Tuesday, January 31, 2017

New York SkylineThere is a standard set of urban planning tips for communities looking to reduce childhood obesity and increase physical activity: build your neighborhoods on a connected grid pattern, install and maintain sidewalks, and provide access to public transit and parks within walking distance. This makes it sound like children living in urban environments should be more active and less likely to be obese (Lopez & Hynes, 2006; Marshall, 2016). It is true that children living in rural areas are about 25% more likely to be overweight or obese than their peers in metropolitan areas (Johnson & Johnson, 2015; U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2013); however, the benefits of urban living are not equally distributed. Children living in the same city can experience vastly different health environments due to housing opportunities and trends, city- and state-level investment decisions, and neighborhood characteristics (Rose & Miller, 2016).

Within urban areas, lower income residents are less likely to have access to public transportation, have longer commute times, and have an increased reliance on convenience foods, resulting in growing overweight and obesity (Marshall, 2016). In urban Los Angeles County, two out of three children do not live within walking distance (1/4 mile) of a park, and children of color have access to much less park space than white children (USC, n.d.). There is also growing evidence that children in urban areas actually get less physical activity than children in rural or small metropolitan areas (Joens-Matre et al., 2008; Johnson & Johnson, 2015). This is possibly due to environmental and social hazards that discourage activity. Abandoned buildings, vacant lots, and sidewalk maintenance issues in lower income areas where economic disinvestment has occurred, along with crime, are barriers to physical activity and active living in urban cores (Lopez & Hynes, 2006).

Given the proven importance of physical activity and green space access to both mental and physical health, more work needs to be done to ensure that all children have healthy spaces to grow and play.

The importance of green spaces. Green space in urban areas has several measured positive effects on human and environmental health. Access to green space is associated with increased physical activity, more positive indicators of mental health, and lower levels of depression and stress. Parks and green spaces also reduce the heat effect of urban construction and help regulate air and water pollution (Larson, Jennings & Cloutier, 2016). An infographic from the University of Southern California’s Environmental Health Centers illustrates the benefits of urban parks and green space, including increased attention and understanding, physical activity, emotional wellbeing, and self-discipline; and decreased behavior problems, obesity, and stress (USC, n.d.).

Although much of the evidence has been gathered overseas, particularly in Australia, Great Britain, and the Netherlands, it appears that access to green spaces is correlated with increased physical activity, reduced screen time, and healthier weight status in children (Janssen & Rosu, 2015; Sanders, Feng, Fahey, Lonsdale & Astell-Burt, 2015; Sanders, Xiaoqui, Fahey, Lonsdale & Astell-Burt, 2015). The relationship between green space and health is substantial for all groups, but is particularly strong for youth and people with lower socioeconomic status (Maas, Verheij, Groenewegen, de Vries, & Spreeuwenberg, 2006). A study exploring green space access, health, and ethnicity in England found that access to urban green space was an important predictor of overall health for the country’s black and minority ethnic (BME) population (Roe, Aspinall, & Ward Thompson, 2016).

There is also evidence that access to green spaces can improve the mental health of children. The ill-effects of childhood stress have been discussed on this blog in an earlier post and include a higher risk for risky health behaviors and poor health outcomes such as diabetes, obesity, and heart disease. Studies have found significant childhood stress prevalence in low-income urban populations (Burke, Hellman, Scott, Weems & Carrion, 2011). The Urban Child Institute Partnership focuses on socio-emotional development of children in Memphis and Shelby Counties in Tennessee. In a 2015 paper, Off to a Good Start, researchers note that community assets—libraries, museums, and green spaces like parks, playgrounds, and gardens—can be leveraged to help support the socio-emotional development of young children (Martin, et al., 2015). There is emerging evidence that children who are exposed to nature—via a walk in a park versus a walk on a city street—can improve some aspects of their classroom functioning (Jaffe 2015).

Economic disinvestment and gentrification. The positive benefits of urban green space may not be accruing to the children who need it most. A study combining data on violent crimes with data on walking trail proximity and child overweight and obesity found that having a walking trail near the home reduces a child’s weight but only in low crime areas (Sandy, Tchernis, Wilson, Liu, & Zhou, 2012). Nationwide housing trends, including the aftereffects of the 2008 Great Recession and mortgage crisis, have disproportionally affected low-income communities and communities of color. Recent reinvestment in urban areas—gentrification—has accelerated in recent years and risks further disrupting these communities. According to PolicyLink, between 20% and 58% of census tracts in the nation’s 15 largest cities gentrified between 2000 and 2013 (Rose & Miller, 2016). While gentrification can improve the housing stock, economic opportunities, and access to healthy spaces for low-income residents, the danger occurs when these residents can no longer afford to live in a gentrifying area and are forced to move. According to the Centers for Disease Control and Prevention, the negative health effects of displacement due to gentrification include increased levels of stress and exposure to violence and crime, as well as reduced access to affordable and healthy housing, healthy food choices, exercise facilities, and social support (CDC, 2013). Economic disinvestment can lead to concentrated poverty and resulting problems like higher crime rates. However, reinvestment can displace these children and their families before they are able to enjoy the benefits that come with growth and reduced crime rates.

What is being done? The link between where one lives and health has long been understood. Elements of your neighborhood like access to green spaces for physical activity, to grocery stores with healthy and affordable food, and to good schools and good jobs, all have a strong and measurable impact on your health and the health of your family (Coulton, Richter, Kim, Fischer & Cho, 2016; Rose & Miller, 2016). Research on the groundbreaking Moving to Opportunity study, conducted by the US Department of Housing and Urban Development, shows that children who move from low-income neighborhoods to low-poverty areas show improvements in educational achievement, long-term earnings, and health and happiness, with the effect being strongest if children move when younger (Wolfers, 2015).

Several stakeholders are working to support access to healthy homes and green spaces in urban cores without displacing existing families. Cities working with Place Matters, an initiative supported by the Robert Wood Johnson Foundation and the Joint Center, have identified several priorities for developing healthy housing and reducing health disparities, including housing code enforcement, mitigating the impact of displacement due to gentrification, and supporting access to parks and green spaces (RWJF, 2014). Organizations like the National Low Income Housing Coalition and the Coalition for Smarter Growth, along with the US Department of Housing and Urban Development, are also focused on helping families stay in their homes. It’s vital to ensure that all of the families in our cities have healthy housing and access to parks and green spaces.

Works Cited

  • Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), 408-413. doi:10.1016/j.chiabu.2011.02.006
  • Centers for Disease Control and Prevention. (2013). Health effects of gentrification. Healthy places. Atlanta, GA: CDC. https://www.cdc.gov/healthyplaces/healthtopics/gentrification.htm
  • Coulton, C., Richter, F., Kim, S.J., Fischer, R., & Cho, Y. (2016). Leveraging integrated data systems to examine the effect of housing and neighborhood conditions on kindergarten readiness. Cleveland, OH: Center on Urban Poverty and Community Development, Case Western Reserve University. http://povertycenter.case.edu/wp-content/uploads/2016/04/Coulton_et_all_2016_Leveraging_Integrated_Data.pdf
  • Jaffe, E. (2015, Sep 7). “Urban Trees Enhance Children’s Brains, Too.” CityLab, from The Atlantic. Washington, DC: Atlantic Media Company. Retrieved 1/18/2017 from http://www.citylab.com/design/2015/09/urban-trees-enhance-childrens-brains-too/404089/.
  • Janssen, I., & Rosu, A. (2015). Undeveloped green space and free-time physical activity in 11 to 13-year-old children. International Journal Of Behavioral Nutrition & Physical Activity, 121-7. doi:10.1186/s12966-015-0187-3
  • Joens-Matre, R. R., Welk, G. J., Calabro, M. A., Russell, D. W., Nicklay, E., & Hensley, L. D. (2008). Rural-urban differences in physical activity, physical fitness, and overweight prevalence of children. The Journal Of Rural Health: Official Journal Of The American Rural Health Association And The National Rural Health Care Association, 24(1), 49-54. doi:10.1111/j.1748-0361.2008.00136.x
  • Johnson, J. 3., & Johnson, A. M. (2015). Urban-rural differences in childhood and adolescent obesity in the United States: a systematic review and meta-analysis. Childhood Obesity (Print), 11(3), 233-241. doi:10.1089/chi.2014.0085
  • Larson, L. R., Jennings, V., & Cloutier, S. A. (2016). Public Parks and Wellbeing in Urban Areas of the United States. Plos ONE, 11(4), 1-19. doi:10.1371/journal.pone.0153211
  • Lopez, R. P., & Hynes, H. P. (2006). Obesity, physical activity, and the urban environment: public health research needs. Environmental Health: A Global Access Science Source, 525.
  • Maas, J., Verheij, R. A., Groenewegen, P. P., de Vries, S., & Spreeuwenberg, P. (2006). Green space, urbanity, and health: how strong is the relation?. Journal Of Epidemiology And Community Health, 60(7), 587-592.
  • Marshall, A. (2016, Apr 1). “The Complicated Problem of Urban Obesity.” CityLab, from The Atlantic. Washington, DC: Atlantic Media Company. Retrieved 1/18/2017 from http://www.citylab.com/politics/2016/04/obesity-is-a-city-problem/476547/
  • Martin, L.T., Padilla, L., Cannon, J.S., Auger, A., Diamond, R., Joyce, C., Spurlock, K.L., & Chandra, A. (2015). Off To A Good Start: Social and Emotional Development of Memphis' Children. Santa Monica, CA: RAND Corporation. http://www.rand.org/pubs/tools/TL161.html
  • Robert Wood Johnson Foundation. (2014, May 5). Place Matters: Eliminating health disparities in Alameda County, California. Culture of Health Blog. Princeton, NJ: RWJF. http://www.rwjf.org/en/culture-of-health/2014/05/place_matters_elimi2.html
  • Roe, J., Aspinall, P. A., & Ward Thompson, C. (2016). Understanding Relationships between Health, Ethnicity, Place and the Role of Urban Green Space in Deprived Urban Communities. International Journal Of Environmental Research And Public Health, 13(7), doi:10.3390/ijerph13070681
  • Rose, K. & Miller, T.K. (2016). Healthy communities of opportunity: An equity blueprint to address America’s housing challenges. Oakland, CA: PolicyLink. http://kresge.org/sites/default/files/library/healthy_communities_of_opportunity_-_an_equity_blueprint_to_address_americas_housing_challenges.pdf
  • Sanders, T., Xiaoqi, F., Fahey, P. P., Lonsdale, C., & Astell-Burt, T. (2015). The influence of neighbourhood green space on children's physical activity and screen time: findings from the longitudinal study of Australian children. International Journal Of Behavioral Nutrition & Physical Activity, 121-9. doi:10.1186/s12966-015-0288-z
  • Sandy, R., Tchernis, R., Wilson, J., Liu, G., & Zhou, X. (2013). Effects of the built environment on childhood obesity: the case of urban recreational trails and crime. Economics And Human Biology, 11(1), 18-29. doi:10.1016/j.ehb.2012.02.005
  • U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (2013). Child Health USA 2012. Rockville, MD: U.S. Department of Health and Human Services. Retrieved from http://mchb.hrsa.gov/chusa12/pc/pages/ruc.html.
  • University of Southern California. (n.d.). Infographic: Children’s Health and Urban Parks. Los Angeles, CA: USC Environmental Health Centers. http://envhealthcenters.usc.edu/infographics/infographic-childrens-health-urban-parks
  • Wolfers, J. (2015, May 4). Why the new research on mobility matters: an economist’s view. The Upshot. New York: The New York Times [online edition]. https://www.nytimes.com/2015/05/05/upshot/why-the-new-research-on-mobility-matters-an-economists-view.html?_r=1&abt=0002&abg=1

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