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) DimensionDefinitionExamples of Measures Density and intensity Land use mix Street connectivity Street scale Aesthetic qualities Regional structure Amount of activity/area Proximity of different land uses Directness and availability of alternative routes Three-dimensional space on a building-bounded street Attractiveness and appeal of a place Distribution of activities and transportation facilities across the region Persons/acre or jobs/square mile Commercial floor space : land area ratio Distance from house to nearest store Share of total land area per use Intersections/square mile Average block length Buildings height : street width ratio Average distance from street to buildings Percent of ground in shade at noon Number locations with graffiti/square mile 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 micro- physiologic changes (e.g. PA may reduce CHD risk through improvements in cardiac endothelial cell function, collateral circulatory changes, or through improved oxygen uptake)