Abstract
Health
and the Built Environment:
The Effects of Where We Live, Work and Play
By
Henry
Louis Taylor, Jr.
Health and the Built Environment: The Effects of Where We
Live, Work and Play explores the role played by the built
environment in causing health problems among inner city residents,
with a particular emphasis on the African American community.
Notwithstanding, the issues discussed in this essay impact all
socioeconomic groups living in distressed central city and suburban
neighborhoods and this includes Latinos, Asians, Native Americans,
and low-income working class whites. Moreover, the built environment,
albeit in different ways, also contributes to the health problems
of middle-class central city and suburban residents. Nonetheless,
given the staggering health disparities between blacks and whites,
and the extent to which the literature on heath and the built
environment neglects issues pertaining to inner city communities,
the emphasis on African Americans is more than warranted.
Health
and the Built Environment is not only concerned with the
health effects of where we live, work, and play, but also with
the type of urban planning strategies and public policies needed
to address the problem. It argues that the active living movement
and the new urbanism and smart growth planning strategies are
primarily informed by sprawl and conditions found in middle-class
central city and suburban neighborhoods. Thus, the policies, urban
designs, and new construction ideas emanating from these movements
will only minimally impact built environment conditions found
in distressed inner city communities.
An
emerging trend in the design, urban planning, and medical professions
is one that investigates how the built environment contributes
to the health problems of Americans. This viewpoint is based on
the notion that inadequate diet and sedentary living increases
the risk for many chronic diseases, such as cardiovascular disease,
hypertension, colon cancer, type-2 diabetes, osteoporosis, obesity,
anxiety and depression. A consensus now exists among health scientists,
medical practitioners and other professionals that an active lifestyle
reduces the risk for many chronic diseases and/or facilitates
the successful management of those illnesses. Within this context,
the active living movement arose a few years ago to attack the
sedentary culture problem. It stressed the development of a lifestyle
that integrates physical activity into daily routines, with the
goal of accumulating minimally 30 minutes of activity each day
by walking, bicycling, exercising, working in the yard, taking
the stairs, or engaging in some other type of physical activity.
The
active living movement supported the activities of new urbanism
and smart growth. Urban planners advocating this approach to residential
development suggest that transportation policy, neighborhood design,
and existing land use patterns contribute to physical inactivity
and the development of a culture of sedentary living. They call
for a new approach to residential development that promotes high
density neighborhoods and mixed land-use developments that bring
residential, commercial, and retail activities closer together
so that traffic is reduced and more cycling and walking is encouraged.
Collectively, active living, new urbanism, and smart growth are
constructing a new model of residential development that incorporates
wellness into the design and construction of neighborhoods.
However,
this essay argues that these movements are not only primarily
based on conditions found in predominantly white middle-class
central city and suburban communities, but also their advocates
do not consider the significant differences that exist in dissimilar
parts of the built environment. The point is that the barriers
to active living found in distressed inner city neighborhoods
are significantly different from those found in other parts of
the metropolis. Here, built environment issues are more complex
and challenging. Consequently, a distinct approach must be used
to attack them. For example, in the inner city, barriers to active
living and a healthy lifestyle are impeded by crime, violence,
fear, inadequate food security, dilapidated housing, poorly maintained
sidewalks, streets, sewer and water lines, and blight. These conditions
create stressors that are produced by poverty, low-incomes, joblessness,
difficult work situations, and the struggle to make ends meet,
along with cultural and financial obstacles to health care. These
built environment issues have produced a health crisis so severe
that in December 2004, the NAACP said “the fight for quality
health care is the new civil rights battle.”
The
obstacles to wellness erected by the inner city built
environment cannot be solved unless the emerging model of health
care connects its strategy to the quest to radically reconstruct
the inner city built environment. Toward this end, design professionals,
urban planners, health scientists, medical practitioners, public
health experts, and policy makers must develop insight into the
differential barriers to wellness found in inner city
neighborhoods and then formulate strategies and policies to attack
them.
Selected
Readings
Andrew
L. Dannenberg, J.R. Jackson, H. Frumkin, R.A. Schieber, M. Pratt,
C. Kochtitzky, and H.H. Tilson, The Impact of Community Design
and Land-Use Choices on Public Health, American Journal
of Public Health (September 2003)93:1500-1508.
Carlos
J. Crespo, Ellen Smit, Ross E. Andersen, Olivia Carter-Pokras,
and Barbara E. Ainsworth, Race/Ethnicity, Social Class and
Their Relation to Physical Inactivity During Leisure Time: Results
from the Third National Health and Nutrition Examination,
American Journal of Preventive Medicine, (2000)18/1:46-53.
Carlos
J. Crespo, Steven J. Keteyian, Gregory W. Heath, and Christopher
T. Sempos, Leisure-Time Physical Activity Among U.S. Adults,
Archives of Internal Medicine (1996)156:93-96.
Daniel
Trudeau and Meghan Cope, Labor and Housing Markets as Public
Spaces: Personal Responsibility and the Contradiction of Welfare-Reform
Policies, Environment and Planning (2003)35:779-798.
Frank W. Booth and Manu V. Chakravarhy, Cost and Consequences
of Sedentary Living: New Battleground for an Old Enemy (March
2002)3/6:1-6.
Julie
M. Feinsilver, Healing the Masses: Cuban Health Politics
at Home and Abroad (Berkeley: University of California
Press, 1993): 26-62.
Keith
Lawrence, Stacey Sutton, Anne Kubisch, Gretchen Susi, and Karen
Fulbright-Anderson, Structural Racism and Community Building,
The Aspen Institute Roundtable on Community Change, June 2004.
Rhonda
Jones-Webb, Drinking Patterns and Problems Among African Americans:
Recent Findings, Alcohol Health and Research World
(1998)22/4: 260-264.
Ross
E. Anderson, Carlos J. Crespo, Susan J. Barlett, Lawrence J. Cheskin,
and Michael Pratt, Relationship of Physical Activity and Television
Watching with Body Weight and Level of Fatness Among Children:
Results from the Third National Health and Nutrition Examination
Survey, The Journal of the American Medical Association
(March 25, 1998) 279: 938-942.
Sabina
Deitrick and Cliff Ellis, New Urbanism in the Inner City:
A Case Study of Pittsburgh, Journal of the American
Planning Association(Autumn 2004)70/4:426-442.
Special
Report: The State of African American Health, The Crisis
(November/December 2004):17-35.
Henry
Louis Taylor, Jr. and Sam Cole, Structural Racism and Efforts
to Radically Reconstruct Inner City Neighborhoods (November
2000), The CyberHood (Feature Paper Archive),
www.thecyberhood.net.
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