Health, the Built Environment and Smart Growth: Linkages & Solutions Safe & Healthy Communities Consulting Tina Zenzola, MPH

Urban Sprawl Separated land uses, low densities and leap-frog development

 250% increase in vehicle miles traveled (915 billion miles) ( )  US average = 73 mins/day of driving  200% increase in workers commuting to another county Asphalt Nation

Low priority for other modes of transportation Safety Access

Expansive “greenfield” development Developing open space and agricultural land at a rate of 2.2 million acres per year

Schools on the fringe Credit: Manitovic Public School District Then: the social and physical center of the community. Now: on the edge of neighborhoods; too far for kids to walk.

The Public Health Impacts of the Built Environment  Physical activity  Obesity & chronic disease  Pedestrian injuries  Asthma & respiratory disease  Crime & violence  Social capital  Child psychosocial development  Elder health & mobility  Water quality & quantity  Mental health  Health disparities SHCC

Smart Growth is a Public Health Strategy

MIX LAND USES & TAKE ADVANTAGE OF COMPACT BUILDING DESIGN Smart Growth: a Public Health Strategy

The burden of physical inactivity n The Problem 25% of adults are sedentary 60% of adults not active enough n The Outcome 64% overweight and 1 in 3 obese Diabetes, heart disease, cancer, depression Physical inactivity is a primary factor in over 250,000 deaths annually. n Medical costs associated with physical inactivity and its consequences may exceed $76 billion annually. Data Sources: 2000 BRFSS, 1999 NHANES, Powell 1994, Pratt et. al SHCC

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, JAMA 2003 Jan 1;289(1). No Data 10%

No Data 10% Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, JAMA 2003 Jan 1;289(1) Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS

No Data 10% Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, JAMA 2003 Jan 1;289(1) Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS

No Data 10% Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, JAMA 2003 Jan 1;289(1) Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS

No Data 10% Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, JAMA 2003 Jan 1;289(1) Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS

Our “Indicator Species” is in trouble n The rate of overweight in kids has doubled n 70% chance of being overweight/obese as adults n 78% don’t get recommended activity n 1 in 3 will be diabetic 1 st generation of kids in the US that aren’t expected to live as long as their parents

The disappearing walk to school n 1 in 4 trips made by 5-15 year olds are for the journey to and from school. n Only 10% of these trips are made by walking and bicycling. n 25% of the morning rush hour traffic is parents driving kids to school Photo: / Dan Burden SHCC

Neighborhood environment is one of the strongest predictors of whether a person will be physically active. Brownson, et al King, et al SHCC

Growing body of evidence n San Diego study: 70 minutes more physical activity/week among residents in walkable neighborhood; 35% vs. 60% overweight ( Saelens, Sallis, et. al. 2003) n 6 lb weight difference in sprawling vs. compact counties n King County study: 5% increase in neighborhood’s “walkability” index correlated with 32% increase in active transportation; 0.23 point reduction in BMI (Frank, Sallis, et. al. 2006) SHCC

Community Design Policies Work! n Community-scale policies & design are effective: Zoning for compact, mixed-use development Transit-oriented development Policies related to street design & connectivity n Street-scale policies & design are effective: Traffic calming Street lighting Improving street crossings SHCC The Task Force on Community Preventive Services concluded that:

Does design make a difference for kids? n Marin, Co SR2S evaluation: 64% increase in number of kids walking to school with safety & traffic calming improvements & encouragement. n CA SR2S evaluation: 15% of kids walked to school more often after physical improvements (vs. 4% when no improvements). Designing to Reduce Childhood Obesity. ALR, February 2005

But, isn’t it really just about making bad choices? n People make decisions in a context so we have to consider the context. n Individual vs. environmental- level interventions. n Most major public health improvements have been due to improvements in our living/working environment. SHCC

CREATE RANGE OF HOUSING OPPORTUNITIES & CHOICES Smart Growth: a Public Health Strategy

Housing & Health Disparities n Housing is a “Social Determinant of Health” Physical conditions – substandard housing Concentration of poverty contributes to poor health status

The “Graying of America” By 2025, one in five Americans will be 65 years or older and over 6 million will be 85+ years Source: U.S. Bureau of the Census, Projections of the Total Resident Population by 5 Year Age Groups and Sex, with Special Age Categories, Middle Series (NP-T3),

Senior health and mobility “Aging in Place” n Housing & transportation options: Fewer falls & injuries Increased mobility Maintain social networks Overall physical function improved Increase lifespan, quality of life

CREATE WALKABLE NEIGHBORHOODS Smart Growth: a Public Health Strategy

Pedestrian Injury & Death n 6% of trips on foot, but 25% of MV deaths are pedestrians (San Diego) n Per mile, walking is 23x more fatal than driving n Seniors and school kids are the most vulnerable n Most dangerous = wide, arterials in suburban areas (South and Western metro areas) n 50% less risk of pedestrian injury for kids living near speed humps

The forgotten pedestrian n Traffic flow prioritized over pedestrian safety n Only 1% Federal Hwy funds for pedestrians n Engineering practices & traffic laws reflect bias & lack of understanding of child pedestrian behavior SHCC

Battery Hens: Cooped up for life  Kept indoors  Restricted boundaries & mobility  Can’t stretch, flap wings  Weak bones and muscles  Frustration, fighting, pecking

Battery Hen Children? n “Cradle-room- house-doorstep- neighborhood” sequence interrupted n Smaller “Cognitive maps” n Social isolation of teens n ADHD & Ritalin n Future attitudes about driving, walking

FOSTER DISTINCTIVE, ATTRACTIVE COMMUNITIES WITH A STRONG SENSE OF PLACE Smart Growth: a Public Health Strategy

Healthy environments promote social networks & social capital n Loneliness and isolation are toxic; social relationships are healthy n People with strong social networks: Live longer Have fewer heart attacks and heart disease Are less depressed and use alcohol and drugs less Have fewer teen births Are healthier overall

PRESERVE OPEN SPACE, FARMLAND, NATURAL BEAUTY & CRITICAL ENVIRONMENTAL AREAS Smart Growth: a Public Health Strategy

Trees : Nature’s Balm  Crime  Aggression  Coping  ADHD  Stress  Social ties Living without trees Living with trees Living without treesLiving with trees Kuo, et. al. University of Illinois, Urbana

Water quality & quantity n Fewer impervious surfaces n Contamination from runoff Groundwater pollution H 2 0 shortages SHCC

PROVIDE A VARIETY OF TRANSPORTATION CHOICES & STRENGTHEN & DIRECT DEVELOPMENT TOWARDS EXISTING COMMUNITIES Smart Growth: a Public Health Strategy

Driving Ourselves Crazy Stress and mental health n Longer commutes contribute to stress, road rage n Stress: heart disease, musculosketal symptoms, traffic collisions n Depression, anxiety

Cars, Kids & Asthma n Most common chronic childhood disease; up by 160% since 1980 n Cal EPA Studies: 7% more asthma among kids living in neighborhoods with high traffic pollution n 2X greater risk of asthma symptoms in 5-7yr olds living 250 ft or less of major road (McConnell et. al. 2006) n Almost 10% of CA’s public schools located within 500 feet of high–very high volume roads

SMART GROWTH PRINCIPLES PA & Obesity Pedestrian Injuries Environmental Health Social Capital Mental Health Health Disparities Elder Mobility Create walkable neighborhoods XXXXXXX Mix land uses XXXXXXX Foster distinctive, attractive places with a strong sense of place XXXXX Strengthen and direct development towards existing communities XXXX Provide a variety of transportation choices XXXXXXX Preserve open space, farmland, natural beauty and critical environmental areas XXXX Take advantage of compact building design XXX Create range of housing opportunities and choices XXXX Encourage community and stakeholder collaboration XXXXXX Make development decisions predictable, fair and cost effective The Public Health Potential of Smart Growth Safe & Healthy Communities Consulting, 2003

Integrating Health into Community Design The challenge facing those with responsibility for assuring the health and quality of life of Americans is clear. We must integrate our concepts of ‘ public health issues ’ with ‘ urban planning issues ’. Urban planners, engineers, and architects must begin to see that they have a critical role in public health. Similarly, public health professionals need to appreciate that the built environment influences public health as much as vaccines or water quality. Jackson & Kochtitzky, 2001 SHCC