Influence of health equity-based Healthy City infrastructure on walking practice

Objectives: This study examined the associations between individual and regional factors, with a focus on Healthy City infrastructure, particularly the inclusion of health equity principles in Healthy City ordinances, and the walking practice of local residents in South Korea. Methods: Using cross-sectional data from the 2023 Community Health Survey and municipal-level statistics, a two-level multilevel logistic regression model was applied to analyze the data on 222,165 adults residing within 228 local government jurisdictions. Results: Walking practice was significantly associated with demographic and health behavioral factors at the individual level. At the regional level, public transportation usage and inclusion of health equity in Healthy City ordinances were positively associated with walking practice. Conclusion: Health equity-oriented Healthy City infrastructure—such as ordinances embedding equity principles—was positively associated with residents’ walking practice and may serve as an indirect indicator of equity-focused urban health governance. However, more refined measures are needed to further elucidate the role of Healthy City infrastructure in promoting healthy behaviors.