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PubMed2003

Environmental equity and health: understanding complexity and moving forward.

The authors invoke a population health perspective to assess the distribution of environmental hazards according to race/ethnicity, social class, age, gender, and sexuality and the implications of these hazards for health. The unequal burden of environmental hazards borne by African American, Native American, Latino, and Asian American/Pacific Islander communities and their relationship to well-documented racial/ethnic disparities in health have not been critically examined across all population groups, regions of the United States, and ages. The determinants of existing environmental inequities also require critical research attention. To ensure inclusiveness and fill important gaps, scientific evidence is needed on the health effects of the built environment as well as the natural environment, cities and suburbs as well as rural areas, and indoor as well as outdoor pollutants.

Cost of Illness↗

PubMed2003

Healthy places: exploring the evidence.

"Sense of place" is a widely discussed concept in fields as diverse as geography, environmental psychology, and art, but it has little traction in the field of public health. The health impact of place includes physical, psychological, social, spiritual, and aesthetic outcomes. In this article, the author introduces sense of place as a public health construct. While many recommendations for "good places" are available, few are based on empirical evidence, and thus they are incompatible with current public health practice. Evidence-based recommendations for healthy place making could have important public health implications. Four aspects of the built environment, at different spatial scales-nature contact, buildings, public spaces, and urban form-are identified as offering promising opportunities for public health research, and potential research agendas for each are discussed.

City Planning↗

PubMed2003

The impact of community design and land-use choices on public health: a scientific research agenda.

The design of a community's built environment influences the physical and mental health of its residents. Because few studies have investigated this relationship, the Centers for Disease Control and Prevention hosted a workshop in May 2002 to help develop a scientific research agenda on these issues. Workshop participants' areas of expertise included physical activity, injury prevention, air pollution, water quality, urban planning, transportation, architecture, epidemiology, land use, mental health, social capital, housing, and social marketing. This report describes the 37 questions in the resulting research agenda. The next steps are to define priorities and obtain resources. The proposed research will help identify the best practices for designing new communities and revitalizing old ones in ways that promote physical and mental health.

Centers for Disease Control and Prevention, U.S.↗

PubMed2004

Confronting the challenges in reconnecting urban planning and public health.

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.

City Planning↗

PubMed2006

The role of in situ unit operation/process infiltration treatment on partitioning and speciation of rainfall-runoff.

Management decisions regarding the potential fate and toxicity of anthropogenic metal elements requires a knowledge of metal partitioning and speciation as mediated by in situ control systems (ICS). This study focussed on Cd, Zn, Cu and Pb, common anthropogenic metal elements generated in the built environment and examined the influence of variable event-based hydrology and passive ICS by an engineered partial exfiltration reactor (PER) system on partitioning and speciation. The feasibility and efficiency of the PER as an in situ stormwater runoff control strategy to attenuate levels of metal elements was evaluated. Results indicate that higher rainfall intensity resulted in higher dissolved fraction (fd) values for influent Zn, Cu and Cd, but did not have a significant influence on partitioning of Pb. Speciation indicated that divalent fractions of Cd, Zn, Cu and Pb were changed marginally by the PER. Cu and Pb mainly complexed with organic matter in the influent, while carbonate complexes of these metals in the effluent significantly increased. The PER consistently and statistically reduced all loadings of Cd, Cu, Pb and Zn for all examined events, whether on a mass or concentration basis. As an unsaturated flow unit operation/process the PER can efficiently remove ionic or complexed forms of metal elements. Such UOPs are a potential quality and quantity ICS strategy for rainfall-runoff.

Cities↗

PubMed2006

Air quality management using modern remote sensing and spatial technologies and associated societal costs.

This paper presents a study of societal costs related to public health due to the degradation of air quality and the lack of physical activity, both affected by our built environment. The paper further shows road safety as another public health concern. Traffic fatalities are the number one cause of death in the world. Traffic accidents result in huge financial loss to the people involved and the related public health cost is a significant part of the total societal cost. Motor vehicle exhausts and industrial emissions, gasoline vapors, and chemical solvents as well as natural sources emit nitrogen oxides and volatile organic compounds, which are precursors to the formation of ground-level Ozone. High concentration values of ground-level Ozone in hot summer days produce smog and lead to respiratory problems and loss in worker's productivity. These factors and associated economic costs to society are important in establishing public policy and decision-making for sustainable transportation and development of communities in both industrialized and developing countries. This paper presents new science models for predicting ground-level Ozone and related air quality degradation. The models include predictor variables of daily climatological data, traffic volume and mix, speed, aviation data, and emission inventory of point sources. These models have been implemented in the user friendly AQMAN computer program and used for a case study in Northern Mississippi. Lifecycle benefits from reduced societal costs can be used to implement sustainable transportation policies, enhance investment decision-making, and protect public health and the environment.

Air Pollutants↗

PubMedDate not supplied

Recreating communities to support active living: a new role for social marketing.

The lack of routine physical activity has become an all too pervasive health threat in the United States. Social marketing can be used directly to promote increased physical activity among people who have access to active living options (e.g., safe and convenient sidewalks or bike paths). A second, albeit indirect, use of social marketing to promote physical activity--and the focus of this article--involves promoting behaviors that influence the built environment for the purpose of increasing people's access to active living options. This use of social marketing involves changing the behavior of consumers, developers, distribution channels (e.g., real estate agents) and policy makers. The approach offers public health and other organizations a disciplined, consumer-focused means of mobilizing their available resources in a manner that maximizes the odds of creating active living communities. These means include understanding the competition, understanding target markets, creating mutually beneficial exchanges, segmenting markets and targeting them based on anticipated return. This article identifies specific opportunities for applying the social marketing approach to create active living communities, and identifies opportunities at the state and national level that will enhance the effectiveness of local efforts.

Community Health Planning↗

PubMedDate not supplied

A site-specific literature review of policy and environmental interventions that promote physical activity and nutrition for cardiovascular health: what works?

OBJECTIVE: To review the literature to determine whether policy and environmental interventions can increase people's physical activity or improve their nutrition. DATA SOURCES: The following databases were searched for relevant intervention studies: Medline, Chronic Disease Prevention File, PsychInfo, Health Star, Web of Science, ERIC, the U.S. Department of Transportation, and the U.S. Department of Agriculture. STUDY SELECTION: To be included in the review, studies must have (1) addressed policy or environmental interventions to promote physical activity and/or good nutrition; (2) been published from 1970 to October 2003; (3) provided a description of the intervention; and (4) reported behavioral, physiological, or organizational change outcomes. Studies that had inadequate intervention descriptions or that focused on determinants research, individual-level interventions only, the built environment, or media-only campaigns were excluded. DATA EXTRACTION: We extracted and summarized studies conducted before 1990 (n = 65) and during 1990-2003 (n = 64). DATA SYNTHESIS: Data were synthesized by topic (i.e., physical activity or nutrition), by type of intervention (i.e., point-of-purchase), and by setting (i.e., community, health care facility, school, worksite). Current studies published during 1990-2003 are described in more detail, including setting and location, sample size and characteristics, intervention, evaluation period, findings, and research design. Findings are also categorized by type of intervention to show the strength of the study designs and the associations of policy and environmental interventions with physical activity and nutrition. CONCLUSIONS: The results of our review suggest that policy and environmental strategies may promote physical activity and good nutrition. Based on the experimental and quasi-experimental studies in this review, the following interventions provide the strongest evidence for influencing these behaviors: prompts to increase stair use (N = 5); access to places and opportunities for physical activity (N = 6); school-based physical education (PE) with better-trained PE teachers, and increased length of time students are physically active (N = 7); comprehensive work-site approaches, including education, employee and peer support for physical activity, incentives, and access to exercise facilities (N = 5); the availability of nutritious foods (N = 33), point-of-purchase strategies (N = 29); and systematic officer reminders and training of health care providers to provide nutritional counseling (N = 4). Further research is needed to determine the long-term effectiveness of different policy and environmental interventions with various populations and to identify the steps necessary to successfully implement these types of interventions.

Adult↗

PubMedDate not supplied

Assessing the walkability of the workplace: a new audit tool.

PURPOSE: Walking can be incorporated into most people's daily routines if the process is made convenient by a well-designed built environment. Walkability rarely is assessed in the workplace, where adults spend much of their time. METHODS: From existing tools, we developed an instrument to audit walkability at a single government agency's facilities, which were located in multiple states. We used a five-point scale to evaluate nine elements of walkability: pedestrian facilities, pedestrian-vehicle conflicts, crosswalks, route maintenance, walkway width, roadway buffer, universal accessibility, aesthetics, and shade. Weighted scores ranged from 20 to 39 (poor), to 40 to 69 (fair), to 70 to 100 (good). RESULTS: Of 79 walking route segments surveyed on 10 agency campuses, 34% were rated poor, 32% fair, and 34% good. Repeat assessment of 20 walking route segments by three independent observers yielded similar scores. CONCLUSION: Facility planners may find this walkability instrument useful in identifying and eliminating barriers to convenient walking opportunities in workplaces such as office parks and university campuses.

Adult↗

PubMedDate not supplied

Research for an ageing society.

This article outlines the research agenda of the Economic and Social Research Council's Growing Older Programme. The Programme focuses on extending quality life and is composed of six sub-themes: defining and measuring quality of life; inequalities in quality of life; technology and the built environment; healthy and productive ageing; family and support networks; and participation and activity in later life. The Programme aims not only to produce high quality research on the factors determining quality in old age and how it can be extended but, also, to contribute constructively to policy and practice. The article also introduces the new UK National Collaboration in Ageing Research which brings together four of the research councils to raise the profile of research on ageing and to develop a multidisciplinary approach.

Aged↗

PubMed1996

Spectrum of healthcare delivery from hospital to home in the United Kingdom.

Technological, economic and demographic levers for change are radically modifying patterns of health care delivery and the subsequent built environment that houses the service. In particular the nature of the hospital is changing to a smaller more acute facility. This paper sets out some recent analyses of where service delivery might be located on the spectrum of hospital to home in the UK and identifies some of the alternative patterns of delivery currently being pursued. The underlying imperative for change is economic but could be an opportunity for innovation in health building design.

Community Health Services↗

PubMed1992

Executive forum: design for therapeutic outcomes.

In summary, the two major characteristics of design for therapeutic outcomes are: 1) that it takes into account the functional requirements of patients as these are influenced by illness or disability and 2) that it supports processes of care and treatment aimed at specific desired outcomes. The challenge is a large one and requires a multi-disciplinary effort. Nurses and physicians should be included on design teams, whether in the planning of new facilities, or the redesign of older ones. Physicians will be able to articulate the treatment goals, as will experienced nurses who, in addition, have a handle on the day-to-day activities that can be more effectively carried out by or for patients with the support of good design. In the endeavor to design for therapeutic outcomes, nurses and physicians must be part of the design team, but we should not expect all of them to have the same understanding of the built environment as a design professional has. Rather, their input is an essential complement to the design professional's skills and of critical importance in articulating the requisities of specific patient groups. Because of cost considerations and because there are many users within the hospital, there will of necessity be some trade-offs, but concentration on what the therapeutic outcomes should be for different groups of patients will go a long way toward achieving truly functional designs.

Adult↗

PubMed1987

Psychiatric hospital design.

Particular issues of the interior built environment can influence the patient's perception of space, and therefore his or her behavior. This article specifically deals with the methodology of how to achieve successful psychiatric hospital design, planning and selecting the design team, organizing the design process, and budgeting within the context of interior design. Also discussed are various design elements such as furnishings, wall coverings, floor coverings, and window treatments as they pertain to patients' acceptance, aesthetics, maintenance, and budget.

Color↗

PubMedDate not supplied

Sick building syndrome.

Dr. Hodgson summarizes what is known about human symptoms and discomfort in the built environment, and formulates several critical hypotheses that show striking parallels to the questions arising from discussions of the IEI/MCS syndrome.

Diagnosis, Differential↗

PubMed2002

On the value of architecture and facility management in health administration education.

This article discusses the role and function of architecture and facility management in health administration education vis-à-vis an interdisciplinary set of courses taught in a graduate-level health administration program. These courses provide the future health care executive with theory and applied knowledge on a variety of topics. These include the history of health care facilities, issues in facility planning and management, principles of patient and staff-focused design, campus master planning, participatory methods to involve end users in the design of their work, and care settings. Additional skills acquired include an introduction to contract negotiations, the reading of technical documents such as blueprints, the post-occupancy assessment of facilities-in-use, and familiarity with future trends. Students address the topic of managerial ethics in relation to the built environment in some detail as a vehicle to illustrate the nature of key fine-grain issues of importance to the health administration scholar and professional. The discussion concludes with the presentation of a model curriculum in this subject area.

Architecture↗

PubMed2000

Sustainable regulation of construction.

The seminar examined the role building codes and regulations can have in promoting a more sustainable approach to construction, particularly through their application to non-industrial building materials. A range of building materials such as straw, bamboo, rammed earth, adobe, and cob (a mixture of clay and chopped straw) were described and illustrated by slides to show their building potential. The current codes have a prime concern to protect the health and safety of people from the built environment. They have been developed almost exclusively for mainstream industrial materials and methods of construction, which makes them difficult to use with alternative, indigenous, or non-industrial building materials, even though those materials may be considered more sustainable. The argument was put forward that with only one-third of the world population living in modern industrial buildings today, it is not sustainable to re-house the remaining rapidly expanding population in high technology dwellings. Many of the low technology building materials and methods now used by the majority of people in the world need only incremental improvement to be equal or superior to many of their industrial replacements. Since these can be more sustainable methods of building, there needs to be an acceptance of the use of alternative materials, particularly in the developing parts of the world, where they are being rejected for less sustainable industrial methods. However, many codes make it difficult to use non-industrial materials; indeed, many of the industrial materials would not meet the demands that must be now met if they were now being introduced as new materials. Consequently, there is a need to develop codes to facilitate the use of a wider range of materials than in current use, and research is needed to assist this development. Sustainable regulation should take into account the full range of real impacts that materials and systems have in areas such as resource use and depletion, toxicity of the processes that produce them, and their potential for re-use and recyclability.

Building Codes↗

PubMed2003

A conceptual framework for the sustainable management of wastewater in Harare, Zimbabwe.

The aim of this study was to formulate an integrated wastewater management model for Harare, Zimbabwe, based on current thinking. This implies that wastewater is treated/disposed of as close to the source of generation as possible. Resource recovery and reuse in a local thriving urban agriculture are integrated into this model. Intervention strategies were considered for controlling water, nitrogen and phosphorus flows to the lake. In the formulation of strategies, Harare was divided into five major operational areas of high-, medium-, and low-density residential areas, and also commercial and industrial areas. Specific options were then considered to suit landuse, development constraints and socio-economic status for each area, within the overall criteria of limiting nutrient inflows into the downstream Lake Chivero. Flexible and differential solutions were developed in relation to built environment, population density, composition of users, ownership, future environmental demands, and technical, environmental, hygienic, social and organisational factors. Options considered include source control by the users (residents, industries, etc.), using various strategies like implementation of toilets with source separation, and natural methods of wastewater treatment. Other possible strategies are invoking better behaviour through fees and information, incentives for cleaner production, and user responsibility through education, legislative changes and stricter controls over industry.

Conservation of Natural Resources↗

PubMed2003

Guidelines and health care buildings.

What are guidelines, why we need them, by whom they are introduced? These are some of the questions that are intended to be approached in this presentation. Apart from the services they offered to the design process and the built environment especially in the health care facilities the main discussion today is if guidelines, norms, standards are necessary tools in healthcare design or they act as barrier in the creation of a proper healing environment.

Architecture↗