Science and Policy Update May 29, 2014: The Built Environment

Bridging the Public Health and Planning Gap: A Brief History
By: Monika Shankar, Health and Environment Associate

For this inaugural science and policy update, let’s go back to basics on the topic of health and the built environment. The built environment is defined as the physicial, human-made places where we live, work, and play. Historically, the two fields converged as cities grew due to rapid urbanization and industrialization. Corburn points out in “Confronting the Challenges in Reconnecting Urban Planning and Public Health”, that these trends produced poor housing conditions, inadequate sanitation and dangerous work circumstances. These conditions contributed to the spread of infectious disease such as cholera and typhoid. At this early stage, planners held a very important role in the field of public health, and public health officials weighed in on matters concerning planning. However, as the field of public health shifted towards the investigation of microbes and health interventions via medicine, the fields began to separate.

Today, there is a growing body of evidence (see here, here and here) that both the direct (for example, air pollution) and indirect (for example, housing instability) effects of the built environment can have detrimental impacts on public health. Based on this, there are some who strive to reconnect the two fields. PSR-LA’s board member Dr. Richard Jackson has been at the forefront of moving the field of public health and health equity from the periphery to the center of the planning debate. His seminal work Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities breaks down how our modern cities have been designed to produce unhealthy residents and communities. And this reveals only the tip of the iceberg. Studies have shown that by reducing cars and instead focusing on pedestrian and bike infrastructure, we can significantly decrease diabetes. If we took 20% fewer car trips, we could save 500 lives and avoid upwards of 100,000 hospital admissions yearly. And the data keeps growing…

Physicians and public health professionals can play a tremendously important role in shaping a healthy built environment and contributing to positive public health outcomes. They are often at the frontlines, witnessing the health impacts of poorly planned urban environments on individuals and communities. Also, the very powerful physician voice is both credible and trusted in both community and political spaces. When doctors speak, people listen. Finally, the message that physicians and public health advocates promote – one of prevention and protection – resonates with individuals and officials. For these reasons, it is important for physicians and public health professionals to step outside of their traditional clinical approaches to treatment and health promotion, and begin once again to weigh in on the complex interplay of factors shaping the built environment.

Additional resources:

“A Model Curriculum for a Course on the Built Environment and Public Health: Training for an Interdisciplinary Workforce” by Botchwey ND, Hobson SE, Dannenberg AL, Mumford KG, Contant CK, McMillan TE, Jackson RJ, Lopez R, and Winkle C.

“Confronting the Health Impacts of Gentrification and Displacement” by Cohen R.

“Neighbourhoods and Health” by Kawachi I and Berkman LF.

“Planning and Public Health: Research Options for an Emerging Field” by Malizia EE.

“Sorting out the connections between the built environment and health: a conceptual framework for navigating pathways and planning healthy cities” by Northridge ME, Sclar ED and Biswas P.

“The impact of community design and land-use choices on public health: a scientific research agenda” by Dannenberg AL, Jackson RJ, Frumkin H, Schieber RA, Pratt M, Kochitzky C and Tilson HH.

“We Don’t Know Nearly As Much About The Link Between Public Health and Urban Planning As We Think We Do” by Badger E.