Built Environment Design, Cancer Prevention & Inequality

Results from “Built environment design and cancer prevention through the lens of inequality”

Koohsari MJ, Nakaya T, McCormack GR & Oka K

The Built Environment and Cancer Prevention

The built environment refers to the human-made spaces that people use in their day-to-day lives, including where they work, live and recreate (1). There is increased interest in the role of these spaces in the cancer prevention continuum and this interest extends beyond understanding the relationship between the built environment and cancer prevention at the individual-level (2). Additionally, the built environment can be considered relevant in explaining some inequalities in cancer, specifically that some socially disadvantaged population subgroups who are at greater risk of developing cancer may often have lesser access to health supportive environments. A recent interdisciplinary article* focused on the links between the built environment and cancer prevention strategies at the primary, secondary and tertiary level, and considered the impact the built environment may have on cancer inequalities.

The Cancer Prevention Continuum and the Built Environment

At the Primary Prevention level cancer rates can be directly impacted by the built environment. Living in health-supportive built environments may limit exposure to urban carcinogenic sources (3), and reduce behavioral risk factors like physical inactivity, alcohol consumption, unhealthy diet and smoking (4). At the Secondary prevention level the built environment is related to cancer detection as it affects how individuals access cancer screening centres. Both geographic proximity and transportation access to these centres, as well as perceived urban design attributes such as aesthetics and safety (5) can impact people’s screening behaviour. Finally, at the Tertiary Prevention level cancer remission and survivorship outcomes are also influenced by the built environment. Survivors may rely on the built environment, such as public green space, for their daily behaviours, or may be exposed to environmental stressors such as noise, pollution, crowding, unsafe conditions and physical barriers to movement. Additionally, spatial proximity also impacts survivors’ access to healthcare facilities for regular visits.

Inequality, Cancer Prevention and the Built Environment

Inequality impacts cancer prevention at all three levels within the cancer prevention continuum. The ability to live in a health-supportive neighbourhood is greatly impacted by cost of living as built environment design attributes that support healthy living are often found in more affluent areas. This means that socially disadvantaged populations are often prevented from living in these neighbourhoods, exposing them to more environmental risk factors for cancer. The built environment can also inhibit spatial proximity to cancer screening centres and healthcare facilities or impede access to these facilities for vulnerable populations, creating disparities in access, especially for older adults, rural populations and people living with disabilities.

While the role of the built environment on cancer prevention remains unclear, the possible built environment-cancer links are important, especially when considering potential inequality challenges. Future studies should consider the extent to which socially disadvantaged populations can benefit from built environment change in relation to cancer risk.

Suggested Citation

Koohsari MJ, Nakaya T, McCormack GR, Oka K. Built environment design and cancer prevention through the lens of inequality. Cities. 2021 Dec;119:103385.

Written by Calli Naish, BAS; Infographic by Hallie Horvath & Calli Naish

Posted November 17, 2021


  1. Roof K, Oleru N. Public health: Seattle and King County’s push for the built environment. Journal of environmental health. 2008 Jul 1;71(1):24-7.

  2. Gomez SL, Shariff‐Marco S, DeRouen M, Keegan TH, Yen IH, Mujahid M, Satariano WA, Glaser SL. The impact of neighborhood social and built environment factors across the cancer continuum: current research, methodological considerations, and future directions. Cancer. 2015 Jul 15;121(14):2314-30.

  3. Turner MC, Andersen ZJ, Baccarelli A, Diver WR, Gapstur SM, Pope III CA, Prada D, Samet J, Thurston G, Cohen A. Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. CA: a cancer journal for clinicians. 2020 Nov;70(6):460-79.

  4. Whiteman DC, Wilson LF. The fractions of cancer attributable to modifiable factors: A global review. Cancer epidemiology. 2016 Oct 1;44:203-21.

  5. Beyer KM, Malecki KM, Hoormann KA, Szabo A, Nattinger AB. Perceived neighborhood quality and cancer screening behavior: evidence from the Survey of the Health of Wisconsin. Journal of community health. 2016 Feb 1;41(1):134-7.