Healthy Neighbourhoods Hub (HNH) Framework: A Practical Guide for Fostering Healthy and Inclusive Living in Florence’s Urban Environment

Abstract

By 2050, an estimated 69% of the global population will reside in urban areas, underscoring the pivotal role of city neighbourhoods in enhancing quality of life by respecting and accommodating diverse identities and needs. The physical environment of neighbourhoods significantly influences community health and well-being, alongside social factors and access to health services. In Italy, prioritising health-promoting and accessible designs in neighbourhoods can form a solid foundation for urban health strategies. This study introduces a theoretical framework developed for the Healthy Neighbourhoods Hub (HNH) project in Florence, Italy, aiming to enhance health and accessibility across different scales. The HNH framework categorises healthy and inclusive neighbourhoods into 7 themes, 25 general characteristics, and 67 specific attributes, supported by verifiable variables derived from comprehensive research and design tools. This innovative framework addresses the need for multilevel, multidisciplinary approaches, and spatialization efforts to ensure equitable benefits for all community members.

1. Introduction

1.1. Planning Models for Health in Urban Spaces: Approaches, Documents, and Tools

Extensive studies in public health, social sciences, and urban planning are consistently highlighting a concept that resonates with common understanding: the significance of the built environment in shaping health outcomes [1,2,3]. A growing body of evidence suggests that the built environment plays a significant role in determining urban health [4,5,6,7]. Urban health refers to a strategic orientation that integrates health protection and promotion actions into urban design, emphasising the strong dependence between physical, psychological, and social well-being and the urban environment in which people live [8]. The concept of urban space encompasses various scales, ranging from metropolitan areas to cities and neighbourhoods [9]. However, if health is generated in the context of daily life, i.e., in the neighbourhoods and communities where people live, form relationships, work, shop, and engage in leisure activities, the neighbourhood and community are identified as the primary dimensions in which to address the issue of health and well-being [10,11,12]. The resources available for planning healthy places are extensive, but the focus on the neighbourhood scale is relatively limited in this field [13,14,15,16,17]. To highlight the importance of integrating health in urban and territorial planning and policies, worldwide experimental case studies are presented [18,19] and public spaces are addressed as drivers of this challenge [20,21]. Policy and planning levels are deeply investigated, proposing key actions to policymakers and urban planners to value the concept of the city health development plan, working mainly at a macro-level scale.

Strategic approaches are suggested by the European Healthy Cities Network to foster multi- and intersectoral work, including whole of city and health in all policies approaches. The healthy city standard is set by harmonising social, physical, and cultural surroundings to establish a space that actively promotes inclusivity and supports the endeavour for health and wellness for everyone [22]. The reference framework implements the 2030 Agenda for Sustainable Development and it is shaped around the themes presented in the Copenhagen Consensus of Mayors [23]. Overarching goals are operationalised through strategic approaches, including designing urban places that deliver for equity and community prosperity, and core themes, including designing urban places that improve health and well-being. In this framework, the physical built environment is considered at an urban planning scale in terms of air quality, road safety, active mobility, housing quality, green spaces, urban ecosystems, and urban food systems. The meso level of architectural projects and the micro level of product and service design are not being addressed. Targeted populations are younger and older people, disadvantaged people, and people with disabilities.

Adaptable tools and checklists related to evidence-informed guidance are suggested to design places that serve to improve health and well-being for all [9]. Technical resources address specific issues, such as age-friendly cities, air pollution, integrated transport, etc., and are a valuable thematic help for people working to improve the quality of places to foster improved health and well-being for all at the local and municipal levels.

In the effort of addressing health equity in urban context with a broader perspective, in 2017, Gehl, the former Gehl Institute, and the Robert Wood Johnson Foundation (RWJF) developed the Inclusive Healthy Places (IHP) Framework [24]. Thought as a tool to help public realm practitioners identify social determinants that their work can improve, and remove systemic barriers to health, the framework clusters drivers, indicators, and metrics under guiding principles—the context, process, design and programmes, and fostering conditions—to ensure these factors are integrated into and measured throughout the lifecycle of a public space project. Other approaches implement the concept of restorative urbanism [25], promoting mental health and well-being with a macro- and micro-perspective through city planning and urban design.

The consideration of urban space planning and design in the post-COVID-19 era has further validated the significance of the local and neighbourhood scale to make our cities more resilient to future pandemics. In 2021, UN-Habitat gave some recommendations for post-pandemic scenarios at the neighbourhood level [26], including (i) Emphasise neighbourhood-focused city planning promoting self-contained and socially inclusive communities; (ii) Enhance neighbourhood strategies with localised decision making and bottom–up processes; (iii) Prioritise accessibility and inclusion; (iv) Acknowledge the multifunctionality of public spaces; (v) Develop interconnected, accessible public space networks; and (vi) Investigate options for retrofitting city center neighbourhoods with mixed-use areas. The implications of the challenges posed by COVID-19 on the design of public spaces, transportation systems, and connectivity in cities remain open to further reflection and consideration by designers, planners, and policymakers all over the world [27,28].

At a national level, in Italy, an interesting starting point for integrating health in urban and territorial planning and policies could be considered the document titled “Gaining Health” (Guadagnare salute), resulting from a collaboration of the Italian Ministry of Health with the European region of the World Health Organisation [29]. The aim of this document was the definition of a European strategy to combat chronic diseases through the adoption of healthy lifestyles. The strategy is implemented with multicomponent interventions, including communication activities and actions. In some of the issues addressed, a conscious urban design is nominated as one of the actions that national authorities could foster to promote for example physical activity. Increasing attention to the relationship between health and the urban environment, in 2017, the Italian Presidency of the Council of Ministers incorporated indications from the World Health Organisation and introduced the prior assessment of urban plans and support to the authorities in the definition of planning instruments [30]. Criteria used in urban plans assessment are related to the protection of living environments from environmental pollutants and the development of an environment conducive to health promotion and road safety. In 2021, the Italian Ministry of Health published the “Guidance document for urban planning with a focus on Public Health” (Documento di indirizzo per la pianificazione urbana in un’ottica di Salute Pubblica), a policy document with an avowedly cross-sectoral approach structured as a methodological operational guidance tool to support strategies and programmes of the Regional Plans for Prevention, in coherence with the provisions of the National Prevention Plan 2020–2025 [31]. This document, addressed to regional and local planners and administrators, explicitly calls into question the health, environmental, transport, and urban planning sectors, including their regulatory frameworks. It was elaborated from 2018 to 2021 by a group of experts joined at the “Working Group on Urban Health” (Tavolo di lavoro su Città e Salute) and has its roots on an important project by the Italian Centre for Disease Prevention and Control (CCM). The project, titled “Urban Health: best practices for assessing health impacts of urban redevelopment and environmental regeneration interventions” (Urban Health: buone pratiche per la valutazione di impatto sulla salute degli interventi di riqualificazione e rigenerazione urbana e ambientale), centres on urban health assessment with the purpose of developing and disseminating best practices [32]. The project goal is to transfer best practices to practitioners and decision-makers to guide urban policies towards improving the health of citizens, also with a view to equity. In a targeted initiative, the project developed a comprehensive multicriteria evaluation instrument, which integrates twenty indicators across seven broad thematic categories (environment, ground and underground, sustainability and hygiene in constructed spaces, urban and social progress, mobility and transportation, and outdoor areas). These categories are preceded by a set of universal criteria that encompass demographic and epidemiological information, both external and internal coherence, projections for construction, and designated purposes. The alignment of each indicator with urban health goals is assessed and assigned a level of performance—high, moderate, or low. The document acknowledges the significance of the city’s physical aspects, including its morphology and functions, in advancing urban health [33]. This marks a groundbreaking advancement for Italian guidelines in incorporating health considerations into urban planning, without extending this integration outside the urban planning scale, thereby missing out on the integration of various architectural disciplines.

A compelling and relatively unexplored scenario within the Italian regulatory framework pertains to the neighbourhood scale. Adopting an “urban health advantage” viewpoint, which highlights the health-related advantages of city living, requires neighbourhoods to have a physical environment that is designed to be supportive of health and well-being [34]. To reach that goal, health should be considered a driver of built environment design, and people’s bio-psycho-social well-being [35,36] should be treated as a fundamental input to the design process, not just an expected result. This expands the notions of inclusion, accessibility, and usability by also promoting the adoption of healthy behaviours in neighbourhood contexts.

1.2. A New Theoretical Framework for Healthy and Inclusive Neighbourhoods

Based on these premises, the Healthy Neighbourhoods Hub (HNH) (Quartieri Sani HUB) research project [37,38,39] aims to establish a theoretical framework that can steer the development of healthy and inclusive neighbourhoods across various scales, including the regional and urban design level (macro-scale), architecture design level (meso-scale), and product and service design level (micro-scale). The research project brings together researchers from the Department of Architecture at the University of Florence, spanning four different disciplines: urban and landscape planning, architecture, and product design. The primary partners of the project, in addition to the University of Florence, are the Municipality of Florence, the Metropolitan City of Florence, the Local Health Authority (i.e., the Azienda USL Toscana Centro), the Florence Health Society (i.e., Società della Salute di Firenze), and an urban furniture manufacturing company (i.e., Metalco Group).

The introduction of a new framework is intended to address the lack of emphasis on multiscalarity, interdisciplinarity, and spatialization in previous endeavours, which are crucial for ensuring equity and broad benefits across all population segments. These aspects required systematic organisation within the Italian context, where policies may outline specific objectives such as health and equity promotion, so translating these into practical implementation often proves challenging in terms of maintaining a cohesive and efficient approach across various levels and domains.

The HNH project’s main goal was to define a theoretical approach for advancing urban health [1,8] through a multidimensional strategy focused on the neighbourhood level. The two-year study was situated in two neighbourhood areas within the city of Florence, including the five districts of San Frediano, Pignone, Le Piagge, Nave a Petriolo, and Nave a Brozzi. In both neighbourhood areas is located a House of the Community (HoC), that is also a subject of this study, a primary healthcare structure that can serve as a focal point for a proximity network that extends beyond the traditional provision of health services, offering tailored social services and representing a driver for health promotion in the neighbourhood. This network can help foster social connections and promote community engagement, contributing to overall health and well-being at the neighbourhood level. Within the Healthy Neighbourhoods Hub (HNH) research project, through an action research process, urban spaces and HoCs were reimagined as physical infrastructures to promote healthy habits among diverse users [40].

1.3. Significance of the Paper

The paper outlines the development of the framework for healthy and inclusive neighbourhoods and discusses its originality and integration with subsequent research phases, encompassing user studies, engagement initiatives, and on-site environmental observations. The HNH framework interprets the urban health approach at the neighbourhood level, incorporates multidisciplinary contribution to the theme, and broadens the scope of disciplines involved in promoting health in urban contexts, fostering a more comprehensive understanding of the relationship between the built environment and health, not only focusing on urban planning as the primary design discipline for driving spatial transformations. This research illustrates how utilising a novel theoretical approach to the design of urban spaces in neighbourhoods can lead to modifications in the built environment that serve to advance both health and equity [1].

2. Materials and Methods

2.1. Proximity, Healthy Lifestyles, and Inclusion as Core Topics of the HNH Framework

Starting from the Ottawa Charter [41,42] as the core document introducing the promotion of health in urban environment, the research team engaged in an extensive multidisciplinary dialogue, with each member contributing their expertise and key references related to the subject, as detailed at the end of this paragraph. After a comprehensive discussion, three core aspects were identified as crucial for HNH research project to explore when examining the built environment as a health determinant in neighbourhoods.

These three aspects are:

• Proximity;
• Healthy lifestyles;
• Inclusion.

They are important topics that are related to the aforementioned context of healthy cities and the biopsychosocial health model, framing the 2030 Agenda for Sustainable Development goals SDG-3: Good Health and Well-Being, and SDG-11: Sustainable Cities and Communities. Each topic is explored according to the multidisciplinary approach of the HNH research project with the aim of collecting relevant studies and documents useful to identify properties of the built environment implementing those three aspects (Figure 1).

The topic of proximity examines the built environment in terms of accessibility to services and places [43]. It is explored from the viewpoint of design for social innovation [44,45,46,47]. Interpreting this topic through the caring concept [48] leads to the emergence of models for the 15 min and 20 min city [49,50,51,52,53] and dimensions of proximity [54]. Proximity is also examined under the perspective of urban landscape quality and recognisability [55,56,57].

Healthy lifestyles can be impacted by the built environment in two ways: directly, through immediate effects such as the quality of the indoor and outdoor environment, and indirectly, by altering behaviours that can influence health, for example, by promoting walking to increase physical activity [58,59]. Direct impact of built environment on health is considered in terms of health promoting buildings [60,61], salutogenic design [62,63], biophilic design [64,65,66], evidence-based design [14,67,68,69], and nature-based solutions [70,71]. Indirect impact on behaviours is considered in terms of active design [72,73,74,75,76], age-friendly environment and healthy ageing [77,78], and design for behaviour change [79,80,81].

The topic of inclusion explores the built environment regarding the presence of inclusive services, spaces, products, artefacts, and participatory communities [82,83,84]. It is investigated from the perspective of design for service inclusion [85,86,87], inclusive service design [88,89], universal design [90,91], design for all [92,93], inclusive design [94,95], and participatory and collaborative urban planning [96,97,98].

2.2. Identifying Built Environment Properties and Data Collection

During data collection, the multidisciplinary research team collaborated to collect key documents related to each topic. The data collection phase occurred in January 2022. For the search, the WHO directory of resources for planning healthy environments [99] was used as the initial source, with inclusion criteria focused on documents type (recommendations, design guide, toolkit, checklist, and best practices reports) and scale (city and neighbourhood). Documents referring to areas significantly different for geographical and economic characteristics were excluded, and 24 documents were sorted. During the researchers’ examination process, selected documents must have offered guidance intended for or adaptable to urban space design concerning proximity, healthy lifestyles, and inclusion topics. From the initial sorted list, 5 documents were selected [68,72,77,100,101]. Subsequently, the search was enhanced by incorporating crucial reference texts for specific approaches and perspectives highlighted in the preceding section (e.g., health promoting buildings, biophilic design, universal design, etc.), along with case study reports or articles (e.g., 20 min city, Barcelona’s superblocks, etc.). Also, existing documents focusing on neighbourhood scale were added [13,14,15,16,17]. The research team has deliberately included seminal reference texts that are fundamental to specific approaches or fields. While primary reference texts in specific fields (e.g., universal design) may exceed five years in age, their significance persists due to the foundational concepts and definitions they originally introduced. The team members worked together with a multidisciplinary approach to identify properties and features relevant to built environment design that address the specific topic. For proximity topic 4, documents were collected, and 31 properties extracted, as shown in

Table 1. Collected documents related to proximity topic.

Reference	Title	Main Properties/Features Identified
Transport for London, 2017 [100]	Healthy Streets for London: Prioritising Walking, Cycling and Public Transport to Create a Healthy City	Pedestrians from all walks of life; People choose to walk, cycle, and use public transport; Clean air; People feel safe; Not too noisy; Easy to cross; Places to stop and rest; Shade and shelter; People feel relaxed; Things to see and do.
Center for Active Design, 2018 [101]	Introducing the Assembly: Civic Design Guidelines	Improve voting access and awareness; Increase access to community information; Elevate the visibility of local government; Support community-driven design processes.
Mehdipanah et al., 2019 [49]	Effects of Superblocks on health and health inequities: a proposed evaluation framework	Air/Noise pollution; Traffic safety; Walkability; Recreational spaces; Commercial availability; Housing value; Sense of community; Sense of security; Social networks.
Emery & Thrift, 2021 [53]	20 min Neighbourhoods—creating healthier, active, prosperous communities. An introduction for council planners in England	Diverse and affordable homes; Well connected paths, street, and spaces; Schools at the heart of communities; Good green spaces in the right places; Local food production; Keeping jobs and money local; Community health and well-being facilities; A place for all ages.

; for healthy lifestyles topic 11, documents were collected and 134 properties extracted, as shown in

Table 2. Collected documents related to healthy lifestyles topic.

Reference	Title	Main Properties/Features Identified
The City of New York, 2010 [72]	The Active Design Guidelines: Promoting Physical Activity through Design	Land use mix; Transit and parking; Park, open spaces, and recreational facilities; Children’s play areas; Public plazas; Grocery stores and fresh produce access; Street connectivity; Traffic calming; Designing pedestrian pathways; Programming streetscapes; Bicycle networks and connectivity; Bikeways; Bicycling infrastructure.
Sallis et al., 2012 [74]	Role of built environments in physical activity, obesity, and cardiovascular disease	Walkable community design (density, connected streets, mixed land uses, access to transit); Pedestrian and bicycle facilities (access, connectivity, design, quality, safety); Building design (stairways, parking placement); Location of workplace/school (access to transit, access to sidewalks and bike paths); Home design and equipment (stairs, exercise, labour-saving, entertainment); Park and trails (access, design, quality); Private recreation facilities; Pedestrian and bicycle facilities; Trees and aesthetics.
Salingaros, 2015 [65]	Biophilia and healing environments. Healthy principles for designing the built world	Natural features; Geometrical stability; Ornamental variety; Light; Colour; Gravity; Fractals; Curves; Detail; Water; Life.
Urban Land Institute, 2015 [68]	Building healthy places toolkit: Strategies for enhancing health in the built environment	Mix of land uses; Well-connected street networks at the human scale; Sidewalks and enticing, pedestrian-oriented streetscapes; Infrastructure to support biking; Visible, enticing stairs to encourage everyday use; Stair prompts and signage; High-quality spaces for multigenerational play and recreation; Play spaces for children; Grocery store and farmers market accommodation; Healthy food retail; On-site gardening and farming; Access to drinking water; Smoking banned; Materials and products supporting healthy indoor air quality; Proper ventilation and airflow; Indoor lighting quality; Minimised noise pollution; Access to nature; Facilitation of social engagement; Pet-friendly policies.
Sport England, 2015 [75]	Active Design: Planning for Health and Well-being through Sport and Physical Activity	Activity for all; Walkable communities; Connected walking and cycling routes; Co-location of community facilities; Network of multifunctional open space; High-quality streets and spaces; Appropriate infrastructure; Active buildings; Management, maintenance, monitoring, and evaluation; Activity promotion and local champions.
World Health Organization, 2016 [77]	Age-Friendly Environments in Europe: Indicators, Monitoring and Assessments	Outdoor environments (Walkability, Accessibility of public spaces and buildings, Public safety); Transport and mobility (Availability and accessibility of public transport, Accessibility of public transportation vehicles and stops, Accessibility of priority vehicle parking); Housing (availability and affordability of housing, accessibility of housing, housing programmes and resources, ability to age in place, safety at home); Social participation (engagement in sociocultural activity, participation in leisure-time physical activity, engagement in lifelong learning, opportunities for participation, accessibility of participation opportunities); Social inclusion and non-discrimination (positive social attitude towards older people, availability of intergenerational activities, sense of belonging, influence in the community); Civic engagement and employment (engagement in paid employment, engagement in volunteering activity, participation in local decision-making); Communication and information (availability of information, usability of information material, Internet access, assistance available); Community and health services (access to health and dental care, supportive health services, availability of home- or community-based services, emergency preparedness).
Peters, 2017 [60]	Superarchitecture: Building for better health	Daylight; Airflow; Thermal comfort; Acoustic qualities; Spatial variation; Access to nature; Colour schemes.
Forsyth et al., 2017 [14]	Creating healthy neighbourhoods: evidence-based planning and design strategies	Variety of housing options; Universal design principles integrated into planning and design; Increased access and exposure to healthy food options; Mixed-use neighbourhoods with a balance of activities; Population density to support services; Connected, “healthier” travel circulation pattern; Increased access to recreational facilities and green spaces; Land-use planning and urban design coordinate with transit; Safer neighbourhood transportation options for all road users; Adequate pedestrian and cyclist infrastructure and amenities; Public spaces, programs, and events to support interaction; Reduced street crime and fear of crime in public realm; Reduced pollutants and separation of people from toxins; Resilience built in areas vulnerable to natural disasters; Reduced unwanted noise and separation of people from noise.
BC Centre for Disease Control, 2018 [13]	Healthy Built Environment Linkages Toolkit: Making the Links between Design, Planning and Health	Create complete neighbourhoods through mixed land use; Built compact neighbourhood through efficient planning; Enhance connectivity with efficient and safe networks; Prioritise new developments within or beside existing communities; Use streets designs which prioritize active transportation; Make active transportation networks safe and accessible for all ages and abilities; Design connected routes for active transportation and support multiple modalities; Consider the aesthetic of road, rail and waterway networks; Preserve and connect environmentally sensitive areas; Maximise opportunities for everyone to access natural environments; Reduce urban air pollution by expanding natural elements across the landscape; Mitigate urban heat islands by expanding natural elements across the landscape; Increase equitable access to and affordability of healthy food options; Protect agricultural land and increase the capacity of local food systems; Support community-based food programs; Prioritise affordable housing options through diverse housing forms and tenure type; Ensure adequate housing quality for everyone; Provide specialised housing options to support the needs of marginalised populations; Site and zone housing developments to minimise exposure to environmental hazards.
London, 2020 [102]	Healthy Placemaking: Well-being Through Urban Design	Clean air; Contact with nature; Social interaction; Feeling safe; Living somewhere healthy; Peace and tranquillity; Regular exercise.
Ministero della Salute, 2021 [31]	Documento di indirizzo per la pianificazione urbana in un’ottica di Salute Pubblica	Air and smell; Water supply; Noise; Ionising radiation; Soil consumption; Soil permeability and water management; Waste management; Energy efficiency; Population density; Functional and social mixité; Universal design and social inclusion; Road network and parking system; Public transport; Pedestrian and cycling networks; Outdoor spaces system; Green and blue areas; Lighting and visual comfort.

; and for inclusion topic 5, documents were collected and 47 properties extracted, as shown in

Table 3. Collected documents related to inclusion topic.

Reference	Title	Main Properties/Features Identified
Connell et al., 1997 [103]	The Principles of Universal Design	Equitable use; Flexibility in use; Simple and intuitive use; Perceptible information; Tolerance for error; Low physical effort; Size and space for approach and use.
CABE, 2006 [104]	The principles of inclusive design	Inclusive design places people at the heart of the design process; Inclusive design acknowledges diversity and difference; Inclusive design offers choice where a single design solution cannot accommodate all users; Inclusive design provides for flexibility in use; Inclusive design provides buildings and environments that are convenient and enjoyable to use for everyone.
DESA, 2009 [105]	Creating an inclusive Society: Practical strategies to promote social integration	Inclusive policies and legislation; Access to clean and safe places for living, work and recreation; Access to information and communication; Access to public spaces; Access to resources; Access to basic services, including education, health care, clean water and sanitation; Access to transportation; Transparent and accountable decision-making processes; Adequate income and employment opportunities; Affirmation of human rights; Opportunity for personal development; Respect for diversity; Freedom (of choice, religion, etc.); Participation in decision-making; Social protection; Solidarity.
Bevan & Croucher, 2011 [15]	Lifetime Neighbourhoods	Resident-led activities; Voluntary sector delivery at local level; Variety of approaches for information and advice; Transport linking together different types of transportation to provide a coordinated service; Walkable environments; Orientation and wayfinding; Adequate provision of away from home toilets; Local access to retail outlets; Accessible food/fresh food; Inclusive and walkable environments (streets, pavements, footpaths and cycle routes that are sufficiently maintained, clean, well-lit, with adequate road crossing points and seating/places to rest in public places); Safe streets and play areas for children; Greenspace providing opportunities for social contact; Social networks to develop and reduce intergenerational tensions; Supported social networks/practical help tackling social isolation; Places for people to meet; Tackling of crime/fear of crime and anti-social behaviour.
Ministero della Salute, 2021 [31]	Documento di indirizzo per la pianificazione urbana in un’ottica di Salute Pubblica	Equal use of urban space by different categories of users; Wayfinding through different modes of communication (visual and sensory); Participation and involvement of various social stakeholders.

.

2.3. Data Analysis

The previously mentioned documents all generated qualitative data, which were analysed by the multidisciplinary research group and restructured according to two phases. The complete analysis process adhered to a design thinking approach and embraced a collaborative design perspective among the researchers.

2.3.1. Phase I (Diverging Phase)

Applying a multilevel approach, researchers working at the regional and urban design level (macro-scale), architecture design level (meso-scale), and product and service design level (micro-scale) identified relevant categories for their respective design levels to address the creation of a healthy and inclusive built environment in Florence’s neighbourhoods. They assigned properties related to the three core topics under investigation to each category. The researchers extracted and summarised the properties and features from the data collection tables. Criteria for relevant categories identification and for properties selection from the data collection tables are related to the significance of impact of these items on the built environment design of urban public space and areas surrounding HoCs, according to HNH research project perspective. The criteria for identifying relevant categories and selecting properties from the data collection tables are based on the impact significance of these elements on the design of the urban built environment and areas surrounding HoCs in Florence neighbourhoods, as viewed from the perspective of the HNH research project.

In this phase, three tables were generated, each pertaining to a specific scale and detailing the characteristics of the healthy neighbourhoods. From the macro-level analysis process, 2 relevant categories were identified, and 18 properties and features were assigned, of which 7 were related to the proximity topic, 8 to the healthy lifestyles topic, and 3 to the inclusion topic (Figure 2).

From the meso-level analysis process, 4 relevant categories were identified, and 20 properties and features were assigned, of which 5 were related to the proximity topic, 11 to the healthy lifestyles topic, and 4 to the inclusion topic (Figure 3). From the micro-level analysis process, 6 relevant categories were identified, and 10 properties and features were assigned, of which 4 were related to the proximity topic, 3 to the healthy lifestyles topic, and 3 to the inclusion topic (Figure 4).

2.3.2. Phase II (Converging Phase)

After reviewing three tables created during Phase I and through a collaborative process between multidisciplinary researchers and lead investigators, the research team developed two insights. The first one is that the identified categories define the domains to consider for designing a healthy and inclusive neighbourhood responding to a multiscalar perspective and can therefore be used as a reference point for establishing a conceptual framework adopting this viewpoint. At the same time, a framework orientated according to these categories will never merge the diverse scale considered. In other words, while a framework that is based on specific-scale categories can be useful for organising and analysing information, it may not be able to capture the complexity and nuances of a neighbourhood, which can be influenced by a wide range of factors operating at different scales. Therefore, the second insight to supplement it with a broader, more holistic perspective that takes into account the interplay of different scales and factors in shaping the neighbourhood. The research team observed a common thread running through various scales, with properties and features converging around specific thematic areas, indicating overarching themes that cut across different levels of analysis. These overarching themes expanded the panorama of the initial three core topics considered, widening the view on built environment design in Florence neighbourhoods. The discovery of these cross-cutting themes broadened the scope of the initial set of three core topics. Information from the tables related to a specific scale was thus synthesised and consolidated into a single table (Figure 5) where properties and features were grouped around emerging transversal themes.

Following the analysis phase, the multidisciplinary research team further developed and structured each emerging theme, progressing towards the ultimate goal of establishing a comprehensive framework for designing healthy and inclusive neighbourhoods. This culmination of the analysis phase resulted in the formalisation of the HNH framework, representing the original scientific contribution outlined in this paper.

3. Results

The HNH research has resulted in the development of a multidisciplinary and multiscalar conceptual framework (Figure 6). This framework synthesises and systematises the key characteristics of healthy and inclusive neighbourhoods into seven distinct themes: (i) the neighbourhood for all; (ii) the neighbourhood of the interactions; (iii) the active neighbourhood; (iv) the neighbourhood of the senses; (v) the green neighbourhood; (vi) the smart neighbourhood; and (vii) the neighbourhood of the 1500 m. The seven themes incorporate spatial and environmental elements that foster health and well-being goals at the neighbourhood level.

3.1. Seven Themes of the HNH Framework

In particular, a neighbourhood demonstrates health and inclusivity when it exhibits the following traits.

3.1.1. Neighbourhood for All

It expresses active citizen participation and encourages collaborative communities, with residents working together to address shared challenges and decision-making processes. The neighbourhood promotes equity and security, creating an environment where residents feel able and secure to freely engage with their community (Figure 7).

The neighbourhood for all is expressed through the following:

• Public spaces that promote citizen engagement, facilitate self-organisation, foster spontaneous community activities, and are designed with adaptable features to meet diverse community needs. These spaces prioritise multicultural, intergenerational participation, and celebrate diversity across generations, genders, cultures, and social backgrounds;
• Pathways and spaces that are barrier-free, adaptable to multigenerational and multicultural needs and abilities, and complemented by architectural elements and furnishings that promote rest and relaxation. These include considerations such as the design of paths, rest areas, and communication spaces, with attention to materials, colours, lighting, sensory perceptions, and the integration of greenery and natural elements (e.g., water). Presence and quality of seating options, tables, public restrooms, and water fountains are also important. Pathways and spaces present wayfinding systems with multisensory characteristics cater to users with physical, cognitive, visual, and hearing impairments, as well as those from diverse cultural backgrounds.

3.1.2. Neighbourhood of the Interactions

It highlights the crucial role of social relations in promoting health and well-being within neighbourhoods. The built environment is designed to encourage and enable residents to connect with one another, fostering social support networks, positive social relations, relational activities, and dedicated spaces (Figure 8).

The neighbourhood of the interactions is expressed through the following:

• Aggregative architectural spaces that foster community gathering (e.g., squares and courtyards), designed to encourage appropriate use and interaction among people and featured by furnishings that facilitate dialogue and spontaneous engagement (e.g., benches, tables, open-air games, equipment for specific activities—work, study, cultural exchange—for physical activity and active breaks, shelters, and protection elements). The community’s interactions are also visible in spaces that promote mutual aid, collaboration, and shared services, such as book-sharing activities. These spaces are designed with flexible and transformable products that simplify community activities, such as chairs, tables, covers, storage products, and landscaping materials for managing shared spaces like urban gardens;
• Quality of access to public buildings, such as HoCs, designed so that the architectural space and its elements are accessible, welcoming, and inclusive. This includes the integration of furnishings like seating and furniture that not only facilitate access to the services offered but also promote social interaction and inclusiveness;
• Identity elements of the neighbourhood consisting of architectural and landscape choices that define landmarks or an integrated design of furnishings and wayfinding systems that express the neighbourhood’s brand.

3.1.3. Active Neighbourhood

It is an efficient, energetic, industrious neighbourhood that stimulates mind and body. The built environment is designed to encourage and facilitate physical activity, providing ample opportunities for residents to engage in movement, exercise, and playful recreation. It is culturally rich and engaging, fostering a sense of vibrancy and vitality (Figure 9).

The active neighbourhood is expressed through the following:

• Existence of areas and street furniture setups that promote secure physical activities, both individual and group-oriented, involving the provision of safe and appealing equipment, supported by inclusive information systems to ensure proper usage;
• Presence of pathways integrated in the normal routine of its inhabitants equipped with furniture products for light body movement, suitable for different ages and needs and favouring activities such as active breaks; presence of inclusive wayfinding systems to connect and enjoy the spaces described above, as well as street furniture accessories to be applied in the same spaces and dedicated to refreshment and rest (e.g., drinking fountains, benches for resting and stretching, tables for eating food, shelters and covers to protect from excessive heat, cold, and bad weather conditions);
• Signposted and attractive stairs in public buildings, stimulating physical activity;
• Spaces furnished with multigenerational games and dedicated to the stimulation of physical activities; spaces prepared to host temporary events related to physical and recreational activities; and collective, convivial, creative, interactive spaces prepared to host artistic and cultural events furnished with flexible and transformable furnishing products to handle different temporary needs.

3.1.4. Neighbourhood of the Senses

It aims to create an environment that is both stimulating and preserving the sensibilities of body and mind. This is achieved through the systematic integration of the five senses—smell, hearing, sight, touch, and taste—fostering a sensory-focused connection between the residents and the built environment around them (Figure 10 and Figure 11). By engaging the senses in a holistic manner, this neighbourhood creates an immersive and enriching experience for its inhabitants.

The neighbourhood of the senses is expressed through the following:

• Pathways in which the citizen is protected from air and noise pollution, as well as stimulated through the emission of pleasant olfactory and acoustic stimuli (e.g., nature sounds), obtained through urban morphology, architectural elements, and street furniture products that produce shielding, mitigate noise and olfactory pollution and diffuse pleasant sounds, i.e., support and create soundscaping systems;
• Inclusive wayfinding systems that provide information and guidance towards sensory stimulation paths, access to natural elements, and visual exposure to nature, also raising awareness of noise and air pollution. Designs that carefully consider colour use, incorporate visually appealing products, and utilise materials that are pleasing to the touch and eye, with a preference for natural materials that blend with the surrounding context;
• Spaces and products that promote healthy food culture, providing spaces for urban agriculture (e.g., urban garden equipment) and raising awareness of food waste; spaces promoting care and nurturing practices during all stages of life, including childhood, such as breastfeeding stations.

3.1.5. Green Neighbourhood

It promotes health and well-being through the facilitation of contact between living beings, particularly between humans and nature (Figure 12). By intentionally integrating nature into the built environment, residents are able to experience the restorative effects of these interactions.

The green neighbourhood is expressed through the following:

• Connections with open territory and ecological corridors; related wayfinding systems to orient and inform citizens about the presence and use of these aspects;
• Public green areas with spaces, paths and furnishing products that encourage outdoor activities (such as sport, physical activity, socialising, study, work); the space is furnished with products that integrate into the natural system with as little impact as possible and through the use of materials and shapes that are as natural as possible. Inclusive wayfinding systems inform and guide citizens towards contact with urban nature and green areas, as well as highlighting and enabling access to riverbanks;
• Street furniture systems, which are modular and can be equipped with plants and vegetation, to encourage citizen participation in the creation of urban greenery;
• Systems (including information and wayfinding) to support separate collection and bottom–up actions of circular economy (e.g., collection of used clothes, used and still usable products, recycling of reusable raw materials).

3.1.6. Smart Neighbourhood

It is capable of harnessing contemporary technologies and knowledge to create a direct, informative, and self-generating contact with its residents (Figure 13). This approach is data-based and human-centred, with the aim of improving people’s understanding of elements relevant to health promotion. The built environment utilises cutting-edge technologies to interact nimbly with the citizen, tailoring its interactions and services to the diverse needs and preferences of its residents.

The smart neighbourhood is expressed through the following:

• Presence of inclusive information systems, i.e., connected, interactive, and attractive furniture products in terms of setting up information spots (e.g., interactive kiosks) mainly aimed at disseminating and receiving information for more efficient citizen services;
• Furniture items designed to utilise renewable energy sources by encouraging direct engagement with citizens, such as charging stations for small devices and interactive information points that are energy self-sufficient;
• Furniture products and information systems that raise awareness on issues such as the promotion of healthy lifestyles also through creative operations (e.g., guerrilla communication).

3.1.7. Neighbourhood of the 1500 m

It promotes the use of urban space based on the principle of proximity (Figure 14 and Figure 15). This approach encourages healthy activities and the accessibility of essential services within the local sphere. The proximity of these elements is measured and evaluated according to their reachability through slow modes of transportation, such as walking or cycling, within a radius of 1500 m.

The neighbourhood of the 1500 m is expressed through the following:

• Enhancing sustainable transportation (e.g., soft mobility) by implementing support systems for public mobility and interconnectivity, optimising pedestrian pathways for walkability. This includes information services, interactive tools for ticketing, and assistance features, along with designing spaces and connecting routes to improve overall mobility;
• Furniture products that promote the use of active mobility means and modes such as safe and connected bicycle and light vehicle (e.g., scooters) parking spaces, bicycle repair stations, and information points and wayfinding systems dedicated specifically to active mobility;
• Spaces and furniture products that encourage the use of active transportation methods, such as safe and interconnected parking spaces for bicycles and light vehicles (e.g., scooters), bicycle repair stations, and information points and wayfinding systems specifically designed for active mobility;
• Spaces and systems to support the use of mobility sharing also through information products, user-friendly, well-marked, connected, and interactive parking spaces;
• Spaces furnished with products that promote the best conditions for walkability of accessible routes, e.g., through the presence of benches, tables, fountains, and covers;
• Support spaces and systems to improve the safety of crossings and traffic areas;
• Application of close-to-citizen attractions that enhance the walking experience through active interaction; products and spaces furnished with playful recreational solutions to improve waiting and parking in public urban mobility (e.g., through shelters and waiting or intermodal exchange spaces).

3.2. Characteristics and Variables of a Healthy and Inclusive Neighbourhood

Each of the seven themes is defined by a set of general characteristics that capture the multifaceted nature of healthy and inclusive neighbourhoods. For each of the general characteristics identified, the research has also defined a corresponding set of specific characteristics and subsequent variables. The HNH framework structure is thus composed of themes (n = 7), general characteristics (n = 25), specific characteristics (n = 67), and related variables. The components of this assessment framework can be applied to the analysis of the built environment, allowing for a comprehensive evaluation of the neighbourhood’s performance across the various themes, or they can be used as driving factors and variables to achieve a high-quality neighbourhood design.

4. Discussion

4.1. Contribution to Current Planning Models and Resources for Urban Health

The HNH framework, like earlier resources focused on planning healthy environments, aims to make a contribution by addressing key inquiries such as defining a healthy city [19], determining metrics for a healthy urban planning [31,106], and devising strategies to raise public awareness about urban health [107,108].

Although there is an extensive array of resources available for creating urban spaces with a focus on health from an urban planning perspective [99], only a small fraction of these resources specifically addresses the neighbourhood scale [13,14,15,16,17], out of which none provide guidance for lower design scales (e.g., product design for urban furniture). The HNH Framework aims to fill this gap by offering a unique and modest contribution to the development of procedures for identifying strengths and areas for improvement in the design of urban neighbourhoods, thereby addressing the need for more detailed and nuanced guidance at the local level.

Key aspects of the HNH Framework that promote advancement in this context are as follows:

• Multidisciplinary Approach: HNH framework adopts an interdisciplinary perspective, drawing insights from various academic disciplines to provide a comprehensive understanding of neighbourhood dynamics;
• Multiscalar Perspective: HNH framework operates at multiple scales, examining neighbourhood characteristics at both the local and broader societal levels;
• Thematic Organisation: The neighbourhood characteristics are organised into seven overarching themes, allowing for a structured and coherent analysis of the various factors that shape a neighbourhood’s healthy built environment;
• Synthesis and Systematization: HNH framework synthesises and systematises the complex web of neighbourhood characteristics, providing a clear and structured way to analyse and understand these dynamics;
• Spatialization and Design Focus: The HNH framework establishes spatial variables essential for comprehending how to translate the analysis from checklists into design insights for transforming the built environment of neighbourhoods.

By adopting this multidisciplinary and multiscalar approach, the HNH conceptual framework has made significant strides in advancing our understanding of the multifaceted nature of neighbourhoods and the factors that contribute to their overall well-being and sustainability, pursuing the following objectives:

• Focusing on the neighbourhood scale: rather than approaching health from a solely individual or broader societal perspective, the HNH framework recognises the crucial role that the neighbourhood built environment design plays in shaping the health and well-being of its residents and in facilitating appropriate access to primary healthcare services (e.g., HoCs);
• Emphasising the community dimension: by focusing on the community dimension, the research acknowledges the importance of social connections, collective engagement, and the shared experiences of residents in promoting overall health and inclusivity;
• Promoting design that is sensitive to differences and not biassed towards the dominant culture or norm: the HNH framework strives to create environments that are welcoming, supportive, and responsive to the diverse range of individuals and groups that make up a community;
• Recognizing the neighbourhood as a holistic system: the HNH framework views the neighbourhood as a complex, interconnected system, where various factors, such as the built environment, social dynamics, and access to resources, all contribute to the health and well-being of the community.

By positioning the neighbourhood and community as the central focus for addressing health-related concerns, the HNH framework offers a comprehensive and holistic approach to understanding and improving the overall well-being of urban populations. This shift in perspective underscores the importance of considering the local context and the unique characteristics of each community when developing design strategies and interventions aimed at promoting health and inclusivity.

4.2. Contribution to the HNH Research Project Development

To address citizens’ needs, structure dialogical activities with stakeholders, and establish design contexts, the HNH framework was utilised as a research tool in both desk and in-the-field activities during the research project’s subsequent phases [31]. The outcomes of all activities contributed to enhancing and informing the HNH framework, as shown in the operational model in Figure 16.

Desk activities encompassed the examination of regional, metropolitan, and municipal planning as well as the analysis of neighbourhood inhabitants and their characterization in relation to the HNH framework. In-the-field activities moved on two parallel tracks.

The first field activity involved on-site observation of the built environment of the two selected neighbourhood areas within the city of Florence for cartographic elaboration. An interdisciplinary survey of the area was conducted, using the HNH framework as a guide to identify and observe various elements of the built environment. This was followed by the creation of an open-Source map, which defined and localised areas, spaces, and buildings that contribute to the seven themes of the HNH. The open-Source map could be divided into seven thematic maps, each corresponding to a HNH framework theme. These maps would highlight the strengths and weaknesses of the neighbourhood area, which will be discussed in future publications. The second field activity focused on the engagement phase, which entailed involving various stakeholders from institutions, Houses of Community (HoCs), associations, and citizens through diverse participatory methods and tools. Utilising the HNH framework as a research instrument, stakeholders participated in semi-structured interviews, healthy labs, and open space labs [109]. Innovative techniques like card sorting were employed to prioritise themes during interviews. The collective outcomes of these activities, along with survey findings, were analysed to create a comprehensive overview of the neighbourhood’s strengths, weaknesses, strategies, and insights, aligning these results with the conceptual framework’s seven themes.

4.3. The HNH Framework Value in Practical Use

The theoretical framework developed in the HNH research project can serve as a practical valuable reference for analysing and designing public spaces and functions, with the aim of promoting health and inclusivity in the neighbourhood.

For instance, the HNH framework can be used (i) to evaluate the performance of a neighbourhood in terms of health and inclusivity; (ii) to design or renovate a healthy neighbourhood; (iii) to run a collaborative design process with a focus on health promotion; and (iv) to increase public awareness of health concerns.

Municipal administrations can use the seven themes to assess the health of their city’s neighbourhoods in terms of the built environment, i.e., public spaces and pathways. By identifying the presence or absence of spatial variables associated with each theme in the urban space, maps can be created to represent the neighbourhood’s strengths and weaknesses. By processing these maps, it is possible to create a health map that can be used as a tool to raise awareness about health issues among citizens. Additionally, the HNH framework offers design insights to integrate health-promoting features into the neighbourhood built environment through interconnected actions that link the House of Community with the surrounding environment and network it with the community at both the physical and social levels. The creation of design strategies according to the HNH framework will be discussed in further publications.

The model of the seven themes also serves as a tool to facilitate the participatory process with interested stakeholders (active citizenship, informal groups, third sector organisations, representatives of local government—e.g., neighbourhood councillors) to define priority themes for the design of redevelopment interventions; local residents can use the HNH framework to pinpoint priority areas for action that offer the greatest potential to enhance the health of their communities.

In conclusion, the HNH framework can aid city institutions responsible for health and care promotion by providing crucial guidance on emphasising health-promoting factors to encourage healthy lifestyles, behaviours, and a health-conscious approach to urban space use.

4.4. Limits of the Research

The HNH research project started in January 2022, and the research phase related to the definition of the HNH framework was conducted in the first 6 months. This timeline influenced the referenced timing for the citations used in the work. Moreover, none of the publications included in Table 1, Table 2 and Table 3 directly explore the correlation between pandemics and healthy neighbourhoods or cities concerning the impacts of COVID-19. It is worth noting that, for instance, the Italian Ministry of Health’s document titled “Guidance Document for Urban Planning with a Focus on Public Health” was primarily established before the COVID-19 health emergency. Despite this timing, the document asserts that its validity is not diminished; rather, it underscores its relevance.

Another limitation of the research could be the fact that the HNH project is an action-research initiative focused on developing a tool tailored to the local context of Florence. Given this objective, the need for international compliance of the framework was not considered as a crucial factor in selecting the research methods.