Tuesday, May 17, 2005

"Built Environment" and Health Realities (Disparities)

Where you live determines, in large measure, how well and how long you will live.

Over the past decade or so, substantive, scientific research has tackled the relationship between health outcomes and health disparities and the various realities of "built environments."

Built environment is simply how things are arranged, constructed and included in the spaces where we live.

For example, the presence or absence of sidewalks, bike paths, recreational areas, and parks determines influential health factors such as physical activity and the prevalence of diabetes, obesity, asthma, hypertension and depression.

". . .in those low-income areas that do not have such amenities, the threat of crime keeps people inside. Income segregation--the practice of housing the poor in discrete areas of a city--has also been linked with obesity and adverse mental health outcomes" (from Ernie Hood, "Dwelling Disparities: How Poor Housing Leads to Poor Health," in Environmental Health Perspectives, Volume 113, Number 5, May 2005).

Most poor communities, especially in inner city areas, suffer (literally) for a want of supermarkets and access to healthy foods at affordable prices.

Instead, convenience stores encourage smoking, fast food restaurants feed obesity and diabetes, and liquor stores drive up teen drinking and addiction.

Add in low-quality, often dilapidated housing with the accompanying lead poisoning, asthma triggers and mental health stressors, including violence and social isolation, and you have a formula for disease well above the norm of the larger community.

Hood concludes in the introduction to his important and distressing essay, "Low-income and/or ethnic minority communities--already burdened with greater rates of disease, limited access to health care, and other health disparities--are also the populations living with the worst built environment conditions. Studies have shown that negative aspects of the built environment tend to interact with and magnify health disparities, compounding already distressing conditions."

Lots here to ponder, huh?

One thing seems very clear: we can reasonably expect that dollars invested properly, strategically and wisely in urban environments will pay off not only in terms of improved aesthetics, but also in concrete community health outcomes, and that over the long haul.


owldog said...

Lots to Ponder, Hpefully the risk will be cut down when the single brand new housing units are built.

Neal W. said...

What? Are you telling me that I can no longer blame the poor for their poverty, thereby letting myself off the hook? Nuts.

the_jubinator said...

Yeah, but I don't buy the fact that proximity to convenience stores and fast food restaurants are any sort of excuse for poor health or obesity. Let's not insult the under-priveleged, it still has a lot to do with personal choices...and a lot of this rhetoric implies that we don't trust these folks to make the right choices with their lives/money/health. It's like the kid whose parents treat him like he can't take care of himself or make good decisions on his own...after a while, this "training" or brain washing is manifested in how he lives his life...which is co-dependent with inability to make wise choices.

I don't disagree with the point you're making, I just think this argument is always generalizing & worn out. Take me, for example. I live in a modest neighborhood somewhat isolated from commercialized strip malls & grocery stores. The nearest things within walking distance are convenience stores and fast food joints. We still choose to go to the grocery store and buy regular food most of the time, and rarely go to convenience stores or fast food places.

And it's not really about money either, because I never buy big packages of pricey steaks or set foot in Whole Foods Mkt. Instead, I usually buy a bunch of those Lean Cuisinne or Healthy Choice frozen dinners, which are basically the same price as fast food meals, and very easy, too. I'm saying, there's always a choice, right? No one forced me to eat junky food on my limited budget when I was younger, but I did so out of poor decision making.
And I thought that welfare money couldn't be spent on most of those junk food items anyway.

I'm suggesting that blaming someone for poverty is one thing, but blaming them for their diet is another.

Larry James said...

Jubinator, I find your comments interesting. I do think that you underestimate the challenges facing many low-income families. Take the fact that many, many of these families do not have transportation of their own. Add to that the cost of healthy food and you have a better feel for what is being said here. The other reality is the fact that low-income communities are not as well organized to resist the presence of the over abundance of these stores. It is a big deal in inner city Dallas when a real grocery store opens in the 'hood.