When I think about American cities that can best illustrate the complex relationship between health and environment there is no more interesting picture than the one painted by New Orleans, the venue for the November 2014 American Public Health Association (APHA) 142nd annual meeting. The theme of the meeting was “Healthography: How Where You Live Affects Your Health and Well-being,” a concept gaining a lot of momentum in public health and across various private and federal, state and local initiatives. This approach to health and well-being considers both the built environment and the social elements that make up a community, as well as the relationship between the two.
According to the Centers for Disease Control and Prevention (CDC), the built environment includes “all of the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure).” CDC's Built Environment and Health Initiative focuses on creating healthy places that are “designed and built to improve the quality of life for all people who live, work, worship, learn and play within their borders – where every person is free to make choices amid a variety of healthy, available, accessible and affordable options.” This concept moves beyond the medical model – out of the exam room and into the way people live their daily lives. It provides a more comprehensive picture of what affects an individual’s health. For example, when managing obesity, knowing whether an individual has access to a grocery store carrying healthy and affordable food options and to safe spaces for recreation and exercise are important elements in prescribing a healthier diet and more exercise.
Barriers in the built environment can result in negative health consequences. People with disabilities are at a higher risk of experiencing barriers and the associated adverse outcomes. The CDC cites the absence of ramps for wheelchairs, lack of curb cuts, narrow doorways and lack of access to mass transit or other public services as common barriers experienced by people with disabilities in their communities. These obstacles can limit their access to basic health care, social services and community activities.
These environmental barriers can also affect a person’s physical activity and health. The CDC explains, “Inaccessible or nonexistent sidewalks and bicycle or walking paths contribute to sedentary habits. Poorly designed communities can make it difficult for people with mobility impairments or other disabling conditions to move about their environments; consequently, people with a disability often are more vulnerable to environmental barriers.”
Barriers in the built environment also can create impediments to social engagement critical to establishing a sense of belonging in one’s community. During his presentation on the relationship between the built environment and inclusion for people with disabilities, Dr. Craig Ravesloot, Associate Professor of Psychology at the University of Montana, suggested that inaccessible “environments create behavioral patterns that limit participation...this is where we need to advocate for increased accessibility."
Through my work on various projects at New Editions, I have examined how community integration affects health and wellness, the importance of affordable and accessible communities and the value of formal and informal social supports. Oftentimes these elements of health can be overlooked in the face of addressing illnesses and disease prevention, but their importance cannot be overstated. Designing new communities with all individuals in mind and investing in existing ones to create accessible, affordable and safe neighborhoods where individuals can live, learn, and work regardless of age or disability status is a lofty goal, but a worthwhile one that benefits us all.
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Anna Lenhart has a MPH in Maternal and Child Health. She is a project manager at New Editions and focuses on health and community integration for people with disabilities. Read Anna's bio.