Changing the environment to improve population health: a framework for considering exposure in natural experimental studies
Year: 2016
Type: article
Abstract: There is renewed optimism regarding the use of natural experimental studies to generate evidence as to the effectiveness of population health interventions. Natural experimental studies capitalise on environmental and policy events that alter exposure to certain social, economic or environmental factors that influence health. Natural experimental studies can be useful for examining the impact of changes to 'upstream' determinants, which may not be amenable to controlled experiments. However, while natural experiments provide opportunities to generate evidence, they often present certain conceptual and methodological obstacles. Population health interventions that alter the physical or social environment are usually administered broadly across populations and communities. The breadth of these interventions means that variation in exposure, uptake and impact may be complex. Yet many evaluations of natural experiments focus narrowly on identifying suitable 'exposed' and 'unexposed' populations for comparison. In this paper, we discuss conceptual and analytical issues relating to defining and measuring exposure to interventions in this context, including how recent advances in technology may enable researchers to better understand the nature of population exposure to changes in the built environment. We argue that when it is unclear whether populations are exposed to an intervention, it may be advantageous to supplement traditional impact assessments with observational approaches that investigate differing levels of exposure. We suggest that an improved understanding of changes in exposure will assist the investigation of the impact of complex natural experiments in population health.
Language: English
Subfield: Statistics and Probability
Field: Mathematics
Domain: Physical Sciences
Open Access status: hybrid
Estimated APC paid: $3,079
Funders: Wellcome Trust, United Kingdom Clinical Research Collaboration, National Institute for Health and Care Research, British Heart Foundation, Centre for Diet and Activity Research, Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council
Awards: G2892497062, G3141281824, Environmental and policy approaches to changing physical activity behaviour, UKCRC Centre of Excellence in Diet and Physical Activity Public Health Research, G3295433799, Measuring and Evaluating the Travel, Physical Activity and Carbon Impacts of Connect2, G3588080011, G4723127869, Centre of excellence in diet and physical activity public health., G5788181014, Health impacts of the Cambridgeshire Guided Busway, Understanding how changes to the environment may promote walking, cycling and physical activity, G6552938480, G7534805650, G7686000633, Promoting active travel in the UK: effectiveness and equity of individual and infrastructural interventions, G8840408989, Centre for Diet and Activity Research (CEDAR)
OpenAlex ID: W2327636044