Dearry Presentation

Built EnvironmentandPublic Health: 

Built Environment and Public Health Allen Dearry, Ph.D. National Institute of Environmental Health Sciences NIH, DHHS October 2, 2003

Mission of the NIEHS: 

Mission of the NIEHS

Environmental Health: 

Environmental Health 'In its broadest sense, environmental health comprises those aspects of human health, disease, and injury that are determined or influenced by factors in the environment. This includes not only the study of the direct pathological effects of various chemical, physical, and biological agents, but also the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture.' --Healthy People 2010

Built Environment: 

Built Environment The built environment encompasses all of the buildings, spaces, and products created, or at least significantly modified, by people. Health Canada, Health and Environment Land Use (industrial or residential) Buildings (housing, schools, workplaces) Public Resources (parks, museums) Zoning Regulations Transportation Systems

How might the built environment influence human health?: 

How might the built environment influence human health? Access to medical and other health care Quality of and access to schools Economic opportunities Ease of social interaction and resulting social capital Air and water quality Opportunities for physical activity

Slide6: 

Associations Between Pollutants and Respiratory Health Outcomes in Children

Policy Strategies to Reduce Children’s Exposure to Traffic-Related Air Pollution : 

Policy Strategies to Reduce Children’s Exposure to Traffic-Related Air Pollution

Policy Strategies to Reduce Children’s Exposure to Traffic-Related Air Pollution: 

Policy Strategies to Reduce Children’s Exposure to Traffic-Related Air Pollution

Human Health Benefits from Reductions in Ozone and PM: 

Human Health Benefits from Reductions in Ozone and PM Cifuentes et al. Science 293: 1257-1259, 2001. (2001-2020)

Physical Activity Patterns and Trends: 

Physical Activity Patterns and Trends Walking has declined significantly. Activity at work continues to decline. Activity at home and leisure has declined significantly. Focus on understanding patterns and determinants of activity/inactivity.

Slide11: 

US average= 73 mins/day of driving One-fourth of all trips made are one mile or less, but three-fourths of these short trips are made by car Children between the ages of 5-15 walk/bike 40% less in 1995 than in 1977 For school trips one mile or less, only 31% are made by walking; within 2 miles, only 2% are made by biking. In the US, 6% of trips are by walking/biking. In contrast, Italy is 54%; Sweden, 49%. Travel and Reduced Physical Activity

Prevalence of Overweight and Obesity Among US Adults, Age 20-74 Years*: 

Prevalence of Overweight and Obesity Among US Adults, Age 20-74 Years* Obese BMI ≥30.0 Percent BMI = body mass index. *Age-adjusted by the direct method to the year 2000 U.S. Bureau of the Census estimates using the age groups 20-34, 35-44, 45-54, 55-64, and 65-74 years. NHANES II 1976-80 (n=11207) NHANES III 1988-94 (n=14468) NHANES 1999 (n=1446) NHANES III 1999-2000 (n=4115) Projected 2008

Prevalence of Overweight Among US Children and Adolescents: 

Prevalence of Overweight Among US Children and Adolescents Source: Centers for Disease Control and Prevention , National Center for Health Statistics, National Health and Nutrition Examination Survey

Slide14: 

What is this public health achievement of the 20th Century?

Slide15: 

Source: USDA; 1986 Surgeon General's Report Great Depression End of WW II Nonsmokers’ Rights Movement Begins 1st Surgeon General’s Report Fairness Doctrine Messages on TV and Radio Federal Cigarette Tax Doubles Broadcast Ad Ban Adult Per Capita Cigarette Consumption and Major Historical Events—United States 1900-2000 Master Settlement Agreement Nicotine Medications Available Over the Counter 1st Smoking- Cancer Concern 1st World Conference on Smoking and Health Surgeon General’s Report on Environmental Tobacco Smoke 1st Great American Smokeout Source: USDA; 1986 Surgeon General's Report

Smoking vs Obesity: 

Smoking vs Obesity Smoking $100 billion/yr in health care costs 400,000 preventable deaths Many programs to deal with the issue Declining Obesity $117 billon/yr in health care costs 300,000 preventable deaths Almost no programs to deal with the issue Increasing

Slide17: 

Progression of Chronic Diseases Genetics Obesity Insulin Resistance Arthritis Hyperinsulinemia Type 2 Diabetes Social Disability Diabetic Complications Hypertension, Stroke, Coronary Heart Disease Lifestyle Sleep Apnea, Other Breathing Disorders Cancer (colon andamp; prostate) Environment

The Built Environment and Physical Activity: 

The Built Environment and Physical Activity Zoning, planning, and architectural issues. Building designs mitigate against use of stairs. City planning and zoning often ignore pedestrian traffic. Few incentives exist to design communities to be walkable, to enhance biking and moving. Crime and safety concerns are critical issues.

Challenges: 

Challenges Complexity of the built environment and health outcomes. Lack of reliable and valid indicators of built environment effects. Insufficient data on interventions to improve health status. Growth of mega-cities that cross state and national borders.

NIEHS Plans to Address theBuilt Environment and Obesity: 

NIEHS Plans to Address the Built Environment and Obesity Education Video development to enhance children’s physical activity. Research Srinivasan S, O’Fallon L, and Dearry A. 2003 Am J Public Health 93(9): 1446-1450. Develop measures of healthy community environments. Assess effectiveness of changes in community design, planning, and development in reducing the extent of obesity. Multidisciplinary research teams: Biomedical and behavioral scientists, clinicians, planners, developers, architects, and community members. Collaborations RWJ Fdn: Active Living by Design NIH Obesity Task Force: Genetics, Neurobiology, Medical Care Interagency: CDC, HUD, DOT Built Environment and Obesity Workshop, May, 2004, DC

What is needed for a successful response?: 

What is needed for a successful response? Effective measures and indicators for sustainable communities. Examine positive health impacts of sustainable and planned communities. Multilevel techniques of measurement and longitudinal models for assessing impact of the built environment. Improved communication and partnership strategies. - Srinivasan S, O’Fallon L, Dearry A. 2003 Am J Public Health 93(9): 1446-1450.