Environmental health is in the midst of a paradigm shift. Today, features of the built environment, such as architecture and urban planning, are considered as important to human health as features of the natural environment, such as air quality and water pollution. The built environment includes building conditions, neighborhood design, recreational area safety and accessibility, and transportation infrastructure among its attributes. But it is the nexus where the built environment affects human health that is the focus of much research.
Effects of urban sprawl
One problem being investigated is the relationship between obesity and urban sprawl. Urban sprawl is a development pattern characterized by low-density, decentralized, automobile-dependent neighborhoods. Its health implications include physical inactivity, obesity, stress, and mental health issues.
The nation’s worsening obesity epidemic highlights the potential health effects of the built environment. Research suggests that we, as healthcare practitioners, need to better understand the neighborhood environmental constraints that contribute to decreased physical activity and increasing obesity in our patients. The research indicates that we need to rethink how we address obesity and understand why maintaining an ideal weight is so difficult.
The built environment includes the constructed features of our homes, offices, neighborhoods, and cities. It includes interior ventilation, street layout, the presence or absence of sidewalks, and population density. Features that promote physical activity—walkable streets, less urban sprawl, and the presence of a supermarket in a community— have been found to protect health and reduce obesity. At the same time, features that seem to promote physical inactivity—cul-de-sac developments, auto-dependent communities, and homes far from retail and nonresidential places—increase the obesity risk. Consider, too, that suburban populations have longer commute times, resulting in less time for health-promoting activities and increased stress associated with getting to and from work.Effective intervention
Higher weight and other health disparities are most evident in persons of Hispanic ethnicity, black race, lower income, and less education. This suggests that maintaining a healthy weight is not solely a matter of choice or will power, but is also related to a person’s social and cultural environment. Urban sprawl could accentuate obesity in individuals who fall into one or more groups plagued with health disparities.
Therefore, simply telling patients to eat better and exercise more is not effective. We need to recognize the factors that affect health but that patients can not control. For example, if a person lives in a neighborhood with nowhere to purchase healthy food and unsafe streets or parks, he or she can not easily acquire the behaviors needed to prevent weight gain. We need to help patients gain access to healthy food and safe places for physical activity.
Public health nurses play a critical role in combating the effects of urban sprawl by helping communities without easy access to supermarkets or quality fruits and vegetables find the nutritious foods they need. Strategies include partnering with local small businesses to provide more fresh produce at affordable prices, setting up community carpooling programs for organized grocery shopping excursions, and lobbying for public transportation in areas that are geographically isolated from supermarkets offering healthy options.
Urban sprawl affects nurses, too. Working long hours can lead to an improper diet and a lack of exercise. Workplace stress also may be exacerbated by commute-related stress. Of course, nurses can make healthier choices to decrease the risk of obesity. They can work shorter hours, schedule breaks in the workday to seek out healthy meals, carpool with coworkers to decrease the stress of the commute, and bargain for a housing allowance in employment contracts if housing is expensive, so they can live closer to their jobs.
The roots of America’s obesity epidemic are complex. In isolation, the usual prescriptions that aim at the proximate causes—consuming fewer calories and burning more—fail. By addressing the built and social environmental factors that affect health, nurses can help their patients—and themselves—live healthier lives.
Russ Lopez, ScD, is a Research Assistant Professor at Boston (Massachusetts) University School of Public Health. Kristen Welker-Hood, ScD, RN, is a Senior Policy Fellow in the Center for Occupational and Environmental Health at the American Nurses Association.