Pollack Roxana, Olsen Jonathan R, Heppenstall Alison, Hoehn Andreas, Boyd Jennifer, Hardy Vicki Ponce, Littlejohn Jennifer, Stevenson Amy, Mitchell Richard, Meier Petra, Stokes Jonathan
MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK.
School of Political and Social Sciences, University of Glasgow, Glasgow, UK.
BMC Public Health. 2024 Dec 18;24(1):3426. doi: 10.1186/s12889-024-20928-5.
'Twenty-minute neighbourhoods' (or variations, such as 15-minute cities) are receiving increasing policy attention with anticipated impacts on population health (inequalities) outcomes alongside sustainability improvements. Yet, factors contributing to possible health impacts are not well understood. This scoping review aimed to identify proposed and evidenced pathways to health (inequality) outcomes from international policy plans.
We first identified relevant academic literature, searching Scopus, (Ovid) Medline and Embase databases. A second search aimed to identify local or national planning or policy documents on government websites and related organisations. We followed a snowball search strategy to retrieve examples identified from the academic literature search and from the C40 cities network. These policy documents were our primary target for extraction, and we extracted and analysed by individual place. Pathways to health and health inequality outcomes identified in these documents were inductively coded thematically. We used Sankey diagrams to visually aggregate the thematic codes for each place relating to pathways to health outcomes and social determinants (mechanisms).
In total, 36 places across 17 countries were included, described across 96 academic articles, policy plans and reports. While different health improvement outcomes were included as a goal in nearly all policy plans, most frequently references were to health in general rather than specific health outcomes. Pathways to health were discussed in numerous policy plans across three overarching themes: proximity, place redesign, and environmental action. Proximity pathways were most frequently outlined as the means to achieve health outcomes, with active travel acting through increased physical activity/reduced obesity as the most frequent individual pathway. However, few plans specified what would actually be implemented in practice to achieve the increased proximity to services. Health inequalities were only mentioned by six places specifically, although nearly half of all places mentioned broader inequality aims (e.g., poverty reduction). Possible unintended consequences to health inequalities also received some attention, for example through displacement of residents.
Pathways to assumed health (inequality) outcomes require better specification and evidence. Health inequalities are particularly under-explored, and scenario modelling might provide a means to explore the dynamic aspects necessary to examine these important outcomes pre-implementation.
“20分钟社区”（或其变体，如15分钟城市）正受到越来越多的政策关注，预计对人口健康（不平等）结果以及可持续性改善会产生影响。然而，导致可能的健康影响的因素尚未得到充分理解。本范围综述旨在确定国际政策计划中提出的并得到证据支持的通向健康（不平等）结果的途径。
我们首先在Scopus、（Ovid）Medline和Embase数据库中检索相关学术文献。第二次检索旨在识别政府网站和相关组织上的地方或国家规划或政策文件。我们采用滚雪球搜索策略，以检索从学术文献搜索以及C40城市网络中识别出的示例。这些政策文件是我们提取的主要目标，我们按单个地点进行提取和分析。在这些文件中确定的通向健康和健康不平等结果的途径进行了主题归纳编码。我们使用桑基图直观地汇总每个地点与通向健康结果和社会决定因素（机制）的途径相关的主题代码。
总共纳入了17个国家的36个地点，涵盖在96篇学术文章、政策计划和报告中。虽然几乎所有政策计划都将不同的健康改善结果作为目标，但最常提及的是总体健康而非特定健康结果。在众多政策计划中，围绕三个总体主题讨论了通向健康的途径：接近度、场所重新设计和环境行动。接近度途径最常被概述为实现健康结果的手段，积极出行通过增加身体活动/减少肥胖作为最常见的个体途径发挥作用。然而，很少有计划具体说明在实践中实际将采取什么措施来实现与服务的更近距离。只有六个地点专门提到了健康不平等，尽管几乎一半的地点提到了更广泛的不平等目标（如减贫）。对健康不平等可能产生的意外后果也受到了一些关注，例如通过居民搬迁。
通向假定的健康（不平等）结果的途径需要更好的明确说明和证据。健康不平等尤其未得到充分探索，情景建模可能提供一种手段，来探索在实施前检查这些重要结果所需的动态方面。
