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UNCHealth Minority Sorting Out the Connections Between the Built Environment and Health: A Conceptual Framework for Navigating Pathways and Planning Healthy Cities Mary E. Northridge, PhD, MPH Mailman School of Public Health, Columbia University Editor-in-Chief, American Journal of Public Health UNCHealth History: Minority Squalid living conditions of the 19th century industrialized cities. Theory: Important for asking the right questions. Methods: Qualitative and quantitative, citizen control to effect the outcome of a process. Tools: Geographic Information Systems (GIS), multi-level modeling. UNCHealth Minority History Urban Reform Movement Which Gave Birth to Urban Planning and Public Health Jacob Riis, Photojournalist, “How the Other Half Lives” UNCHealth Minority The Developing World 1 Billion People Out of a Global Population of 6 Billion Presently Live in Slum-like Conditions. UNCHealth Minority Slums, Slum Dwellers, & Health Sclar ED, Northridge ME Task Force 8: Charged with improving the lives of at least 100 million slum dwellers by 2020. UNCHealth Theory Minority Asking Different Research Questions, Generating New Ideas. UNCHealth Minority Making The Connections “A Joint Urban Planning and Public Health Framework: Contributions to Health Impact Assessment” (Northridge ME, Sclar ED) “Social Determinants of Health and Environmental Health Promotion” (Schulz AJ, Northridge ME) J Urban Health. 2003; 80:556-568, p. 559. Conceptual Framework HEALTH & WELL-BEING Health Outcomes Well-Being PROXIMATE Stressors/Buffers Health Behaviors Social Integration/Support FUNDAMENTAL INTERMEDIATE Natural Environment Built Environment Macrosocial Factors Social Context Inequalities FUNDAMENTAL Natural Environment Macrosocial Factors Historical Conditions Political Orders Economic Order Legal Codes Human Rights Doctrines Social and Cultural Institutions Ideologies Inequalities Distribution of Material Wealth Distribution of Employment Opportunities Distribution of Educational Opportunities Distribution of Political Influence INTERMEDIATE Built Environment Land Use Transportation Services Public Resources Zoning Regulations Buildings Social Context Community Investment Policies Enforcement of Ordinances Community Capacity Civic Participation and Political Influence Quality of Education PROXIMATE Stressors/Buffers Environmental, Neighborhood, Health Behaviors Workplace, and Housing Conditions Dietary Practices Violent Crime and Safety Physical Activity Police Response Health Screening Financial Insecurity Environmental Toxins Unfair Treatment Social Integration/Support Social Participation and Integration Shape of Social Networks and Resources Available Social Support HEALTH & WELL-BEING Health Outcomes Infant and child health Well-Being Obesity Hope/Despair Cardiovascular Diseases Life Satisfaction Diabetes Psychosocial distress Cancers Happiness Injuries and Violence Disability Infections Diseases Body Size and Body Image Respiratory Health Mental Health All-Cause Mortality UNCHealth Minority Importance of Theory • No single “best” framework • Multiple perspectives valuable • Deeper understanding UNCHealth Minority Methods By utilizing a variety of research designs, methods, and approaches, we can better develop, test, and validate our conceptual models. UNCHealth Minority The Harlem Children’s Zone Asthma Initiative (HCZAI): A community-building initiative of Harlem Children’s Zone, Inc. Enhanced community-based health care delivery by Harlem Hospital Center, Dept. of Pediatrics. UNCHealth Minority Pediatric asthma at Harlem Hospital Center: #1 reason for childhood hospitalizations #1 reason for Pediatric Emergency Department (PED) visits #1 PED revisit rate in NYC UNCHealth Minority Goals of HCZAI Reduce school absenteeism Reduce emergency medical visits Reduce hospitalizations UNCHealth Minority Evaluation Rigorous Participatory Multi-method Multi-level Ongoing HCZ Project Columbia University UNCHealth Minority Focus Groups With Parents of Children With Asthma “The [initiative] is really willing to take action. They bring the vacuum right into our house and are like, „Okay, let‟s do this right now.‟” UNCHealth Minority Focus Groups With Parents of Children With Asthma “My child is more responsible and aware of this own condition. He is less likely to panic and understands asthma better.” UNCHealth Minority Focus Groups With Parents of Children With Asthma “They help you with everything that you need. They‟re absolute guardian angels. You know, it don‟t have to be exactly related to asthma…you know anything that you need help with…” UNCHealth Minority Range of Interventions Medical Social Environmental Educational Legal UNCHealth Minority Sustainability Through Policy Change Insurance coverage for community-based health services. Training and support for community health workers. Increased reimbursement under Medicaid. UNCHealth Minority HCZAI Partnership Harlem Children’s Zone, Inc. Harlem Hospital Center Columbia University NYC Dept. of Health & Mental Hygiene NYS Dept. of Health Local Public and Charter Schools Volunteers of Legal Services Robin Hood Foundation Others… UNCHealth Minority Using GIS as a Tool for Community Change Improving data integration for partnering organizations. Mapping local knowledge and environmental exposures. Directing and delivering heath care services. UNCHealth Minority “You know there is a need. But the need changes. And the face of poverty changes. And what we do changes.” Robert M. Coard, President Action for Boston Community Development UNCHealth Minority Thanks, Seth!
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