Aging and Community Design Atlanta Area Agency on Aging June 17, 2005

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Aging and Community DesignAtlanta Area Agency
on AgingJune 17, 2005

• Howard Frumkin, M.D., Dr.P.H.
• Department of Environmental and Occupational
  Health
• Rollins School of Public Health, Emory University
• Atlanta, Georgia

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The population is aging.
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Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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By 2030, 1 in 5 residents in metro Atlanta will
be over age 60.
Source Kathryn Lawler, Aging Atlanta.
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Atlantas elderly live both in the central city
and in the suburbs.
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Source S. Rosenbloom, The Mobility Needs of
Older Americans. Brookings, 2003.
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Source Kathryn Lawler, Aging Atlanta, based on
1990 and 2000 Census data.
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Concentrations of 65 Population
Source Kathryn Lawler, Aging Atlanta, based on
2000 Census data.
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Many of the elderly are on limited incomes.
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Source Kathryn Lawler, Aging Atlanta, based on
2000 Census data.
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Most older men live with a spouse. Many older
women live alone.
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Source Kathryn Lawler, Aging Atlanta, based on
2000 Census data.
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Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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Most older people travel by car.
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Source S. Rosenbloom, The Mobility Needs of
Older Americans. Brookings, 2003.
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Older drivers

• Make as many trips as younger drivers
• Often drive friends who can no longer drive
• Tend to drive shorter trips
• Tend to avoid highways
• Concentrate their driving between 9 am and 1 pm

Sources S. Rosenbloom, The Mobility Needs of
Older Americans. Brookings, 2003 G. Giuliano,
Land use and travel patterns among the elderly.
Transportation in an Aging Society, TRB 2004.
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Source G. Giuliano, Land use and travel
patterns among the elderly. Transportation in an
Aging Society, TRB 2004.
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Most elderly people are generally healthy.
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Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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But many older people are sedentary and out of
shape.
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Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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And many elderly people have health problems,
often implying disabilities.
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PHYSICAL ACTIVITY
CLEAN AIR
Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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NEARBY DESTINATIONS
Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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GOOD PEDESTRIAN INFRASTRUCTURE
ALTERNATIVES TO DRIVING
Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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LEGIBLE NEIGHBORHOODS
Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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SOCIAL INTERACTION
Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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23 of older adults have a disability that
prevents them from leaving their homes.
Source Kathryn Lawler, Aging Atlanta, based on
2000 Census data.
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PHYSICAL ACTIVITY
CLEAN AIR
Source Federal Interagency Forum on Aging.
Older Americans 2004 Key Indicators of
Well-Being.
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What do older people need in a community?
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What do the elderly need in a community?

• Housing alternatives.
• Community-based
• Affordable
• Opportunities to mix and mingle.
• Opportunities for physical activity.
• Clean air.
• Transportation alternatives.
• Easy access to amenities (community centers,
  parks, medical faculties, church, etc.).

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Are we designing and building communities that
provide these things?
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The streetscape
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Sidewalks
The National Never Walk Campaign
11 Strategies
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Strategy 1Dont Build Sidewalks
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Strategy 2Build Repellant Sidewalks
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Strategy 3Allow Sidewalks to Disintegrate
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Strategy 4Build Treacherous Sidewalks
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Strategy 5Obstruct Sidewalks
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Strategy 6Use creative design.
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Strategy 7Crosswalks should be dysfunctional,
if not silly.
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Strategy 8Combine Multiple Strategies
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Strategy 9Never place an interesting or
useful destination within walking distance of
where anybody lives
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Strategy 10Just Say It
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Strategy 11Make everything
car-accessible.Everything.
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Pharmacies
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Dry Cleaners
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Booze
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Baked goods
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Flowers
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Auto Service
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Fine
Food
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Coffee
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A nice touch Braille buttons for blind drivers
Banking
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Mail Boxes
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Drive-Thru Weddings Little White Chapel Las
Vegas, Nevada
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Child support payments
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Davidson, Tennessee
Pensacola, Florida
Drive-Thru Funeral Homes
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Parking
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Trees
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The result
April 22, 2003
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Could these community features affect the health
and well-being of the aged?

• ? air pollution
• climate change
• ? traffic-related injuries
• ? physical activity
• ? water quantity and quality
• ? heat island effect
• mental health impact
• ? social capital

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Air pollution
Source USEPA. 1970 - 2002 Average annual
emissions, all criteria pollutants. January 2005.
http//www.epa.gov/ttn/chief/trends/trends02/tren
dsreportallpollutants010505.xls
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Sprawl and climate change

• Forest loss (350,000 acres in metro Atlanta over
  30 years)
• CO2 emissions from motor vehicles

New York Times, Nov 27 2001
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U.S. Greenhouse Gas Emissions by Economic Sector,
2001
7
6
8
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19
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EPA, Inventory of U.S. Greenhouse Gas Emissions
and Sinks 199-2001. April, 2003.
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Potential Impacts of Climate Change on Human
Health
Morbidity/mortality
Heat
Morbidity/mortality
Severe weather events

• Climate change effects
• Temperature
• Sea level
• Precipitation

Vector biology
Infectious diseases
Air pollutants
Respiratory disease
Malnutrition
Food supply
Civil conflict
Morbidity/mortality/ dislocation
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Car Crashes
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Fatal crash involvement rates for older drivers,
United States, 1990 and 1995.
Source   Dellinger Am J Epidemiol,
2002155(3)234-241
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Crash fatality rates for older drivers, United
States, 1990 and 1995.
Source   Dellinger Am J Epidemiol,
2002155(3)234-241
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Automobile fatality rates by city,
2003(excluding pedestrian fatalities
deaths/100,000/year)
Source NHTSA, Traffic Safety Facts 2003.
www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSFAnn/TSF20
03F.pdf
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Dekalb Neighbor, July 4, 2001
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Trends Traffic Volume and Pedestrian
Fatalities
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Walking and biking shares of urban travel in
North America and Europe, 1995 Source Pucher and
Dijkstra, Promoting safe walking and cycling to
improve public health Lessons from the
Netherlands and Germany, Am J Public Health 2003
931509-16.
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Walking and biking shares of urban travel by age
in the US, Germany and the Netherlands,
1995 Source Pucher and Dijkstra, Promoting Safe
Walking and Cycling to Improve Public Health
Lessons from the Netherlands and Germany, Am J
Public Health, 2003 931509-16.
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Fatality and non-fatal injury rates in the US,
Germany and the Netherlands, 2000   Source Pucher
and Dijkstra, Promoting Safe Walking and Cycling
to Improve Public Health Lessons from the
Netherlands and Germany, Am J Public Health,
2003 931509-16.
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Non-walkable environment
Physical Activity
Sedentary lifestyle
Overweight
Adverse health outcomes
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Source Holtzclaw J, Transp Planning Tech 2002.
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Triple-wide coffins?
On the Final Journey, One Size Doesn't Fit
All. New York Times, September 23, 2003.
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Sprawl?
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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Prevalence () of overweight among children and
adolescents
Source 1999-2002 NHANES
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Inactivity, overweight and health
Evidence links inactivity and overweight with
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Relative Risk of cancer among men in the highest
BMI category, compared to those in the reference
category (BMI 18.5 - 24.9 ). shows
non-smokers. Source Calle et al., New Eng J
Med 20033481625-38.
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Relative Risk of cancer among women in the
highest BMI category, compared to those in the
reference category (BMI 18.5 - 24.9 ). shows
non-smokers. Source Calle et al., New Eng J
Med 20033481625-38.
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Diabetes among U.S. adults, 1990
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Diabetes among U.S. adults, 1991-92
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Diabetes among U.S. adults, 1993-94
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Diabetes among U.S. adults, 1995
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Diabetes among U.S. adults, 1997-98
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Diabetes among U.S. adults, 1999
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Atlantas heat island, 1972-93
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Chicago heat wave, 1995
Source Whitman et al., AJPH 1007871515-18.
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Road Rage

• 1990-96 51 ? rate of events in which an
  angry or impatient driver tries to kill or injure
  another driver after a traffic dispute.
• 10,000 reported incidents
• 12,610 injuries
• 218 deaths
• AAA Foundation for Traffic Safety, 1997

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Road Rage
SOURCE Mississippi State U., 1999 National
Highway Safety Survey. January, 2000.
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Self-reported aggressive driving behaviors (
respondents in each category)
Source MSU SSRC, 2000
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Social capital

• Social capital defined as
• Social networking and engagement
• Trust and reciprocity

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Community design and social capital

• Longer commute time ? ? social involvement
• Homogeneous housing subdivisions ? obstacle to
  aging in place
• Few third places ? ? social interaction
• Income inequality ? ? social involvement

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Sprawl and income inequality
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Sprawl and income inequality
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Could these community features affect the health
and well-being of the aged?

• ? air pollution
• climate change
• ? traffic-related injuries
• ? physical activity
• ? water quantity and quality
• ? heat island effect
• mental health impact
• ? social capital

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Smart Growth as Public Health?
Atlanta Journal-Constitution, May 12, 2000, May
17, October 30, 2000
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Features of smart growth

• Higher density, more contiguous development
• Preserved green spaces
• Mixed land uses with walkable neighborhoods
• Limited road construction, balanced by
  transportation alternatives
• Architectural heterogeneity
• Economic and racial heterogeneity
• Development and capital investment balanced
  between central city and periphery
• Effective, coordinated regional planning

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Where Do We Go From Here?

• Better research
• New partnerships
• Better messages
• Social marketing
• Celebrate synergy
• Showcase success

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BETTER RESEARCH
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Research issues

• On what scale to measure sprawl?
• Neighborhood
• County
• MSA
• What aspect(s) of sprawl matters?
• Connectivity, density, mixed use?
• How to combine environmental, nutritional,
  social, and behavioral factors?
• What design features work best?

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NEW PARTNERSHIPS
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Building healthy communities for the elderly
requires partnerships

• Urban planners
• Aging advocates
• Physicians and nurses
• Transportation engineers
• Epidemiologists
• Landscape architects
• Environmentalists
• Developers
• Lenders
• Neighborhood activists
• ...and many others.

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BETTER MESSAGES
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Key frames (and values)

• Smart Growth is about
• Wholesome, healthy places
• More choices
• Sense of community (better together)
• Fiscal responsibility (fix it first)
• True prosperity

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SOCIAL MARKETING
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CALIFORNIA SAYS ITS LONG ANTI-TOBACCO CAMPAIGN
HAS PAID OFFUSA Today, January 26 2005

• From 1988 to the present
• Adult smoking prevalence fell from 23 to 16
• High school smoking prevalence fell from 22 to
  13
• Lung cancer incidence fell from 73.6 to 57.9
  /100,000/year

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Elements of Social Marketing

• Understanding the competition
• Understanding target markets
• Creating mutually beneficial exchanges
• Segmenting markets and targeting based on
  anticipated return
• Maibach E. Recreating communities to support
  active living A new role for social marketing.
  Am J Health Promot 200318114-19.

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CELEBRATE SYNERGY
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SMART GROWTH good for Obesity! Heart
disease! Cancer! Depression! Diabetes! Gall
bladder! Social life!
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? Depression
? Air pollution
? CO2 emissions
?Physical activity
And by the way ? Infrastructure costs
? Social capital
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Synergy
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SHOWCASE SUCCESS
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A model from Europe
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Envisioning Change
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Conclusions

• Our aging population has specific needs
• We can design and build safe and healthy
  communities to meet these needs
• We can do it through
• Better research
• New partnerships
• Better messages
• Social marketing
• Celebrating synergy
• Showcasing success
• The elderly will benefitand so will everybody
  else

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Thank you!