The Built Environment & Health: Housing, Neighbourhoods, Regions & Societies

1. The Built Environment & Health: Housing, Neighbourhoods, Regions & Societies James R. Dunn, Ph.D. Centre for Research on Inner-City Health, St. Michael’s Hospital Depts. of Geography & Public Health Sciences, University of Toronto

3. GEOGRAPHY: Greek geo -, from ge , earth

4. Geography Matters “Everything is real estate. You’re a product of your geography” Lenny Bruce

5. Geography Doesn’t Matter “Looking at things in a spatial perspective can be as meaningless as saying the Titanic sank in the afternoon” (Kirby)

6. Virtually everything in our built environment is the way it is because someone designed it that way. - Dr. Richard Jackson (Public Health Officer for State of California and former Director of Center for Disease Control)

7. Objectives • illustrate connections between the built environment and health • key issues in housing and health • key issues in neighbourhoods and health • how policies & practices related to land use and automobile travel affect health • what can be done?

8. …from cell to society… House/Home Individual Human Life Cycle family/household neighbourhood community Death Conception city/region national socio-economic environment Adapted from Hertzman & Kelly (2000)

9. A Conceptual Framework for Housing, SES and Health • Physical Hazards • Physical Design • Psychological Benefits • Social Benefits • Political Dimensions • Financial Dimensions • Location • owners/renters • different income levels • (dis)ability • mental illness • age spectrum (kids, seniors) • gender • ethnicity/immigration • family/household status

10. A Conceptual Framework for Housing, SES and Health • Physical Hazards • physical, chemical, biological hazards • does SES affect the likelihood of exposures in the home? • are there socio-economic differences in the capacity and likelihood of taking ameliorative action on exposures? • Physical Design • falls, accidents, accessibility, etc. • restorative environments; balance b/w social interaction and privacy; surveillance zones; spaces for unsupervised play • important for frail elderly, people w/ disabilities, children

11. Your House is an Exposure Chamber

12. A Conceptual Framework for Housing, SES and Health • Physical Hazards • physical, chemical, biological hazards • does SES affect the likelihood of exposures in the home? • are there socio-economic differences in the capacity and likelihood of taking ameliorative action on exposures? • Physical Design • falls, accidents, accessibility, etc. • restorative environments; balance b/w social interaction and privacy; surveillance zones; spaces for unsupervised play • important for frail elderly, people w/ disabilities, children

13. A Conceptual Framework for Housing, SES and Health • Psychological Benefits • expression of identity, status, prestige • construction of meaning regarding house / home • pride in home, home as a reflection of self, sense of belongingness in neighbourhood, adequacy of home for making & maintaining social ties, absence of stigmatizing features • control, refuge, privacy, continuity, etc. • exercise of control & demand in everyday conditions • home as a place of refuge, worry about forced move, fear of crime / victimization, inability to move, frequency of moves, strain of housework, strain of housing costs

14. “Pride of Ownership”

15. Emergent Research Questions for Housing, SES and Health • Psychological Benefits • expression of identity, status, prestige • construction of meaning regarding house / home • pride in home, home as a reflection of self, sense of belongingness in neighbourhood, adequacy of home for making & maintaining social ties, absence of stigmatizing features • control, refuge, privacy, continuity, etc. • exercise of control & demand in everyday conditions • home as a place of refuge, worry about forced move, fear of crime / victimization, inability to move, frequency of moves, strain of housework, strain of housing costs

16. A Conceptual Framework for Housing, SES and Health • Social Benefits • housing / home central to social relations • adequacy of home for making & maintaining social ties, neighbourhood connectedness for support and contacts, social capital • Political Dimensions • housing policy: who wins and loses and why? • government policies support housing industry, decline of public sector in housing • political struggle for neighbourhood conditions • resistance of unwanted land uses, ability to demand amenities and insist on maintenance to high standard

17. A Conceptual Framework for Housing, SES and Health • Financial Dimensions • resdistributive impacts of housing policies • affordability, tenure, and regressive transfers • relationship b/w housing wealth and health? • health effect of a high rent-to-income ratio? • % of government ‘spending’ on owning vs. renting? • Location • land markets and socio-spatial sorting - social environments • systematic exposure to health hazards, health-promoting or diminishing opportunity structures; social capital

18. Key Principles and Challenges • housing as a cornerstone of a healthful life • a challenge and an opportunity • hard to ‘prove’ relationships b/w housing & health • housing improvements => ‘cascade’ effect over many areas of life: e.g., bio-physical hazards, social support, educational outcomes, labour force attachment, control over everyday life, etc. • connect housing & health with n’hoods research • avoid attributing too much importance to residential location • reconstruct daily time-space paths for descriptive info on dynamics of ‘exposures’ in residential & non-residential env’ts • complex causal chains with long latency periods • focus on effects of housing on known antecedents to good health and measures sensitive to change

19. Neighbourhoods & Health

20. Neighbourhood Effects & Health • resurgence of interest in how places shapes health since early 1990s • heavy emphasis on ‘compositional effects’ – places shape health because of who lives there • Macintyre began studying direct effects of local social and physical env’ts that may shape health • debate over ‘contextual’ vs. ‘compositional’ effects • can these be separated? can compositional features be emergent as contextual effects? • now appears that there is no single ‘universal’ effect of area on health • i.e., ‘do n’hoods affect health?’ is unanswerable • there are some area effects on some population groups in some places – a complex picture • all agree that better theory is needed - complexity

21. N Engl J Med, 345(2): 99-106, July 12, 2001

23. miasma competition theory neighbourhood deprivation neighbourhood affluence social capital collective efficacy social disorganization ‘broken windows’ community assets public services reputation of neighbourhood opportunity structures crime & delinquency child & youth early child dev’t mental health health behaviours coronary heart disease neural tube defects low birth weight etc… Neighbourhood Effects: theories, measures, outcomes & methods

24. Some other considerations • importance of residential neighbourhoods • humans are mobile – when and to what extent do residential n’hoods matter? • what methods are best for understanding place effects and n’hood effects? • what kinds of evidence do we have / need for policy interventions? • how do we define the relevant geographic scale, both theoretically and practically?

25. Built Environments & Health at the Regional & Societal Level

26. Built Environment and Health: Conditions & Connections • urban sprawl & automobile dependency • air pollution & respiratory illness • physical inactivity, obesity & CVD • health community relations / social isolation • mental health • injuries • child development

27. Respiratory & Cardiovascular Effects of Built Environments • built environment & travel patterns affect air pollution, physical activity and obesity • land use patterns, automobile orientation & urban sprawl are key • density • land use mix • location of developments • street connectivity • transit access

28. Community design affects activity

29. Community design affects activity

30. Community design affects activity Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)

31. Community design affects activity Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)

32. Community design affects activity Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)

33. Community design affects activity Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)

34. Community design affects activity Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)

35. Suburban environment:Low density, automobile-dependent suburban development favors certain socio-economic groups, and limits the mobility and independence of people at both ends of the life cycle. Children are limited by issues of safety and access while seniors find that as they age and their physical vigor and incomes begin to decline, they become more isolated. Source: Howe, Deborah, “Aging and Smart Growth: Building Aging Sensitive Communities

36. Suburban Sprawl

37. Exurban Sprawl

38. Traffic congestion Air and water pollution Increased flooding and erosion Loss of farmland and open space Mismatch between jobs and people Inner city decline and poverty Shrinking urban tax base Loss of community Segregation by income and race Fiscal stress in suburban communities Overcrowded suburban schools Increased traffic accidents and road rage Obesity Social isolation Increased stress Mental health problems In sum, sprawl has “received the blame for seemingly every bad aspect of contemporary urban life.” (Wells Fargo Bank report on sprawl).

39. What Can Be Done? Need to better define our visions of community THIS? OR THIS?

40. What Can Be Done? The changes may only involve something as simple as paint stripes to slow traffic

41. We Are Not Powerless to Change the Built Environment Virtually everything in our built environment is the way it is because someone designed it that way. Source: www.urban-advantage.com

42. Ten Principles Of Smart Growth • Mix land uses • Take advantage of compact building design • Create a range of housing affordable opportunities and choices • Create walkable neighborhoods • Foster distinctive, attractive communities with a strongsense of place • Preserve open space, farmland, natural beauty, and critical environmental areas • Strengthen and direct development towards existing communities • Provide a variety of transportation choices • Make development decisions predictable, fair, and cost effective • Encourage community and stakeholder collaboration in development decisions

43. Sprawl Vs. Smart Growth

44. jim.dunn@utoronto.ca