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Walkability and Redlining: How Built Environments Impact Health and Perpetuate Disparities

From the AJMC article

Built environments can shape how active an individual is, while policy decisions made decades ago impact health disparities today. To address these critical social determinants of health, experts are calling for increased cooperation between urban planners and the public health field.

In the world of real estate, location is everything, serving as a major driving force behind both rent prices and mortgage rates. But a growing body of research highlights that when it comes to health outcomes, location may also affect disease risk, and where you reside can impact how you live.

One analysis included in the review revealed that between 2001 and 2012 in Ontario, Canada, higher neighborhood walkability was associated with a stable prevalence of overweight and obesity, and decreasing diabetes incidence. By 2012, all 3 rates were significantly lower compared with less walkable areas, where levels of obesity continued to rise.2

But geographic and population density alone does not account for this association, as destinations also influence the advantages of neighborhood walkability, explained Gillian Booth, MD, MSc, of the Department of Medicine at University of Toronto in an interview with The American Journal of Managed Care® (AJMC®).

Booth is a scientist at the MAP Centre for Urban Health Solutions within the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, and coauthor of the aforementioned studies.

Factors outside of design, density, and destinations affect neighborhood-specific health outcomes, and can even negate the benefits of living in highly walkable areas, she stressed.

Based on their research, Booth and colleagues found those living in areas with low levels of traffic-related air pollution reaped greater benefits from walkability with regard to hypertension and diabetes risk.

“But if there [were] really high concentrations of air pollution, the benefit of walkability was completely eliminated, because air pollution itself is a risk factor for diabetes,” she said. “It’s not enough to just build [environments] right.”

Apart from pollution, additional influences can sway the extent to which individuals take advantage of walkability and the neighborhood’s capacity to enact environment-level improvements. Safety, sidewalk conditions, crime rate, and transportation options all function to encourage or dissuade walking, regardless of a space’s design.

“We always have to think about where people live and the neighborhood environment as a whole, and what makes the neighborhood healthy and what doesn’t,” Booth said. “There’s a lot of interest now into, not only how do we make healthier designs, but about how do we make more equitable decisions in terms of where to invest.”

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