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!