The built environment: how city design impacts child health

Environmental factors, such as soil, air and water quality, are well known to influence population health. With the increasing urbaniza tion of Canada and other countries around the world, more attention is now being paid to how the ‘built environment’ – all the elements of the environment designed by humans – also plays a crucial role in human health. This article briefly examines how a few key components of the built environment contribute to child health. Thoughtful placement of schools and efforts to create safe, walkable neighbourhoods can increase the number of students who walk to school instead of relying on cars. Providing children and their families with recreational infrastructure promotes physical activity. Creating farmers’ markets in urban cores increases access to a less expensive source of nutritious food for a city’s inhabitants. Knowledge about these interactions between urban design and child health can allow physicians to provide more practical advice to their patients about developing a healthy lifestyle within a city. It is also a promising field for physician advocacy: by offering their expertise to inform city planning decisions and persuading city planners to consider the health impacts of their decisions, physicians can help make it easier for their young patients to live a healthy, active lifestyle. THE BUILT ENVIRONMENT AND URBANIZATION When considering individual patients, we are taught to consider the impact of patients’ environments on their health: where and with whom they live, what kind of work they do, etc. It stands to reason that factors of a larger environment – such as a neighbourhood or city – may influ ence the health of groups of people living there. Of specific interest is the built environment (BE) – all of the elements of the environment designed by humans –including the land-use zoning of a neighbourhood, road layouts, access to shops and facilities, and the presence or absence of sidewalks. A growing body of research illustrates that BE design in urban and suburban areas can have a significant impact on the health of people living in these areas. This article endeavours to give a practical overview of the influence of BE on health, with a specific focus on how BE can influence child health, activity levels and development. Where people live in Canada has changed dramatically since World War II and the subsequent boom of industry, with an increased proportion of the population moving toward urban areas. Currently, 68% of the Canadian population lives in metropolitan areas and this figure contin ues to increase annually. 1 The development of sufficient housing and infrastructure for the rapidly growing number of city dwellers often results in urban sprawl. The low-density housing and partitioned land use common to suburban areas may now be contributing to chronic health problems. 2 At least four main threats of sprawl to population health have been identified: physical inactivity, poor air quality, more motor vehicle collisions due to reliance on cars, and mental health issues.