Tuesday, August 27, 2019

DESIGNING THE HEALTHY NEIGHBORHOOD: DERIVING PRINCIPLES FROM THE EVIDENCE BASE

By Ellen M. Bassett, Timothy Beatley, Reuben M. Rainey, Robert Lamb Hart, David P. Howerton, J. Timothy McCarthy II, Paul Milana, and Stuart Siegel

The built environment is a critical factor in human health outcomes. In the late 19th and early 20th centuries, for instance, poor urban environments were a great threat to city residents from all walks of life. Rapidly growing cities experienced severe epidemics of infectious diseases, including tuberculosis, cholera, typhoid, and yellow fever. These epidemics were effectively mitigated through investment in public infrastructure and better urban planning. Sewers were built to manage human waste, public parks were created give access to fresh air, building standards were changed to ensure safe shelter, and development regulations served to reduce traffic congestion and relieve urban overcrowding. Importantly, visionary architects and planners of the time recognized the role of urban design as a tool for improving health. Some of the earliest American suburbs—like Riverside, Illinois, planned by Vaux and Olmstead—were created as havens from the industrial city and designed in a way that incorporated nature and health-giving open space throughout the model community. In reaction to heavily polluted London, Ebenezer Howard envisioned the “garden-city” which strove to integrate the best of the city with the benefits of rural life. His iconic vision informed the thinking of other leading 20th century designers and urbanists who created places like the New Deal-era Greenbelt towns—practical but utopian communities designed to provide decent housing, strong community life, and nearby employment and amenities to its residents. Our triumph over the acute diseases of the city provides important lessons for today since communities across the United States now face a different type of health threat—namely the spread of chronic diseases, such as asthma, Type-2 diabetes, cancer, and heart disease.1 Of particular concern relative to the rise of chronic diseases is the global rise in levels of obesity. The prevalence of obesity or extreme obesity for adults aged 20 to 74—conventionally measured as a Body Mass Index exceeding 30 for obesity and 40 for extreme obesity—has risen from 14.3% in 1960-62 to 41.9% in 2010-2011 (Fryar, et al.(a), 2014). Child and adolescent (aged 2 to 19) obesity now measures at 16.9%, up from 5.2% in 1971-1974 (Fryar, et al.,(b), 2014). At the same time that obesity has risen, average rates of physical activity have fallen for both adults and children. In the US, only 48% of adults meet the Surgeon General’s Guidelines for physical activity, namely 150 minutes of moderate intensity aerobic activity like brisk walking every week (http://www.cdc.gov/physicalactivity/data/ facts.html). Physical inactivity amongst children is also a concern. For instance, in 2009, 13 percent of children five to 14 years old usually walked or biked to school compared with 48 percent of students in 1969. The concern with obesity and physical inactivity is so pronounced in our public health conversations because of the known link between these factors and chronic diseases such as diabetes, heart disease and various forms of cancer.


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