Health, the Built Environment and Smart Growth: Linkages

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Health, the Built Environment and Smart Growth
Linkages Solutions
Tina Zenzola, MPH
Safe Healthy Communities Consulting
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Urban Sprawl
Separated land uses, low densities and leap-frog
development
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Asphalt Nation

• 250 increase in vehicle miles traveled (915
  billion miles) (1960-1997)
• US average 73 mins/day of driving
• 200 increase in workers commuting to another
  county

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Low priority for other modes of transportation
Safety
Access
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Expansive greenfield development
Developing open space and agricultural land at a
rate of 2.2 million acres per year
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Schools on the fringe
Now on the edge of neighborhoods too far for
kids to walk.
Then the social and physical center of the
community.
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The Public Health Impacts of the Built Environment

• Physical activity
• Obesity chronic disease
• Pedestrian injuries
• Asthma respiratory disease
• Crime violence
• Social capital
• Child psychosocial development
• Elder health mobility
• Water quality quantity
• Mental health
• Health disparities

SHCC
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Smart Growth is a Public Health Strategy
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Smart Growth a Public Health Strategy
MIX LAND USES TAKE ADVANTAGE OF COMPACT
BUILDING DESIGN
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The burden of physical inactivity

• The Problem
• 25 of adults are sedentary
• 60 of adults not active enough
• The Outcome
• 64 overweight and 1 in 3 obese
• Diabetes, heart disease, cancer, depression
• Physical inactivity is a primary factor in over
  250,000 deaths annually.
• Medical costs associated with physical inactivity
  and its consequences may exceed 76 billion
  annually.

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Data Sources 2000 BRFSS, 1999 NHANES, Powell
1994, Pratt et. al. 2000
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS
1993-94
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS
1995-96
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS
1997-98
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS
1999
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS
2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
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Our Indicator Species is in trouble

• The rate of overweight in kids has doubled
• 70 chance of being overweight/obese as adults
• 78 dont get recommended activity
• 1 in 3 will be diabetic

1st generation of kids in the US that arent
expected to live as long as their parents
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The disappearing walk to school

• 1 in 4 trips made by 5-15 year olds are for the
  journey to and from school.
• Only 10 of these trips are made by walking and
  bicycling.
• 25 of the morning rush hour traffic is parents
  driving kids to school

Photo www.pedbikeimages.org / Dan Burden
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Neighborhood environment is one of the strongest
predictors of whether a person will be physically
active.
Brownson, et al. 2001 King, et al. 2000.
SHCC
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Growing body of evidence

• San Diego study 70 minutes more physical
  activity/week among residents in walkable
  neighborhood 35 vs. 60 overweight (Saelens,
  Sallis, et. al. 2003)
• 6 lb weight difference in sprawling vs. compact
  counties
• King County study 5 increase in neighborhoods
  walkability index correlated with 32 increase
  in active transportation 0.23 point reduction in
  BMI (Frank, Sallis, et. al. 2006)

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Community Design Policies Work!
The Task Force on Community Preventive Services
concluded that

• Community-scale policies design are effective
• Zoning for compact, mixed-use development
• Transit-oriented development
• Policies related to street design connectivity
• Street-scale policies design are effective
• Traffic calming
• Street lighting
• Improving street crossings

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Does design make a difference for kids?

• Marin, Co SR2S evaluation 64 increase in number
  of kids walking to school with safety traffic
  calming improvements encouragement.
• CA SR2S evaluation 15 of kids walked to school
  more often after physical improvements (vs. 4
  when no improvements).

Designing to Reduce Childhood Obesity. ALR,
February 2005
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But, isnt it really just aboutmaking bad
choices?

• People make decisions in a context so we have to
  consider the context.
• Individual vs. environmental-level interventions.
• Most major public health improvements have been
  due to improvements in our living/working
  environment.

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CREATE RANGE OF HOUSING OPPORTUNITIES CHOICES
Smart Growth a Public Health Strategy
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Housing Health Disparities

• Housing is a Social Determinant of Health
• Physical conditions substandard housing
• Concentration of poverty contributes to poor
  health status

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The Graying of America

• By 2025, one in five Americans will be 65 years
  or older and over 6 million will be 85 years

Source U.S. Bureau of the Census, Projections of
the Total Resident Population by 5 Year Age
Groups and Sex, with Special Age Categories,
Middle Series 1999- 2100 (NP-T3),
www.census.gov/population/www/projections/natsum.h
tml
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Senior health and mobilityAging in Place

• Housing transportation options
• Fewer falls injuries
• Increased mobility
• Maintain social networks
• Overall physical function improved
• Increase lifespan, quality of life

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CREATE WALKABLE NEIGHBORHOODS
Smart Growth a Public Health Strategy
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Pedestrian Injury Death

• 6 of trips on foot, but 25 of MV deaths are
  pedestrians (San Diego)
• Per mile, walking is 23x more fatal than driving
• Seniors and school kids are the most vulnerable
• Most dangerous wide, arterials in suburban
  areas (South and Western metro areas)
• 50 less risk of pedestrian injury for kids
  living near speed humps

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The forgotten pedestrian

• Traffic flow prioritized over pedestrian safety
• Only 1 Federal Hwy funds for pedestrians
• Engineering practices traffic laws reflect bias
  lack of understanding of child pedestrian
  behavior

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Battery Hens Cooped up for life

• Kept indoors
• Restricted boundaries mobility
• Cant stretch, flap wings
• Weak bones and muscles
• Frustration, fighting, pecking

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Battery Hen Children?

• Cradle-room-house-doorstep-neighborhood
  sequence interrupted
• Smaller Cognitive maps
• Social isolation of teens
• ADHD Ritalin
• Future attitudes about driving, walking

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FOSTER DISTINCTIVE, ATTRACTIVE COMMUNITIES WITH A
STRONG SENSE OF PLACE
Smart Growth a Public Health Strategy
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Healthy environments promote social networks
social capital

• Loneliness and isolation are toxic social
  relationships are healthy
• People with strong social networks
• Live longer
• Have fewer heart attacks and heart disease
• Are less depressed and use alcohol and drugs less
• Have fewer teen births
• Are healthier overall

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PRESERVE OPEN SPACE, FARMLAND, NATURAL BEAUTY
CRITICAL ENVIRONMENTAL AREAS
Smart Growth a Public Health Strategy
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Trees Natures Balm
Living with trees
Living without trees
Living without trees
Living with trees

• Crime
• Aggression
• Coping

• ADHD
• Stress
• Social ties

Kuo, et. al. University of Illinois, Urbana
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Water quality quantity

• Fewer impervious surfaces
• Contamination from runoff

• Groundwater pollution
• H20 shortages

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PROVIDE A VARIETY OF TRANSPORTATION CHOICES
STRENGTHEN DIRECT DEVELOPMENT TOWARDS
EXISTING COMMUNITIES
Smart Growth a Public Health Strategy
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Driving Ourselves Crazy Stress and mental health

• Longer commutes contribute to stress, road rage
• Stress heart disease, musculosketal symptoms,
  traffic collisions
• Depression, anxiety

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Cars, Kids Asthma

• Most common chronic childhood disease up by 160
  since 1980
• Cal EPA Studies 7 more asthma among kids living
  in neighborhoods with high traffic pollution
• 2X greater risk of asthma symptoms in 5-7yr olds
  living 250 ft or less of major road (McConnell
  et. al. 2006)
• Almost 10 of CAs public schools located within
  500 feet of highvery high volume roads

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The Public Health Potential of Smart Growth
Safe Healthy Communities Consulting, 2003
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• Integrating Health into
• Community Design
• The challenge facing those with responsibility
  for assuring the health and quality of life of
  Americans is clear. We must integrate our
  concepts of public health issues with urban
  planning issues. Urban planners, engineers, and
  architects must begin to see that they have a
  critical role in public health. Similarly, public
  health professionals need to appreciate that the
  built environment influences public health as
  much as vaccines or water quality.
• Jackson Kochtitzky, 2001

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