Will moving into social and affordable housing in the Athletes' Village increase family physical activity levels? Evaluation of a natural experiment

It is assumed that where you live has an impact on your health; this is often given as a reason for poor health amongst those living in less privileged surroundings. There have been a number of large-scale housing regeneration projects over the years, which aim to improve the living conditions and lifestyles of those living in low cost housing. However, these projects are long-term (often taking a decade or so to complete), making it difficult to demonstrate effects on lifestyle above those taking place over time. Effects of the built environment on physical activity levels are of particular interest as higher physical activity levels have a beneficial impact on a wide range of health outcomes. The specific provision of social and affordable housing provided by the Athletes' Village after the London 2012 Olympic Games (available from 2013) offers a unique opportunity to examine whether and how the 'built environment' affects physical activity patterns and body size in adults and children moving into the area. We will recruit a cohort of families before the Village accommodation becomes available, and follow up those that move into the Village, and compare physical activity patterns with those in families that do not move to the Village over a 2 year period. We will measure how the built environment is used in terms of walkability, ease of access, convenience of use etc., and how perceptions of the local environment influence its use, e.g. perceived levels of safety, social interactions and cohesion etc. Physical activity patterns will be assessed using accurate movement sensors, body size will be measured objectively using bio-electrical impedance. Geographical positioning systems will be employed to trace patterns of use of the local environment. While the short time scale of the intervention is unique, the findings will be generalisable, informing future design of residential developments that are destined to take place elsewhere. The key to public value of the proposal is that: (i) evidence based policy requires evidence on whether environmental changes thought to benefit residents actually do; (ii) the cost of evaluations such as that proposed is small compared to the costs of building and compared to the potential health benefit; (iii) small changes distributed widely in the population have the potential to deliver major health benefits; (iv) such benefits can only be identified by carefully designed evaluations of natural experiments. Finally we recognize the importance of disseminating our findings; we believe our proposed pathway to dissemination, including a stake holder forum including individuals identified by our extensive network of contacts, will provide this.

We propose to examine whether people moving into the Athletes' Village increase their physical activity levels to a greater extent than people who do not. To observe the impact of this natural experiment, a two-year longitudinal (cohort) study will be carried out, examining changes in physical activity levels in 600 families which move into the Village (intervention) with 600 families which do not. Participants (who apply to live in social and affordable homes in the Village) will be studied initially in their current place of residence and then either in the Villlage (intervention) or the same place of residence (controls). Changes in physical activity (measured objectively using Actigraph monitors) and body build (including bio-electrical impedance) occurring in families living in the Village will be compared with changes occurring in those living in surrounding boroughs. Research objectives will examine:-
(i) whether families living in social and affordable housing in the Village show a sustained change in their physical activity levels, compared to their levels before moving into the Village, and by comparison with physical activity changes in families outside the Village.
(ii) whether any increase in physical activity in children and adults living in the Village is directly attributable to use of their local built environment, and if so, which facilities.
(iii) whether changes in physical activity patterns in families living in the Village are modified by other factors including age, gender, ethnicity, proximity to facilities, perceived social cohesion and safety, social class / employment status.
(iv) we will examine (i) in relation to adiposity as well as physical activity levels.
The study will provide proof of principle that the built environment can increase physical activity levels. Results will inform evidence-based urban planning that will happen in the future, and the way in which environmental changes impact on health inequalities.

The social rented sector (including accommodation rented from local authorities and housing associations) accounts for 3.6 million properties in England. Trends in the supply of social and affordable housing have increased over the last decade. The biggest increase has been in the affordable sector, with 58,000 additional affordable home being supplied in England from 2009 to 2010. In London, as elsewhere, there is a shortage of affordable housing and Strategic Housing Market Assessment (SHMA) estimates that at least 33,000 new homes, including 18,000 affordable homes, are needed every year. A target has been set by the London Mayor of delivering 50,000 affordable homes, of which 30,000 will be socially rented, by March 2012 (25,000 have been provided in the last 2 years). A number of housing activities are ongoing in London; these include the Kidbroke estate Greewich which will provide 1500 new affordable homes, Woodberry down in Hackney 2300, Clapham Park in Lambeth will provide 85 new affordable homes but will see a major regeneration of existing housing stock. The Athletes Village will also contribute to this housing stock, with 1400 new homes, but will be unique in providing these in a short space of time (within a year). While other initiatives are ongoing and future projects are needed to address the demand for new housing, it is important to appreciate the effect of these new built environments on health and health behaviour (physical activity levels) in both the young and old, privileged and less privileged. The findings from this study will identify features of new housing that result in higher physical activity levels, providing evidence-based recommendations for future builds which are needed to keep up with current demand. As such, there are many housing providers outside the academic community who will benefit from these findings. A major drive of this initiative will be to disseminate these findings to these individuals, using the network of contacts and stakeholders that we are currently involved with. It is important to recognise that these findings are generalisable to the wider provision of housing in major conurbations, both at a national and international level, in order to provide built environments which encourage healthy living.