The Built Environment and
Human Health: An Initial
‘Sight’ at the Local Status
Max A. Zarate, Ph.D.
East Carolina University
The 3rd Annual Jean Mills Health Symposium:
Making Research Real in Reducing Health Disparities and
Transforming Health Services
February 9, 2007
OUTLINE
► The
built environment
► Influences
on physical activity
► North
Carolina and Pitt County
health statistics
► Health
statistics and the built
environment
THE BUILT ENVIRONMENT
► Types
of environments that affect
human health
 Natural –water, air, soil  food
 Built –indoor (buildings) and outdoor (roads,
parks, walking & biking paths, shopping
centers/malls, etc)
 Social –SES, schools, jobs, churches, etc
THE BUILT ENVIRONMENT
(cont’d)
► Indoor:
trend  improved design,
operation, and environmental quality of
buildings
 Base: linking people’s use of space to
physical measurements of indoor
environmental quality
 Technology: making buildings more
environmentally friendly, productive to
live/work in, and economically to operate
THE BUILT ENVIRONMENT
(cont’d)
► Outdoor:
interest of urban planning in
human behavior  urban design and
transportation planning
 Theoretical, empirical, and practical work
aimed at the following public health goals:
►Enhancement
to quality of life
►Improvement in system efficiency
►Reductions in environmental impacts
THE BUILT ENVIRONMENT
(cont’d)
Dimensions of the Built Environment
(Source: Handy et al, 2002)
Dimension
Definition
Examples of Measures
Density and intensity
Amount of activity/area
Persons/acre or jobs/square mile
Commercial floor space : land area ratio
Land use mix
Proximity of different land
uses
Distance from house to nearest store
Share of total land area per use
Street connectivity
Directness and availability
of alternative routes
Intersections/square mile
Average block length
Street scale
Three-dimensional space on
a building-bounded street
Buildings height : street width ratio
Average distance from street to buildings
Aesthetic qualities
Attractiveness and appeal of
a place
Percent of ground in shade at noon
Number locations with graffiti/square mile
Regional structure
Distribution of activities and
transportation facilities
across the region
Rate of density decline with distance from
downtown
Based on activity concentrations and
transportation network
THE BUILT ENVIRONMENT
(cont’d)
INFLUENCES ON PHYSICAL
ACTIVITY
A range of theories and models has been
used to specify variables believed to
influence physical activity (PA) and other
human behaviors. Researchers test
hypotheses by assessing:
 Associations that help to “understand and
predict” behaviors
 Interventions that are designed to modify
the influences believed to lead to behavior
change
INFLUENCES ON PHYSICAL
ACTIVITY (cont’d)
► The
logic of causality: defining correlates
and determinants
There are few examples of absolute causal
factors that “cause” the outcome in 100% of
cases, but none in the behavioral realm
Correlates: reproducible associations or predictive
relationships
Determinants: causal factors (variations in these
factors are followed systematically by variations
in PA behavior)
INFLUENCES ON PHYSICAL
ACTIVITY (cont’d)
► The
logic of causality (cont’d)
What causes coronary heart disease (CHD)?
Probable causal variables include: physical inactivity,
high cholesterol levels, tobacco use, and genetic
factors
This group of factors may contribute to microphysiologic changes (e.g. PA may reduce CHD risk
through improvements in cardiac endothelial cell
function, collateral circulatory changes, or
through improved oxygen uptake)