Towards Healthy Settlements

Urban health is believable to be a considerable challenge of the twenty-first century (Leeuw in Global Change and Human Health 2:34–45 [11]). The population booms in most countries after the Second World War accelerated the progress of urbanization, after which the relationship between urbanization and health have gradually become apparent in the academic literature (Leeuw in Global Change and Human Health 2:34–45 [11]). The importance of health for urban development has been increasingly recognized, in particular with the revision of globally sustainable development goals, which propose that the equity, inclusiveness and accountability in health and development are the core principles and themes of sustainable development (WHO, Global report on urban health: Equitable, healthier cities for sustainable development, 2016). Being seen as both a key determinant and a resource, health is increasingly highlighted as a central component of sustainable development (Corvalán et al. in Epidemiology 10:656 [9]; Goodland in Annu Rev Ecol Syst 26:1–24 [21]; Schirnding in The Lancet 360:632–637 [36]). To capture the benefits of health for sustainable development, a considerable body of knowledge has been generated in various fields focusing on the health effects of urbanization, such as environmental health, infectious disease public health, and lifestyle-related behavioral health (Leeuw in Global Change and Human Health 2:34–45 [11]). Specifically, urbanization and the resulting changes towards sedentary lifestyles lead to a remarkable transformation in the problematization of health, shifting from infectious to chronic disease etiology (Sarkar et al. in Healthy Cities: Public Health through Urban Planning. Edward Elgar Publishing [35]). However, the causation or correlation between health and urbanization have not been explained by the unequivocal and empirically validated theories, particularly it is difficult to ascertain the causal relations within specific local contexts (Leeuw in Global Change and Human Health 2:34–45 [11]; Galea and Vlahov in Annu Rev Public Health 26:341–365 [19]; Srinivasan et al. in Am J Public Health 93:1446–1450 [37]). In response to these constrains, an integrated, multi-disciplinary, multi-sectoral approach for urban health research is necessary, one that integrates urban planning, social psychology, epidemiology, public health and environmental sciences (Hollander and Staatsen in Landsc Urban Plan 65:53–62 [10]).

To comprehend the health implications of suburbanization in China, this chapter intends to lay a theoretical foundation by reviewing the literature related to suburbanization and health-promoting environments. A human ecological perspective is adopted, focusing on the transactions between people and their environments. Suburbanization as a distinctive form of urban expansion and residential neighborhoods as identifiable human settlements are selected as the basis for analysis. In addition, a healthy neighborhood is treated as a theoretical concept as well as a goal of urban development. A human ecological conceptual framework for understanding health determinates in the urban environment is formulated, and institutional factors in suburbanization and housing development are raised as an explanatory tool, which formulate the residential environment and the resultant way of life.

To understand the suburban living and its health effects in China, the housing development that is companied with suburbanization should be paid attention to, which is important to the creation of health-promoting environment. Although the quality of commodity housing has improved greatly after more than three decades’ development, little attention has been paid to the health implications of living in commodity housing estates, especially in suburban areas. Market-led suburbanization may have neglected the health of residents during urban expansion; moreover, the suburban lifestyle shaped by suburbanization and suburban housing planning and design may have various impacts on human health. Thus, it is necessary to know what are the empirical issues in housing development in terms of promoting health benefits of its residents, and what are the most popular health issues in urban residents of China.

As presented in Chap. 1, this study aims to formulate recommendations for developing healthy neighborhoods in China’s suburban environments by investigating the health performance of suburban residents and the factors of the neighborhood environment influencing the health. Three research questions are proposed: (1) What is the health performance of the residents in SCHEs of Guangzhou? (2) What factors derived from SCHEs’ living environment affected the health performance of residents, and how? (3) How have the institutional factors in housing development caused the health implications of the neighborhood living environment?

The expeditious urbanization in China is accompanied with urban spatial expansion and lifestyle transition, contributing to the health transition from infectious diseases to chronic diseases. The twenty years has seen an obvious and speedy increase in the prevalence of obesity of Chinese population, leading to chronic and cardiovascular disease. In particular, the middle-income population is getting fat fast with the changes of diet and lifestyle, especially the physical activity. For mental health, the prevalence of mental disorders of Chinese people has been underestimated, including both clinical disorder and everyday psychopathology such as anxiety and stress. In addition, these health implications of suburbanization have been less discussed in Chinese context. Thus, this chapter presents the findings of the analysis on the general health of the residents in SCHEs.

The literature has acknowledged that multiple factors derived from urban environments and lifestyles have crucial effects on individual’s physical and mental health. Concerning urban transition and lifestyle changing, residential suburbanization and its effects on residents’ health is a worthy subject to be explored. The risks of being obese and general physical health are inevitably in association with the way of life formulated by the living environment. Mental disorders and their causes in urban environment have been largely ignored in China’s suburban living environment.

Factors associated with physical and mental health have been identified from residential environment and residential behavior, respectively. However, the mutual effects of environmental and behavioral factors have not been considered in previous analysis chapters. As discussed in Chap. 2, people-environment congruity is the essence of a health-promoting environment, so examination of residents-environment transactions could help to understand the interactions between environmental and behavioral factors and to identify the issues in the creation of a health-promoting environment. Furthermore, since the residential environmental factors that influence health are determined by housing development, it is argued that institutional factors in housing development could have great impact on the formation of health-promoting environments. Thus, this chapter aims to explain how the factors affecting health have been formulated through people-environment transactions in suburban living and how the residential environment has been affected by the SCHEs development institutionally.

Health implications of urbanization and urban environment have been popular multi-disciplinary themes in academic literature. In China, suburbanization stimulated by the spread of commodity housing is distinctive, so its effects on human health are worthy of investigation to fill the research gap. Three commodity housing estates in the suburban Panyu District, Guangzhou were investigated and assessed in terms of their residents’ health performance, its relationship with the characteristics of the residential environment, and residential behavior patterns, identifying the factors that affect health in relation to the residential environment and health-related residential behaviors. This study then interprets the factors that are crucial to the creation of health-promoting environment: examining the transactions between environmental and behavioral factors from a human ecological perspective, and explaining the institutional determinants of the residential environmental factors that affect health in housing development.