This research project seeks to identify changes to the built environment that small and medium-size cities can make to promote health and health equity. We focus specifically on small and medium-size cities—that is, cities whose populations are less than 250,000—because little research explores how small and medium-size cities are implementing policies, plans, programs, project, and pilots to address the health inequities in their communities. Based on a literature scan, we identified six built environment domains that are connected to community health and cover common policy and practitioner fields:
- Safe, healthy, and affordable housing
- Active living assets and facilities
- Regional and local infrastructure
- Food security, health, and nutrition
- Vacant property reclamation and urban greening
- Neighborhood and community design
Through our research scan and analysis under each domain, we selected 10 interventions across different dimensions of the built environment that could affect health and health equity. In this report, we present the research evidence for the interventions’ effectiveness and examples of their application in small and medium-size cities. In addition to presenting these interventions, we share 13 promising practices for small and medium-size cities that are focused on how to apply a health equity lens to built environment interventions and how to overcome implementation challenges.
Accompanying the paper is a file that contains demographic, economic, and health data on the 72 small and medium-size cities that our quantitative analysis considered.