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Built Environment and Injury

The built environment is a key cross-cutting factor that influences the incidence of injury in Western Australia. In recent years, more attention has been drawn towards the built environment and its relationship with injury.

The built environment refers to the human-made space, in which people live, work and recreate.1 It is also inclusive of any natural environments that are modified for use by humans, such as parks and water sources.

There is a well-established link between elements of the built environment and the risk of an injury or chronic health condition.2 As a result, the importance of the built environment is noted in state, national and international frameworks, and is a key concept to be considered in all injury prevention initiatives.

What is the impact of the built environment on injury?

The built environment can act as a protective or risk factor for injury depending on its design features. A well-built environment can help to reduce the risk of injury by making it easier to engage in protective behaviours and reduce physical hazards. Whilst poorly designed built environments can increase the risk of many injury types including; falls, assault, transport injuries and alcohol-related injuries.

Personal security and safety

Crime, vandalism and anti-social behaviour can increase the risk of assault-related injuries. High incidences of crimes, especially violent crime, in an area may cause people to worry about their safety.3 This contributes to decreased engagement in outdoor activities, increased anxiety and poor mental health. Additionally, safety concerns may deter people from using active modes of transport and exercising, particularly at night, increasing the risk of falls later in life due to physical inactivity.4,5

Transport

Urbanisation has made private vehicles the most common mode of transport in Australia.6 In addition to this heightened use increasing the risk of transport-related injuries, poorly designed pedestrian and cycle pathways can elevate the risk of transport-related injuries.7,8 These design features can also decrease engagement in active transport modalities such as walking, cycling or catching public transport.

Accessibility and walkability

Access to the public transport system and greenspaces, such as parks and natural reserves, can influence the amount of physical activity completed as individuals are more likely to walk or cycle if they live in neighbourhoods that are easier to access with well-connected streets and have walkable distances to key destinations.9

The development of environments with a sense of place also provides a place for social interactions and a sense of belonging in a community, which can reduce social isolation and improve mental health wellbeing.10,11

A high density of liquor stores results in easier access to alcohol, which can increase the risk of alcohol-related injuries.12 Additionally, an increased exposure to alcohol advertisements is associated with an increased consumption of alcohol in young people and an earlier initiation of alcohol use.13

Initiatives that support injury prevention

Environmental health initiatives may target multiple risk factors and reach more people than education and other midstream approaches.14 This makes modification and improvements to the built environment ideal for preventing injury at a population level.

Some of the built environment factors that can reduce the risk of injury are road infrastructure, including the prioritisation of the safety of vulnerable road users and street lighting, surveillance infrastructure through CCTV and passive surveillance, and legislations on alcohol availability and advertising.

Streets that are designed to prioritise pedestrians and cyclists are able to increase road safety, social connection and active travel for all users. Active travel increases physical activity which reduces falls in older ages, transport-related injuries and improves mental health wellbeing.15 

Design features that are able to improve safety and encourage active travel include: walkable and connected streets, speed reduction through speed limits and speed bumps, prioritising pedestrians and cyclists by having pedestrian crossings, median refuge islands and pedestrian overpasses or underpasses.8,16 

Modifications that are proven to promote social connection and enhance mental health wellbeing, include; more greenery and green spaces, recreational facilities and improved transport connectivity to these local facilities to allow people to exercise and socialise.17,18 

Crime Prevention Through Environmental Design (CPTED) can help to reduce crime and increase people’s perception of safety and security in a neighbourhood. The theory of CPTED provides four principles that can be used to prevent crime, and these principles are surveillance, territorial definition, access control and space management.19

1. Surveillance
Crime is less likely to occur where it is clearly visible to the public as perpetrators do not want to be caught. Both active surveillance such as the use of CCTV and passive surveillance (increasing the number of people in the area to see and report crime, i.e. creation of open spaces, addition of windows towards the street and well-designed street lighting) can be beneficial in supporting the identification of issues.

2. Territorial definition
People are more likely to recognise and report crime to protect the public space and their own private space when they feel a sense of ownership to the community. A clear definition between private and public spaces using transition zones can help people create a sense of security and safety.

3. Access control
Restricting and permitting access to some places can reduce the potential risk for injury especially in high-risk areas. The use of landscape and urban design features to define boundaries and allow for good passive surveillance is beneficial. This may include the use of bollards and physical deterrents such as seating and planter boxes to restrict vehicle access. Formal access control measures should also be used if natural access control is insufficient. Some design features are

4. Space management
People feel safer in areas that are well-kept and maintained, which improves people’s perception of safety and increases the desire and the time spent in these areas. The design of public spaces should be supporting the appropriate use, surveillance activities and reduce vandalism. Additionally regular maintenance to the public spaces including street lighting, footpaths and the removal of graffiti is recommended to support the continued use of public spaces.

Policies on reducing the availability of alcohol through restricting the liquor outlet density in an area and the size of liquor stores can help in reducing alcohol-related injury within the area.20

The restriction of alcohol advertisement is another effective strategy to limit exposure of alcohol within the area, thus reducing alcohol-related injury.21

Resources

References

1.         Wasfi, R. & Kestens, Y. Chapter 12 - Built environment and health. in Urban Form and Accessibility (eds. Mulley, C. & Nelson, J. D.) 187–205 (Elsevier, 2021). doi:10.1016/B978-0-12-819822-3.00005-5.

2.         Built environment and health. Australian Institute of Health and Welfare https://www.aihw.gov.au/reports/australias-health/built-environment-and-health (2022).

3.         Won, J., Lee, C., Forjuoh, S. N. & Ory, M. G. Neighborhood safety factors associated with older adults’ health-related outcomes: A systematic literature review. Soc. Sci. Med. 165, 177–186 (2016).

4.         Sherrington, C. et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst. Rev. (2019) doi:10.1002/14651858.CD012424.pub2.

5.         Putrik, P. et al. Assessing the role of criminality in neighbourhood safety feelings and self-reported health: results from a cross-sectional study in a Dutch municipality. BMC Public Health 19, 920 (2019).

6.         Australian Bureau of Statistics. Transport: Census. Australian Bureau of Statistics https://www.abs.gov.au/statistics/industry/tourism-and-transport/transport-census/latest-release (2022).

7.         Australian Government. Injury in Australia, Introduction. Australian Institute of Health and Welfare https://www.aihw.gov.au/reports/injury/injury-in-australia/contents/all-causes-of-injury (2023).

8.         Zegeer, C. V. & Bushell, M. Pedestrian crash trends and potential countermeasures from around the world. Accid. Anal. Prev. 44, 3–11 (2012).

9.         Kamruzzaman, Md. et al. Built environment impacts on walking for transport in Brisbane, Australia. Transportation 43, 53–77 (2016).

10.       Mahmoudi Farahani, L. The Value of the Sense of Community and Neighbouring. Hous. Theory Soc. 33, 357–376 (2016).

11.       Mavoa, S., Davern, M., Breed, M. & Hahs, A. Higher levels of greenness and biodiversity associate with greater subjective wellbeing in adults living in Melbourne, Australia. Health Place 57, 321–329 (2019).

12.       Liang, W. & Chikritzhs, T. Revealing the link between licensed outlets and violence: Counting venues versus measuring alcohol availability: Alcohol, violence and licensed outlets. Drug Alcohol Rev. 30, 524–535 (2011).

13.       Anderson, P., de Bruijn, A., Angus, K., Gordon, R. & Hastings, G. Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use: A Systematic Review of Longitudinal Studies. Alcohol Alcohol 44, 229–243 (2009).

14.       Springer, A. E., Evans, A. E., Ortuño, J., Salvo, D. & Varela Arévalo, M. T. Health by Design: Interweaving Health Promotion into Environments and Settings. Front. Public Health 5, 268 (2017).

15.       van Gameren, M. et al. Physical activity as a risk or protective factor for falls and fall-related fractures in non-frail and frail older adults: a longitudinal study. BMC Geriatr. 22, 695 (2022).

16.       Government of Western Australia. Driving Change. Road Safety Strategy for Western Australia 2020-2030. (2020).

17.       Saeri, A. K., Cruwys, T., Barlow, F. K., Stronge, S. & Sibley, C. G. Social connectedness improves public mental health: Investigating bidirectional relationships in the New Zealand attitudes and values survey. Aust. N. Z. J. Psychiatry 52, 365–374 (2018).

18.       Zhang, Y. et al. Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review. Environ. Health 22, 2 (2023).

19.       Government of Western Australia. Safer Places By Design: Crime Prevention Through Environmental Design Planning Guidelines. https://www.wa.gov.au/system/files/2023-06/safer-places-by-design-cpted-guidelines.pdf (2023).

20.       Western Australia Department of Justice. Liquor Control Act 1988. (2021).

21.       Department of Health and Aged Care. National Alcohol Strategy 2019-2028. https://www.health.gov.au/sites/default/files/documents/2020/11/national-alcohol-strategy-2019-2028.pdf (2019).

 

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