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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income PeoplesTogether, these results suggest that women who are on a low income or living in lowSES neighbourhoods may disproportionately benefit from greater availability of physicalactivity resources. A study in small areas across England found that, after adjustment forpotential confounders, the level of greenness moderated the relationship between arealeveldeprivation for various health outcomes that are plausibly linked to physicalactivity. 38 The findings are significant because they suggest that good locational accessto greenspace may attenuate health inequalities.In summary, while there is a paucity of literature evaluating the influence of access toopen space on disadvantaged groups, the evidence that is available suggests that betterlocational access in more disadvantaged areas is particularly advantageous to thesegroups and the implementation of suitably designed initiatives has potential to reduceinequalities in physical activity (and related health outcomes). However, while moststudies have found neighbourhood open space to be associated with increased physicalactivity levels, the size of this effect suggests that improving access alone is unlikely tobe sufficient in increasing physical activity levels to recommended levels. 15 Therefore,interventions to improve access to open space require complementary strategies whichaim to influence individual and social environmental factors.ConnectivityThere is a small but growing body of research examining the effects of streetconnectivity on physical activity and related health outcomes. While precise operationaldefinitions of connectivity vary, neighbourhoods with a high degree of connectivity aredesigned with a well-connected street network with plentiful intersections, small blocksizes and few cul-de-sacs. High levels of connectivity can facilitate walking throughactive transport and increase overall physical activity through providing shorter trips, alarger range of destinations within easy reach, reducing the speed of traffic, and39 40decreasing reliance on private forms of transport.Most research into the influence of street connectivity on individual-level physical activitycomes from the US. This body of research has overwhelming demonstrated that in theUS context, greater levels of connectivity are related with higher levels of physicalactivity and lower prevalence of physical activity-related morbidity and mortalitymeasures. Studies in the US have generally found small but statistically significantassociations between street connectivity and total and/or vigorous physical activity. 9 41-44For example, using data collected from children wearing accelerometers and GISmeasures of neighbourhood connectivity it was found that street connectivity accountedfor an additional six percent (after adjustment for sex) of the variance in objectivelymeasured physical activity. 43 Similar findings were found among older women. 45 Somestudies have found the effects of connectivity on physical activity to be limited to leisureactivity rather than utilitarian forms. 46 Others have found the effects to be limited toyounger people. 47 However, not all US studies have found a significant associationbetween connectivity and physical activity. 48 For instance, a study in Atlanta found thatwhile other characteristics of the built environment were significant, local streetconnectivity was not associated with overall physical activity levels of local residents,although there was evidence of an effect among white males. 49Outside the US there is a paucity of research into street connectivity and physicalactivity. One study in an urban area in Queensland, Australia using GIS-derivedmeasures of street connectivity to local parkland found counterintuitive associations with135
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesself-reported measures of achieving sufficient levels of physical activity. 50 The resultssuggested that respondents who had unacceptable connectivity to parkland were morelikely to attain sufficient levels of physical activity that those who had more directlocational access. In a sample of 705 adolescent girls (mean age 14.7) in the AveiroDistrict of Portugal, street connectivity was a predictor of active transportation. 51Other research has considered physical activity-related health outcomes such asobesity. Studies examining the effect of neighbourhood connectivity (objectivelymeasured using GIS) on body weight are scarce and many, 49 52-54 although not all, 55-57have found there to be an association. However, even when a positive association wasnoted the effect was not consistent across all social and demographic groups and/or allmeasures of weight/obesity.Few studies have explicitly compared the effects of connectivity on different socialgroups, and considered the implications for health inequalities. In a sample of1282 Australian women it was found that street connectivity in each participant’sneighbourhood mediated inequalities (measured between educational groups: a proxyfor socio-economic status) in physical activity for transport but not for leisure. 16 Theauthors suggested that public health strategies to reduce social inequalities in physicalactivity could usefully focus on environmental strategies such as modifications to thebuilt environment.In summary, the review of the international literature suggests that neighbourhoodconnectivity has a modest but important role to play in influencing physical activity andrelated health outcomes. However, the total number of studies is low with very fewcompleted outside of the US. Unsurprisingly, few researchers have considered theimplications of street connectivity for inequalities in physical activity and related healthoutcomes. This area is clearly a key area for future investigation.Results: National contextWhile the evidence base around open space, connectivity, and physical activity is welldeveloped in countries such as the US and Australia, in New Zealand the field ofresearch is in its infancy. Access to open space and health has received attention fromone team of researchers based at Massey, Otago and Canterbury Universities. Thegroup used a GIS approach to develop a national index of access to a variety of healthrelated‘community resources’ for neighbourhoods across the country. Among thecommunity resources of interest were access to open space and beaches, which weremeasured using the travel time from the centroid of each neighbourhood (n=38,254) tothe closest park and beach (from the Land Information New Zealand dataset). 58 Analysisof the index found that locational access to open space (parks) was better in moredeprived neighbourhoods (measured using NZDep) across New Zealand, suggesting apro-equity distribution. 59 For beaches there was no relationship with area deprivation.However, these national-level trends were not consistent in rural areas and in someregions of the country with large Māori and low income populations (eg, Northland, WestCoast), where the opposite pattern could be observed for some resources. 60With regards to any association between access to open space and physical activityrelated health outcomes, the research team used the New Zealand Health Survey(12529 participants in 1178 neighbourhoods across the country) and appended the136
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