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Article Excerpt
ABSTRACT
This invesigation lops a conceptual community health model and operationalizes that model by focusing on the physical environment and community health relationship utilizing a data inventory for the state of Michigan. Furthermore, this study identifies data gaps, challenges, and potential solutions from the physical design and planning perspectives. Conceptual model operationalization entailed a literature review to identify physical environment independent variables and a data inventory for the state of Michigan. One hundred and sixty-one articles were reviewed. Fortyseven independent under natural, constructed and social environments, while twenty-seven dependent variables were identified under physical, social, mental, and environmental health. These identified independent and dependent variables were used to conduct the data inventory for Michigan. The literature review and data inventory highlighted four methodological issues. These issues were: breadth and availability of independent variables such as sidewalks; need for analysis at a higher geographic resolution; the potential of geographic information systems (GIS); and the limited scope of the dependent health variable (i.e., walking and biking behaviors). This investigation concludes the development of a robust community health model requires more appropriate data and methods. This necessitates partnerships between public health and the physical planning disciplines.
INTRODUCTION
The connection between the built environment and community health is currently at the forefront of land use planning and public health research agendas (Transportation Research Board 2005; Corburn 2004; Dannenberg et al. 2003; R. Jackson 2003). The vast majority of this research is focused on the connection between community design and physical activity. Of particular interest is the connection between suburbanization and sedentary lifestyles, as inactivity has a known relationship to chronic diseases and obesity. The following paper reports on the beginning stages of a multi-disciplinary effort to model the relationship between the built environment and community health in Michigan. The dependent variable, community health, is defined more broadly to include measures of mental health, physical health, social capital, and environmental integrity. The paper summarizes the methodological challenges of moving beyond physical activity as the dependent variable. Several steps are identified that must be taken by both public health and the physical planning disciplines before a more robust model is possible.
This paper first presents a conceptual model for investigating the relationship between community design and community health. Second, it identifies and discusses the data challenges faced in trying to operationalize a more robust model. These measurement issues and data challenges include: differences in scale for units of analysis and incompatible data scales, data at various levels of aggregation and compatibility, limited independent variables (scope, data availability, identification of key independent variables), and limited availability and breadth of measures for health, the dependent variable. While these issues offer an opportunity for geographers, landscape architects, and physical planners to contribute to and advance the research in community design and health, creating the appropriate data sets necessitates a partnership between public health departments and researchers.
OBJECTIVE
In 2004, a multi-disciplinary group of researchers with an interest in the subject of health and the built environment gathered to discuss a possible modeling effort that could use the rich geographic information system (GIS) data inventory of Michigan State University to build upon the work of authors such as Ewing et al. (2003), which related built environment variables to health outcomes. The research group represented the disciplines of geography, landscape architecture, urban planning, parks and recreation studies, public health, and community nutrition. The goals of the group were to define a holistic conceptual model of the health-built environment relationship, to operationalize the model, and to inventory data to see if a modeling effort for Michigan communities could be conducted.
Background-A Call for a Holistic Model
While it has been acknowledged that there are "multiple pathways through which the built environment may affect human health and well-being," the vast majority of the research in this area to date has focused on the relationship between the built environment and physical activity (Northridge et al. 2003, 556). Many of the leading researchers in planning are transportation specialists seeking to understand the connection between the built environment and travel behavior (Frank et al. 2003; Handy et al. 2003; Ewing and Cervero 2001). Their studies have consistently shown a positive correlation between denser, more mixed used environments and increased walking and biking behaviors (Lee and Moudon 2004; Saelens, Sallis, Black, et al. 2003; Craig et al. 2002; Berrigan and Troiano 2002). A well-publicized study by Ewing et al. (2003) linked urban design to two health outcomes: obesity and hypertension. Specifically Ewing et al. reported that residents of sprawling counties were more likely to walk less, weigh more, and have greater hypertension prevalence than residents of compact counties.
Other studies have attempted to analyze the impact of the built environment using a broader definition of health. Dannenberg et al. (2003), for instance, recognized that the design of a community's built environment influences the physical and mental health of its residents. Numerous studies have examined the effects of land development on environmental health, in particular water and air quality (Frumkin et al. 2004; Brabec et al. 2002). Other studies have investigated health disparities associated with social and racial segregation in development patterns (Huston et al. 2003; Crespo et al. 2000; Ross 2000). Finally, several authors have investigated the interface of urban design and social capital, which is hypothesized to impact upon human health. Echoing the work of Putnam (2000), Freeman (2001) concluded that the proportion of residents who drive to and from work is significantly related to whether or not an individual has a neighborhood social connection. Lund (2003) and Leyden (2003) both found that certain physical elements of the built environment are related to neighbor interaction and social capital, respectively.
A common view across this literature is that transdisciplinary research is required to get a better grasp of the relationship between the built environment and health (Transportation Research Board 2005; Corburn 2004; Dannenberg et al. 2003; L. Jackson 2003; Srinivasan et al. 2003). Researchers approach their work with the distinct theoretical and methodical lenses of their disciplines; increasingly disciplinary perspectives are criticized as blinders that unwittingly prevent seeing the big picture. In the realm of physical activity research, for instance, Hoehner et al. (2003) have noted that transportation planners see activity as an induced response to an external demand; the scrutinized activity, moreover, is usually functional or utilitarian in nature, such as a trip to work. In contrast, public health researchers tend to see physical activity as internally motivated and recreational in orientation.
In addition to the need for transdisciplinary studies, many researchers have called for a better understanding of which specific variables in the built environment affect health (Transportation Research Board 2005; R. Jackson 2003; Leyden...
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