Geography 3432
Environment and Health
The Built Environment and Health
(Frank et al. Chapters 1 and 3)
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Discussion
Frank et al. Model
Physical activity and health
Suburbanization and design
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Discussion
• How does the built environment effect health?
• What specifically is the focus of Frank et al.?
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Frank et al.’s Framework:
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Elaboration of Framework
• Built environment – where we live and work
• Public health – outcomes, e.g., obesity, heart
disease, stress
• Activity patterns – esp. walking bicycling
• Land use – e.g., proximity home, work school
• Design – small scale features that influence how
people feel about an urban “environment”
• Transportation systems – esp. for walking,
biking, driving, public transit
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Health Patterns
• “Premature” death (e.g. cardiovascular disease)
and disability (e.g., osteoporosis) from
preventable diseases
• Obesity increasing
– risk factor for all sorts of illness/disease
• Many health risks decrease with increased
physical activity
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Causes of Death
• note the causes that disappear in later period
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Obesity
Overweight
• 1 category above normal Body Mass Index (based
on height:weight ratio)
Obese
• 2 categories above
Prevalence
• 1999-2000 CDC study – US 31% obese, 34%
overweight = 65% above “normal”
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Obesity Patterns
• increasing over time
Causes of “Obesity”
• diet
• activity
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20 Minute Workout?
• 80s – early 90s 20 minutes vigorous exercise
• 1996 US Surgeon General report
– 30 minutes of moderate activity on most days
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1980s aerobics tv show “The 20 Minute Workout”
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Moderate Activity Benefits
• Muscle strength
• Blood pressure
– e.g., Reduction risk coronary heart disease on par with
stopping smoking!
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Depression and anxiety
Obesity
Skeletal development of kids
Bone density adults
Independence (esp. elderly)
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Guideline: Active
• moderate-intensity physical activity for at least 30
minutes on 5 or more days of the week or
OR
• vigorous-intensity physical activity 3 or more days
of the week for 20 or more minutes
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Sedentary Reap New Benefits Quickest
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Modifiable Behaviours and Mortality
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Improve How Much?
• If half “sedentary” population became irregularly
active (not quite guideline) total # deaths drop by:
– CHD 3.9%
– Colon cancer 2.5%
– Diabetes 1.5%
• If same population met activity guidelines:
– CHD drop 7.1%
– Colon cancer drop 7.4%
– Diabetes 5.2%
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Genetics or physical activity
• Maybe premature death/disability is mostly genetic?
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Genetics or physical activity
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Improvements in Physical Activity
Over Time?
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Discussion
• What explains low physical activity in North
America?
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Interconnected Causes
of Sedentary Lifestyles
• Behavioural
– “victim blaming”
– choice available, e.g., transportation
• Suburbanization
– landuse
– design
• Time
– what happened to the 35hr work week?
• Wealth
– very much so
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Physical Activity and Wealth
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Is suburbanization bad for your health?
Garden Cities
• started late 1800s
• reaction to
overcrowded and dirty
large cities
• access to nature
(healthy)
• best aspects of rural and
urban living
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Garden Cities vs Industrial Cities
Philadelphia first half 20th C (Source)
Hagerstown, MD 2010 (Source)
Other Examples of Cities/Suburbs Inspired by the Garden City Movement
•Shaker Heights, Ohio
•Kapuskasing, Ontario
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Full Circle
• Olmstead – designer (Central Park), architect,
writer
– advocate for residential outside CBD – space, greenery
– CBD too crowed, stressful and generally unhealthy
• Levittown NY and PA – post war American (and
Canadian) dream
– first “suburbs” – entire communities
– traffic calming
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Transportation: Modal “Choice”
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Transportation:
Children and Modal Choice
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Transportation:
Children and Modal Choice
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What’s the Epidemiologic Evidence?
• Many studies show significant but weak
relationships between measures like “sprawl”,
“walkability” etc. and “activity”,
“overweight/obese”, “depression”, “alcohol
abuse” (Renalds et al. 2010 A systematic review of built environment and health, Family and
Community Health, 33(1): 68-78)
• most use ecologic or case-control study design
(what does this imply?)
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Discussion
• How can we increase physical activity (not
personally per se, but as a public health problem)?
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Design Barriers
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Design Barriers
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Designing for Pedestrians
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Exercise/Conclusion
• Do we need to sacrafice the American/Canadian
dream to achieve walkable/cyclable cities?
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