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Health, Equity,  and the Built Environment Advancing Health Equity: From Theory to Practice Richmond, VA September 10, 2009 Howard Frumkin, M.D., Dr.P.H., Director National Center for Environmental Health / Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention
The sense of place
What is the “Built Environment”? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ten Leading Causes of Deaths, US (2004) Affected by the Built Environment
Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Healthy housing
Housing hazards ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Housing disparities ,[object Object],[object Object]
Selected substandard housing conditions 2005 American Housing Survey Tables 2-2 (Height and Condition of Buildings) and 2-7 (Additional Indicators of Housing Quality) http://www.census.gov/hhes/www/housing/ahs/ahs05/tab2-2.xls  and http://www.census.gov/hhes/www/housing/ahs/ahs05/tab2-7.xls PER CENT
Trailers ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opportunities for housing
Solutions: Healthy housing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Healthy schools
Active transport to school,  1969 and 2001 Source:  CDC.  Kids Walk-to-School: Then and Now—Barriers and Solutions.   www.cdc.gov/nccdphp/dnpa/kidswalk/then_and_now.htm
Two approaches to school siting Hubbard Lake Elementary School Hubbard Lake, Michigan  "Outstanding in Its Field"
Safe Routes to School
The “food environment” at school
Fast food near schools ,[object Object],[object Object],[object Object],Austin SB et al.  Clustering of fast-food restaurants around schools: A novel application of spatial statistics to the study of food environments.  Am J Public Health  2005;95:1575–81.
Solutions: Healthy schools ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parks and greenspace
 
 
Community gardens
Park proximity and health  Large urban parks, Copenhagen, summer ,[object Object],[object Object],[object Object],[object Object],Nielsen and Hansen,  Health & Place  2007
Neighborhood greenness and childhood weight gain ,[object Object],[object Object],[object Object],[object Object],Bell JF, Wilson JS, Liu GC.  Neighborhood greenness and 2-year changes in body mass index of children and youth.  Am J Prev Med  2008;35:547-53.
Trees and urban Life
 
 
Robert Taylor Homes interview study   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],University of Illinois William Sullivan, Frances Kuo www.lhhl.uiuc.edu Images courtesy of W. Sullivan
Places to explore and play
Play in natural settings
Getting kids outdoors
Arabia Mountain Trail, Georgia
Solutions: Parks and greenspace ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neighborhood design
 
 
 
 
Squalor and blight
 
Squalor and Blight in the  American Housing Survey (2005) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Broken Windows Theory ,[object Object],[object Object]
Gentrification
American Journal of Psychiatry  1996;153:1516-23/
Solutions: Healthy community design ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transportation
 
Pedestrian infrastructure
 
 
 
 
 
 
 
Pharmacies
Dry Cleaners
Fine Food
Coffee
Tunnel of Vows Drive-Thru Wedding Chapel Las Vegas, NV
Funerals Gardner Memorial Chapel Davidson, TN Junior Funeral Home Pensacola, FL Adams Funeral Parlor Compton, CA
The next frontier of drive-thru: Health care?
 
Parking
?
April 22, 2003 The   result
 
Factors that predict walking ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transportation and air quality:  The Atlanta Olympics Friedman et al.  JAMA  2001;285:897-905 Peak traffic    23% Peak ozone    28% Acute asthma among children    11-44%
Less driving, fewer fatalities Ewing et al.  Am J Public Health  2003;93:1541-45 Sivak.  UMTRI-2008-39, July 2008
Transit and physical activity ,[object Object],[object Object],[object Object]
Transportation equity
Solutions: Healthy transportation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complexity  Reality (simplified)
Climate change
Peak petroleum Source: Hubbert, 1956
Resource depletion
The courage to paddle upstream
 
 
Health Impact Assessment
Beyond the short term Hau de no sau nee (the Six Nations Iroquois Confederacy): planning for the seventh generation
Care for the individual patient Care for the community Care for future generations THE CLINICAL APPROACH THE PUBLIC HEALTH APPROACH THE LEGACY APPROACH
Promoting co-benefits
Co-benefits:  Trees ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Co-benefits: Food and nutrition
Co-benefits: Transportation    Physical activity    Air pollution And by the way…    Infrastructure costs    Social capital    CO 2  emissions    Depression    Injuries    Osteoporosis
Envisioning Change
 
 
 
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you!

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Health, Equity and the Built Environment: What do Healthy Communities Look Like?

Notas do Editor

  1. Changes in land use from farm, field, and forest to residential.
  2. Individual lots can be very large.
  3. Same here—monotony and isolation. Wherever you want to go, you have to go by car.
  4. Low connectivity.
  5. Friedman MS, Powell KE, Hutwagner L, Graham LM, Teague WG. Impact of changes in transportation and commuting behaviors during the 1996 summer Olympic games in Atlanta on air quality and childhood asthma. JAMA 2001;285:897-905
  6. Ewing R, Schieber R, Zegeer C. Urban sprawl as a risk factor in motor vehicle occupant and pedestrian facilities  Am J Public Health 2003;93:1541-45. Sivak M. Is the U.S. on the Path to the Lowest Motor Vehicle Fatalities in Decades? University of Michigan Transportation Research Institute Report # UMTRI-2008-39, July 2008. Available: http://deepblue.lib.umich.edu/bitstream/2027.42/60424/1/100969.pdf.
  7. Public Street Improvements and Infill Development COLFAX AVENUE, DENVER, COLORADO: Done in association with Space Analytics, LLC for Colfax on the Hill, Inc., funded in part by the Denver Foundation 1 - Existing conditions 2 - Mixed-use buildings on one corner 3 - Public street improvements: street trees, street lamps, decorative traffic signals, sidewalk bulbouts 4 - Additional mixed-use development, remodeling of existing buildings
  8. Infill Development on declining shopping center EL CERRITO, CALIFORNIA: Done to demonstrate infill development potential on shopping center site. 1 - existing conditions 2 - Additional Stores built up to the street , Mixed-use architecture (office space above retail), zebra-striped crosswalks, street trees, street lamps added 3 - Mixed-use architecture (residential added above office space) 4 - Additional infill accommodates pedestrians and improves visibility for merchants
  9. Traffic Calming on Neighborhood Street NAPLES PARK, FLORIDA: Done with Dover, Kohl & Partners and Glatting Jackson, Inc. to demonstrate traffic calming techniques for Collier County, Florida 1 - existing conditions 2 - Neighborhood traffic circle added, sidewalks and zebra-stripped crosswalks added, landscaped with palm trees OR 3 - landscaped with shade trees