Health, equity, and the built environment

Built and social indices for hazards in Children's environments

Leveraging the capabilities of the Historical Spatial Data Infrastructure (HSDI) and composite indices we explore the importance of children's built and social environments on health. We apply contemporary GIS methods to a set of 2000 historical school records contextualized within an existing HSDI to establish seven variables measuring the relative quality of each child's built and social environments. We then combined these variables to create a composite index that assesses acute (short-term) health risks generated by their environments. Our results show that higher acute index values significantly correlated with higher presence of disease in the home. Further, higher income significantly correlated with lower acute index values, indicating that the relative quality of children's environments in our study area were constrained by familial wealth. This work demonstrates the importance of analyzing multiple activity spaces when assessing built and social environments, as well as the importance of spatial microdata.

Road safety, health equity, and the built environment: perspectives of transport and injury prevention professionals in five Canadian municipalities

BACKGROUND

Concerns regarding health equity (HE) and the built environment (BE) are well established in the Canadian urban context. Transport and injury prevention professionals across sectors, such as transportation and public health, are involved in designing and implementing BE interventions that enhance the safety of vulnerable road users (VRUs). Results from a larger study examining barriers and facilitators to BE change are used to illustrate how transport and injury prevention professionals perceive HE concerns in their work in five Canadian municipalities. Broadening our understanding of how HE influences the professional BE change context is crucial when advocating for modifications that enhance the safety of equity-deserving VRUs and groups who experience marginalization.

METHODS

Interview and focus group data were gathered from transport and injury prevention professionals working in policy/decision-making, transport, police services, public health, non-profit organizations, schools/school boards, community associations, and private sectors across five Canadian urban municipalities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. Data were analyzed using thematic analysis (TA) to illustrate how equity considerations were perceived and applied in participants' BE change work.

RESULTS

The results of this study illustrate transport and injury prevention professionals' awareness of the varying needs of VRUs, as well as the inadequacies of current BEs in the Canadian urban context and consultation processes utilized to guide change. Participants emphasized the importance of equitable community consultation strategies, as well as specific BE changes that would support the health and safety of VRUs. Overall, the results highlight how HE concerns inform transport and injury prevention professionals' BE change work in the Canadian urban context.

CONCLUSION

For professionals working in urban Canadian transport and injury prevention sectors HE concerns influenced their perspectives of the BE and BE change. These results illustrate a growing need for HE to guide BE change work and consultation processes. Further, these results contribute to ongoing efforts in the Canadian urban context to ensure that HE is at the forefront of BE policy change and decision-making, while promoting existing strategies to ensure that the BE, and related decision-making processes, are accessible and informed by a HE lens.

Consequences of living environment insecurity on health and well-being in southwest China: The role of community cohesion and social support

Growing populations in developing countries have exacerbated inequality in the spatial distribution of living environments. As a result, whether living environment factors matter to health and well-being is increasingly attracting policy and scholarly attention. Yet, crucial knowledge gaps remain regarding the implications, consequences and mechanisms of one's living environment on health and well-being in developing countries. This study examined the association between living environment and psychological distress, self-rated health and satisfaction with life among Chinese adults. Furthermore, it also explored the moderating role of community cohesion and the mediating role of social support on these factors. Using probability proportionate to size sampling methods, 3765 respondents and 148 community organisers were recruited from 160 communities in Yunnan, China, in 2018. Ordinary least squares regression and structural equation modelling were conducted. The findings indicate that residents who lived in communities with higher levels of environment insecurity had lower levels of subjective health and well-being (psychological distress: β = 1.088, p < 0.001; self-rated health: β = -0.104, p < 0.01; satisfaction with life: β = -0.164, p < 0.001). Moreover, community cohesion played a moderating role in the relationship between living environment insecurity and self-rated health (β = 0.212, p < 0.05) and satisfaction with life (β = 0.183, p < 0.05); however, it had no significant effects on psychological distress. Furthermore, the moderated effects of community cohesion on living environment insecurity were mediated through perceived social support for self-rated health (proportion of total effect mediated = 11%) and satisfaction with life (proportion of total effect mediated = 29%). The present findings have implications for policy makers and community committees who can work towards social inequality in developing countries. The integrated programmes of improving living conditions and strengthening community capacity are crucial to residents' health and well-being.

The blueprint of disaster: COVID-19, the Flint water crisis, and unequal ecological impacts

COVID-19 is unique in the scope of its effects on morbidity and mortality. However, the factors contributing to its disparate racial, ethnic, and socioeconomic effects are part of an expansive and continuous history of oppressive social policy and marginalising geopolitics. This history is characterised by institutionally generated spatial inequalities forged through processes of residential segregation and neglectful urban planning. In the USA, aspects of COVID-19's manifestation closely mirror elements of the build-up and response to the Flint crisis, Michigan's racially and class-contoured water crisis that began in 2014, and to other prominent environmental injustice cases, such as the 1995 Chicago (IL, USA) heatwave that severely affected the city's south and west sides, predominantly inhabited by Black people. Each case shares common macrosocial and spatial characteristics and is instructive in showing how civic trust suffers in the aftermath of public health disasters, becoming especially degenerative among historically and spatially marginalised populations. Offering a commentary on the sociogeographical dynamics that gave rise to these crises and this institutional distrust, we discuss how COVID-19 has both inherited and augmented patterns of spatial inequality. We conclude by outlining particular steps that can be taken to prevent and reduce spatial inequalities generated by COVID-19, and by discussing the preliminary steps to restore trust between historically disenfranchised communities and the public officials and institutions tasked with responding to COVID-19.

Neighborhood Perceptions Among Pregnant African American Women in St. Louis, Missouri, Before and After the Shooting of Michael Brown

Purpose: This study aims to examine perceptions of neighborhood quality and safety before and after the death of Michael Brown and the unrest that followed. Methods: In this secondary analysis of baseline data from one site in The Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium, pregnant African American women in the St. Louis region completed a survey of neighborhood perceptions. Logistic regression was used to explore associations between perceptions among those completing baseline surveys and entering the study before and after August 9, 2014 (range: 2012-2015), adjusted for demographic characteristics. Results: Of 267 participants, half (n=134) completed the survey after August 9, 2014. Thirty-four percent of participants completing the survey after this date felt "The crime rate in my neighborhood makes it unsafe to go on walks during the day" compared with 21% of those completing the survey before (adjusted odds ratio=2.0, 95% confidence interval: 1.1-3.7). There were no consistently significant differences in demographic characteristics or in the remaining 16 neighborhood items. Conclusions: This study is an example of how an unexpected shift in the community context in the wake of a profound event may impact health behaviors and outcomes in a measurable way. Clinical Trials Registration: NCT01768793.

Community-Based Participatory Research at Jacksonville Florida Superfund Ash Site: Toxicology Training to Improve the Knowledge of the Lay Community

Until the late 1960's, Jacksonville, Florida incinerated its solid waste with the resultant ash deposited in landfills or used to fill flood-prone areas. These filled areas were later developed into parks, school sites and residential areas. Lead in soil at these sites was the major toxicant of concern and driver of clean-up actions. During the period of assessment of lead-levels in soil, there were no established lines of communication between the City and residents of affected neighborhoods resulting in mistrust in the community. To address communication issues, a community-based, culturally sensitive Community Environmental Toxicology Curriculum (CETC) and a short video were developed for community stakeholders to inform them of risks, health effects, remediation processes and preventive measures. Pre-and post-tests were developed to measure knowledge gained from the toxicology training. Learning gains averaged 47% and 24% for the community leaders and residents respectively. Most participants strongly agreed that the community toxicology curriculum was a useful tool for promoting awareness of environmental risks in their community and addressing the gap in trust between residents and agencies involved in site remediation.

Putting Sex Into Context in Later Life: Environmental Disorder and Sexual Interest Among Partnered Seniors

Background and Objectives

This study examines whether neighborhood and household disorder is associated with sexual interest among partnered seniors.

Research Design and Methods

Analyses use dyadic data from Wave 2 of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults (2010-2011). Measures of environmental disorder were conducted by trained interviewers. Survey data were also linked to census tract information from the 2009 American Community Survey. We used actor-partner interdependence models to estimate the likelihood of reporting low sexual interest.

Results

There was no observed association between neighborhood context (physical disorder or census tract socioeconomic disadvantage) and sexual interest, but husbands were more likely to report low sexual interest if they lived in more disorderly households. High marital quality protected against low sexual interest, but these evaluations did not mediate or moderate the putative effect of household disorder.

Discussion and Implications

Regardless of the broader neighborhood context, helping older adults maintain an orderly home space may help sustain sexual functioning. Future research should consider how various features of the environment matter for additional aspects of late-life sexuality.

Social Disadvantage and Instability in Older Adults' Ties to Their Adult Children

OBJECTIVE

We examine whether racial and socioeconomic factors influence older adults' likelihood of experiencing instability in their social network ties with their adult children.

BACKGROUND

Recent work shows that socially disadvantaged older adults' social networks are more unstable and exhibit higher rates of turnover, perhaps due to greater exposure to broader social-environmental instability. We consider whether this network instability applies to older adults' ties with their adult children, which are often the closest and most reliable social ties in later life.

METHODS

We use two waves of data from the National Social Life, Health, and Aging Project (N=1,456), a nationally representative, longitudinal study of older Americans. Through a series of multivariate regression models, we examine how race and education are associated with how frequently older adults reported being in contact with child network members, and how likely older adults were to stop naming their children as network members over time.

RESULTS

African American and less educated individuals reported significantly more frequent contact with their adult child network members than did whites and more educated individuals. Nevertheless, these populations were also more likely to stop naming their children as network confidants over time.

CONCLUSION

African American and less educated older adults are at greater risk of losing access to the supports and other resources that are often provided by adult children, or of not being able to consistently draw on them as they age, despite the fact that these ties demonstrate greater potential for support exchange at baseline.

(Where) Is Functional Decline Isolating? Disordered Environments and the Onset of Disability

The onset of disability is believed to undermine social connectedness and raise the risk of social isolation, yet spatial environments are seldom considered in this process. This study examines whether unruly home and neighborhood conditions intensify the association between disability onset and several dimensions of social connectedness. I incorporate longitudinal data from the National Social Life, Health, and Aging Project, which contains environmental evaluations conducted by trained observers ( N = 1,558). Results from Poisson, ordinal logistic, and linear regression models reveal heterogeneous consequences of disablement: disability onset was associated with reduced core network size, fewer friends, lower likelihood of social interaction, and less overall social connectedness-though mainly when accompanied by higher levels of household disorder. There was limited evidence that neighborhood disorder moderated consequences of disability. Findings point to the importance of the home as an environmental resource and underscore important contextual contingencies in the isolating consequences of disability.

Household Disorder, Network Ties, and Social Support in Later Life

Family relationships, social interactions, and exchanges of support often revolve around the household context, but scholars rarely consider the social relevance of this physical space. In this article the author considers social causes and consequences of household disorder in the dwellings of older adults. Drawing from research on neighborhood disorder and social connectedness in later life, she describes how network characteristics may contribute to household disorder and how household disorder may weaken relationships and reduce access to support. This is explored empirically by estimating cross-lagged panel models with data from 2 waves of the National Social Life, Health, and Aging Project. The results reveal that household disorder reflects a lack of social support, and it leads to more kin-centered networks and more strain within family relationships. The author concludes by urging greater attention to how the household context shapes-and is shaped by-the social interactions and processes that occur within it.

Improving health and well-being independently of GDP: dividends of greener and prosocial economies

Increases in gross domestic product (GDP) beyond a threshold of basic needs do not lead to further increases in well-being. An explanation is that material consumption (MC) also results in negative health externalities. We assess how these externalities influence six factors critical for well-being: (i) healthy food; (ii) active body; (iii) healthy mind; (iv) community links; (v) contact with nature; and (vi) attachment to possessions. If environmentally sustainable consumption (ESC) were increasingly substituted for MC, thus improving well-being and stocks of natural and social capital, and sustainable behaviours involving non-material consumption (SBs-NMC) became more prevalent, then well-being would increase regardless of levels of GDP. In the UK, the individualised annual health costs of negative consumption externalities (NCEs) currently amount to £62 billion for the National Health Service, and £184 billion for the economy (for mental ill-health, dementia, obesity, physical inactivity, diabetes, loneliness and cardiovascular disease). A dividend is available if substitution by ESC and SBs-NMC could limit the prevalence of these conditions.

Self-assessed health of elderly people in Brussels: does the built environment matter?

The living environment plays a key role in the "Aging in Place" strategy. We studied the influence of the built environment on the health status of elderly people living in Brussels. Using census and geo-coded data, we analysed whether built environment factors were associated with poor self-assessed health status and functional limitations of elderly residents (aged 65 and over). We concluded that evidence of such an association is weak and vulnerable to the composition of the neighbourhood.

Social resources and disordered living conditions: evidence from a national sample of community-residing older adults

For older adults aging in the community, living conditions can promote health, enhance coping, and reduce disablement--but they can also create stress and increase risks of illness, accidents, and decline. Although socioeconomic disparities in housing likely contribute to inequalities in interior conditions, I argue that living conditions are also shaped by social resources such as coresidential relationships, social network ties, and social support. In this article, I examine the distribution of a set of risky or stressful physical and ambient living conditions including structural disrepair, clutter, lack of cleanliness, noise, and odor. Using data from the National Social Life, Health, and Aging Project (NSHAP), I find that low-income and African American older adults have more disordered living conditions as do those with poorer physical and mental health. In addition, older adults who have a coresident partner, more nonresidential network ties, and more sources of instrumental support are exposed to fewer risky or harmful living conditions. This suggests that living conditions are an important, though overlooked, mechanism through which household composition, social networks, and social support affect health and well-being in later life.

Extricating sex and gender in air pollution research: a community-based study on cardinal symptoms of exposure

This study investigated sex and gender differences in cardinal symptoms of exposure to a mixture of ambient pollutants. A cross sectional population-based study design was utilized in Sarnia, ON, Canada. Stratified random sampling in census tracts of residents aged 18 and over recruited 804 respondents. Respondents completed a community health survey of chronic disease, general health, and socioeconomic indicators. Residential concentrations of NO₂, SO₂, benzene, toluene, ethylbenzene and o/m/p-xylene were estimated by land use regression on data collected through environmental monitoring. Classification and Regression Tree (CART) analysis was used to identify variables that interacted with sex and cardinal symptoms of exposure, and a series of logistic regression models were built to predict the reporting of five or more cardinal symptoms (5+ CS). Without controlling for confounders, higher pollution ranks increased the odds ratio (OR) of reporting 5+ CS by 28% (p < 0.01; Confidence Interval (CI): 1.07–1.54). Females were 1.52 (p < 0.05; CI: 1.03–2.26) times more likely more likely to report 5+ CS after controlling for income, age and chronic diseases. The CART analysis showed that allergies and occupational exposure classified the sample into the most homogenous groups of males and females. The likelihood of reporting 5+ CS among females was higher after stratifying the sample based on occupational exposure. However, stratifying by allergic disease resulted in no significant sex difference in symptom reporting. The results confirmed previous research that found pre-existing health conditions to increase susceptibility to ambient air pollution, but additionally indicated that stronger effects on females is partly due to autoimmune disorders. Furthermore, gender differences in occupational exposure confound the effect size of exposure in studies based on residential levels of air pollution.

A population approach to transportation planning: reducing exposure to motor-vehicles

Transportation planning and public health have important historical roots. To address common challenges, including road traffic fatalities, integration of theories and methods from both disciplines is required. This paper presents an overview of Geoffrey Rose's strategy of preventive medicine applied to road traffic fatalities. One of the basic principles of Rose's strategy is that a large number of people exposed to a small risk can generate more cases than a small number exposed to a high risk. Thus, interventions should address the large number of people exposed to the fundamental causes of diseases. Exposure to moving vehicles could be considered a fundamental cause of road traffic deaths and injuries. A global reduction in the amount of kilometers driven would result in a reduction of the likelihood of collisions for all road users. Public health and transportation research must critically appraise their practice and engage in informed dialogue with the objective of improving mobility and productivity while simultaneously reducing the public health burden of road deaths and injuries.

Urban sprawl, smart growth, and deliberative democracy

Urban sprawl is an increasingly common feature of the built environment in the United States and other industrialized nations. Although there is considerable evidence that urban sprawl has adverse affects on public health and the environment, policy frameworks designed to combat sprawl-such as smart growth-have proven to be controversial, making implementation difficult. Smart growth has generated considerable controversy because stakeholders affected by urban planning policies have conflicting interests and divergent moral and political viewpoints. In some of these situations, deliberative democracy-an approach to resolving controversial public-policy questions that emphasizes open, deliberative debate among the affected parties as an alternative to voting-would be a fair and effective way to resolve urban-planning issues.

Linking science and policy through community-based participatory research to study and address health disparities

With its commitment to balancing research and action, community-based participatory research (CBPR) is well suited to efforts at the intersections of science, practice, and policy to eliminate health disparities. Drawing on a larger study, we use 2 case studies to highlight the role of CBPR in helping achieve policy changes promoting, respectively, access to healthy foods (Bayview, San Francisco, CA) and higher air quality standards (Harlem, New York, NY). We then present facilitating factors and challenges faced across all 10 case studies from the larger study. Although we underscore the importance of analyzing contribution rather than claiming attribution in policy-focused work, CBPR's attention to both the distributive and the procedural justice necessary for eliminating health disparities may make it a particularly relevant approach in such work.

Preventing Chronic Disease among the Aged: A Call for Evidence-Based Design Research

The quality of the built environment and the public health and well-being of its inhabitants are profoundly interwoven. Among all age groups, the aged are particularly susceptible to disengagement or avoidance of the built environment and the physical exercise options it affords; this can have a deleterious influence on personal health. In this discussion, concepts drawn from the fields of architecture, landscape research, urban and regional planning, and environmental gerontology are drawn together in the context of a hybrid conceptual and operative model. This model is put forth to assist in the acquisition of knowledge in the field to further understanding of how chronic diseases among the aged can be reduced through the provision and utilization of sufficiently supportive outdoor physical activity options in the everyday environment. This hybrid model, the Prospect-Refuge Competency Index (PRCI), combines key elements of prospect-refuge theory and environmental press-competency theory. It can be applied to diverse settings and user constituencies. The discussion concludes with the presentation of a set of hypotheses for the neighborhood/community level and the residential/exterior environs level of inquiry.

Childhood Development and Access to Nature: A New Direction for Environmental Inequality Research

Although environmental inequality researchers have increased our understanding of race- and class-based environmental inequality in many important ways, few environmental inequality studies ask whether children are disproportionately burdened by environmental pollution or whether poor and minority youth are less likely than their White and wealthier counterparts to spend time in green spaces and the natural world. This gap in the literature undermines the ability of researchers to fully understand and explain environmental inequality. To demonstrate the importance of filling this gap, the authors (a) highlight current research findings from the environmental health, environmental education, and environmental psychology literatures regarding the cognitive, emotional, and physical importance of childhood exposure to nature and (b) summarize the few existing studies that have examined class- and race-based inequalities in children's exposure to the natural world and industrial environmental hazards. The authors then suggest several avenues of research that would, if undertaken, significantly increase our understanding of youth-based environmental inequality. By synthesizing findings across multiple disciplines, the authors hope to convince environmental inequality researchers of the importance of investigating children's differential exposure to nature, green spaces, and industrial environmental hazards.

The built environment, climate change, and health: opportunities for co-benefits

The earth's climate is changing, due largely to greenhouse gas emissions resulting from human activity. These human-generated gases derive in part from aspects of the built environment such as transportation systems and infrastructure, building construction and operation, and land-use planning. Transportation, the largest end-use consumer of energy, affects human health directly through air pollution and subsequent respiratory effects, as well as indirectly through physical activity behavior. Buildings contribute to climate change, influence transportation, and affect health through the materials utilized, decisions about sites, electricity and water usage, and landscape surroundings. Land use, forestry, and agriculture also contribute to climate change and affect health by increasing atmospheric levels of carbon dioxide, shaping the infrastructures for both transportation and buildings, and affecting access to green spaces. Vulnerable populations are disproportionately affected with regard to transportation, buildings, and land use, and are most at risk for experiencing the effects of climate change. Working across sectors to incorporate a health promotion approach in the design and development of built environment components may mitigate climate change, promote adaptation, and improve public health.

Child poverty and environmental justice

BACKGROUND

Child poverty and social inequality in Western countries are growing both in scope and in complexity. The clustering of income poverty in urban settings reflects the complex process of residential segregation. Living in segregated neighbourhoods with much poverty and predominantly substandard housing is usually associated with poor physical, chemical and social environmental living conditions at the individual and community level which influence and shape children's health both directly and indirectly.

OBJECTIVE

This paper shows research data on the link between child poverty and income-related health inequalities according to the unequal exposure to environmental hazards as well as the unequal distribution of environmental resources in the domestic environment and within the local context as an increasing public health issue in Germany. The links between these factors are drawn from the conceptual framework of environmental justice. Examples are shown of integrated approaches to alleviate social and environmental disparities at the community level.

CONCLUSION

The implications of environmental justice for public health include the need to uncover the link between socioeconomic factors and environmental health disparities related to the man-made environment. Developing relevant indicators for environmental inequalities in the context of housing and health is an important task for public health research. More emphasis should be placed on a comprehensive holistic approach to understand the mechanisms by which socioeconomic factors modify children's susceptibility and exposure to environmental hazards, particularly in low-income areas.

The need for the "new health geography" in epidemiologic studies of environment and health

Growth during the past decade in what can be broadly referred to as social and environmental epidemiologic research has been an important contributor to an emerging understanding of environment and health relationships. While the incorporation of geographic information systems as well as concepts such as "neighborhoods" might be viewed as evidence of social epidemiology moving closer to health geography, I argue that the two fields are not well aligned. Health geography has much more to contribute to studies of environment and health, and attention by social epidemiologists to those potential contributions could help rectify this misalignment. This paper suggests a number of geographic perspectives on health and environment that could create useful connections between geography and public health, via social epidemiology. To illustrate this potential, I use an ongoing study of a Texas community exposed to a large petrochemical complex-an inquiry constructed in the mode of social epidemiology - as a case in point. I apply several perspectives and concepts from geography to the case study. Cultural ecology, discourse materialized, political ecology, and territoriality are used to assess the Texas City situation and suggest important types of understandings that can enhance the social epidemiology approach to environment and health. I conclude with a discussion of the prospects for a social epidemiology infused with this type of geographic thought and analysis.

Climate change and developing-country cities: implications for environmental health and equity

Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity.

Proximity of licensed child care facilities to near-roadway vehicle pollution

OBJECTIVES

We assessed child care facilities' proximity to heavily traveled roadways in an attempt to estimate the extent of potential exposure of young children to vehicle-related pollution in this understudied microenvironment.

METHODS

We examined approximately 24,000 licensed child care facilities in California located within 200 m of heavily traveled roadways.

RESULTS

Approximately 57000 of the available slots in California child care centers (7% of the overall capacity) are in facilities located within 200 m (650 ft) of roadways averaging 50000 or more vehicles per day, and another 172000 (21%) are in facilities located within 200 m of roadways averaging 25,000 to 49,000 vehicles per day. Facilities providing care to infants or preschool-aged children and facilities located in disadvantaged areas were more often situated in medium-or high-traffic areas.

CONCLUSIONS

Additional research is needed to further clarify the significance of the child care microenvironment in terms of potential childhood exposures to vehicle-related pollutants. Design strategies, notification standards, and distance-based siting restrictions should be considered in the facility licensing process and in land use and transportation planning.