Public Health: What Does the Built Environment Have to do With It? Candace D. Rutt, Ph.D. Division of Nutrition and Physical Activity Centers for Disease Control and Prevention

What is the “Built Environment”? Pretty much everything –Buildings Size, type, function, aesthetics, density –Transportation systems Highways, roads, bike lanes, transit, sidewalks –Greenspace Parks, undeveloped land

Built Environment 101: Learning to Talk the Talk Density –The number of people either residing or working in an area Land-use –The degree to which different types of activities (i.e., residential, commercial, business) exist together within a specific area

Built Environment 101: Learning to Talk the Talk Connectivity - How well pedestrian facilities are connected - Speed and volume of automobile traffic - Wideness and condition of sidewalks - Number of intersections

Urban Sprawl/Suburbia Low density, low land-use, low connectivity, auto dependent with poor pedestrian and transit infrastructure

Traditional Neighborhood/ Smart Growth High density, high land-use mix, high connectivity, and has more transportation choices

Why Should We Care About It? The way we build our cities, communities and neighborhoods affects our health and the environment –Air pollution –Noise pollution –Water pollution –Greenspace

Additional Consequences Physical activity Food environment Obesity Mental health Crime Social Capital AccessibilityInjuryTransportation

Source: Atlanta Journal-Constitution, March 10, 2006 ….And It’s Happening in Your Backyard

Air Pollution In 1997, vehicles accounted for: – 58% of CO – 30% of NOx – 27% of VOCs – 9% of PM A study in Austria, France, and Switzerland found that automobile related pollution was responsible for more deaths than traffic accidents (WHO, 2001)

Pollution During the 1996 games in Atlanta there was a 22% decline in traffic counts, a 28% decline in daily ozone levels, and a 41% decrease in acute asthma care events (Friedman et al., 2001)

Water Pollution Increased impervious surfaces reduces the land’s ability to filter water Consequently: –Surface water quality declines –Ground water supply is reduced –Land becomes more prone to flooding

Greenspace Growth affects greenspace which has been linked to physical activity, safety, attentional restoration, productivity, happiness, social ties and sense of community, aggression, stress, and mortality

Social Capital Living in walkable mixed-use communities was found to be related to higher levels of social capital (Leyden, 2003) Each additional 10 minutes in daily commuting time cuts involvement in community affairs by 10% (Putnam)

Accessibility In Houston 3 out of 5 disabled and elderly people did not have sidewalks between their residence and the nearest bus stop People who do not own a car are not able to participate in social or economic activities

Pedestrian Safety Only 5% of trips are made on foot but account for 12% of all traffic deaths For every 1% increase in the sprawl index pedestrian fatality rates fell by 3.56% after adjusting for pedestrian exposure (Ewing et al., 2003)

Pedestrian Safety Most dangerous roads tend to have: –Multiple lanes –High speeds –No sidewalks –Long distances between crosswalks –Roadways lined with large commercial establishments and apartments (Hanzlick, 1999)

Transportation The average driver spends 443 hour per year behind the wheel which is about 11 work weeks (Pope, 1999)

We’re Driving Ourselves Crazy Number of miles we drive 25% increase in last 10 years Time we spend in traffic 236% increase since 1982 Money lost in time and fuel $78 billion in 2000

Transportation Automobile crashes are the leading case of death for people ages 1 – 24 and cost $200 billion per year (CDC, 1999) Commuting has been related to back pain, cardiovascular disease, and stress (Koslowsky et al., 1995)

Transportation There was a 51% increase in road rage from 1990 to 1996 (Mizell, 1997)

Nutrition Environment Availability of food Portion sizes More time in automobiles –Preference for convenience foods –Easy access while driving (Berry et al., 1985; Bureau of the Census, 1976; 2000; Center for Science in Public Interest, 2003; Edelman et al., 1986; Policy et al., 1979 Porikos et al., 1982; Rolls et al., 1992; Rolls & Hetherington, 1989) (Berry et al., 1985; Bureau of the Census, 1976; 2000; Center for Science in Public Interest, 2003; Edelman et al., 1986; Policy et al., 1979 Porikos et al., 1982; Rolls et al., 1992; Rolls & Hetherington, 1989)

Nutrition Environment From 1972 to 1997 the number of fast food restaurants doubled and the number of restaurants rose by 35% (Bureau of the Census, various years) From 1977 to 1995 there was a 200% increase in the percentage of meals eaten at fast food restaurants (National Restaurant Association, 1998) A 10% increase in the number of fast food restaurants increases the number of overweight people by 4% and the number of obese people by 7% (Chou, Grossman, & Saffer, 2001)

Nutrition Environment Healthy diets are associated with the availability of supermarkets: (Morland 2002) Healthy diets are associated with the availability of supermarkets: (Morland 2002) Fruit and vegetable intake increases by 32% for each additional supermarket in a census tract for African AmericansFruit and vegetable intake increases by 32% for each additional supermarket in a census tract for African Americans Achieving recommended levels of fat and saturated fat among African Americans is also associated with the availability of supermarketsAchieving recommended levels of fat and saturated fat among African Americans is also associated with the availability of supermarkets

Portion sizes have also been increasing at fast food restaurants and at home from 1977 to 1996 (Nielson & Popkin, 2003) Nutrition Environment

BAGEL 20 Years Ago Today 140 calories 3-inch diameter How many calories are in this bagel?

140 calories 3-inch diameter Calorie Difference: 210 calories 350 calories 6-inch diameter BAGEL 20 Years Ago Today

SPAGHETTI AND MEATBALLS 20 Years AgoToday 500 calories 1 cup spaghetti with sauce and 3 small meatballs How many calories do you think are in today's portion of spaghetti and meatballs?

Calorie Difference: 525 calories 1,025 calories 2 cups of pasta with sauce and 3 large meatballs 20 Years AgoToday 500 calories 1 cup spaghetti with sauce and 3 small meatballs SPAGHETTI AND MEATBALLS

320 caloriesHow many calories are in today’s turkey sandwich? TURKEY SANDWICH 20 Years AgoToday

Calorie Difference: 500 calories 820 calories320 calories TURKEY SANDWICH 20 Years AgoToday

The average per capita calories consumed increased 550 calories per day from 1970 to 1997 (Bureau of the Census, various years) Just an extra 100 calories a day leads to an extra 10 pounds a year Nutrition

Physical Activity Environment Declines across most domains of physical activity –Recreational –Occupational –Household –Transportation Increase in attractive sedentary activities (James, 1995; McArdle et al., 1997)

U.S. children between the ages of 2 and 17 spend an average of 3 years of their life watching television (A.C. Nielson Co., 1998) Children who watch more than 5 hours of TV a day are 5 times more likely to be overweight than children who watch less than 2 hours a day Leisure Time Physical Activity

Household Physical Activity Decrease in energy expenditure due to “time-saving” devises –lawn mowers –snow blowers –vacuum cleaners –washing machines –microwaves

The percentage of trips made by biking and walking in the U.S.dropped from 6.7% in 1980, to 4.4% in 1990, and to 3.3% in 2000 (U.S. Census, 1980, 1990, 2000) –Number of automobiles per household –Individual attitudes and demographics –Changes in the built environment (density, land- use, connectivity) Transportation Physical Activity Transportation Physical Activity

Obesity For each 1 point rise in the urban sprawl index (0 – 100) the risk for being overweight increased by 0.2% and the risk for being obese increased by 0.5% (Lopez, 2004) County sprawl index was associated with minutes walked, BMI and hypertension (Ewing et al., 2003)

Obesity Each additional hour spent in the car was associated with a 6% increase in the likelihood of obesity (Frank et al., 2004) Each kilometer walked per day was associated with a 4.8% reduction in the likelihood of obesity (Frank et al., 2004)

So What Can a MCH Professional Do? Networking –With other health professionals –Within health department –Establish professional relationships with local planners and developers Advocacy –Educate others –Attend local zoning and planning meetings Science –Perform research, present at scientific meetings, publish papers

Summary The way we design and build the places we live, work, and play has an impact on our health As a public health professional you can have a positive impact on what happens in your neighborhood and community