Spatial analysis of the Healthy Built Environment: an application on Cardiovascular Risk Factors in the canton of Geneva

Most of the world population lives in urban areas, the share of the urban population is estimated to increase in the future decades. The complexity of different land uses and services in urban areas, which composes the built environment, influences human health and wellbeing. Concerning urban areas, to a large extent, spatial planning has the potential to shape the built environment to become healthier. The necessity of addressing the built environment is coherent with the crucial need for human health to act in all policies effectively and outside healthcare to prevent negative impact and promote positive impacts across multiple sectors. Research and practice already addressed diverse health challenges related to the built environment, grouped under the large umbrella of "urban health". Policies, tools, projects, and programs have already been created in separate sectors to integrate health in governance. Despite these efforts, health is often seen as a restrain to development in spatial planning, encountering resistance in each of its phases: diagnosis, formulation, implementation, monitoring, and evaluation. In this research, we focused on diagnosis as a crucial driver for understanding the relationship between the built environment and health and advocating for healthier cities through data and spatial analysis. The call for a built environment diagnosis aims to jointly address most of the relevant urban health issues linked to urban areas and within urban areas. The following concepts are required to comprehend better and address the healthiness of the built environment: (i) a structured framework to understand the stratification of multiple built environment determinants of health (ii) the spatial distribution of those determinants to understand inequalities within urban areas (iii) the integration of the expert's perspectives in addressing multiple urban health issues, (iv) the understanding of the geospatial links between the built environment and health data. The thesis aims to assess the spatial distribution of characteristics of the built environment related to health in the state of Geneva (Switzerland). This work employs a holistic approach to explore how inequalities in the health-related built environment are distributed in space and compare it with geospatial health data adopting global and local geospatial approaches. Using multiple spatial analysis methods for both built environment and health data and building a framework for a broad assessment of urban health, three hypotheses are tested in three sections. Initially we develop a conceptual framework for urban health issues. Then the framework is adapted and employed to diagnose the healthiness of the BE in the canton of Geneva using a local and global method to generate synthetic indicators. Then we analyse the stakeholder perspective on urban health issues and on the integration of health in planning. In the last section, we analyse the spatial distribution of health data and study whether the healthy BE provide a good estimate of Cardiovascular risk factors.