The Role of Clinicians to Empower Communities through Utilization of the Built Environment

"It is time for a shift to communities intentionally designed to facilitate physical and mental well-being. To effect this change, we need to draw upon the unique ability of humans to plan creatively for healthy communities."

—Richard J. Jackson, MD, MPH

In recent years there has been a growing awareness about the impact of built environments on individual behavior, health and disease risk, morbidity, and mortality. The built environment encompasses the human impact on physical structures, materials, infrastructure, and spatial arrangements within communities for living. Crucial factors related to health (such as transportation and food deserts) and interactions between community members are influenced by human activity, culture, and environmental development. For years, traditional public health models used the built environment to address specific health issues related to air and water quality, land sanitation, toxin exposure, workplace and fire code safety, along with access for people with disabilities. However, inclusion of the built environment within medical framework is new for clinicians and educators. Recent research and in practice has shown the design of the built environment to enhance or constrain an individual's choices. It has a major influence on rates of chronic disease and medical conditions, social issues such as interpersonal and community violence, mental health, and social inequalities. ¹ This field of study is interdisciplinary and interfaces with health policy and technology, management, community sustainability, and public/population health.

The built environment as an independent factor in community health and inequality is a nascent field. The profound effects of the built environment on both physical and mental health outcomes are especially pronounced among disadvantaged and vulnerable communities. In many cases, a change to the built environment will solve multiple issues simultaneously. ² In so doing, the built environment is addressing the social inequalities that are both a cause and end result of health disparities, health injustice, and health segregation. Recreating the built environment has the potential to remove barriers and marginalization that currently divide communities. It serves as a lens for examining health that necessarily brings social justice into focus. It grants the rights of people to have a safe environment where they can live free from structural barriers that include air pollution, lack of affordable housing, poor transportation, lack of walkability, inadequate food access, and dearth of parks and green designs. These built environment themes are illustrated through various projects that will be discussed below as developed through a series of interviews with people organizing and leading ventures in this emerging field.

Built Environment: Conceptual Framework

The built environment encompasses the layout, design, and designated use of a community's physical structures including its housing, transportation systems, recreational resources, food resources, and businesses. ³ There are factors associated with the built environment at various levels (including community, family, and individual) and these are all interrelated and linked to disparities in health outcomes. Community factors include transportation and business investments, food access, health care access, housing access, air and water pollution, contaminated land, sociocultural and psychosocial factors, and residential segregation. Family and individual factors include active living, dietary intake and patterns, behavioral outcomes, social isolation and social cohesion, family resources, and socioeconomic status. ²

Low-income communities often lack the infrastructure to support healthy eating and active lifestyles. ³ Research has shown that low-income and vulnerable communities have few supermarkets with fresh foods and also a very limited number of parks and recreation facilities. ² Proximity to small convenience stores (rather than grocery stores that sell fresh produce) has been linked with increased rates of obesity and tobacco use. On the other hand, individuals are more likely to be physically active when they live in communities with more parks and walking trails; accessible public transit; less litter, vandalism, and graffiti; and more pedestrian and bicycle friendly street patterns. ⁴ This physical activity acts as a protective factor against multiple chronic conditions including cardiovascular disease, obesity, diabetes, and musculoskeletal abnormalities. A lack of sidewalks, bike paths, and recreational areas can also trigger social isolation leading to increased rates of depression. ² [End...