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Article

Epidemic, Urban Planning and Health Impact Assessment: A Linking and Analyzing Framework

by
Xiji Jiang
1,
Dan Ye
2,3,*,
Wenlong Lan
1 and
Yinglu Luo
4
1
College of Architecture, Xi’an University of Architecture and Technology, Xi’an 710055, China
2
College of Architecture and Urban Planning, Tongji University, Shanghai 200092, China
3
Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong SAR 999077, China
4
College of City Construction, Jiangxi Normal University, Nanchang 330022, China
*
Author to whom correspondence should be addressed.
Buildings 2024, 14(7), 2141; https://doi.org/10.3390/buildings14072141
Submission received: 8 June 2024 / Revised: 2 July 2024 / Accepted: 5 July 2024 / Published: 12 July 2024
(This article belongs to the Section Architectural Design, Urban Science, and Real Estate)
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Abstract

:
The occurrence and spread of infectious diseases pose considerable challenges to public health. While the relationship between the built environment and the spread of infectious diseases is well-documented, there is a dearth of urban planning tools specifically designed for conducting Health Impact Assessments (HIAs) targeted at infectious diseases. To bridge this gap, this paper develops a comprehensive framework of an HIA for Urban Planning and Epidemic (HIA4UPE), formulated by considering the progression of public health incidents and the distinct transmission patterns of infectious diseases. This framework is designed to provide a comprehensive assessment by including a health risk-overlay assessment, health resource-quality assessment, health resource-equality assessment, and health outcome-impact prediction, enabling a multidimensional evaluation of the potential impacts of current environmental conditions or planning proposals on the incidence of infectious diseases. Furthermore, this paper advances the application of spatial analysis and computation, comprehensive assessment methodologies, and predictive analytics to conduct specific assessments. The theoretical framework and analytical tools presented in this paper contribute to the academic discourse and offer practical utility in urban planning and policymaking on epidemic prevention and control.

1. Introduction

The COVID-19 pandemic has alarmed the global community regarding the urgency of public health challenges, which can rapidly evolve into catastrophic events. The potential harm that infectious diseases can cause needs to be taken seriously. According to data released by the Institute for Health Metrics and Evaluation (IHME) in the Global Burden of Disease, it is estimated that, in 2021, there were 105.2 deaths from infectious diseases per 100,000 people worldwide. Meanwhile, global institutions, such as the WHO, began to focus on the role that urban planning could play in addressing public health. In 2020, the World Health Organization (WHO) and the United Nations Human Settlements Programme (UN-Habitat) released a pivotal resource guide, Integrating Health in Urban and Territorial Planning. This guide underscores the critical role of health as a central tenet in urban and territorial planning, advocating that prioritizes human and environmental health in urban development. This is especially important in the current era, characterized by the prevalence of infectious diseases. Existing studies have shown that urban planning is foundational in responding to acute infectious diseases, primarily manifesting in long-term prevention (anti-epidemic) and immediate emergency responses (against epidemic). Regarding long-term prevention, urban planning can strategically manipulate physical elements such as land use, population density, and green spaces to cultivate a conducive urban environment, thereby reducing the risk of residents being exposed to infectious diseases [1,2]. During the emergency response phase, the strategic spatial distribution of healthcare facilities—such as medical centers—and the availability of essential supplies become paramount considerations in urban planning. Meanwhile, creating community-centric health space patterns often results in enhanced resilience and adaptability [3,4]. Therefore, the potential exists to employ urban planning as a vital policy instrument for preventing and managing infectious diseases; however, a systematic and scientific application of urban-planning tools necessitates further investigation.
The Health Impact Assessment (HIA) is essential for embedding health considerations within various policies, fostering urban planning incorporating anti-epidemic and against-epidemic strategies. HIA can be an important tool for integrating public health considerations into urban-planning decision-making. The WHO began utilizing HIA tools during the third phase of the European Health Cities network’s development from 1998 to 2003. This initiative significantly contributed to forging a robust link between health and urban planning [5]. A quintessential example is the San Francisco Department of Public Health’s utilization of HIA to scrutinize development projects through a health lens in conjunction with collaborative efforts among other governmental entities and community organizations to propel health-oriented environmental planning [6]. In recent years, the role of HIA in urban planning has become increasingly pronounced. For instance, Fischer et al. [7], after examining spatial-planning documents in England, noted that there are between 100 and 200 plans or projects annually that incorporate HIAs, signifying a growing significance of this tool within the UK’s planning framework.
Despite HIA’s valuable applications in urban planning, the predominant focus has traditionally centered on noninfectious chronic diseases (NCDs) [8,9,10], traffic injuries [11], and physical activities [12,13]. However, there is a notable gap in attention to infectious diseases within the HIA framework. In urban planning, there is a relative dearth of quantitative HIA tools specifically tailored to address infectious diseases [14], a circumstance potentially linked to the shifting focus of public health discourse toward non-communicable diseases. The existing assessment instruments, while highly targeted, are particularly concerned with brownfield redevelopment [15] and industry-specific projects [16], indicating a need for enhanced applicability. Furthermore, the predictive scope of many assessment tools regarding health outcomes is limited, typically encompassing only a select few categories of infectious diseases, necessitating improved predictive capabilities.
Against this backdrop, employing HIA tools from an interventional perspective to evaluate the potential infectious disease implications of current environmental conditions, spatial plans, and proposed projects or initiatives presents both an urgent practical necessity and possesses planning applicability. This paper delves into the intricate relationship between urban planning, public health, and the HIA to construct a comprehensive theoretical framework. This framework is designed to leverage HIA tools for advocating urban-planning interventions to prevent and contain infectious diseases. In terms of the literature evidence, we conducted a comprehensive search on the Web of Science using a combination of keywords related to urban planning (or city planning or spatial planning), the built environment, infectious diseases (or public health events or epidemics), and Health Impact Assessment (HIA). We selected highly relevant, frequently cited, and recently published articles to synthesize the existing literature that explores the correlation between spatial factors and the transmission dynamics of infectious diseases, as well as the application and challenges of HIA. We also summarize and propose the analytical techniques and methods available for conducting an HIA targeting infectious diseases within urban planning.

2. Urban Planning, Public Health, and HIA

2.1. Urban Planning and Public Health

Globally, urbanization is invariably characterized by an aggregation of population, territorial expansion, and heightened construction density. These urban characteristics can exacerbate the transmission of infectious diseases, given the enhanced mobility and concentrated living conditions they foster. Throughout history, cities have been the epicenters of numerous epidemics, which have resulted in considerable mortality and substantial economic repercussions. The recurrent nature of these events serves as a stark reminder for policymakers and urban planners to implement proactive measures to reshape the urban environment. A retrospective examination of historical precedents, encompassing both ancient and contemporary urban settings, reveals a wealth of experience in managing and mitigating the impact of infectious diseases on urban populations.
In antiquity, the emergence of infectious-disease outbreaks frequently resulted in dramatic declines in urban populations, compelling rulers and architects to contemplate diverse preventative strategies to curb the onset and dissemination of such afflictions. For instance, the plague that ravaged Athens during the classical era caused a significant depopulation [17]. In response, the city transformed its street infrastructure, transitioning from the initial narrow, meandering pathways to a grid layout with orthogonal roads [18], ensuring adequate sunlight exposure and effectively controlling the epidemic. Similarly, ancient Rome enacted municipal policies to minimize residents’ exposure to mosquitoes, thereby reducing the risk of malaria. These initiatives included the drainage of swamps, the installation of covered sewerage systems, the clearance of vegetation from drainage channels, and the construction of brick or concrete buildings [19]. Eastern cities also embraced analogous measures. For example, Chang An established a comprehensive urban epidemic response system in ancient China, considering factors such as urban location, municipal infrastructure construction, isolation facility configuration, disease-affected zone management, and urban greening [20].
The genesis of contemporary urban planning can be traced to the 19th century, when it emerged as a strategic response to the rampant spread of infectious diseases within burgeoning urban centers. Urban planners formulated benchmarks for urban health facilities and residential development, enhanced subterranean drainage systems, and implemented zoning regulations. These pioneering initiatives substantially ameliorated urban living conditions and curtailed the prevalence and transmission of infectious diseases. However, the advent of bacterial theory in the early 20th century precipitated a divergence between urban planning and public health disciplines [21]. As the incidence and intensity of urban infectious diseases waned, urban planning began to decouple from its original public health underpinnings. The transition into the new millennium marked a paradigm shift, with chronic non-communicable diseases emerging as the predominant health challenge for urban dwellers. This development catalyzed a renewed convergence of urban planning and public health [22]. Many research studies [17,18,19] and practical planning initiatives [20,21] were undertaken in this contemporary reintegration. However, the focal point of these efforts gravitated away from infectious diseases, reflecting the evolving landscape of urban health challenges. Next, we illustrate how HIAs are applied in urban planning.

2.2. HIA and Its Application in Urban Planning

The HIA has its conceptual genesis in Environmental Impact Assessment (EIA), from which it has progressively refined its scope to concentrate on health-related evaluations. The WHO provided a seminal definition of HIA in 1999, characterizing it as “a practical approach used to judge the potential health effects of a policy, program or project on a population, particularly on vulnerable or disadvantaged groups”. Within the urban-planning domain, HIA serves as a pivotal analytical instrument and can scrutinize the latent health implications inherent in distinct planning proposals or among competing schemes. It is equipped to propose strategic recommendations to attenuate or preempt detrimental health impacts. The application of HIA in urban planning underscores its significance in fostering a health-oriented approach to urban development, aligning with influential contributions to the field [23,24].
HIAs can be executed as standalone evaluations or integrated into broader frameworks such as the Integrated Impact Assessment (IIA) or Environmental Impact Assessment (EIA). HIAs can also be tailored to address specific health outcomes, exemplified by the Mental Health Impact Assessment (MHIA) [21]. Presently, HIAs are predominantly concentrated on chronic-disease evaluations [25,26,27,28], with a comparatively limited scope allocated to assessing infectious diseases. A notable case is the HIA conducted in Baltimore, USA, by Litt et al. [15] that assessed the health implications of urban brownfields on adjacent communities, encompassing infectious respiratory ailments. Moreover, a select array of HIA tools has been devised to predict the prospective health ramifications of urban environments concerning infectious diseases. Still, there are inherent limitations in their evaluative and predictive efficacy. For instance, Lau et al. [16] formulated a predictive HIA matrix for hookworm disease, capable of forecasting future health impacts predicated on a spectrum of risk indicators, but they failed to connect with urban planning and related policies. Another pertinent example is the macroscope assessment tool, crafted by scholars from the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, which designates influenza and pneumonia as outcomes for health prediction [15]. Nonetheless, this tool employs a rudimentary logarithmic linear regression model, neglecting the intricacies of infectious disease-transmission dynamics, thereby necessitating rigorous validation of its predictive accuracy.
HIA has been prominently featured as essential in developing global health cities [5]. The evaluative outcomes of the HIA contribute novel insights and a foundational basis for urban planning [29]. Numerous countries have embraced HIA practices within urban planning, extending across various domains. These include comprehensive urban-planning initiatives [30], local development frameworks [31], land-use and -development strategies [32], slow traffic systems [33,34], zoning regulations [35], urban regeneration projects [36], and significant reconstruction endeavors [37]. Various HIA tools have been developed to facilitate these assessments, such as the Health Development Measurement Tool (HDMT), introduced by the San Francisco Department of Public Health; and the Parks and Trails Health Impact Assessment Toolkit, developed by the U.S. Centers for Disease Control and Prevention. However, most of these tools are predominantly scale-based, with a relative dearth of instruments capable of providing predictive analytics and direct guidance for planning schemes. Furthermore, there appear to be no HIA tools specifically tailored for urban planning in the context of infectious diseases.

3. Epidemic and Built Environment’s Influence

3.1. Characteristics of Epidemic

The epidemic, defined as “caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another” [38], unfolds through three principal stages: source, transmission, and susceptible person [39]. The emergence of epidemics can precipitate an Emergent Public Health Event, leading to substantial disease burdens and formidable health challenges. These acute public health incidents are often marked by high intensity, challenges in preparation and prevention, intricate management and resolution processes, and grave repercussions [40,41]. From a developmental standpoint, it is imperative to underscore the importance of routine, comprehensive prevention measures, and enhancing response capabilities in urban planning and governance.

3.2. The Influence of Built Environment on The Epidemic

Empirical evidence increasingly indicates that elements of the built environment can significantly contribute to mitigating and controlling infectious diseases. The genesis and dissemination of such diseases result from a complex interplay between ecological and social dynamics [42], shaped by many factors. These include the connectivity between cities, modes of transportation, emergency response mechanisms, and the intricate web of social network interactions. Within the context of the built environment, both the “remote environment” and the “local environment” are recognized as pivotal in influencing the transmission dynamics of infectious diseases. Urban planning, as a discipline, can exert targeted interventions on these environmental determinants [43,44,45].
Remote environments, characterized by their macroscopic attributes, profoundly influence the aggregation and movement of populations, as well as the overarching state of emergency preparedness and the allocation of resources to combat infectious diseases. These factors can systematically influence the incidence and propagation of infectious diseases. Cross-regional urban connections, driven by processes such as globalization and urbanization, amplify the flows of people and goods, thereby becoming significant conduits for disseminating infectious diseases [46,47,48]. Urbanization is a disruptive force in the transmission of local infectious diseases [1,42,46,48,49,50,51]. The siting and construction of large-scale projects, such as transportation hubs and exhibition centers, substantially impact the management of infectious disease control, including the entry, isolation, and centralized treatment of affected individuals [52,53,54]. Moreover, as the intensity of an epidemic escalates, there is a sharp increase in the demand for societal anti-epidemic resources and food, which in turn elevates the standards required for logistical transportation support [55,56].
The local environment, defined by its intimate connection with individuals or groups, directly influences residents’ exposure risks and provides fundamental support for emergency scenarios. This environment can be effectively modulated through strategic spatial design optimization and the thoughtful arrangement of essential health infrastructure. Key components of the built environment, such as urban form, open spaces, ecological settings, and the distribution of health facilities, are direct determinants that can affect the likelihood of epidemic occurrences. Firstly, the concentration of populations and the consequent rise in urban density often lead to heightened healthcare demands and a marked escalation in the risk of infectious disease outbreaks and transmission [1,42,46,57]. Secondly, a favorable urban wind environment [42] and water environment [42,44,57] and favorable community ecosystems [58,59] can enhance urban living conditions. These external urban environments may play a pivotal role in reducing the risk of pathogen transmission and thus safeguarding public health. Furthermore, the configuration of urban facilities impacts epidemic dynamics in various ways. On a positive note, the judicious scaling and placement of primary medical facilities, such as hospitals, and emergency epidemic-prevention infrastructure (e.g., mobile hospital wards) bolster urban overall emergency-response capacity [60]. Community emergency service facilities offer critical services, including triage, initial treatment, non-hospital care, or isolation, and their agility in adapting to emergent situations is a vital adjunct to conventional emergency medical resources [61]. Conversely, given that 75% of human infectious diseases are zoonotic in origin [62], venues such as wet markets and waste-disposal facilities, which entail frequent interactions with animals or their remains, are significant potential sources of infection [57]. These sites necessitate careful consideration in urban planning and management to mitigate public health risks.

4. A Comprehensive Framework of HIA for Urban Planning and Epidemic (HIA4UPE)

4.1. Establishment and Composition of HIA4UPE

Wang et al. [63] proposed an HIA framework aimed at urban planning, including the health risk-overlay assessment, health resource-quality assessment, health resource-equality assessment, and health-outcome assessment. Expanding upon this foundational work, we put forward an integrated and analytical framework termed HIA for Urban Planning and Epidemic (HIA4UPE) according to three key links of prevention and control epidemic (i.e., isolating pollution sources, interrupting transmission routes, and protecting susceptible populations), from the perspective of the development process of public health events. As can be seen from Figure 1, this framework underscores the importance of conducting health-impact assessments based on the built environment throughout the entire spectrum of times, both in peacetime and during infectious diseases. It advocates for analysis and the formulation of corresponding planning intervention strategies from the three environmental aspects of infectious disease control and prevention. Building upon this foundational framework, we compiled Table 1, which integrates direct literature evidence (Section 3.2) and a summary of the literature on the common categories of infection sources, transmission pathways, and susceptible populations frequently associated with spreading infectious diseases [64,65,66].
This table shows the specific built-environment factors and urban-development characteristics that can be regulated in the development process of public health events and the corresponding key links of intervention. This systematic approach facilitates a more targeted and effective public health response within the urban-planning paradigm.
Within the framework of the four principal evaluative components, the analysis of health risk factors is primarily dedicated to assessing the potential distribution of diverse sources of infection and the conceivable adverse health repercussions that may stem from the interplay between these sources and their transmission pathways. The assessment of the quality of health factors and the equity of resources is concentrated on the potential salutary effects that could be realized by obstructing transmission pathways and safeguarding vulnerable populations. The evaluation in this area predominantly targets health facilities and the ecological environment, which are instrumental in mediating the impact of infectious diseases. Moreover, we build a sophisticated predictive model by synthesizing the findings from the health-risk, factor-quality, and resource-equity analyses with the temporal and spatial data of infected individuals. These models can provide foresight into an epidemic’s current status or prospective trajectory under various policy interventions or strategic initiatives (i.e., health outcomes can impact prediction).

4.2. Assessment Modules of HIA4UPE

4.2.1. Health Risk-Overlay Analysis

The health risk-overlay analysis critically assesses the potential adverse effects on the emergence and dissemination of infectious diseases within existing conditions or proposed urban-planning initiatives. Its fundamental goal is to delineate the possible distribution of covert infection sources and integrate environmental factors that substantially influence pathogen transmission and human exposure, including elements such as wind and water environments [67,68]. Water bodies have been confirmed to be associated with the occurrence of certain infectious diseases (such as hepatitis and cholera) [68], and the three-dimensional urban form (including building height, volume, layout, arrangement, etc.) affects wind speed and wind patterns [67], thereby influencing the spread and diffusion of pathogens.
This analysis involves juxtaposing health risk factors within the immediate local environment—encompassing sites like urban wet markets, waste collection, transportation, and disposal facilities—with remote environmental elements that could facilitate disease spread, such as globalization, urbanization, and rural–urban development. Additionally, it considers local environmental factors like wind patterns, water systems, and urban density. Through this multi-layered approach, a thorough examination of the spatial dynamics of infectious disease occurrence, dissemination, and severity is performed. The analysis aims to identify risk impact zones and to formulate targeted intervention strategies for areas identified as high risk.

4.2.2. Health Factor-Quality Analysis

Regarding the positive impact on infectious diseases, we advocate for a health elements-quality analysis that identifies and assesses elements with the potential to exert positive effects on prevention and control measures within current conditions or urban-planning frameworks. This analysis primarily extends to emergency support facilities and urban open spaces. Emergency support facilities are pivotal in providing robust backing for epidemic response initiatives and sustaining residents’ daily routines during extraordinary periods [69], including medical facilities dedicated to detection, treatment, and isolation, as well as facilities for the production and transportation of medical supplies, food, and large-scale public projects with the capacity for “pandemic transition”, such as exhibition centers. Green areas and squares are crucial proximate environmental elements for urban open spaces. They act as vital ventilation corridors during normalcy [70] and can be repurposed as temporary medical isolation zones, goods transportation, or storage facilities during epidemics [71]. An empirical study in Guangzhou, China, analyzed the possibility of urban–rural units serving as emergency medical facilities; the study found that factors such as park size, traffic conditions, location, and wind direction are key factors affecting their ability to serve as emergency medical facilities [72].
Generally, the assessment of health services levels forms the cornerstone of this analytical section, which includes considerations of the supply of health resources, the comprehensiveness of their configuration, accessibility, and their service area. Urban planners can derive recommendations on the strategic placement and arrangement of health facilities based on the outcomes of these analyses.

4.2.3. Health Resource Equity Analysis

The dynamics of infectious disease transmission among populations exhibit considerable variability [73], underscoring the imperative to concentrate on vulnerable demographics as a fundamental element in advancing health equity [74]. It is essential to underscore the significance of integrating spatial distribution, health requirements, and service provision for susceptible groups within the broader context of health risk analysis for infectious diseases. This holistic approach is instrumental in pinpointing locales with pronounced health challenges and devising targeted optimization strategies. For example, the elderly, children, and individuals with pre-existing chronic conditions are frequently categorized as vulnerable to infectious diseases. Consequently, augmenting investment in sanitation infrastructure within communities frequented by these groups is imperative [75]. This enhancement should encompass establishing healthcare facilities that correspond to the scale of the population served, ranging from hospitals to primary healthcare centers [76]. Furthermore, the superimposition of areas with high concentrations of susceptible populations onto zones deemed at elevated risk facilitates the formulation of more nuanced community planning and management policies. Such policies can effectively intervene in locales or in proximity to areas where the risk of infectious disease transmission is heightened.

4.2.4. Health Outcome-Impact Prediction

Given the distinct attributes of infectious diseases, examining prevailing environmental conditions or implementing targeted intervention strategies can offer insights into their potential implications for disease transmission. This foresight, in turn, facilitates the anticipation of epidemic progression trends [42,77,78]. In the planning phase, both distal and proximal environmental factors warrant scrutiny as pivotal elements for analysis. The outcomes of assessments concerning health risk, health quality, and health equity should be regarded as significant determinants. By amalgamating temporal and spatial epidemic data, it becomes feasible to rationalize the selection of predictive models from various disciplines, such as dynamic modeling [74], logistic growth models [75], or machine-learning algorithms [79]. Such an evaluation can forecast infectious disease dissemination’s spatial and temporal contours under prevailing environmental conditions, without interventions. It can elucidate the effects of both immediate and broader environmental factors on disease spread and, based on these insights, devise pertinent planning interventions. Furthermore, the evaluation can predict the health outcomes associated with specific planning initiatives, foreseeing the alterations in the spatial and temporal expansion of infectious diseases that might result from potential environmental modifications. This capability is instrumental in the further refinement of planning strategies and the proposition of pertinent policy measures.

5. Analyzing Methods of HIA4UPE

Figure 2 provides a schematic representation of the intricate analytical procedures and potential methodological approaches for assessing health risks, quality, equity, and predictive outcomes. Risk (negative), quality (positive), and equity are relatively independent and permit individualized analysis. The boundary of zones serves as an analytical deliverable, underpinning the development of strategic planning interventions. The predictive analysis of health outcomes is multifaceted, demanding an integrated assessment of affected individuals’ spatial and temporal distribution and progression patterns. It also involves the discernment and appraisal of health-impacting zones, coupled with the contemplation of planning interventions and regulatory measures, including but not limited to lockdowns and the suspension of public transit. Therefore, the HIA4UPE framework mandates a repertoire of diverse analytical techniques. These can be broadly stratified into three principal categories: spatial analysis and computational modeling, integrative evaluation, and prospective predictive analytics.

5.1. Spatial Analysis and Computational Technology (SACT)

The SACTs are a multifaceted domain that includes methodologies such as ecological simulation, impact area analysis, spatial accessibility analysis, spatial matching, and spatial aggregation. These methodologies are extensively applicable across the various stages of the four major assessment dimensions. The environment is intrinsically associated with the occurrence and prevalence, influencing transmission pathways by affecting the dispersal of microorganisms or vectors [80,81]. Leveraging principles from fluid dynamics [82,83], ecological simulation methods are utilized to simulate the wind fields and water flows within the analysis area. By overlaying potential sources of infection, such as wet markets or landfills, it becomes possible to analyze the spatial spread range of pathogens or viruses, delineating multi-level impact areas.
Subsequently, spatial accessibility analysis techniques can be employed for the service area analysis of health elements, typically using an opportunity-based cumulative calculation method to consider the spatial supply-and-demand relationship between health facilities (supply points) and the health demands of the population, thereby reflecting facility accessibility. The main methods include the Floating Catchment Area method [84], the Two-Step Floating Catchment Area (2SFCA) Method [85,86], and the Gaussian-based two-step floating catchment area method (Ga2SFCA) [87]. The spatial matching feature analysis often incorporates tools such as Lorenz curves [88], Gini coefficients [88], and bivariate spatial autocorrelation [89,90], which can uncover the degree of spatial distribution matching between health resources and certain groups, thereby reflecting the equity of health-resource allocation.

5.2. Comprehensive Assessment Technology (CAT)

The CATs are predominantly employed for the integrated evaluation of health risks and health quality. This process entails amalgamating various health risk or quality assessment indices into a unified overall evaluation value derived from the assessment values of individual health risk or quality elements. The methodologies frequently applied in this context include the Entropy Weight Method [91,92], the Analytic Hierarchy Process (AHP) [91,92], the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) [93,94], the Fuzzy Comprehensive Evaluation Method [95,96], and the Grey Relational Analysis Method [97,98]. Additionally, advanced or hybrid analytical techniques build upon the algorithms mentioned above, such as the Fuzzy-TOPSIS [94,99] and the Hierarchy–Entropy Weight Method [100].
In general, the outcomes of comprehensive assessments can provide a basis for formulating holistic planning and intervention strategies for infectious diseases. They can also identify elements that should be prioritized or concerned within the planning process and support delineating clusters for health risk and quality areas. Firstly, the composite health risk or quality index based on various analytical units, such as grids or administrative districts, reflects the current health status (concerning infectious diseases) at different spatial locations within a city. The deployment of visual mapping techniques enables a discernible comprehension of regions at an elevated risk for infectious diseases or where the related services and safeguards might be deficient. Secondly, determining the relative importance of each factor (i.e., the weight) is a crucial aspect of comprehensive assessment methods [101,102]. This can reveal significant spatial risk factors in the urban spread of infectious diseases and spatial quality factors that have a more important impact on prevention and control, thereby guiding the planning and formulation of targeted intervention strategies. It is crucial to acknowledge that while many methods apply to comprehensive assessments, each has its own set of applicable conditions and limitations. For instance, AHP requires less quantitative data, but its reliance on subjective weighting may suffer from a lack of persuasiveness [103]. Therefore, research must prudently select the appropriate evaluation techniques and methods contingent on the specific analytical concerns and objectives.

5.3. Prediction Analyzing Technology (PAT)

PAT facilitates the simulation and prediction of the spatiotemporal dissemination of infectious diseases, grounded in a dataset reflecting patient spatiotemporal behaviors at a defined scale. It integrates the assessment results of three modules—health risk-overlay analysis, health resource-quality analysis, and health-equity analysis—and incorporates relevant policy management measures, such as traffic control and centralized isolation of patients. Specifically, the analysis consists of three main steps:
Policy and monitoring alignment: In accordance with the policy environment, delineate the trajectories of population mobility and the rigor of infectious disease surveillance. Concurrently, ascertain the contagion levels in pivotal zones, informed by the abovementioned assessment findings. This step lays the “data foundation” and establishes the fundamental guidelines for spatiotemporal predictive analytics.
Spatiotemporal patient profiling: Clarify the current spatiotemporal location of patients and depict their behavioral trajectories. Characterize the transmission chain, summarize behavioral characteristics, and identify the main spatial agglomeration areas. Time–geographic-related methods [104,105] can be used for this analysis.
Disease transmission simulation: With the spatiotemporal data of patients and the disease transmission dynamics as a basis, employ advanced analytical techniques such as system dynamics [106], logistic growth [107], or machine learning [79] to simulate the spatial spread of the disease over a certain period.
It merits emphasis that existing artificial intelligence reinforcement learning can create a complex interactive environment involving various objects and mechanisms related to real map models. This capability enables simulated individuals to interact dynamically with their environmental context, updating their status in real time [108]. Such advancements hold the potential for more granular and dynamic assessments of the efficacy of various planning interventions for curbing the spread of infectious diseases.

6. Conclusions

The HIA has become an essential tool for integrating health considerations into urban planning. The advent of the COVID-19 pandemic has accentuated the need to explore its potential in curbing the tide of infectious diseases. Within the current milieu characterized by a marked increase in the incidence and severity of infectious disease outbreaks, examining Health Impact Assessments’ pivotal role in establishing a nexus between urban planning and infectious disease mitigation has emerged as a pressing and consequential pursuit. Such a nexus is paramount for augmenting the spatial environment’s efficacy in prevention, containment, and response mechanisms pertaining to public health crises.
A constellation of critical insights and conclusions has emerged after meticulously examining the existing literature. Initially, it is evident that contemporary urban planning is inextricably linked to the domain of public health, mirroring a historical progression that has oscillated from integration to divergence, culminating in a contemporary renaissance of interconnectivity. The HIA has emerged as a pivotal catalyst in this renaissance, amplifying its relevance and influence within the urban-planning discourse. Subsequently, the prevailing utilization of the HIA is predominantly concentrated on evaluating the ramifications of spatial planning and development projects on key health determinants, such as residents’ physical activity levels, exposure to environmental pollutants, the prevalence of non-communicable diseases, and traffic-related risks. In contrast, a notable dearth of analytical focus exists on the dynamics of infectious disease emergence and dissemination. Lastly, the aggregation of empirical evidence underscores the substantial influence that diverse components of the built environment exert on the genesis and propagation of infectious diseases. These influences can be bifurcated into two distinct typologies: remote and local environment. Both jointly influence the transmission and spread of infectious diseases within cities, and spatial planning must fully understand the macroscopic health impacts of the remote environment and prioritize interventions in the local environment. Additionally, the influence and path of environmental factors are closely related to the key elements of the three infectious diseases: infection, transmission, and susceptibility.
Leveraging this groundwork, we introduce an evaluation framework from the perspective of planning intervention, involving different periods of public health events. This framework is aptly denoted as the Comprehensive Framework of Health Impact Assessment for Urban Planning and Epidemic (HIA4UPE). As an integral component of this framework, the HIA is meticulously segmented into four specialized domains: health risk-overlay analysis, health factor-quality analysis, health resource-equity analysis, and health outcome-impact prediction. This structured approach underscores the imperative of multidimensional assessment, focusing on the critical vectors of infectious source control, transmission pathway interruption, and susceptible population safeguarding. It is posited that the ideation of urban-planning interventions must be calibrated with these three pivotal facets in view. Additionally, we advance a triad of analytical methodologies, proposed for implementation within the Health Impact Assessment discourse of this study: Spatial Analysis and Computational Technology, which provides sophisticated geospatial insights; Comprehensive Assessment Technology, offering a holistic appraisal of health determinants; and Prediction Analyzing Technology, which enhances the prognosticative accuracy of health outcomes.
Despite the contributions of our research, several limitations require acknowledgment. Initially, the built-environment factors susceptible to intervention and analytical methodologies necessitate continuous augmentation and sophistication. The literature evidence cited within this paper does not claim to be exhaustive, and the advent of novel technological advancements presents an opportunity to enhance the precision of our evaluative outcomes. For example, the ScLouvain and ScLeiden Methods introduced by Wang et al. [109] provide an innovative, automated community network-based detection methodology. These methodologies surpass the conventional accessibility algorithms, such as the two-step floating catchment area method, in terms of flexibility and ensure the spatial continuity of the delineated service areas, facilitating a more discerning analysis of health-facility accessibility across a spectrum of scales and configurations. Furthermore, the applicability and efficacy of the holistic framework presented in this paper are subjects that demand ongoing empirical validation. Therein lies the need for additional targeted empirical validation to further refine the framework and to augment its capacity to offer robust evaluative guidance. The overarching objective of our research is to provide an effective assessment framework and tool to inform planning practices and policymaking in response to urban infectious disease prevention and control. We regard this initiative as a groundbreaking foray that sets the stage for successive endeavors in Health Impact Assessment, concurrently fostering the perpetual enhancement of the Comprehensive Framework of Health Impact Assessment for Urban Planning and Epidemic (HIA4UPE).

Author Contributions

Conceptualization, X.J. and D.Y.; methodology, X.J.; validation, D.Y.; formal analysis, X.J.; resources, Y.L. and W.L.; writing—original draft preparation, X.J. and D.Y.; writing—review and editing, D.Y. and W.L.; visualization, X.J.; supervision, D.Y. and X.J. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Xi’an University of Architecture and Technology Talent Research Initiation Project, grant number 1960324011.

Data Availability Statement

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. HIA4UPE framework.
Figure 1. HIA4UPE framework.
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Figure 2. Analyzing the program of HIA4UPE. Note: Blue represents spatial analysis and computing technology, orange represents comprehensive evaluation technology, and green represents predictive analysis technology.
Figure 2. Analyzing the program of HIA4UPE. Note: Blue represents spatial analysis and computing technology, orange represents comprehensive evaluation technology, and green represents predictive analysis technology.
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Table 1. Controllable built-environment factors and key intervention links in the process of public health events.
Table 1. Controllable built-environment factors and key intervention links in the process of public health events.
Built EnvironmentPublic Health Event
Development Phases		Intervention
Principles		Key Links
DimensionSpecific
Factors		BeforeOccursAfterPreventionEmergency
Response		Controlling the Infectious SourceInterrupting the Transmission PathwayProtecting Susceptible Populations
Remote environmentGlobalization△●△△● √
Integration△●△△● √
Urbanization△●△△●√√
Site selection and construction of large-scale projects○●○○● √√
Medical industry structure and layout○●○●● √√
Logistics transportation△●△△● √
Food production and processing△●△△●
Local environmentDensity●△○●△ √
Wind environment●△○●△ √
Water environment●△○●△ √
Public transportation△●△△● √
Open space●△○●△ √√
Classification and grading of medical facilities●●●●● √√
Community emergency services facilities●●●●● √√
Wet market○●○○●√√√
Refuse collection, transfer, and disposal station○●○○●√√√
Note: ● High intervention; ○ moderate intervention; △ low intervention; √ intervention links.
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MDPI and ACS Style

Jiang, X.; Ye, D.; Lan, W.; Luo, Y. Epidemic, Urban Planning and Health Impact Assessment: A Linking and Analyzing Framework. Buildings 2024, 14, 2141. https://doi.org/10.3390/buildings14072141

AMA Style

Jiang X, Ye D, Lan W, Luo Y. Epidemic, Urban Planning and Health Impact Assessment: A Linking and Analyzing Framework. Buildings. 2024; 14(7):2141. https://doi.org/10.3390/buildings14072141

Chicago/Turabian Style

Jiang, Xiji, Dan Ye, Wenlong Lan, and Yinglu Luo. 2024. "Epidemic, Urban Planning and Health Impact Assessment: A Linking and Analyzing Framework" Buildings 14, no. 7: 2141. https://doi.org/10.3390/buildings14072141

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