1. Rutt, Candace PhD
  2. Dannenberg, Andrew L. MD, MPH
  3. Kochtitzky, Christopher MSP

Article Content

The last few years have seen resurgence in interest in the interaction between the built environment and health. However, the relationship between public health and the built environment is not new in the United States. The first government policy to regulate this relationship, Euclidian zoning, separated different land uses (such as residential and commercial) to protect people living in residential areas from infectious diseases caused by commercial pollution (US Supreme Court, Village of Euclid, Ohio v Ambler Reality Co, 272 US 365, 1926).


Recently researchers have begun examining how the built environment and policy influence not only infectious diseases but also chronic diseases by influencing risk factors such as nutrition and physical activity. For example, recent research has highlighted how separation of land uses (Euclidian zoning) and decreased population density are related to several negative health outcomes, such as increased obesity and hypertension at least partly stemming from decreased walking for transportation.1,2


The articles in this issue of the journal examine the effectiveness of innovative built environment and policy interventions across the United States. The interventions range from policies requiring that transportation officials, planning officials, and developers work together to efforts using health impact assessment (HIA) to evaluate housing developments in San Francisco and a coal-fired power plant in rural Florida.


The article by Dalby3 highlights some of the unique challenges faced by rural areas, such as how to incorporate growth without losing character. One recommendation this study made was to incorporate smart growth principles into rural developments to create local towns and villages with walkable centers. Similar techniques are being used across the country in both rural (Haddam, CT) and urban areas.4,5


In both large cities and rural towns, current zoning ordinances, such as Euclidian zoning, often prevent smart growth development, because they require the separation of different types of land uses. Nonetheless, many places have modified their zoning laws to allow for compact walkable environments and infill development. Montgomery County, Maryland, for example has enacted ordinances requiring that properties close to schools have sidewalks, and the county has a master plan for parks. It also uses zoning to preserve the rural feel of parts of the county and uses parking revenues to fund bicycle and walking projects.


Public health language and policy changes have also been incorporated into several general plans in California communities. These plans include a focus on healthy eating, access to food, physical activity, and healthcare, and the reduction of tobacco and alcohol use.6 For example, the general plan in Watsonville, California, encourages convenience stores to carry fruits and vegetables.6


Another promising development is the use of HIA to increase awareness among stakeholders and decision makers about the health impacts of proposed policies and projects. The Eastern Neighborhoods Community HIA, led by the San Francisco Health Department, resulted in a land use vision for the city, measurable health objectives with indicators, and a tool to evaluate future housing developments in San Francisco.7 Their project included a broad range of stakeholders, including the community, planners, developers, small business, and nonprofit groups.


An HIA was also completed for a coal-fired power plant in a disadvantaged rural Florida county.8 The analysis showed that although particulate matter (PM10) and ozone pollution from the plant would lead to very small increases in mortality, other significant impacts, such as global warming, were likely to occur because of carbon dioxide emissions. They also found that new jobs created from the coal plant could have either a null or a positive effect on health, depending on the demographic profile of those employed by the newly created jobs. Because of existing income disparities in the region, significant positive health impacts, such as reduced mortality, were predicted if Black residents were employed in the midlevel positions. The HIA thus recommended that the coal plant hire a representative demographic distribution of Whites and Blacks.


The Economic Development Authority accepted this recommendation and said they would work with the training institutions to recruit Black workers, although the Economic Development Authority had no authority to enforce the recommendation on the company (M. Simmons, PhD, written communication, 2007). This positive attitude doubtless left its mark on the community, although the coal plant's construction was subsequently halted because of the plant's risk for global warming.


A new area of research funded by the Robert Wood Johnson Foundation, Healthy Eating Research, examines how the built environment influences access to and consumption of healthy foods. Increasing the availability of fresh fruits and vegetables is an important public health issue, particularly in low-income areas, because the lowest-income areas in the nation have 30 percent fewer supermarkets than the highest-income areas.9 In Pennsylvania, the Food Trust responded to the need for supermarkets in urban areas by lobbying for providing funding incentives to supermarkets in underserved communities. By educating key stakeholders and the media about the urgency of the problem and presenting key evidence, the trust was able to get the needed policy changes and funding for this program.


Another area that has been recently receiving increased attention is the decline in the number of children walking and bicycling to school and the role the built environment plays in influencing children's and parents' decisions to make active travel choices.10 Several innovative programs were conducted under the Healthy Neighborhoods/Healthy Kids program. During this program, children evaluated the built environment and offered suggestions to make the environment more pedestrian friendly. After they identified needed modifications, the children worked with city council members, planners, park officials, safety officials, and others to get trails, sidewalks, crosswalks, bike racks, and neighborhood gardens added to their communities.11 These case studies illustrate how children can be involved in efforts to improve the quality of their environments with assistance from teachers and parents.


Many of the articles in this issue illustrate the need for educating the community and stakeholders about the connection between the built environment and public health. Conflicting political interests, difficulty in collaborating across a wide range of disciplines, lack of data, lack of funding, and fear of new regulations were frequently mentioned as barriers.6,7 Feldstein et al.6 and Farhang et al.7 attributed many of their successes to having political will, a project champion or advocate, local capacity, flexibility to adapt as situations change over time, an understanding that built environment changes can take several years or decades to have impact, and strong partnerships. Common goals were often cited as essential to facilitate collaboration between agencies. One excellent example of this was Montgomery County's annual growth policy, which requires that zoning, transportation, and development review are closely coordinated.


Although the articles in this issue illustrate progress across diverse regions of the nation, considerable work remains. Planning, transportation, and public health officials need to continue improving collaboration across projects. For these varied disciplines, to work effectively together will take institutional support, resources, and an understanding of each other's disciplines. Hopefully, over time these model programs can be disseminated across the country to assist in improving public health by enhancing the positive impacts and reducing the negative impacts of the built environment.




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10. Centers for Disease Control and Prevention. Kids Walk-to-School. Published 2007. Accessed January 15, 2007. [Context Link]


11. Nelson KM. Designing healthier communities through the input of children. J Public Health Manag Pract. In press. [Context Link]


12. Perry RD, Laurison HB, Karpyn A, Giang T. Closing the grocery gap in underserved communities: the creation of the Pennsylvania fresh food financing initiative. J Public Health Manag Pract. In press.


13. US House of Representatives Select Committee on Hunger. Obtaining Food: Shopping Constraints on the Poor. Washington; DC: US House of Representatives Select Committee on Hunger; 1987.