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26th Annual Minority Health Conference

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Health and the Built Environment:
The Effects of Where We Live, Work and Play


Henry Louis Taylor, Jr.

Health and the Built Environment: The Effects of Where We Live, Work and Play explores the role played by the built environment in causing health problems among inner city residents, with a particular emphasis on the African American community. Notwithstanding, the issues discussed in this essay impact all socioeconomic groups living in distressed central city and suburban neighborhoods and this includes Latinos, Asians, Native Americans, and low-income working class whites. Moreover, the built environment, albeit in different ways, also contributes to the health problems of middle-class central city and suburban residents. Nonetheless, given the staggering health disparities between blacks and whites, and the extent to which the literature on heath and the built environment neglects issues pertaining to inner city communities, the emphasis on African Americans is more than warranted.

Health and the Built Environment is not only concerned with the health effects of where we live, work, and play, but also with the type of urban planning strategies and public policies needed to address the problem. It argues that the active living movement and the new urbanism and smart growth planning strategies are primarily informed by sprawl and conditions found in middle-class central city and suburban neighborhoods. Thus, the policies, urban designs, and new construction ideas emanating from these movements will only minimally impact built environment conditions found in distressed inner city communities.

An emerging trend in the design, urban planning, and medical professions is one that investigates how the built environment contributes to the health problems of Americans. This viewpoint is based on the notion that inadequate diet and sedentary living increases the risk for many chronic diseases, such as cardiovascular disease, hypertension, colon cancer, type-2 diabetes, osteoporosis, obesity, anxiety and depression. A consensus now exists among health scientists, medical practitioners and other professionals that an active lifestyle reduces the risk for many chronic diseases and/or facilitates the successful management of those illnesses. Within this context, the active living movement arose a few years ago to attack the sedentary culture problem. It stressed the development of a lifestyle that integrates physical activity into daily routines, with the goal of accumulating minimally 30 minutes of activity each day by walking, bicycling, exercising, working in the yard, taking the stairs, or engaging in some other type of physical activity.

The active living movement supported the activities of new urbanism and smart growth. Urban planners advocating this approach to residential development suggest that transportation policy, neighborhood design, and existing land use patterns contribute to physical inactivity and the development of a culture of sedentary living. They call for a new approach to residential development that promotes high density neighborhoods and mixed land-use developments that bring residential, commercial, and retail activities closer together so that traffic is reduced and more cycling and walking is encouraged. Collectively, active living, new urbanism, and smart growth are constructing a new model of residential development that incorporates wellness into the design and construction of neighborhoods.

However, this essay argues that these movements are not only primarily based on conditions found in predominantly white middle-class central city and suburban communities, but also their advocates do not consider the significant differences that exist in dissimilar parts of the built environment. The point is that the barriers to active living found in distressed inner city neighborhoods are significantly different from those found in other parts of the metropolis. Here, built environment issues are more complex and challenging. Consequently, a distinct approach must be used to attack them. For example, in the inner city, barriers to active living and a healthy lifestyle are impeded by crime, violence, fear, inadequate food security, dilapidated housing, poorly maintained sidewalks, streets, sewer and water lines, and blight. These conditions create stressors that are produced by poverty, low-incomes, joblessness, difficult work situations, and the struggle to make ends meet, along with cultural and financial obstacles to health care. These built environment issues have produced a health crisis so severe that in December 2004, the NAACP said “the fight for quality health care is the new civil rights battle.”

The obstacles to wellness erected by the inner city built environment cannot be solved unless the emerging model of health care connects its strategy to the quest to radically reconstruct the inner city built environment. Toward this end, design professionals, urban planners, health scientists, medical practitioners, public health experts, and policy makers must develop insight into the differential barriers to wellness found in inner city neighborhoods and then formulate strategies and policies to attack them.

Selected Readings

Andrew L. Dannenberg, J.R. Jackson, H. Frumkin, R.A. Schieber, M. Pratt, C. Kochtitzky, and H.H. Tilson, The Impact of Community Design and Land-Use Choices on Public Health, American Journal of Public Health (September 2003)93:1500-1508.

Carlos J. Crespo, Ellen Smit, Ross E. Andersen, Olivia Carter-Pokras, and Barbara E. Ainsworth, Race/Ethnicity, Social Class and Their Relation to Physical Inactivity During Leisure Time: Results from the Third National Health and Nutrition Examination, American Journal of Preventive Medicine, (2000)18/1:46-53.

Carlos J. Crespo, Steven J. Keteyian, Gregory W. Heath, and Christopher T. Sempos, Leisure-Time Physical Activity Among U.S. Adults, Archives of Internal Medicine (1996)156:93-96.

Daniel Trudeau and Meghan Cope, Labor and Housing Markets as Public Spaces: Personal Responsibility and the Contradiction of Welfare-Reform Policies, Environment and Planning (2003)35:779-798.

Frank W. Booth and Manu V. Chakravarhy, Cost and Consequences of Sedentary Living: New Battleground for an Old Enemy (March 2002)3/6:1-6.

Julie M. Feinsilver, Healing the Masses: Cuban Health Politics at Home and Abroad (Berkeley: University of California Press, 1993): 26-62.

Keith Lawrence, Stacey Sutton, Anne Kubisch, Gretchen Susi, and Karen Fulbright-Anderson, Structural Racism and Community Building, The Aspen Institute Roundtable on Community Change, June 2004.

Rhonda Jones-Webb, Drinking Patterns and Problems Among African Americans: Recent Findings, Alcohol Health and Research World (1998)22/4: 260-264.

Ross E. Anderson, Carlos J. Crespo, Susan J. Barlett, Lawrence J. Cheskin, and Michael Pratt, Relationship of Physical Activity and Television Watching with Body Weight and Level of Fatness Among Children: Results from the Third National Health and Nutrition Examination Survey, The Journal of the American Medical Association (March 25, 1998) 279: 938-942.

Sabina Deitrick and Cliff Ellis, New Urbanism in the Inner City: A Case Study of Pittsburgh, Journal of the American Planning Association(Autumn 2004)70/4:426-442.

Special Report: The State of African American Health, The Crisis (November/December 2004):17-35.

Henry Louis Taylor, Jr. and Sam Cole, Structural Racism and Efforts to Radically Reconstruct Inner City Neighborhoods (November 2000), The CyberHood (Feature Paper Archive),



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