The Built Environment and Health (Frank et al. Chapters 1 and 3)

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The Built Environment and Health(Frank et al.
Chapters 1 and 3)
Geography 3432Environment and Health

• Discussion
• Frank et al. Model
• Physical activity and health
• Suburbanization and design

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Discussion

• How does the built environment effect health?
• What specifically is the focus of Frank et al.?

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Frank et al.s Framework
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Elaboration of Framework

• Built environment where we live and work
• Public health outcomes, e.g., obesity, heart
  disease, stress
• Activity patterns esp. walking bicycling
• Land use e.g., proximity home, work school
• Design small scale features that influence how
  people feel about an urban environment
• Transportation systems esp. for walking,
  biking, driving, public transit

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Health Patterns

• Premature death (e.g. cardiovascular disease)
  and disability (e.g., osteoporosis) from
  preventable diseases
• Obesity increasing
• risk factor for all sorts of illness/disease
• Many health risks decrease with increased
  physical activity

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Causes of Death

• note the causes that disappear in later period

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Obesity

• Overweight
• 1 category above normal Body Mass Index (based
  on heightweight ratio)
• Obese
• 2 categories above
• Prevalence
• 1999-2000 CDC study US 31 obese, 34
  overweight 65 above normal

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• Obesity Patterns
• increasing over time
• Causes of Obesity
• diet
• activity

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20 Minute Workout?

• 80s early 90s 20 minutes vigorous exercise
• 1996 US Surgeon General report
• 30 minutes of moderate activity on most days

1980s aerobics tv show The 20 Minute Workout
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Moderate Activity Benefits

• Muscle strength
• Blood pressure
• e.g., Reduction risk coronary heart disease on
  par with stopping smoking!
• Depression and anxiety
• Obesity
• Skeletal development of kids
• Bone density adults
• Independence (esp. elderly)

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Guideline Active

• moderate-intensity physical activity for at least
  30 minutes on 5 or more days of the week or
• OR
• vigorous-intensity physical activity 3 or more
  days of the week for 20 or more minutes

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Sedentary Reap New Benefits Quickest
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Modifiable Behaviours and Mortality
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Improve How Much?

• If half sedentary population became irregularly
  active (not quite guideline) total deaths drop
  by
• CHD 3.9
• Colon cancer 2.5
• Diabetes 1.5
• If same population met activity guidelines
• CHD drop 7.1
• Colon cancer drop 7.4
• Diabetes 5.2

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Genetics or physical activity

• Maybe premature death/disability is mostly
  genetic?

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Genetics or physical activity
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Improvements in Physical Activity Over Time?
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Discussion

• What explains low physical activity in North
  America?

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Interconnected Causes of Sedentary Lifestyles

• Behavioural
• victim blaming
• choice available, e.g., transportation
• Suburbanization
• landuse
• design
• Time
• what happened to the 35hr work week?
• Wealth
• very much so

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Physical Activity and Wealth
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Is suburbanization bad for your health?

• Garden Cities
• started late 1800s
• reaction to overcrowded and dirty large cities
• access to nature (healthy)
• best aspects of rural and urban living

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Garden Cities vs Industrial Cities

• Other Examples of Cities/Suburbs Inspired by the
  Garden City Movement
• Shaker Heights, Ohio
• Kapuskasing, Ontario

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Full Circle

• Olmstead designer (Central Park), architect,
  writer
• advocate for residential outside CBD space,
  greenery
• CBD too crowed, stressful and generally unhealthy
• Levittown NY and PA post war American (and
  Canadian) dream
• first suburbs entire communities
• traffic calming

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Transportation Modal Choice
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TransportationChildren and Modal Choice
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TransportationChildren and Modal Choice
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Whats the Epidemiologic Evidence?

• Many studies show significant but weak
  relationships between measures like sprawl,
  walkability etc. and activity,
  overweight/obese, depression, alcohol abuse
  (Renalds et al. 2010 A systematic review of built
  environment and health, Family and Community
  Health, 33(1) 68-78)
• most use ecologic or case-control study design
  (what does this imply?)

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Discussion

• How can we increase physical activity (not
  personally per se, but as a public health
  problem)?

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Design Barriers
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Design Barriers
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Designing for Pedestrians
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Exercise/Conclusion

• Do we need to sacrafice the American/Canadian
  dream to achieve walkable/cyclable cities?