Quality of health promotion programs is associated with built environment features in Jerusalem

Abstract Background Neighbourhood built environment and infrastructure influence health status. Greater walkability, green spaces and healthy food accessibility can enhance healthy lifestyles. While health promotion programs (HPPs) have been shown to improve population's health, little is known about the reciprocal influences between the built environment and quality and distribution of HPPs across a city. Methods HPPs operating in Jerusalem focusing on healthy diet and physical activities were located and evaluated for quality using the European Quality Instrument for Health Promotion (EQUIHP) in 2017. HPPs location, intervention type and characteristics of the target population were documented. Using Geographic Information System (GIS), we combined infrastructure data from the Jerusalem Municipality and socioeconomic score (1 lowest - 10 highest) from Israel's Central Bureau of Statistics. Associations between distribution and quality of HPPs and the built environment at the neighbourhood (n = 115) level and municipal planning area level (7 areas) were assessed. Results Overall 93 HPPs operating in 349 locations and serving 582,500 adult residents, were identified in Jerusalem. Higher HPP quality, at the municipal planning area, was associated with higher density of HPPs, longer bike or walking lanes and fewer food stores. Positive significant (p