Health, the Built Environment and Smart Growth: Linkages & Solutions

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

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

3. Asphalt Nation • 250% increase in vehicle miles traveled (915 billion miles) (1960-1997) • US average = 73 mins/day of driving • 200% increase in workers commuting to another county

4. Low priority for other modes of transportation Safety Access

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

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

7. 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

8. Smart Growth is a Public Health Strategy

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

10. The burden of physical inactivity • The Problem • 25% of adults are sedentary • 60% of adults not active enough • 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. • Medical costs associated with physical inactivity and its consequences may exceed $76 billion annually. SHCC Data Sources: 2000 BRFSS, 1999 NHANES, Powell 1994, Pratt et. al. 2000

11. No Data <4% 4%-6% 6%-8% 8%-10% >10% Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1993-94 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

12. No Data <4% 4%-6% 6%-8% 8%-10% >10% Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1995-96 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

13. No Data <4% 4%-6% 6%-8% 8%-10% >10% Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1997-98 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

14. No Data <4% 4%-6% 6%-8% 8%-10% >10% Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1999 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

15. No Data <4% 4%-6% 6%-8% 8%-10% >10% Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2001 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

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

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

18. Neighborhood environment is one of the strongest predictors of whether a person will be physically active. Brownson, etal. 2001 King, et al. 2000. SHCC

19. Growing body of evidence • San Diego study: 70 minutes more physical activity/week among residents in walkable neighborhood; 35% vs. 60% overweight (Saelens, Sallis, et. al. 2003) • 6 lb weight difference in sprawling vs. compact counties • 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

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

21. Does design make a difference for kids? • Marin, Co SR2S evaluation: 64% increase in number of kids walking to school with safety & traffic calming improvements & encouragement. • 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

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

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

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

25. By 2025, one in five Americans will be 65 years or older and over 6 million will be 85+ years The “Graying of America” 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 1999- 2100 (NP-T3), www.census.gov/population/www/projections/natsum.html

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

27. Smart Growth: a Public Health Strategy CREATE WALKABLE NEIGHBORHOODS

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

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

30. Battery Hens: Cooped up forlife • Kept indoors • Restricted boundaries & mobility • Can’t stretch, flap wings • Weak bones and muscles • Frustration, fighting, pecking

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

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

33. Healthy environments promote social networks & social capital • Loneliness and isolation are toxic; social relationships are healthy • 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

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

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

36. Fewer impervious surfaces Contamination from runoff Water quality & quantity • Groundwater pollution • H20 shortages SHCC

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

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

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

40. The Public Health Potential of Smart Growth Safe & Healthy Communities Consulting, 2003

41. 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