Experts Explore Links Between Health Problems and the Built Environment

NEW YORK CITY, April 7??? Chronic diseases like obesity, asthma, diabetes, heart disease and depression are increasingly prevalent in our society in part because of how our communities are being designed. A lack of sidewalks and bike paths fuels America???s obesity epidemic, for example. The construction of sprawling suburban communities increases our reliance on automobiles, which degrades air quality and exacerbates respiratory ailments. Paving more land involves chopping down more trees, which eliminates a natural cooling source and triggers the use of electricity-guzzling air conditioners.

Audience members listening in Hosack Hall as leaders in health, urban planning and policy discussed the relationship between health and the built environment.

These and other human health impacts related to the built environment were the focus of a recent daylong conference at The New York Academy of Medicine, co-sponsored by the Centers for Disease Control and Prevention (CDC). All presenters agreed that a connection exists between community design and the erosion of health. ???How we???ve built our own environment has affected our climate, has affected our water, has affected our air,??? said Richard J. Jackson, M.D., M.P.H., Director of the CDC???s National Center for Environmental Health, and the keynote speaker at the March 25 conference, attended by about 150 people.

But they also concurred that more scientific proof of this link is needed in order to influence regional and local planning initiatives, such as creation of more pedestrian-oriented growth patterns that can positively affect health. ???In my romantic view, if we really can make the scientific link between community design, activity level and chronic diseases???I think we have the opportunity to make very significant changes in patterns of growth,??? said Robert Yaro, Executive Director of the Regional Plan Association (RPA). ???It will take a generation to turn things around.???

The anticipated epidemics of the 21st century???obesity, heart disease, depression and respiratory problems, among them???are in many ways byproducts of our built environment, Jackson explained. Adults of today were able to walk to school, the library and the park when they were kids. Many kids of today rely on someone to drive them to these venues, which may be located 10 miles away. Youths feel less autonomous as a result, and this has psychological repercussions, Jackson said. Ritalin use among kids nationwide has increased from 70 million doses in 1987 to 360 million in 1998. The new, more sprawling community layouts also leaves kids getting less exercise???the average child today is 11 pounds heavier than in the 1970s.

The odds of being active would increase if our communities were designed to foster activity, said Ana Diez Roux, M.D., Ph.D., M.P.H., Associate Director of the Center for Social Epidemiology and Population Health at the University of Michigan. Several decades ago, more people strolled in their neighborhoods and walked to the store because the community layout made it possible. Even today, walking is about 40 percent higher in neighborhoods with pre-1947 homes than in communities with homes built after 1977, her research shows. ???Transportation and urban planning policies should be viewed as health policies,??? Diez Roux said.

But despite an intuitive link between the structure of neighborhoods and cardiovascular disease, among other chronic ailments, there???s only some empirical evidence to support it, she said. ???There???s an intuitive sense that how one organizes space is going to influence health, but the amount of evidence is limited at this point,??? agreed David Vlahov, Ph.D., Director of the Academy???s Center for Urban Epidemiologic Studies. (An October conference at the Academy will explore the health effects of urban environments. Visit www.isuh.org/conference.html for details).

For some health woes, a clear correlation with environmental factors already exists. Asthma cases have substantially increased in recent years as we have spent more and more time indoors, said Paul Giardina, Chief of the U.S. Environmental Protection Agency???s Radiation and Indoor Air Branch in Region 2, which includes New York. People today spend 90 percent of their time inside, where air pollution is significantly more concentrated than outdoors, Giardina said. A recent study found that reducing indoor asthma triggers???like mold, dust mites, animal dander, cockroach allergens and tobacco smoke???has a direct correlation to reducing asthma hospitalizations and school absenteeism, Giardina said. Lead paint is another example of an environmental factor that???s proven harmful to human health, explained Richard Roberts, J.D., President of the Urban Investment Group at Goldman, Sachs and Co., and an Academy trustee. Used extensively in housing projects for decades, lead paint caused childhood lead poisoning at alarming rates. Roberts helped to institute a mandatory lead inspection and abatement program throughout the housing projects when he was Commissioner of the city Department of Housing Preservation and Development in the ???90s. This has resulted in a dramatic 46 percent drop-off in childhood lead poisoning cases since 1999.

Beyond the physical ailments that the built environment can cause, it also affects our psychological state, said environmental psychologist Gary William Evans, Ph.D., a professor at Cornell University. Living in high-rise housing, living in a home where there are too many people per room, living with malodorous air, getting too few hours of daylight, and living near a noisy airport have all been shown to be predictors of psychological distress and/or depression, Evans said. To be most ???livable,??? our built environment should be designed to foster feelings of control and mastery, which are eroded by overcrowding and noise. It should encourage social interaction, which is eroded by a lack of public spaces and town squares. And it should offer ???restoration,??? which is nurtured through design elements like spots of quiet solitude that help people recover from mental fatigue. ???To me, the issues of planning and public health are one and the same issue: urban planning and public health have to begin to fit together,??? added Elliott Sclar, Ph.D., Director of the Graduate Program in Urban Planning at Columbia University.

A host of laws have been adopted since the late ???60s to encourage environmentally sound planning. An Environmental Impact Statement must be completed on every development project so that policymakers realize the consequences of the proposed action??? will more emissions/traffic /noise/odor result????and are equipped to consider alternatives. ???The built environment attracts other activities: delivery trucks, buses, taxis, garbage trucks, just to name a few,??? said Robert Kulikowski, Ph.D., Director of the city???s Office of Environmental Coordination. ???If we work to see that environmental impacts are addressed or mitigated, then we are going to see a benefit to public health.???

In order to reshape society???s patterns of growth, the public must be made to understand the detrimental health affects caused by urban sprawl, said RPA???s Yaro. ???Most of us like living in sprawling communities,??? he said. Fortunately, we are starting to realize the repercussions of our planning choices. Eighteen states have adopted ???smart growth??? initiatives, and the governors of both Massachusetts and New Jersey have made the taming of sprawl the hallmarks of their administration. Yaro said he is eagerly awaiting the day when we can create ???Sprawl Kills??? bumper stickers that are backed by scientific evidence. It???s not here yet, but the day will come.

While solutions to some of the problems are obvious ??? build more bike paths in cities, and more sidewalks in rural areas??? the roadblock, as always, is funding. The CDC???s Jackson said that the next federal transportation bill proposes a budget of $150 billion for the next six years, nearly all of which is designated for highways. Only 0.6 percent is allocated for pedestrians, and virtually nothing for bike paths and other environmentally-friendly transportation options. More state and local governments would climb aboard the smart-growth movement if financial incentives were offered to do so, he said.

???We???ve got to put together a plan for health and the environment in the 21st century,??? said Jackson. ???Health professionals can???t do our jobs without the architect, without the planner, without the builder. They profoundly influence our health and the health of every generation.???

Posted on April 7, 2003

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