place of residence. For these characteristics, sub-group analysis were conducted. The residential neighbourhood was defined as a circular buffer of 1000m and as street network buffers of 1000m and 1500m. Bivariate, bivariate-controlled and multivariate regression analysis were conducted. The results from the present empirical study demonstrate that walkability is associated with health-related outcomes within the adult population of Graz. There was a consistent positive association between the walkability indicators and biking for transport, active modes of transport and neighbourhood satisfaction with infrastructure. Mean neighbourhood satisfaction and neighbourhood satisfaction with both social-environmental quality and social cohesion was negatively associated with walkability. No or almost no associations between walkability and walking for transport, general walking, BMI and self-rated health were found. The walkability measures household unit density, proportion of mixed land use, four-way intersection density and the newly developed Graz walkability index showed the strongest associations between walkability and health-related outcomes. The sub-group analysis found especially an association between walkability and health-related outcomes among men, among younger respondents, among respondents with a high socio-economic status and among respondents residing in the East part of the city. Since the walkability indicators have shown consistent associations with some health-related outcomes and fulfil most criteria for public health surveillance indicators, it was concluded that these indicators should be considered for surveillance and planning. In order to incorporate the implementation of the walkability indicators into the surveillance and planning system, a consensus exercise should be conducted with stakeholders from public health, urban and transport planning. Agreement should be achieved which indicators are useful and meaningful for surveillance and planning in Graz. Generally, further research investigating the association between walkability and biking for transport and neighbourhood satisfaction is needed.