Professor Billie Giles-Corti was a “lone wolf”, she says, when she started her research career. In 2022, the time has come for public discourse about the direct links between city planning and health. She is part of a global network making the connections between liveability and health outcomes.
THIRTY years ago, Professor Billie Giles-Corti was considering her PhD topic.
The World Health Organization had just set its goals for health promotion. Health was put on the agenda of policy makers in all sectors and at all levels and health promotion was no longer just about primary health care. It sparked Professor Giles-Corti’s imagination about the built environment and health.
What began as a PhD turned out to be a twenty-year career, influencing cities across Australia and globally.
The built environment and health
At the University of Western Australia, Professor Giles-Corti completed her PhD on how physical activity is influenced by the built environment.
“Physical activity is actually a very complex behaviour because there are many domains. There’s active transport, recreation, going to gym. At that stage there was no evidence about any of those behaviours and how the environment affected people’s physical activity.
“This sparked me on a journey of what turned out to be a very multi-disciplinary endeavour.”
Professor Giles-Corti is a Vice-Chancellor’s Professorial Fellow at RMIT University and Director of the Healthy Liveable Cities Lab at RMIT University’s Centre for Urban Research.
At UWA, Giles-Corti went on to set up the Centre for the Built Environment and Health.
As her framework for why liveable cities are essential for better health outcomes has developed, Professor Giles-Corti and her team are now focused on the how – how can we change cities and how will this change people?
The Liveability Index
When Professor Giles-Corti first moved from Perth to Melbourne, it was the fastest growing city in Australia and one of the most liveable cities in the world.
Professor Giles-Corti took up the position of Director of the McCaughey Centre, VicHealth Centre for the Promotion of Mental Health and Community Wellbeing, Melbourne School of Population and Global Health in 2011. At the time, four of the six growth areas were in the North-West of Melbourne and the Victorian Department of Health North-West Region was concerned about health and social problems. Professor Giles-Corti was asked to get involved in developing a strategy to address these issues.
She was asked to meet all the local government authorities and department heads working in the North-West region.
“It was a fantastic introduction to Melbourne. It was a gift. It created an incredible network of people,” she says.
From these interviews she discovered that people’s health in these areas was being affected by a lack of public transport, lack of access to local shops and having to travel long distances for employment and that people were not spending time in their neighbourhood. These were the upstream factors, the root causes of the social issues. These are the social determinants of health critical for promoting health outcomes in the community.
Access to public transport is one of the ‘upstream’ determinants of public health. (Source: iStock)
A framework for ‘liveability’ evolved from this work. ‘Liveability’ was a concept that policy makers knew and valued but this work gave it a public health lens.
“We were able to translate the upstream causes into a concept that was valued by the people who we were trying to influence,” she says.
With her research team, Professor Giles-Corti explored the association between upstream social determinants of health and urban liveability.
“Dr Melanie Lowe – then a PhD student – led a review that defined liveable neighbourhoods as safe and socially cohesive, environmentally sustainable; they had affordable housing but that housing was connected by convenient public transport, walking and cycling infrastructure to everything you need for daily living, to employment, to shops and services, to leisure, to cultural opportunities,” she says.
Professor Hannah Badland – then a Research Fellow – went on to lead a program of research examining how these ‘domains’ of liveability were associated with health through NHMRC funding for a Centre of Research Excellence in Healthy Liveable Communities. This culminated in the development of a Liveability Index developed by Carl Higgs.
The Liveability work then went national with funding from NHMRC, The Australian Prevention Partnership Centre and the Clean Air and Urban Landscapes Hub of the Environmental Science Program of the Department of Environment. Through policy analysis and mapping the liveability indicators, the team assessed the strengths and weaknesses of current urban policies in Australian cities from a population health perspective.
This work has since been scaled-up and disseminated through the Australian Urban Observatory, a digital platform that translates complex urban data into liveability maps across Australia’s 21 largest cities, led by Associate Professor Melanie Davern. The AUO also houses Australia’s first National Liveability Index and some of the team’s indicators have been incorporated into the Federal Government’s National Cities Performance Framework.
The Lancet Series
In 2016, Professor Billie Giles-Corti co-led the Lancet Series on Urban Design, Transport and Health. The series recommended a set of indicators to monitor progress towards achieving more compact cities that promote health and reduce health inequities. The indicators prioritised the availability and implementation of city planning policies to achieve healthy liveable cities.
Based on her team’s work in Australia, Professor Giles-Corti is now leading a team of over 80 researchers working on a new Lancet Series to measure these recommended indicators globally. Policy analysis and the creation of liveability indicators have been undertaken across six continents, 19 countries and 25 cities.
How can a framework developed in Australia be applied to a diverse range of international cities?
Professor Giles-Corti explains that although the delivery is different, the underlying problems are the same, making the indicators very transferable from one city to another. Proximity to, and connection between, destinations required for daily living are necessities for all cities.
Access to local shops is a factor in ‘liveability’ that promotes good health outcomes in the community. (Source: iStock)
“If you want people to reduce driving you need to have a supermarket and public space within walking distance. Having access to food within a walkable distance is the same need everywhere. It is the delivery that is different, but the problems are the same,” she says.
Most importantly the index discovers the hidden inequities.
“Every city has inequities. We are making visible those inequities and identifying areas where interventions are needed.”
Partnership with the United Kingdom
One of Professor Giles-Corti’s current projects co-led by her early-career colleague Dr Belen Zapata-Diomedi, Joining Impact models of transport with spatial measures of the Built Environment (JIBE), is supported by a UK Research and Innovation (UKRI) – NHMRC Built Environment and Prevention Research Scheme grant.
“The project involves a collaboration with Cambridge University. We are combining skills, but we are all changing at the same time. We are doing innovative geospatial measures that neither side has done before. We are advancing our methods in agent-based modelling and health impact assessment,” she says.
Professor Giles-Corti has also initiated a network of Australian leads of UKRI-NHMRC grant-funded projects.
The purpose of the network is to share methods, learn from one another and advance the field. At some point as the projects evolve, she would like to have a conference where all the projects can be showcased together. She also stresses the importance of facilitating opportunities for early career researchers to work overseas.
Professor Giles-Corti cites the example of Dr Belen Zapata-Diomedi who was a PhD student from her NHMRC Centre of Research Excellence team who took up a fellowship opportunity at Cambridge. It was through this connection that the JIBE project came into being.
“It’s because Belen went there and built that relationship that we ended up doing this project,” she says.
Professor Giles-Corti says she is still in touch with the policy makers she interviewed back when she first moved to Melbourne and has been collaborating with them now for a decade. Indeed, she is still involved with some of the policy makers and practitioners involved with her initial PhD project in Perth.
“It's been a passion project in a way. It came from working with policy makers.
“These relationships have shaped my team’s research ensuring its relevance to policy and practice. Local, state and federal governments have all translated our research into policy and practice. This makes my heart sing – we have a long way to go, but I think we have made a difference. The public discourse about city planning and health now is very different to when I started my PhD in 1993. I was a lone wolf, but not anymore.”
From 2003-2020, Professor Giles-Corti was an NHMRC fellow and an NHMRC Elizabeth Blackburn Senior Principal Research Fellow 2016-2020. During that time, she led the Centre of Research Excellence in Healthy Liveable Communities and an earlier NHMRC Capacity Building Grant and has worked closely with local, national and global policy makers and practitioners. She is currently a Vice-Chancellor’s Professorial Fellow at RMIT University and Director of the Healthy Liveable Cities Lab in the Centre for Urban Research.
Professor Corti has contributed to a second Urban design, transport, and health series published in The Lancet Global Health on 10 May 2022.
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- What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy