Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review.
Study Goal
The researchers aimed to synthesize evidence on the effectiveness of place-based interventions, including walking routes, on health outcomes and health inequalities.
Results Summary
The study found tentative evidence that walking routes and other physical environment interventions can positively impact health outcomes, particularly physical activity, but effects on health inequalities remain unclear due to lack of equity data.
Population
High-income countries (general population, no specific demographic details provided).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
provision of housing/home modifications | increase | health outcomes | - | - | can have positive impacts | #1 |
improving the public realm | increase | health outcomes | - | - | can have positive impacts | #2 |
parks and playgrounds | increase | health outcomes | - | - | can have positive impacts | #3 |
supermarkets | increase | health outcomes | - | - | can have positive impacts | #4 |
transport | increase | health outcomes | - | - | can have positive impacts | #5 |
cycle lanes | increase | health outcomes | - | - | can have positive impacts | #6 |
walking routes | increase | health outcomes | - | - | can have positive impacts | #7 |
outdoor gyms | increase | health outcomes | - | - | can have positive impacts | #8 |
provision of housing/home modifications | increase | physical activity | - | - | can have positive impacts | #9 |
improving the public realm | increase | physical activity | - | - | can have positive impacts | #10 |
parks and playgrounds | increase | physical activity | - | - | can have positive impacts | #11 |
supermarkets | increase | physical activity | - | - | can have positive impacts | #12 |
transport | increase | physical activity | - | - | can have positive impacts | #13 |
cycle lanes | increase | physical activity | - | - | can have positive impacts | #14 |
walking routes | increase | physical activity | - | - | can have positive impacts | #15 |
outdoor gyms | increase | physical activity | - | - | can have positive impacts | #16 |
place-based interventions | increase | physical health | - | - | can be effective at improving | #17 |
place-based interventions | increase | health behaviours | - | - | can be effective at improving | #18 |
place-based interventions | increase | social determinants of health outcomes | - | - | can be effective at improving | #19 |
high agentic interventions | increase | health outcomes | those living in greater proximity to the intervention | - | indicate greater improvements | #20 |
BACKGROUND: Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. METHODS: Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). RESULTS: Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. CONCLUSIONS: Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. TRIAL REGISTRATION: PROSPERO CRD42019158309.