Public Health: What Does the Public Health: What Does the Built Environment Have to do Built Environment Have to do

With It?With It?

Candace D. Rutt, Ph.D.Candace D. Rutt, Ph.D.Division of Nutrition and Physical ActivityDivision of Nutrition and Physical Activity

Centers for Disease Control and PreventionCenters for Disease Control and Preventioncrutt@cdc.govcrutt@cdc.gov

What is the “Built Environment”?What is the “Built Environment”?

Pretty much everything Pretty much everything – BuildingsBuildings

Size, type, function, Size, type, function, aesthetics, densityaesthetics, density

– Transportation systemsTransportation systemsHighways, roads, bike lanes, Highways, roads, bike lanes, transit, sidewalkstransit, sidewalks

– Greenspace Greenspace Parks, undeveloped landParks, undeveloped land

Built Environment 101: Learning Built Environment 101: Learning to Talk the Talkto Talk the Talk

DensityDensity– The number of people either residing or The number of people either residing or

working in an areaworking in an area

Land-useLand-use– The degree to which different types of The degree to which different types of

activities (i.e., residential, commercial, activities (i.e., residential, commercial, business) exist together within a specific areabusiness) exist together within a specific area

Built Environment 101: Learning Built Environment 101: Learning to Talk the Talkto Talk the Talk

ConnectivityConnectivity

- - How well pedestrian How well pedestrian facilities are connected facilities are connected - Speed and volume of - Speed and volume of automobile trafficautomobile traffic

- Wideness and - Wideness and condition of sidewalkscondition of sidewalks

- Number of - Number of intersectionsintersections

Urban Sprawl/SuburbiaUrban Sprawl/Suburbia

Low density, low land-use, low connectivity, auto dependent with poor pedestrian and transit

infrastructure

Traditional Neighborhood/Traditional Neighborhood/Smart GrowthSmart Growth

High density, high land-use mix, high connectivity, and has more transportation choices

Why Should We Care About It?Why Should We Care About It?

The way we build our cities, communities The way we build our cities, communities and neighborhoods affects our health and and neighborhoods affects our health and the environmentthe environment

– Air pollutionAir pollution

– Noise pollutionNoise pollution

– Water pollutionWater pollution

– GreenspaceGreenspace

Additional ConsequencesAdditional Consequences

Physical activityPhysical activity

Food environmentFood environment

ObesityObesity

Mental healthMental health

Crime Crime

Social CapitalSocial Capital

AccessibilityAccessibility

InjuryInjury

Transportation Transportation

Source: Atlanta Journal-Constitution, March 10, 2006

…….And It’s Happening in Your .And It’s Happening in Your BackyardBackyard

Air PollutionAir Pollution

In 1997, vehicles accounted for:In 1997, vehicles accounted for:– 58% of CO 58% of CO – 30% of NOx30% of NOx– 27% of VOCs27% of VOCs– 9% of PM9% of PMA study in Austria, France, and A study in Austria, France, and Switzerland found that automobile related Switzerland found that automobile related pollution was responsible for more deaths pollution was responsible for more deaths than traffic accidents than traffic accidents (WHO, 2001)(WHO, 2001)

PollutionPollution

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

et al., 2001)et al., 2001)

Water PollutionWater Pollution

Increased impervious Increased impervious surfaces reduces the surfaces reduces the land’s ability to filter land’s ability to filter water water Consequently:Consequently:– Surface water quality Surface water quality

declines declines – Ground water supply Ground water supply

is reducedis reduced– Land becomes more Land becomes more

prone to floodingprone to flooding

GreenspaceGreenspace

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

Social CapitalSocial Capital

Living in walkable Living in walkable mixed-use mixed-use communities was communities was found to be related to found to be related to higher levels of social higher levels of social capitalcapital (Leyden, 2003)(Leyden, 2003)

Each additional 10 minutes in daily commuting time cuts involvement in community affairs by 10% (Putnam)

AccessibilityAccessibility

In Houston 3 out of 5 In Houston 3 out of 5 disabled and elderly people disabled and elderly people did not have sidewalks did not have sidewalks between their residence between their residence and the nearest bus stop and the nearest bus stop

People who do not own a car are not able to participate in social or economic activities

Pedestrian SafetyPedestrian Safety

Only 5% of trips are made on foot but Only 5% of trips are made on foot but account for 12% of all traffic deathsaccount for 12% of all traffic deaths

For every 1% increase in the sprawl index For every 1% increase in the sprawl index pedestrian fatality rates fell by 3.56% after pedestrian fatality rates fell by 3.56% after adjusting for pedestrian exposure adjusting for pedestrian exposure (Ewing et al., 2003)(Ewing et al., 2003)

Pedestrian SafetyPedestrian Safety

Most dangerous Most dangerous roads tend to have:roads tend to have:– Multiple lanesMultiple lanes

– High speedsHigh speeds

– No sidewalksNo sidewalks

– Long distances Long distances between crosswalksbetween crosswalks

– Roadways lined with Roadways lined with large commercial large commercial establishments and establishments and apartmentsapartments (Hanzlick, 1999)(Hanzlick, 1999)

TransportationTransportation

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

We’re Driving Ourselves CrazyWe’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

TransportationTransportation

Automobile crashes are the leading case Automobile crashes are the leading case of death for people ages 1 – 24 and cost of death for people ages 1 – 24 and cost $200 billion per year $200 billion per year (CDC, 1999)(CDC, 1999)

Commuting has been related to back pain, Commuting has been related to back pain, cardiovascular disease, and stresscardiovascular disease, and stress (Koslowsky et al., (Koslowsky et al.,

1995)1995)

TransportationTransportation

There was a 51% increase in road rage from There was a 51% increase in road rage from 1990 to 19961990 to 1996 (Mizell, 1997) (Mizell, 1997)

Nutrition EnvironmentNutrition Environment

Availability of foodAvailability of food

Portion sizesPortion sizes

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

Nutrition EnvironmentNutrition Environment

From 1972 to 1997 the number of fast food From 1972 to 1997 the number of fast food restaurants doubled and the number of restaurants doubled and the number of restaurants rose by 35% restaurants rose by 35% (Bureau of the Census, various years)(Bureau of the Census, various years)

From 1977 to 1995 there was a 200% increase From 1977 to 1995 there was a 200% increase in the percentage of meals eaten at fast food in the percentage of meals eaten at fast food restaurantsrestaurants (National Restaurant Association, 1998)(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 EnvironmentNutrition Environment

Healthy diets are associated Healthy diets are associated with the availability of with the availability of supermarkets: supermarkets: (Morland 2002)(Morland 2002)

• Fruit and vegetable intake Fruit and vegetable intake increases by 32% for each increases by 32% for each additional supermarket in a additional supermarket in a census tract for African census tract for African AmericansAmericans

• Achieving recommended levels Achieving recommended levels of fat and saturated fat among of fat and saturated fat among African Americans is also African Americans is also associated with the availability associated with the availability of supermarketsof supermarkets

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

Nutrition EnvironmentNutrition Environment

BAGELBAGEL 20 Years Ago Today

140 calories 3-inch diameter

How many calories are in this bagel?

http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2

140 calories 3-inch diameter

Calorie Difference: 210 calories

350 calories 6-inch diameter

BAGELBAGEL 20 Years Ago Today

http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2

SPAGHETTI AND MEATBALLS20 Years Ago Today

500 calories1 cup spaghetti with sauce and 3 small meatballs

How many calories do you think are in today's portion of spaghetti and meatballs?

http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2

Calorie Difference: 525 calories

1,025 calories 2 cups of pasta with sauce and 3 large meatballs

20 Years Ago Today

500 calories1 cup spaghetti with sauce and 3 small meatballs

SPAGHETTI AND MEATBALLS

320 calories How many calories are in today’s turkey sandwich?

TURKEY SANDWICHTURKEY SANDWICH20 Years Ago Today

http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2

Calorie Difference: 500 calories

820 calories 320 calories

TURKEY SANDWICHTURKEY SANDWICH20 Years Ago Today

http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2

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

NutritionNutrition

Physical Activity EnvironmentPhysical Activity Environment

Declines across most domains of physical Declines across most domains of physical activityactivity– Recreational Recreational – Occupational Occupational – HouseholdHousehold– TransportationTransportation

Increase in attractive sedentary activitiesIncrease in attractive sedentary activities(James, 1995; McArdle et al., 1997)(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 ActivityLeisure 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 ActivityTransportation Physical Activity

ObesityObesity

For each 1 point rise in the urban sprawl For each 1 point rise in the urban sprawl index (0 – 100) the risk for being index (0 – 100) the risk for being overweight increased by 0.2% and the risk overweight increased by 0.2% and the risk for being obese increased by 0.5% for being obese increased by 0.5% (Lopez, 2004)(Lopez, 2004)

County sprawl index was associated with County sprawl index was associated with minutes walked, BMI and hypertension minutes walked, BMI and hypertension (Ewing (Ewing

et al., 2003)et al., 2003)

Obesity Obesity

Each additional hour Each additional hour spent in the car was spent in the car was associated with a 6% associated with a 6% increase in the increase in the likelihood of obesitylikelihood of obesity (Frank et al., 2004)(Frank et al., 2004)

Each kilometer Each kilometer walked per day was walked per day was associated with a associated with a 4.8% reduction in the 4.8% reduction in the likelihood of obesity likelihood of obesity (Frank et al., 2004)(Frank et al., 2004)

So What Can a MCH Professional So What Can a MCH Professional Do?Do?

NetworkingNetworking– With other health professionalsWith other health professionals– Within health departmentWithin health department– Establish professional relationships with local Establish professional relationships with local

planners and developersplanners and developers

AdvocacyAdvocacy– Educate others Educate others – Attend local zoning and planning meetingsAttend local zoning and planning meetings

ScienceScience– Perform research, present at scientific meetings, Perform research, present at scientific meetings,

publish paperspublish papers

SummarySummary

The way we design and build the places The way we design and build the places we live, work, and play has an impact on we live, work, and play has an impact on our healthour health

As a public health professional you can As a public health professional you can have a positive impact on what happens in have a positive impact on what happens in your neighborhood and communityyour neighborhood and community