MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge CB2 0QQ, UK.
MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK.
J Public Health (Oxf). 2020 Aug 18;42(3):e249-e258. doi: 10.1093/pubmed/fdz105.
Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for 'active living' infrastructure (ALI)-walking and cycling infrastructure and open spaces in new communities.
Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically.
Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. 'Evidence' for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant.
We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.
城市设计可以影响人们的体力活动水平，进而影响健康。本定性研究调查了新社区中“积极生活”基础设施（步行和自行车基础设施和开放空间）的地方层面决策。
对地方政府和私营部门利益相关者（包括城市和交通规划者、公共卫生从业者、民选议员和开发商）进行了 35 次半结构化访谈和有限的民族志观察。对访谈记录进行了编码和主题分析。
地方政府中的公共卫生从业者可以充当知识经纪人并发挥领导作用，激励城市和交通规划者等非卫生利益相关者在设计和建设新社区时考虑健康因素。他们需要在早期阶段参与，并获得足够的资源来建立跨部门的关系，支持非健康结果，例如解决拥堵问题，这些问题通常具有更大的政治吸引力。决策的“证据”确定了问题（不仅仅是健康问题），为解决方案提供了信息，并且还可以事后证明决策的合理性，尽管如果不考虑上下文相关性，案例研究的例子并不总是令人信服。
我们提出了一个概念模型，其中需要有三个因素来弥合证据和积极生活基础设施之间的差距：有影响力的公共卫生从业者；非卫生部门的支持性政策；以及充足的资源。
