Are we creating environments conducive or destructive to our health? I am exploring that putting the focus of the built environment to benefit the people that inhabit it in a developing community may encourage healthy behaviors and thereby, have a positive impact in reducing chronic disease. Creating a built environment to benefit the health of the community is relevant to decreasing morbidity and mortality. The relationship between the environment and human health has been extensively studied. Shaping the social and physical environment can enhance public health and well-being.
The environment is intimately connected with human health, illness, and mortality: Some estimates place the toll of the world’s death caused by environmental factors at 40% (Friis, 2012, p.5). When we explore the places we live, work, and play, (i.e. that have buildings, parks, and road structure developed by humans), it is known as the built environment (Friis, 2012, p.77). Creating healthy environments goes further than just creating public access to physical activity; it encompasses establishing communities that extend the access to healthier foods and products, and clean, fresh water resources. There are many ways to create spaces that are conducive to healthier lifestyles. In the article, Ten Principles for Building Healthy Places, they provide examples for developing under used spaces in cities to promote physical activity. Specifically, in New York City, there is an initiative to increase access to park space (Eitler, McMahon & Thoerig, 2013). Other cities are converting parking lots into parks and creating walking and biking trails in under used space (Eitler, McMahon & Thoerig, 2013). These types of developments benefit the health of the people that inhabit those communities by providing a place to be active in a safe and convenient environment. The more spaces like these that become available, a decrease in chronic diseases will likely result due to increased physical activity. It is something I hope can be accomplished around the world but of course, environmental conditions vary across the country and resources are often limited. According to the American Public Health Association, “Despite spending more on health care than any other country in the world, Americans live shorter, less healthy lives than our counterparts in other high-income nations. While this is a national problem, our local communities are where we have the power to influence our health more than ever before” (Greenberg, Salazar, 2016).
Historically, Hippocrates is known as the father of medicine. He emphasized the role of environment as an influence of a person’s health status and health in their world. He explained that the climatic factor and environmental factors such as, prevailing winds, and weather; the air food, and water quality and geographical situations are their influencing factors in leading to changes in the human health conditions (Friis, 2012,p.). He supported the doctrine of equilibrium maintenance among the human body’s humors; black bile, phlegm, and yellow bile (Friis, 2012,p.). The imbalance among these four humors can lead to infectious diseases.
The chronic disease rate is alarming in the United States. Morbidity and mortality continue to increase. Morbidity is the relative incidence of a particular disease (Potteiger, 2010). Mortality is the rate of death (Potteiger, 2010). As countries become more developed the leading cause of mortality and morbidity shift from communicable diseases to chronic diseases. Physical inactivity, a known risk factor for diabetes, high blood pressure, and obesity is the cause of an estimated 11% of total health care expenditures (CDC’s Built Environment, 2015).
There is a theory taught in exercise science classes called Social Cognitive theory that is based upon three factors that interact with each other; the individual, behavior, and environment, to influence a future behavior (Pescatello, 2014, p.357). The environment is the physical, social, and cultural influences in a person’s daily life conducive to whether or not that individual will perform a certain behavior. In this case it is the behavior or physical activity versus sedentary lifestyle. Along with the social cognitive theory is the concept of self-efficacy. Task self-efficacy refers to an individuals’ belief they can actually do the behavior in question, whereas barriers self-efficacy refers to whether an individual believes they can regularly exercise in the face of common barriers such as lack of time, poor weather, and feeling tired (Pescatello, 2014, p.358). To remove some of these barriers to the individual the evaluation of exercise opportunities in the environment in necessary. According to Pescatello (2014), social ecological models consider the following:
“aspects of the natural environment can impact exercise behaviors (e.g. weather, geography) but so too can aspects of the built environment (e.g. access to parks). Importantly, environmental factors influence behavior not only directly but also indirectly through an individual’s perceptions. This type of approach highlights the fact that multilevel interventions may be most effective or even necessary. Targeting aspects of the individual are important, but if a physical environment is not conducive to changing one’s lifestyle, then the exercise intervention will not be successful” (p.365).
The ACSM (American College of Sports Medicine) along with the CDC does provide a recommended amount of exercise Americans should maintain for healthy lifestyles. According to Pescatello (2014, p.9), evidence to support the inverse relationship between physical activity and premature mortality caused by chronic diseases continues to accumulate.
The very first principle, Put People First- in Ten Principles for Building Healthy Places, is so instrumental in making these recommendations applicable into everyday life. According to Eitler (2013, p.10), a healthy urban community is one where basic necessities and community amenities are accessible by walking or biking. Access to space for physical activity, such as walking paths and exercise facilities near work and home, is associated with increased physical activity (Eitler, 2013, p. 10). If someone wants to go workout in a developed community the initial thought is to go to the gym. Which would in turn require you to have a gym membership that cost a monthly stipend. Gym memberships can range from ten dollars a month to more than one hundred dollars a month. If you weren’t active as a kid or have never been an avid “gym goer” utilizing some of the equipment might be intimidating. If the principle “Put People First” was considered into every community design there could be multiple free and simple ways for people to get out, get fresh air, and get daily activity. Something as simple as walkways designed to access different points around the community like the Atlanta Beltline. Parks with benches give everyone a resting point or an impromptu place to do squats or bench dips. Simple hand railings on stairs for safety might encourage elderly or very young to conquer steps safely instead of taking elevator or escalator.
THE PLAN-
Our local communities need to be equipped with the knowledge and tools to implement this healthy relationship between environment and health. The point of changing the built environment is to improve health outcomes. So, how do we take action to reduce the burden of unhealthy environments? Support and promote local government to help address healthy environmental planning, consider health in all sectors, focus on prevention, manage and prevent emerging risk factors, promote health impact assessments. ADD HERE
IMPLEMENTATION- Healthy People 2020 is a federal program, following its earlier version Healthy People 2010, that seeks to increase population health in a number of topics and areas through implementation and policy. One of the pertinent topics that is focused on is Environmental Health. Features of the built environment appear to impact human health-influencing behaviors, physical activity patterns, social networks, and access to resources(Healthypeople.gov). The Atlanta Beltline project is a great example of how one community is building a health focused environment. Increasing “walkability”, access to local healthy foods, and shopping, and meeting areas, benches, greenery. . . . ADD HERE
EVALUATION- Health Impact Assessments- used to measure the improvement in areas of concern. Getting the built environment improvements is no easy task. It involves the cooperation of stakeholders, local government, developers, and concerned residents and local businesses. ADD HERE
I challenge you to think about the environment you live and work in. Do you have to constantly drive yourself to and from your destination? Are you able to walk, bicycle, or ride public transportation to local grocery, shopping, or activities? Is your community attractive to you? Are there parks, benches, or green areas? Do you have access to fresh, unprocessed food? How could your community improve to encourage healthy lifestyles? These are all valuable questions to consider when choosing where to conduct your daily life activities. Some may not have a choice depending on job and family situations. It is critical to our health that our communities take a strong investigation and action into building healthier environments.