Health Impacts of the Built Environment: Within-Urban Variability in Physical Inactivity, Air Pollution, and Ischemic Heart Disease Mortality
Hankey, Steve, Marshall, Julian D., Brauer, Michael, Environmental Health Perspectives
BACKGROUND: Physical inactivity and exposure to air pollution are important risk factors for death and disease globally. The built environment may influence exposures to these risk factors in different ways and thus differentially affect the health of urban populations.
OBJECTIVE: We investigated the built environment's association with air pollution and physical inactivity, and estimated attributable health risks.
METHODs: We used a regional travel survey to estimate within-urban variability in physical inactivity and home-based air pollution exposure [particulate matter with aerodynamic diameter [less than or equal to] 2.5[micro]m ([PM.sub.2.5]), nitrogen oxides ([NO.sub.x]), and ozone ([O.sub.3])1 for 30,007 individuals in southern California. We then estimated the resulting risk for ischemic heart disease (IHD) using literature-derived dose-response values. Using a cross-sectional approach, we compared estimated IHD mortality risks among neighborhoods based on "walkability" scores.
RESULTS: The proportion of physically active individuals was higher in high-versus low-walkability neighborhoods (24.9% vs. 12.5%); however, only a small proportion of the population was physically active, and between-neighborhood variability in estimated IHD mortality attributable to physical inactivity was modest (7 fewer IHD dearhs/100,000/year in high- vs. low-walkability neighborhoods). Between-neighborhood differences in estimated IHD mortality from air pollution were comparable in magnitude (9 more IHD deaths/100,000/year for [PM.sub.2.5] and 3 fewer IHD deaths for [O.sub.3] in high- vs. low-walkability neighborhoods), suggesting that population health benefits from increased physical activity in high-walkability neighborhoods may be offset by adverse effects of air pollution exposure.
POLICY IMPLICATIONS: Currently planning efforts mainly focus on increasing physical activity through neighborhood design. Our results suggest that differences in population health impacts among neighborhoods are similar in magnitude for air pollution and physical activity. Thus, physical activity and exposure to air pollution are critical aspects of planning for cleaner, health-promoting cities.
KEY WORDS: active travel, air quality, environmental planning, infill, risk assessment, urban form. Environ Health Perspect 120:247-253 (2012). http://dx.doi.org/1O.1289/ehp.1103806 [Online 17 October2011]
Physical inactivity is associated with increased risk of several adverse health outcomes including heart disease, type 2 diabetes, colon cancer, breast cancer, and mortality (Colditz et al. 1997; Kelley and Goodpaster 2001; Kohl 2001; Verloop et al. 2000). Active commuting, such as walking or biking to work on a daily basis, has been shown to decrease risk of all-cause mortality and cardiovascular disease (Andersen et al. 2000; Hamer and Chida 2008; Zheng et aI. 2009). Various attributes of the built environment (e.g., population density, street connectivity, land use mix) have been associated with rates of physical activity at the neighborhood level (Ewing et al. 2003; Frank et al. 2005; Saelens et al. 2003a; Sallis et al. 2009). Furthermore, the type of transportation mode used (public transit vs. car) affects personal energy expenditure (Morabia et al. 2010). Thus, an important research question is whether urban planning can reduce physical inactivity and improve health.
Exposure to outdoor urban air pollution is associated with various adverse health out comes including heart disease, respiratory disease, lung cancer, asthma, and mortality (Brunekreef and Holgate 2002; Gent et al. 2003; Pope and Dockery 2006; Pope et al. 2002). Chronic exposures vary at similar magnitudes within-cities as between-cities (Jerrett et al. 2005; Miller et al. 2007) suggesting that neighborhood location, urban design, and proximity to roads can affect exposures (Health Effects Institute 2009; Marshall et al. 2005). …