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Built Environment

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Stephanie Child

on 14 March 2014

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Transcript of Built Environment

Implications and Future Directions
Fundamental Causes of Health Disparities
A Structural Framework
Health and the Built Environment
Built Environment
Examining BE and Health Disparities
Access
to resources are dependent upon built environments
- Sanitary living conditions, clean air
- Fresh fruits and vegetables
- Social capital (ties with neighbors)

Built environments are not distributed evenly across the population (segregation, income)
Built Environments and Health Disparities
Leading causes of death around the world are increasingly from chronic conditions

Chronic conditions are not distributed evenly across populations

Health disparities: differences between groups, gaps in the quality of health across a variety of demographic variables
(gender, race, age, education)
Background:
Health Disparities
Physical environment that supports our basic needs: water, sanitation, shelter
Urban planning and design: Street connectivity, residential density, land use mix, public transportation systems, policies
Structural components (Cohen, 2000) directly influence individuals through behavior
Availability of products
Physical structures
Social structures and policies
Built Environment (BE)
Growing amounts of data link the BE with multiple health outcomes and behaviors (Villanueva, 2013)
Neighborhood environments are linked with physical activity (Frank, 2006)
Diabetes linked with poor living conditions/ disempowerment (Green, 2003)
Land mix use/policies linked with food deserts (Walker, 2010)
Green space linked with mental health/stress/longevity (Maas et al, 2006, Takano, 2002)
Built environments are also thought to be linked with psychosocial mediators of health, such as 'sense of place', neighborhood disorder, and collective efficacy (Cohen, 2008, Sampson, 2002)
BE and Health Outcomes
Link and Phelan (1995) argue that
social structures
(socioeconomic status) are fundamental causes of disease, and health disparities

That is, they are underlying mechanisms that contribute to risk factors/risk conditions associated with health outcomes
Fundamental Cause of Health Disparities
More studies are needed to examine the role of the built environment on health
Relationship between built and social environment
In context of, and independently of race and SES

Examining health within the context of an individuals' environment may provide insight into the barriers of health promotion initiatives
"We shape our buildings, and afterwards our buildings shape us." -Churchill, 1943
Moving Forward
The BE will play a critical role in the future:
Massive urbanization

Urbanization is a major contributor to health disparities (Moore, 2003, Vlahov, 2002).

Understanding how the built environment contributes to health will be key to eliminating structural sources of health disparities.
Car free cities (Chengdu, China and Dubai)

Millennium Cities/Village Initiatives (Africa)

Urban revitalization/reconstruction
Natural disasters
Creation/zoning of mixed use land
Mixed income housing projects
Favelas (Rio de Janiero)
Race/Ethnicity and Socio-Economic Status
and the Built Environment

Key Factors of a Fundamental Cause:
1. The cause influences multiple disease outcomes
2. The cause affects disease outcomes through multiple risk factors
3. The cause involves
access
to resources that can assist in avoiding health risks or minimizing the sequelae of disease once it occurs
4. The association between a fundamental cause and health is reproduced over time via the replacement of intervening mechanisms
Strategic Planning Advisory Panel on Health Disparities, 2010
Health Impact Pyramid, 2010
Race, Place (BE) and SES
Historically, race and SES precede the built environment (segregation laws, income determines residential selection)

However, not always the case
Changes to the BE can increase/decrease wealth
Disparities exist across communities of same race/SES

Built environment effects are sustained even when controlling for individual factors (Vernez Moudon, 2011, LaVeist, 2011, Van Dyck, 2010)
These studies point out that
access
is key structure
Built Environment as a Foundation
Reciprocal nature between physical and social environments (built environment is involved in both)
Built environments are 'hard environments' that may not allow for positive changes even if the social environment does (Stokols, 2010) Changes to the built environment are a necessary step for improvements in health disparities
New Framework for Health Disparities
Disparities are mediated by access to health resources/healthy environments

Access is a structural component
of health that is produced by the built environment, as well as race and socio-economic indicators (Cohen, 2000, Gordon-Larsen, 2006)
Proposed Modifications to this model
2.
Access
to social capital, healthy foods, opportunities for PA
1. Combine Race/ethnicity with
SES and Location (BE)
Perception
of BE
*Disparities occur regardless of
residential segregation:
Chicago Heat Wave Case Study
(Klinenberg, 2010)
3. Role of Perceptions
Exposure-disease-stress model (Gee, 2004)
Taking Advantage of Natural Experiments
Proposed Changes
Making the case
for now
Full transcript