Public health in linkage to land use: Theoretical framework, empirical evidence, and critical implications for reconnecting health promotion to land use policy

The increasing health burdens pose great challenge for planners and policy makers to create a more livable city. Recent literature has linked land use to a wide range of illness and death causes in developed nations. It therefore requires evidence-driven and replicable frameworks to inform land use decisions that integrate with health promotion. This paper proposes a theoretical framework for the mechanistic links between neighborhood land use and public health; and then quantifies their associations at district level, using the case of Shenzhen in developing China. Data for 15 health indicators in 2010 are collected at district level; and a set of standardized land use variables (individual land use type, general land use mix, and physical street conditions) are proposed to comprehensively reflect the neighborhood land use characteristics. Spatial regression is employed to analyze the relationships between health outcomes and land use variables. Results show that the land use exploratory variables vary with health indicators, but several key land use determinants are identified: green land abundance, green land morphology, institutional land proximity, industrial land proximity, blue land abundance, street walkability and street connectivity. Structural equation modeling is further applied to examine the possible mediators and it demonstrates that the casual pathways between land use and public health are quite complex. The developed set of standardized land use variables can serve as practical tools to facilitate land use decisions with health considerations. In practice, several complexities at governance levels challenge the efforts to reconnect land use policies and public health promotion. We put forward three useful solutions to enhancing health connection with land use policy across different international settings. This study captures the nuanced health disparities varied with districts and indicators, and therefore produces some more generalized knowledge that ultimately helps develop land use policies aimed at promoting public health at home and abroad. (C) 2016 Elsevier Ltd. All rights reserved.