Creating A Healthy Environment: The Impact of the Built Environment on Public Health

Here at the start of the 21st century our understanding of which factors promote health and which damage health has grown considerably. The diseases of the 21st century will be “chronic” diseases, those that steal vitality and productivity, and consume time and money. These diseases-heart disease, diabetes, obesity, asthma, and depression- are diseases that can be moderated by how we design and build our human environment. It is now accepted that, in addition to direct hazards from infectious diseases and environmental toxins, human behaviors play a critical role in determining human health. As we begin to include consideration of these factors into our health-related decision-making, we must additionally guard against using too narrow a definition of the environment. Every person has a stake in environmental public health, and as environments deteriorate, so does the physical and mental health of the people who live in them. There is a connection, for example, between the fact that the urban sprawl we live with daily makes no room for sidewalks or bike paths and the fact that we are an overweight, heart disease-ridden society.

Obesity can increase the risk of (adult-onset) type 2 diabetes by as much as 34 fold, and diabetes is a major risk factor for amputations, blindness, kidney failure, and heart disease. The most effective weight loss strategies are those that include an increase in overall physical activity. In a recent type 2 diabetes trial, weight loss and physical activity were more effective in controlling the disease than medication. In addition, for treatment of relatively mild cases of anxiety and depression, physical activity is as effective as the most commonly prescribed medications. It is dishonest to tell our citizens to walk, jog, or bicycle when there is no safe or welcoming place to pursue these “life-saving” activities.

Respiratory disease, especially asthma, is increasing yearly in the U.S. population. Bad air makes lung diseases, especially asthma, worse. The more hours in automobiles, driving over impervious highways that generate massive tree-removal, clearly degrade air quality. When the Atlanta Olympic Games in 1996 brought about a reduction in auto use by 22.5%, asthma admissions to ERs and hospitals also decreased by 41.6%. Less driving, better public transport, well designed landscape and residential density will improve air quality more than will additional roadways.

In order to address these critical health problems we must seize opportunities to form coalitions between doctors, nurses, and public health professionals and others such as architects, builders, planners and transportation officials, so that we are all “at the table” when environmental decisions are made. Such decisions include whether to install sidewalks in the next subdivision. It means thinking about what constitutes safe and affordable housing, safe neighborhoods, providing green space for people to enjoy where they live and work, and rethinking how we travel from one place to another.

Land-use decisions are just as much public health decisions as are decisions about food preparation. What, for example, are the implications for children with asthma of building yet another expressway? We must also question whether a fatality involving a pedestrian isn’t actually the result of poor urban planning, thoughtless land use, or inferior urban design rather than “simply” a motor vehicle crash. We must be alert to the health benefits, including less stress, lower blood pressure, and overall improved physical and mental health, that can result when people live and work in accessible, safe, well-designed, thoughtful structures and landscapes. We must measure the impact of environmental decisions on real people, and we must begin, in earnest, to frame those decisions in light of the well being of children, not only in this country but across the globe.

The health of Europeans

More than three-quarters (76%) of Europeans consider that they are in good health. Approximately one in five citizens believes  that  he  or  she  is  in  very  good  health (21%) or has a more neutral position (19%) as regards his or her health.  Only 5% of respondents described their health as bad (5%) or very bad (1%).

In the European Union, respondents in a majority of the new Member States tend to be more pessimistic about their health in general. The percentages vary considerably from one Member State to another: a small majority of Latvians and Lithuanians (52%) consider that their health is good or very good while the corresponding percentage is close to or higher than 85% in Denmark (84%) and Ireland (87%).There are similar differences if only the results of the “very good” replies are taken into consideration: the Irish (43%) and Danish (44%) are again among those who consider that their health in general is  very good. This time, however, they are  joined by citizens in Greece (46%) and Cyprus (40%). Citizens of the Baltic countries (from 5 to 11% of respondents from those countries consider themselves to be in very good health) while Hungarian citizens are more “negative” (11%) about their health in general. Among the candidate and accession countries, Turkey is the only one where the levels are very close to the EU average. On the other hand, those of the other countries are below the EU average.

An analysis of the replies by socio-demographic variables reveals that men are more optimistic about their health. Fairly logically, age is a discriminating variable; while 89% of young people (aged between 15 and 24) consider that their health is good, only 59% of people aged 55 and over make the same positive diagnosis of their health. The heaviest respondents and those who consider that they are overweight are more  likely  to  view  their  health  negatively.  This  suggests  that  such  people  are aware of the negative health effects of a high body weight.

Health and food

In recent decades, important socio-economic changes in most developed countries have undeniably affected the eating habits and level of physical activity of citizens. This trend is clearly illustrated by the current increase in illnesses directly or indirectly related to the increase in overweight and obesity.

It has been established that that a poor diet and insufficient physical activity are among the main risk factors for various diseases. Physical activity can also help to combat stress.The European Commission and in particular its Directorate General health and Consumer Protection wants to improve public health in the European Union, prevent disease and human ailments and eliminate human health risk factors. The aim of this survey, commissioned by the Directorate General Health and Consumer Protection is to study several areas having an impact on the health of European citizens. More precisely, the intention is to use the results of this study to establish the physical characteristics of European  Union citizens and assess the opinion of citizens on subjects such as health, diet and physical activity in the form of sport.

It is not the first survey carried out on these subjects. Two previous surveys concerning, on the one hand, physical activity and, on the other hand, health and diet, were carried out at the end of 2002 and the beginning of 2003. In relation to those previous studies, the current questionnaire has been revised, but several questions can still be used for comparative purposes in 15 of the 25 European

Union Member States. 

The main themes addressed in this survey are:

- The health and physical characteristics of Europeans,

- Eating habits in the European Union,

- Diet and problems related to being overweight,

- The respondent’s physical activity.

This survey was carried out in November and December 2005. It was commissioned by the Directorate General Health and Consumer Protection and carried out by TNS Opinion & Social, a consortium formed by TNS and EOS Gallup Europe. The methodology used is that of the standard Eurobarometer surveys of the Directorate General Press and Communication (“Opinion  Polls, Press Reviews, Europe Direct” unit). A technical note concerning the interviews carried out by the institutes of the TNS Opinion & Social network is annexed to this report. That note specifies the interview method, as well as the intervals of confidence.

About of the Health

Improvement in the health and nutritional status of the population has been one of the major thrust areas for the social development programmes of the country. This was to be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition services with special focus on under  served and under  pr ivi leged segments of the population. Over the last five decades, India has built up a vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors. These institutions are manned by professionals and paraprofessionals trained in the medical colleges in modern medicine and ISM&H and paraprofessional training institutions. The population has become aware of the benefits of health related technologies for prevention, early diagnosis and effective treatment for a wide variety of illnesses and accessed available services. Technological advances and improvement in access to health care technologies, which were relatively inexpensive and easy to implement, had resulted in substantial improvement in health indices of the population and a steep decline in mortality. The extent of access to and utilization of health care varied substantially between states, districts and different segments of society; this to a large extent, is responsible for substantial differences between states in health indices of the population.

During the 1990s, the mortality rates reached a plateau and the country entered an era  of dual  disease burden. Communicable diseases have become more difficult to combat because of development of insecticide resistant strains of vectors, antibiotics resistant strains of bacteria and emergence of HIV infection for which there is no therapy. Longevity and changing life style have resulted in the increasing prevalence of non-communicable diseases. Under nutrition, micro nutrient deficiencies and associated health problems coexist with obesity and non-communicable diseases. The existing health system suffers from inequitable distribution of institutions and manpower. Even though the country produces every year  over  17,000 doctors  in modern system of medicine and similar number of ISM&H practitioners and paraprofessionals, there are huge gaps  incritical manpower in institutions pro viding primary health care , especially in the remote rural and tribal areas where health care needs are the greatest. Some of the factors responsible for the poor functional status of the system are:

·         mismatch between personnel and infrastructure;

·         lack of Continuing Medical Education (CME) programmes for orientation and  skillupgradation of the personnel;

·         lack of appropriate functional referral system;

·         absence of well established linkages between different components of the system.

Human healt

This chapter describes the observed and projected health impacts of climate change, current and future populations at risk, and the strategies, policies and measures that have been and can be taken to reduce impacts. The chapter reviews the knowledge that has emerged since the Third Assessment Report (TAR) (McMichael et al., 2001). Published research continues to focus on effects in high-income countries, and there remain important gaps in information for the more vulnerable populations in lowand middle-income countries.

State of health in the world Health includes physical, social and psychological wellbeing. Population health is a primary goal of sustainable development. Human beings are exposed to climate change through changing weather patterns (for example more intense and frequent extreme events) and indirectly though changes in water, air, food quality and quantity, ecosystems, agriculture, livelihoods and infrastructure. These direct and indirect exposures can cause death, disability and suffering. Illhealth increases vulnerability and reduces the capacity of individuals and groups to adapt to climate change. Populations with high rates of disease and debility cope less successfully with stresses of all kinds, including those related to climate change.

In many respects, population health has improved remarkably over the last 50 years. For instance, average life expectancy at birth has increased worldwide since the 1950s. However, improvement is not apparent everywhere, and substantial inequalities in health persist within and between countries (Casas-Zamora and Ibrahim, 2004; McMichael et al., 2004; Marmot, 2005; People’s Health Movement et al., 2005). In parts of Africa, life expectancy has fallen in the last 20 years, largely as a consequence of HIV/AIDS; in some countries more than 20% of the adult population is infected (UNDP, 2005). Globally, child mortality decreased from 147 to 80 deaths per 1,000 live births from 1970 to 2002 (WHO, 2002b). Reductions were largest in countries in the World Health Organization (WHO) regions of the Eastern Mediterranean, South-East Asia and Latin America. In sixteen countries (fourteen of which are in Africa), current levels of under-five mortality are higher than those observed in 1990 (Anand and Barnighausen, 2004). The Millennium Development Goal (MDG) of reducing under-five mortality rates by two-thirds by 2015 is unlikely to be reached in these countries. stroke and cancer, account for nearly half of the global burden of disease (at all ages) and the burden is growing fastest in lowand middle-income countries (Mascie-Taylor and Karim, 2003).

Communicable diseases are still a serious threat to public health in many parts of the world (WHO, 2003a) despite immunization programmes and many other measures that have improved the control of once-common human infections. Almost 2 million deaths a year, mostly in young children, are caused by diarrhoeal diseases and other conditions that are attributable to unsafe water and lack of basic sanitation (Ezzati et al., 2003). Malaria, another common disease whose geographical range may be affected by climate change, causes around 1 million child deaths annually (WHO, 2003b). Worldwide, 840 million people were undernourished in 1998-2000 (FAO, 2002). Progress in overcoming hunger is very uneven. Based on current trends, only Latin America and the Caribbean will achieve the MDG target of halving the proportion of people who are hungry by 2015 (FAO, 2005; UN, 2006a)