In this series of public health articles, you will be able to learn about the fundamentals of public health which will serve you well for your medical school interviews. These principles will help you to understand how medicine and public health are intertwined especially as a result of the Coronavirus pandemic.
Built environment refers to the human-made environment that provides the setting for human activity. This includes buildings, parks & green-spaces, neighbourhoods and infrastructure. This environment is built to serve the needs of humans in terms of accommodation, organisation, transportation and many integral aspects. In recent years, research has indicated that the built environment has many impacts on physical and mental health, many positive but also some considerable negatives which demand public health attention.
Our built environment can have direct impacts on our health, such as air quality, or indirect effects, such as health behaviours that impact disease transmission and health.
Environments that were designed and built with health and wellbeing as an integral part will promote healthy behaviours such as physical activity.
Lack of physical activity is a well-known risk factor for obesity which is a risk factor for chronic diseases such as cardiovascular disease, diabetes, stroke and some cancers.
Research suggests that neighbourhoods which had more walkability and “bikeability”, for example more green spaces, safe pedestrian and cycling paths, had higher rates of physical activity and lower rates of obesity. They also showed lower rates of depression, higher social capital and lower alcohol abuse. However, with increasing urbanisation, neighbourhoods and environments do not promote physical activity. There are limited safe open spaces and paths where people are encouraged to walk.
Geographic Information Systems (GIS) programmes show that many distances to essential places such as groceries, healthcare, schools and other amenities throughout cities have limited walkability meaning that people have to drive or take public transport to reach such places. This reduces their walkability. Further, it may force individuals to more frequently get food from takeaways which are closer promoting unhealthy diets.
A study by Harvard School of Public Health found that a distance of 15 km or less to a private or public recreational open space has been linked to increased physical activity, particularly among children. Higher levels of traffic and speed limits within neighbourhoods can also prevent children from taking part in physical activity as parents do not feel it is safe. This is important as lack of physical activity amongst children is a major risk factor for childhood obesity which has many life-course impacts.
Another aspect of the built environment which influences health is poor air quality which results from industrial buildings, factories and traffic zones. Outdoor air pollution is a major cause of death and disease worldwide. The WHO estimates that 4.2 million premature deaths globally are linked to ambient air pollution, commonly from heart disease, stroke, COPD, lung cancer and acute respiratory infections in children. In children and adults, exposure to ambient air pollution is linked with short term and long term reduced lung function and aggravated asthma. Further, maternal exposure to air pollutants is associated with adverse birth outcomes and low birth weight which can have life-course impacts on the child.
There are many interventions associated with the built environment which can tackle these issues such as prioritising rapid urban transit, walking and cycling to reduce the number of cars on the roads, creating green spaces to remove particulate matter, improving energy efficiency of houses, removing housing near industrial locations as much as possible and implementing stricter vehicle emission standards.
The built environment also plays a role in many of the health inequalities. People from lower socioeconomic status and lower education background are more likely to suffer from low income. This in turn means they are forced to live in poorer neighbourhoods which often are overcrowded with limited walking or green spaces. These houses are also of lower quality and less energy efficient.
Further, women and children are often at a disadvantage with children generally spending more time indoors and women, particularly in lower-income countries, spend a lot of time cooking on stoves or fires which release a lot of household pollution. Hence, we see these disparities around the world in age and gender. This makes tackling the built environment and ensuring health and wellbeing is at the forefront a huge public health priority.
Health professionals have a big role to play in helping the public understand the impacts of physical activity and air pollution and offering patients advice on managing their conditions. They are also crucial players in lobbying groups and advocacy campaigns for government and local authorities to create change in policies to improve the built environment.
Key Points:
Built environment refers to the human-made environment that provides the setting for human activity
The built environment hugely affects physical activity. Neighbourhoods which had more walkability and “bikeability”, for example more green spaces, safe pedestrian and cycling paths, had higher rates of physical activity and lower rates of obesity.
Air quality can be improved with interventions around public transport, improving housing quality and creating more green spaces.
The built environment plays a significant role in health inequalities, disproportionately affecting individuals from lower socioeconomic status, women and children.