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The Built Environment & Health: Housing,
Neighbourhoods, Regions & Societies
James R. Dunn, Ph.D.Centre for Research on Inner-City Health, St. Michael’s
HospitalDepts. of Geography & Public Health Sciences, University of
Toronto
GEOGRAPHY: Greek geo -, from ge , earth
Geography Matters
“Everything is real estate. You’re a product of your geography”
Lenny Bruce
Geography Doesn’t Matter
“Looking at things in a spatial perspective can be as meaningless as saying the Titanic sank in the afternoon” (Kirby)
Virtually everything in our built environment is the way it is because someone designed it that way.- Dr. Richard Jackson (Public Health Officer for State of California and former Director of Center for
Disease Control)
Objectives
• illustrate connections between the built environment and health– key issues in housing and health– key issues in neighbourhoods and health– how policies & practices related to land use
and automobile travel affect health– what can be done?
ConceptionConceptionDeathDeath
national socio-economicenvironment
city/region
Human Life Human Life CycleCycle
…from cell to society…
community
neighbourhood
family/household
Individual
Adapted from Hertzman & Kelly (2000)
House/Home
A Conceptual Framework for Housing, SES and Health
• Physical Hazards
• Physical Design
• Psychological Benefits
• Social Benefits
• Political Dimensions
• Financial Dimensions
• Location
• owners/renters• different income
levels• (dis)ability• mental illness• age spectrum (kids,
seniors) • gender• ethnicity/immigration• family/household
status
A Conceptual Framework for Housing, SES and Health
• Physical Hazards– physical, chemical, biological hazards
• does SES affect the likelihood of exposures in the home?• are there socio-economic differences in the capacity and
likelihood of taking ameliorative action on exposures?
• Physical Design– falls, accidents, accessibility, etc.
• restorative environments; balance b/w social interaction and privacy; surveillance zones; spaces for unsupervised play
• important for frail elderly, people w/ disabilities, children
Your House is an Exposure Chamber
A Conceptual Framework for Housing, SES and Health
• Physical Hazards– physical, chemical, biological hazards
• does SES affect the likelihood of exposures in the home?• are there socio-economic differences in the capacity and
likelihood of taking ameliorative action on exposures?
• Physical Design– falls, accidents, accessibility, etc.
• restorative environments; balance b/w social interaction and privacy; surveillance zones; spaces for unsupervised play
• important for frail elderly, people w/ disabilities, children
A Conceptual Framework for Housing, SES and Health
• Psychological Benefits– expression of identity, status, prestige
• construction of meaning regarding house / home• pride in home, home as a reflection of self, sense of
belongingness in neighbourhood, adequacy of home for making & maintaining social ties, absence of stigmatizing features
– control, refuge, privacy, continuity, etc.• exercise of control & demand in everyday conditions• home as a place of refuge, worry about forced move, fear of
crime / victimization, inability to move, frequency of moves, strain of housework, strain of housing costs
“Pride of Ownership”
Emergent Research Questions for Housing, SES and Health
• Psychological Benefits– expression of identity, status, prestige
• construction of meaning regarding house / home• pride in home, home as a reflection of self, sense of
belongingness in neighbourhood, adequacy of home for making & maintaining social ties, absence of stigmatizing features
– control, refuge, privacy, continuity, etc.• exercise of control & demand in everyday conditions• home as a place of refuge, worry about forced move, fear of
crime / victimization, inability to move, frequency of moves, strain of housework, strain of housing costs
A Conceptual Framework for Housing, SES and Health
• Social Benefits– housing / home central to social relations
• adequacy of home for making & maintaining social ties, neighbourhood connectedness for support and contacts, social capital
• Political Dimensions– housing policy: who wins and loses and why?
• government policies support housing industry, decline of public sector in housing
– political struggle for neighbourhood conditions• resistance of unwanted land uses, ability to demand amenities
and insist on maintenance to high standard
A Conceptual Framework for Housing, SES and Health
• Financial Dimensions– resdistributive impacts of housing policies
• affordability, tenure, and regressive transfers• relationship b/w housing wealth and health?• health effect of a high rent-to-income ratio?• % of government ‘spending’ on owning vs. renting?
• Location– land markets and socio-spatial sorting - social
environments• systematic exposure to health hazards, health-promoting or
diminishing opportunity structures; social capital
Key Principles and Challenges
• housing as a cornerstone of a healthful life– a challenge and an opportunity
• hard to ‘prove’ relationships b/w housing & health• housing improvements => ‘cascade’ effect over many areas of life:
e.g., bio-physical hazards, social support, educational outcomes, labour force attachment, control over everyday life, etc.
• connect housing & health with n’hoods research • avoid attributing too much importance to residential location• reconstruct daily time-space paths for descriptive info on dynamics
of ‘exposures’ in residential & non-residential env’ts
• complex causal chains with long latency periods– focus on effects of housing on known antecedents to good
health and measures sensitive to change
Neighbourhoods & Health
Neighbourhood Effects & Health
• resurgence of interest in how places shapes health since early 1990s
• heavy emphasis on ‘compositional effects’ – places shape health because of who lives there
• Macintyre began studying direct effects of local social and physical env’ts that may shape health
• debate over ‘contextual’ vs. ‘compositional’ effects• can these be separated? can compositional features be emergent
as contextual effects?
• now appears that there is no single ‘universal’ effect of area on health
• i.e., ‘do n’hoods affect health?’ is unanswerable• there are some area effects on some population groups in some
places – a complex picture
• all agree that better theory is needed - complexity
N Engl J Med, 345(2): 99-106, July 12, 2001
Neighbourhood Effects: theories, measures, outcomes & methods
• miasma
• competition theory
• neighbourhood deprivation
• neighbourhood affluence
• social capital
• collective efficacy
• social disorganization
• ‘broken windows’
• community assets
• public services
• reputation of neighbourhood
• opportunity structures
• crime & delinquency
• child & youth
• early child dev’t
• mental health
• health behaviours
• coronary heart disease
• neural tube defects
• low birth weight
• etc…
Some other considerations
• importance of residential neighbourhoods
• humans are mobile – when and to what extent do residential n’hoods matter?
• what methods are best for understanding place effects and n’hood effects?
• what kinds of evidence do we have / need for policy interventions?
• how do we define the relevant geographic scale, both theoretically and practically?
Built Environments & Health at the Regional & Societal Level
Built Environment and Health: Conditions & Connections
• urban sprawl & automobile dependency– air pollution & respiratory illness– physical inactivity, obesity & CVD– health community relations / social isolation– mental health– injuries– child development
Respiratory & Cardiovascular Effects of Built Environments
• built environment & travel patterns affect air pollution, physical activity and obesity– land use patterns, automobile orientation &
urban sprawl are key • density• land use mix• location of developments• street connectivity• transit access
Community design affects activity
Community design affects activity
Community design affects activity
Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)
Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)
Community design affects activity
Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)
Community design affects activity
Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)
Community design affects activity
Image courtesy of Will Flessig Director of Planning and Design, Continuum Partners (http://www.continuumpartners.com/)
Community design affects activity
Suburban environment: Low density, automobile-dependent suburban
development favors certain socio-economic groups, and limits the mobility and independence of people at both ends of the life cycle. Children are limited by issues of
safety and access while seniors find that as they age and their physical vigor and incomes begin to decline, they
become more isolated.Source: Howe, Deborah, “Aging and Smart Growth: Building Aging Sensitive Communities
Suburban Sprawl
Exurban
Sprawl
• Traffic congestion• Air and water pollution• Increased flooding and
erosion• Loss of farmland and
open space• Mismatch between jobs
and people• Inner city decline and
poverty• Shrinking urban tax base• Loss of community
• Segregation by income and race
• Fiscal stress in suburban communities
• Overcrowded suburban schools
• Increased traffic accidents and road rage
• Obesity• Social isolation• Increased stress• Mental health problems
In sum, sprawl has “received the blame for seemingly every bad aspect of contemporary urban life.” (Wells Fargo Bank report on sprawl).
Need to better define our visions of community
THIS?
OR THIS?
What Can Be Done?
The changes may only involve something as simple as paint stripes to slow traffic
What Can Be Done?
We Are Not Powerless to Change the Built Environment
Source: www.urban-advantage.com
Virtually everything in our built environment is the way it is because someone designed it that way.
Ten Principles Of Smart Growth
1. Mix land uses
2. Take advantage of compact building design
3. Create a range of housing affordable opportunities and choices
4. Create walkable neighborhoods
5. Foster distinctive, attractive communities with a strongsense of place
6. Preserve open space, farmland, natural beauty, and critical environmental areas
7. Strengthen and direct development towards existing communities
8. Provide a variety of transportation choices
9. Make development decisions predictable, fair, and cost effective
10. Encourage community and stakeholder collaboration in development decisions
Sprawl Vs. Smart Growth
