Sorting out the connections betw

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            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
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             History:
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               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
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             Urban Reform Movement
            Which Gave Birth to Urban
            Planning and Public Health
             Jacob Riis, Photojournalist,
            “How the Other Half Lives”
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            The Developing World


            1 Billion People Out of a
             Global Population of 6
            Billion Presently Live in
              Slum-like Conditions.
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            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.
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                 Theory
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               Asking Different
             Research Questions,
            Generating New Ideas.
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             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
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              Importance of Theory


            • No single “best” framework
            • Multiple perspectives valuable
            • Deeper understanding
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                  Methods

            By utilizing a variety of research
            designs, methods, and
            approaches, we can better
            develop, test, and validate our
            conceptual models.
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            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.
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            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
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                  Goals of HCZAI

             Reduce school absenteeism
             Reduce emergency medical
              visits
             Reduce hospitalizations
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                     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…”
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            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.
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                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.
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            “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
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            Thanks, Seth!

				
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