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 ServicesFebruary 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)

Dimension Definition Examples 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 mileCommercial floor space : land area ratio

Distance from house to nearest storeShare of total land area per use

Intersections/square mileAverage block length

Buildings height : street width ratioAverage distance from street to buildings

Percent of ground in shade at noonNumber locations with graffiti/square mile

Rate of density decline with distance from downtownBased 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)