Community Planning and Built Environment: Designing Better Health

By: Lexi Rosmarin

The duality of the relationship between humans and the environment is pertinent in a world where we are constantly working towards a sustainable future. Humans impact the environment through means of everyday life–driving, walking, smoking, working, and so on. However, the environment, specifically the built environment, also impacts human life. Structures, sidewalks, parks, green spaces, and more impact mental and physical health, as well as the role that humans play on the environment. The bidirectionality of this relationship between human health and the built environment is one that is often overlooked but needs attention for the bettering of environmental and community health.

The field of health geography views health from a perspective of how our built, natural, and geographical location impact patterns in health culturally, socially, and physically.[1] Geographic patterns that relate to the built and natural environment include health inequities, urbanization, and environmental exposures.[2] Health inequities in relation to the built and natural environment include accessibility of public transportation in urban and non-urban areas, closeness of medical facilities (especially in rural areas), lack of access to walkable sidewalks, among others. With regard to urbanization and environmental exposures, a lack of green space and less walkability leads to more pollution and fewer areas for exercise, enjoyment, and community building. These issues, especially walkability, have direct impacts on health and create health issues that are uncontrollable through individual changes in behavior.

The National Walkability Index is a way to measure the walkability of different neighborhoods. Walkability is an integral outcome of built environments and its well-known benefits to physical, social, and mental health make it an important connection between the environment and health. The Environmental Protection Agency (EPA) created this index and it includes neighborhood design, distance to transportation, and diversity of land use.[3] Moreover, walkability infers the designing of communities that are safe and encourages walking through accessible sidewalks, green spaces, and safety policies. Using this Index, researchers find that the amount of U.S. adults who use walking as a form of transportation as well as a form of leisure is higher in areas with a higher walkability index.[4] Considering walkability along with community design proves to be an essential aspect of neighborhood health.

One of the most evidential studies correlating neighborhood walkability and health is published in the Journal of the American Heart Association. Researchers find that, when controlled for other factors, those living in neighborhoods in Ontario, Canada with a low walkability index have a higher 10-year predicted cardiovascular risk than those living in neighborhoods with a higher walkability index.[5] This demonstrates that living in a neighborhood in which the built environment allows for ease of physical activity is associated with better cardiovascular health outcomes. While walkability has a direct impact on health, there are other factors that are indirectly linked with the built environment that cause differences in health between neighborhoods.

In Washington D.C., there are distinct inequities between neighborhoods: some have higher crime rates, more infant mortality, less green space, longer work commutes, or higher poverty rates.[6] These social determinants of health–including built environment–are direct contributors to incidences of cardiovascular disease and stroke.[7] These aspects also directly relate to community design; if there were more walkable sidewalks and green spaces, work commutes may be shorter, leading to less poverty rates and lower crime rates. If there were easily accessible medical centers, infant mortality may be lower. The reason that community design and built environment are so important is because they are attainable ways to change the lives of many who feel their health is out of their control. While things like economic policy and the implementation of better government programs to help those in poverty may feel more long-term and unattainable, the implementation of more green spaces and better sidewalks is something that interests both communities and policymakers alike.

Health is becoming a top priority in community planning of built environments. The American Public Health Association has multiple examples of major U.S. cities taking into account social, mental, and physical health when creating new built environments. One example, in Los Angeles (L.A.), California, demonstrates the importance of working with a community when changing the built environment. In East and Southeast L.A., both home to notoriously underserved populations, public and private sector companies are working to implement more green space, the planting of more trees, and putting health clinics in metro stations that are frequently used by residents of these areas (8). Another example, in Washington D.C., which has grave differences in built environment and health inequities between neighborhoods, shows the impact that including healthy spaces in design plans can have on mental and physical health. Within its public school system, Washington D.C. is implementing community gardens, better air quality, and is taking into account the needs of each individual community (9). 

While built environment and health geography are relatively new concepts at the forefront of public health, they are being increasingly considered in community design in both urban and rural areas. This is an exciting avenue of potential social change because it is realistic and achievable and, most importantly, it takes into account what communities themselves feel would improve their health and well-being

References:

[1] Dummer T. J. (2008). Health geography: supporting public health policy and planning. CMAJ : Canadian Medical Association Journal = journal de l’Association médicale canadienne, 178(9), 1177—1180. https://doi.org/10.1503/cmaj.071783

[2] Dummer T. J. (2008). Health geography: supporting public health policy and planning. CMAJ : Canadian Medical Association Journal = journal de l’Association médicale canadienne, 178(9), 1177—1180. https://doi.org/10.1503/cmaj.071783

[3] Watson, K. B., Whitfield, G. P., Thomas, J. V., Berrigan, D., Fulton, J. E., & Susan A. Carlson. (2020, August). Associations between the National Walkability Index and walking among US Adults — National Health Interview Survey, 2015. Preventive Medicine, 137. https://doi.org/10.1016/j.ypmed.2020.106122

[4] Watson, K. B., Whitfield, G. P., Thomas, J. V., Berrigan, D., Fulton, J. E., & Susan A. Carlson. (2020, August). Associations between the National Walkability Index and walking among US Adults — National Health Interview Survey, 2015. Preventive Medicine, 137. https://doi.org/10.1016/j.ypmed.2020.106122

[5] Howell, N. A., Tu, J. V., Moineddin, R., Chu, A., and Gillian L. Booth. (2019, October 31). Association Between Neighborhood Walkability and Predicted 10-Year Cardiovascular Diseases Risk: The CANHEART (Cardiovascular Health in Ambulatory Care Research Team) Cohort. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.119.013146

[6] American Heart Association News, HealthDay Reporter. (2021, July 15). AHA News: How Healthy Is Your Neighborhood? Where You Live Can Greatly Affect Heart, Brain Health. U.S. News.  https://www.usnews.com/news/health-news/articles/2021-07-15/aha-news-how-healthy-is-your-neighborhood-where-you-live-can-greatly-affect-heart-brain-health

[7] American Heart Association News, HealthDay Reporter. (2021, July 15). AHA News: How Healthy Is Your Neighborhood? Where You Live Can Greatly Affect Heart, Brain Health. U.S. News.  https://www.usnews.com/news/health-news/articles/2021-07-15/aha-news-how-healthy-is-your-neighborhood-where-you-live-can-greatly-affect-heart-brain-health

[8] Los Angeles: Convening New Partnerships, Breaking Out of Silos. (2021). American Public Health Association. https://www.apha.org/-/media/Files/PDF/topics/environment/JCTA_Conversation_Guide_Los_Angeles.ashx

[9] Washington D.C.: A Lesson Plan for Health and Health Equity. (2021). American Public Health Association. https://www.apha.org/-/media/Files/PDF/topics/environment/JCTA_Conversation_Guide_Washington_DC.ashx