Evidence supporting the health benefits of Destinations
Author: Dr Lucy Gunn.
Scope of evidence
This section draws on physical activity research focusing on the number, diversity or mix of, and distance to, different land uses or destinations within the neighbourhood. It draws on evidence that is predominantly from the UK, USA and Australia.
Research suggests that a range of factors contributes to the effectiveness of mixed-use development and the degree to which it encourages walking and physical activity. Mixed land use (the presence of multiple destinations) is a major influence on neighbourhood walkability. A consistent and large body of cross-sectional evidence shows that greater land-use mixes (or numbers of destinations) and shorter distances to destinations (in close proximity to home) are associated with greater amounts of walking. [8, 11–13, 42–47, 62, 86, 89–91, 103–105] Greater land-use mix is positively associated with walking in adults, though evidence is less consistent for children and older adults. [8, 12, 13, 15, 16, 40, 106]
In this section you will learn more about:
- Access to destinations or land uses and neighbourhood or town centres (co-located destinations)
- Destinations and social benefits
- Configuration of town centres and main streets
- Access to schools
- Access to sport and recreation centres
- Density, connectivity and mixed land uses
Access to destinations or land uses and neighbourhood or town centres (co-located destinations)
Studies in the fields of physical activity and health have typically looked at the number of destinations or different land uses present, and at access to destinations or non-residential land uses in individuals’ neighbourhood areas.
A widely used benchmark for measuring neighbourhoods is that they cover a 400-metre radius from the point of origin, which equates to about a five-minute walk. More generally, relationships between access to destinations and land uses, and health are typically investigated at many different distances ranging from 400 metres to 1.6 kilometres. These distances represent a ‘walkable’ distance that can be reached at an average walking pace of between five minutes (400 metres) and 15 minutes (1.6 kilometres).
A ‘pedshed’ is a measure of a walkable catchment area. For example, it is defined as the ratio of area measured using a street network within a five-minute walking distance (a 400-metre service area along the street network) to the theoretical area within a five-minute walking distance (a 400-metre Euclidean or ‘as-the-crow-flies’ area) from the point of origin or destination.  Higher ratios mean better walkability and accessibility. The Western Australian Liveable Neighbourhoods Guidelines set a pedshed target ratio of 60 per cent within a 400-metre walking distance of a mixed-use neighbourhood centre. 
Traditional neighbourhoods tend to contain a diverse mix of destinations integrated in close proximity to a variety of residential dwelling types. Here residents can undertake and fulfil a variety of daily activities and needs (live, work, play) locally.
A major reason for creating walkable neighbourhoods should be to cater for the diverse daily needs of a community by providing a mix of destinations that attract people for a variety of activities.  These destinations are vital to support local walking as part of a daily routine and to give people the option to live without the need for a car.
Mixed-use buildings with ‘active’ ground-floor uses and uses that extend onto the street (such as café seating areas) foster natural surveillance and feelings of safety, and help create a vibrant streetscape in a mixed-use neighbourhood centre. Additionally, the presence of a mix of destinations and/or mixed-use buildings that can accommodate a variety of uses and generate activity at different periods of the day and night is important for creating vibrant, inviting and safe mixed-used areas or centres for neighbourhoods and towns.
This is an important point of difference from conventional development practices in new suburban areas. Conventional neighbourhoods consist of uniform residential dwellings situated on large lots, with few (if any) easily walkable destinations. They are served by large automobile-oriented shopping complexes such as big-box retail parks, shopping malls and office parks, which are removed and segregated from residential areas. Here residents have no destinations to walk to, so work, leisure and recreation activities are usually undertaken outside the neighbourhood.
Living close to a mix of destinations is associated with higher levels of active transport and physical activity across all age groups.  Living near a mix of destinations is consistently associated with higher levels of active transport in children [6, 8], adults [8–14] and older adults. [14–16] The presence of mixed land uses and a variety of destinations near home may be especially important for older adults, who may have reduced mobility.
For children, shorter distance to school is consistently associated with active commuting. [38, 39, 59, 110–112] Access to other destination types, such as public open space and sports facilities or shops, appears to be more important for older children and adolescents, who are more independently mobile than younger children. [6, 39, 69, 70, 72, 113, 114]
A study of the association between proximity to, and mix of, neighbourhood destinations, and walking behaviours in Perth, Western Australia, found that access to post boxes, bus stops, convenience stores, newsagencies, shopping malls and transit stations within 400 metres, and schools, transit stations, newsagencies, convenience stores and shopping malls within 1.5 kilometres, was associated with regular transportation walking. 
For each additional destination present within 400 metres and 1500 metres, transport walking per fortnight increased by 12 and 11 minutes respectively.  Another study found that every additional destination located within 800 metres of home increased a person’s likelihood of walking for at least 150 minutes each week (that is, their likelihood of meeting current Australian physical activity recommendations, which encourage adults to undertake moderate to vigorous physical activity (including brisk walking) for at least 30 minutes, five times per week). 
More recent research also advocates for destinations to be present within 800 metres of home, especially local food outlets such as supermarkets, cafés, takeaway stores and small food stores.  Locating destinations within a distance of 800 metres is advocated in the walkability literature more generally, [46, 115, 116] frequently used destinations such as transport stops, grocery stores, banks and restaurants, which provide for a variety of daily activities to be fulfilled, were associated with increased transportation walking. [41, 51, 105, 117]
Conversely, but further supporting the need to create compact, mixed-use neighbourhoods, several studies have found that in low-density neighbourhoods with few local destinations, fewer people walk and more people drive. [89, 118]
There is also growing evidence associating suburban sprawl with increased body weight,  principally through diminished energy expenditure due to car dependence  and more sedentary leisure behaviours. 
A study by Larry Frank and colleagues in the USA found that a person’s likelihood of being obese declined by 12.2 per cent for each quartile increase in mixed use, and by 4.8 per cent for each additional kilometre walked, but conversely increased by 6 per cent for each hour spent in a car per day. 
Recent longitudinal evidence from the RESIDential Environments Project (RESIDE) in Perth, Western Australia, supports these cross-sectional findings: participants who gained access to seven key transport-related destinations (post offices, bus stops, delicatessens, supermarkets within 800 metres of home, and train stations, shopping centres or CD or DVD stores within 1.6 kilometres) after moving into one of 72 housing developments across the Perth metropolitan region increased their transport walking by around six minutes per week for each type of transport-related destination gained after relocation.  Participants’ recreational walking also increased by around 18 minutes per week for each type of recreational destination (beaches within 800 metres, or parks or sports fields within 1.6 kilometres) gained after relocation. 
The nature or type and mix of destinations may be more important in explaining transport-related walking than the mere presence or number of commercial or retail land uses.  Indeed, researchers are now finding that the mix of destinations is associated with increased transport walking [43, 105, 117, 123] and increases in subjective wellbeing. These studies use a destination-mix score or a local-living index that measures between 7.2 and 15 different types of destinations.
A maximum score of 12 or 15 represents the maximum amount of variation possible among the set of destinations deemed necessary for transport walking in a local neighbourhood. While these findings are encouraging, more work is needed to understand the best mix of destinations to encourage different walking behaviours.
Some land-use patterns have also been associated with recreational walking, although the evidence is inconsistent. For instance, residential densities and land-use mix appear to be associated with recreational walking in adults and older adults. [11, 40, 104] A more interesting landscape, created through varied land uses and mixed-use planning, may encourage and entice recreational walkers who are drawn by the attractive and engaging route rather than specific destinations.” 
Other research suggests that although destinations such as supermarkets or convenience stores are usually associated with necessary spending and walking trips for the purposes of getting to and from destinations, a diverse mix of destinations associated with discretionary spending (such as cafés, restaurants and retail) and community or civic uses and spaces for people of all ages to gather, meet friends and family and engage in social activities, located in pedestrian-orientated main-street centres, may also provide both destinations and an interesting route for recreational walking. [44, 124]
Destinations and social benefits
People living in walkable, mixed-use neighbourhoods have higher social capital than those living in car-oriented neighbourhoods.  However, in areas with more retail destinations it is vital that other environmental strategies are employed to minimise the level of incivilities (graffiti, rubbish, vandalism) and to provide adequate lighting, surveillance and aesthetics. Such measures may help balance out any reduction in residents’ perceptions of safety caused by increased retail activity and greater numbers of people attracted to an area. 
Additionally, there may be a threshold whereby the destinations or land uses that generate social interaction, and the vehicular and pedestrian traffic associated with them, can have a detrimental effect on social connections. [138, 139] However, an increase in activity in town centres might increase perceptions of safety.  These thresholds require further analysis to determine the optimum level of mixed use to strengthen social capital and improve people’s health.
Configuration of town centres and main streets
A growing number of studies support the notion that destinations dominated by large car parks – typical of those found in box-configured shopping centres – may encourage drivers rather than walkers. [53, 54, 81, 83, 141, 142] Neighbourhoods with limited on-street parking in commercial areas, and thus a greater pedestrian emphasis, saw less single-occupant car travel for non-work purposes.
Similarly, one study found that respondents living in neighbourhoods with higher scores for parking facilities at destinations were less likely to walk for transport.  A recent ‘Good for Business’ report by the Heart Foundation of South Australia concluded that creating town centres in more attractive, pedestrian-orientated main-street shopping centre formats significantly increases pedestrian activity and is important in encouraging a shift from car trips to walking trips. 
A recent process evaluation of the implementation of the Liveable Neighbourhoods guidelines in 36 housing developments across Perth in Western Australia compared three types of developments: those with no neighbourhood or town centre accessible within 800 metres; those with a box-configured centre within 800 metres; and, those with a main-street centre within 800 metres. 
Relative to residents living in areas without town centres, the evaluation found that residents living in the neighbourhood with a box-configured centre were less likely to walk for transport, whereas residents were more likely to walk for transport if living close to a main-street centre.  One author suggested that main-street centres may advantage pedestrians due to the clustering of stores. 
Box-configured, car park–dominated centres constrain pedestrian activity and hinder opportunities for social interaction and the creation of social capital and sense of community.  Conversely, main-street centres increase the number of pedestrians,  which in turn increases opportunities for social interaction; these have been associated with increased sense of community  and safety  however this finding could not be replicated in Australia and requires further research. 
Main-street centres also foster natural surveillance and feelings of safety, helping to create an inviting, vibrant and safe streetscape and shopping area. Indeed, a study of four neighbourhoods in San Francisco, California, found that areas exhibiting characteristics of a main-street centre had a higher sense of community than did high-density or suburban-style neighbourhoods. 
South Australia’s ‘Good for Business’ report found that main-street centres are not only important for promoting more walking and cycling, but also have better ‘economic health’, through increased retail rental values, higher sale prices of nearby homes, significantly more pedestrian and cycling activity resulting in increased footfall (the number of people entering a shop or business in a particular period of time), more business generation, and stimulation of the local economy. 
These findings were cited in a 2015 study that suggested replacing car parking with more retail and residential combinations. When combined with greater employment density, such areas provide a day economy and a night economy in which workers and residents provide the demand for retail goods and services that supports local economies.
With the right balance of these urban design features, town and main-street centres can reduce travel times and car-commuting distances in favour of active transport.  Gunn and colleagues found that urban design features surrounding activity centres (centres anchored by a supermarket but not distinguished by their configuration) had a significant impact on their ‘walkability’ with highly walkable activity centres characterized by high street connectivity; greater variety of destinations and higher net residential densities increasing the likelihood of walking. 
Access to schools
The provision of other destinations in a neighbourhood is also important for promoting walking and physical activity. Locating schools near residential areas lets students walk to school, thus promoting daily physical activity among children and youth. 
For more information see the Community Facilities design feature.
Access to sport and recreation centres
The location of sport and recreation centres and infrastructure also plays an important role in determining whether people are physically active, particularly younger people. A considerable body of evidence confirms that easy access to recreational facilities is associated with physical activity among children, adolescents, adults and older adults. [40, 51, 60–73]
The benefits of sport and recreational participation extend beyond physical activity alone. Participating in sport or active recreation provides opportunities for social connection: it can bring people together, expand and strengthen social ties and networks, and provide a sense of belonging. It can also help reduce violence, and promote social interaction and integration. 
Research in rural Western Australia highlights the importance of participating as a volunteer or player in sporting organisations as a means of building social capital. [100, 101] Sports and recreation facilities are therefore an important component of any mixed-use neighbourhood.
Density, connectivity and mixed land uses
Public transport, cycling and pedestrian infrastructure, routes and facilities are important as they facilitate access to destinations. [35, 53, 73, 85, 87, 88, 109, 143] The level of street network connectivity en route also helps determine the degree to which neighbourhood destinations are easily accessible. [8, 35] Increased street connectivity reduces the distances travelled between homes and destinations, and provides a range of routes to choose from, increasing the likelihood of walking between locations or centres. 
Population and residential densities are also critical in creating mixed-use neighbourhoods – they provide the customers required to support local businesses.  Higher densities also generally result in more compact use of land, thus decreasing the distances between homes and destinations.
Cross-sectional studies have consistently associated greater street connectivity with walking. [12–14, 91, 99, 145, 146] There is also consistent evidence that the combination of higher residential densities and mixed land uses is positively associated with adults and older adults walking. [80–84]
These interacting results demonstrate the synergistic effect of combining different built-environment features. For this reason, public health researchers have attempted to combine different environmental components that help predict transport-related walking. The most common has been the development of the ‘walkability index’, which has been used to measure the presence of multiple built-environment features, by combining scores for variables that represent connectivity, density and land-use mix. [4, 94, 97, 98]
The earliest work, undertaken in the USA in 2009,  found significant associations with physical activity. Individuals living in neighbourhoods in the highest walkability quartile were 2.4 times more likely than individuals in the lowest walkability quartile to do 30 minutes or more of moderate physical activity per day.  Subsequent versions of walkability indices, including those developed in Australia, have modified the land-use mix index by varying or adding new land-use categories. 
Evidence from several countries shows a correlation between neighbourhood walkability indices and walking for transport across the life course. [12, 46, 91, 95] Less consistent associations have been found with recreational walking, although one study found that adding a public open space land-use class strengthened the relationship with recreational walking. 
More recent research suggests that the walkability of an area is associated with recreational walking. [48, 86, 88, 121] Some authors find that, although the walkability of the built environment does influence recreational walking, it may not be sufficient on its own – aesthetics, safety and route choices further influence recreational walking.  Recreational walking is enhanced when there is somewhere attractive or interesting to walk to: the evidence shows destinations such as parks, pools, playgrounds and fitness stations prompt more recreational walking. 
Very few attributes are included in walkability indices used in research. It is likely that other factors, such as footpaths, trees, shade and shelter, lighting, parks and open spaces, pedestrian crossings, and road-traffic volumes and speeds are all likely to be important contributors towards the walkability or pedestrian-friendliness of an area. These are discussed in more detail in the Movement Networks design feature
Summary of evidence
|Living near a mix of destinations (within 400–800 metres) is associated with higher levels of active transport use by all age groups.||[8, 11, 12, 14, 38–48]|
|A mix of destinations co-located in a neighbourhood or town centre provides convenient focal points for people to fulfil a variety of daily activities and needs in one place, and encourages use of active transport.||[8–11, 13, 14, 38–41, 43, 47, 49–53]|
|Main-street configurations improve the economic health of centres, through higher retail rental values, higher sale prices of nearby homes, increased business generation, and stimulation of the local economy. They also encourage active forms of transport.||[53–57]|
|Big-box, car park–dominated centres discourage pedestrian activity and hinder opportunities for social interaction and the creation of social capital and sense of community.||[36, 55–57, 147]|
|Locating schools near residential areas facilitates students walking to school, and promotes daily physical activity among children and youth.||[38, 39, 58, 59]|
|Local access to recreational facilities is associated with physical activity among children, adolescents, adults and older adults.||[40, 51, 60–73]|
|Increased fruit and vegetable intakes, healthier diet, better diet quality, and lower body mass index (BMI) and weight status are associated with better access to supermarkets– living within 800m of supermarkets, and an increased density of supermarkets in the neighbourhood.||[19, 20, 74–77]|
|The combination of higher residential density with mixed land use is positively associated with adults and older adults walking and using public transport.||[46, 80–88]|
|Higher-density housing should be incorporated into, or be immediately adjacent to, town or activity centres, to achieve sufficient densities to support local businesses and public transport. Such configurations encourage more adults and older adults to walk for transport.||[44, 80–83, 89–93]|
|Neighbourhood walkability (a combination of residential density, mixed-use planning and street connectivity) is consistently associated with walking for transport, and with general walking.||[4, 12, 94–99]|
|Neighbourhoods that promote interaction between residents – via more walkable, mixed-use planning and sport and recreation facilities – tend to have higher social capital and a stronger sense of community. Residents report a greater sense of well-being and satisfaction with life and the local neighbourhood.||[25, 27–29, 100–102]|