UNC Minority Health Sorting Out the Connections Between the Built Environment and Health: A Conceptual Framework for Navigating Pathways and Planning Healthy Cities Mary E. Northridge, PhD, MPH Mailman School of Public Health, Columbia University Editor-in-Chief, American Journal of Public Health UNC Minority Health History: Squalid living conditions of the 19th century industrialized cities. Theory: Important for asking the right questions. Methods: Qualitative and quantitative, citizen control to effect the outcome of a process. Tools: Geographic Information Systems (GIS), multi-level modeling. UNC Minority Health History Urban Reform Movement Which Gave Birth to Urban Planning and Public Health Jacob Riis, Photojournalist, “How the Other Half Lives” UNC Minority Health The Developing World 1 Billion People Out of a Global Population of 6 Billion Presently Live in Slum-like Conditions. UNC Minority Health Slums, Slum Dwellers, & Health Sclar ED, Northridge ME Task Force 8: Charged with improving the lives of at least 100 million slum dwellers by 2020. UNC Minority Health Theory Asking Different Research Questions, Generating New Ideas. UNC Minority Health Making The Connections “A Joint Urban Planning and Public Health Framework: Contributions to Health Impact Assessment” (Northridge ME, Sclar ED) “Social Determinants of Health and Environmental Health Promotion” (Schulz AJ, Northridge ME) J Urban Health. 2003; 80:556-568, p. 559. Conceptual Framework HEALTH & WELL-BEING Health Outcomes Well-Being PROXIMATE Stressors/Buffers Health Behaviors Social Integration/Support FUNDAMENTAL Natural Environment INTERMEDIATE Built Environment Macrosocial Factors Social Context Inequalities FUNDAMENTAL Natural Environment Macrosocial Factors Inequalities Distribution of Material Wealth Distribution of Employment Opportunities Distribution of Educational Opportunities Distribution of Political Influence Historical Conditions Political Orders Economic Order Legal Codes Human Rights Doctrines Social and Cultural Institutions Ideologies INTERMEDIATE Built Environment Social Context Community Investment Policies Enforcement of Ordinances Community Capacity Civic Participation and Political Influence Quality of Education Land Use Transportation Services Public Resources Zoning Regulations Buildings PROXIMATE Stressors/Buffers Health Behaviors Dietary Practices Physical Activity Health Screening Environmental, Neighborhood, Workplace, and Housing Conditions Violent Crime and Safety Police Response Financial Insecurity Environmental Toxins Unfair Treatment Social Integration/Support Social Participation and Integration Shape of Social Networks and Resources Available Social Support HEALTH & WELL-BEING Health Outcomes Well-Being Hope/Despair Life Satisfaction Psychosocial distress Happiness Disability Body Size and Body Image Infant and child health Obesity Cardiovascular Diseases Diabetes Cancers Injuries and Violence Infections Diseases Respiratory Health Mental Health All-Cause Mortality UNC Minority Health Importance of Theory • No single “best” framework • Multiple perspectives valuable • Deeper understanding UNC Minority Health Methods By utilizing a variety of research designs, methods, and approaches, we can better develop, test, and validate our conceptual models. UNC Minority Health The Harlem Children’s Zone Asthma Initiative (HCZAI): A community-building initiative of Harlem Children’s Zone, Inc. Enhanced community-based health care delivery by Harlem Hospital Center, Dept. of Pediatrics. UNC Minority Health Pediatric asthma at Harlem Hospital Center: #1 reason for childhood hospitalizations #1 reason for Pediatric Emergency Department (PED) visits #1 PED revisit rate in NYC UNC Minority Health Goals of HCZAI Reduce school absenteeism Reduce emergency medical visits Reduce hospitalizations UNC Minority Health Evaluation Rigorous Participatory Multi-method Multi-level Ongoing HCZ Project Columbia University UNC Minority Health Focus Groups With Parents of Children With Asthma “The [initiative] is really willing to take action. They bring the vacuum right into our house and are like, ‘Okay, let’s do this right now.’” UNC Minority Health Focus Groups With Parents of Children With Asthma “My child is more responsible and aware of this own condition. He is less likely to panic and understands asthma better.” UNC Minority Health Focus Groups With Parents of Children With Asthma “They help you with everything that you need. They’re absolute guardian angels. You know, it don’t have to be exactly related to asthma…you know anything that you need help with…” UNC Minority Health Range of Interventions Medical Social Environmental Educational Legal UNC Minority Health Sustainability Through Policy Change Insurance coverage for community-based health services. Training and support for community health workers. Increased reimbursement under Medicaid. UNC Minority Health HCZAI Partnership Harlem Children’s Zone, Inc. Harlem Hospital Center Columbia University NYC Dept. of Health & Mental Hygiene NYS Dept. of Health Local Public and Charter Schools Volunteers of Legal Services Robin Hood Foundation Others… UNC Minority Health Using GIS as a Tool for Community Change Improving data integration for partnering organizations. Mapping local knowledge and environmental exposures. Directing and delivering heath care services. UNC Minority Health “You know there is a need. But the need changes. And the face of poverty changes. And what we do changes.” Robert M. Coard, President Action for Boston Community Development UNC Minority Health Thanks, Seth!