Archive for the ‘health’ Category

The Metropolitan Environment and Health: The Impact of Income Inequality, Racial Segregation and Urban Sprawl on the Risk of Physical Inactivity

Thursday, February 14th, 2013



Physical inactivity is a risk factor for obesity, cardiovascular disease and premature mortality. But despite health warnings, many Americans remain inactive.




The data source was the 2001 Behavioral Risk Factor Surveillance System, a telephone survey of US adults.  Respondents living in all metropolitan areas defined in 2000 were included.  This study used multilevel analysis combining metropolitan level factors:  income inequality (GINI Index), Black-White residential segregation (Dissimilarity Index), urban sprawl (the Urban Affairs Review Sprawl Index) and per capita income along with individual level factors:  sex, age, income, race/ethnicity and education.  The risk of being physically inactive was compared to meeting current CDC guidelines for physical activity.




The final sample consisted of 121,894 adults in 315 metropolitan areas.  In the full multivariate analysis, increased levels of income inequality (odds ratio: 1.052, 95% CI = 1.033, 1.072), segregation (1.008, 95% CI = 1.005, 1.012) and urban sprawl (1.006, 95% CI = 1.003, 1008) were associated with an increased risk of physical activity.




Addressing the physical activity, and its health consequences, may require attention to the structural characteristics of the metropolitan environment.  While recent research highlights the role of the built environment as affecting inactivity, this study suggests that the social environment is also an important predictor of inactivity.

The Relationship Between Rural Status, Individual Characteristics, and Self-Rated Health in the Behavioral Risk Factor Surveillance System

Monday, July 9th, 2012

The Journal of Rural Health


The Relationship Between Rural Status, Individual Characteristics, and Self-Rated Health in the Behavioral Risk Factor Surveillance System


  1. Traci N. Bethea PhD1,
  2. Russell P. Lopez DSc2,
  3. Yvette C. Cozier DSc1,3,
  4. Laura F. White PhD4,
  5. Michael D. McClean ScD5


Article first published online: 31 MAY 2012





  • Epidemiology;
  • health disparities;
  • obesity;
  • self-rated health;
  • social determinants of health


Abstract Purpose: To examine rural status and social factors as predictors of self-rated health in community-dwelling adults in the United States.


Methods: This study uses multinomial logistic and cumulative logistic models to evaluate the associations of interest in the 2006 US Behavioral Risk Factor Surveillance System, a cross-sectional survey of 347,709 noninstitutionalized adults.


Findings: Self-rated health was poorer among rural residents, compared to urban residents (OR = 1.77, 95% CI: 1.54, 1.90). However, underlying risk factors such as obesity, low income, and low educational attainment were found to vary by rural status and account for the observed increased risk (OR = 1.03, 95% CI: 0.94, 1.12). There was little evidence of effect modification by rural status, though the association between obesity and self-rated health was stronger among urban residents (OR = 2.50, 95% CI: 2.38, 2.64) than among rural residents (OR = 2.18, 95% CI: 2.03, 2.34).


Conclusions: Our findings suggest that differences in self-rated health by rural status were attributable to differential distributions of participant characteristics and not due to differential effects of those characteristics.

Income inequality and health

Monday, June 25th, 2012

With the attention paid to the Occupy Wall Street movement and its related actions across the United States (and internationally), there has also been a ride in concern about income inequality.  There are many reasons to be concerned with the huge increase in inequality in the US and other countries over the past thirty years.  Though we can’t say for sure, this rise in inequality has been accompanied by stagnating income and lowered economic opportunities for the majority of the population.

But the concern over income inequality should be much greater because there is substantial evidence that inequality is associated with lower health.  The more unequal a society is, the worse is the health of its population.  The evidence for this first emerged when researchers such as Kawachi and Wilkinson began to report their findings in the 1990s.  Some of the evidence comes from cross national studies:  once per capita income hits about $5000 (in 1990 dollars), differences in income no longer explain differences in health.  At that point, inequality seems to be a better explanatory factor.  Other evidence comes from studies in the US.  People who live in states or metropolitan areas with greater inequality tend to have worse health as well.

The reasons for this association are not entirely clear.  Inequality may result in fewer services or reduced access to medical care.  It may reduce social capital.  As yet we don’t know.

But the association appears fairly strong.  Income inequality is bad for your health.

Breat Cancer Disparities

Monday, June 4th, 2012

The goal of this graph is to make you angry:













What this chart suggests is that while there has been about a 20% reduction in White female breast cancer death  rates since the 1970s, Black female breast cancer death rates have increased. Why?



Here are some of the risk factors for breast cancer:  Age – but the rates are age adjusted so that shouldn’t be a factor here.  Later date of first pregnancy – but the age of Blacks and whites at first pregnancy are about the same, as are overall fertility rates.  Mammography rates – these are also now about the same (thank you to everyone who worked on reducing this disparity).  Obesity  – Black female obesity rates are higher, but isn’t this more of a symptom of disparity than a cause?  Genetics – no genetic factors have been identified that would account for these disparities.

So we are left with a mystery.  And a disgrace.

Key dates in the history of the built environment

Tuesday, February 28th, 2012

These dates are drawn from my upcoming book, Building American Public Health: Urban Planning, Architecture, and the Quest for Better Health in the United States

The list can be found at:

Social networks and social capital

Thursday, March 31st, 2011

The growth of social networks such Facebook and Twitter have raised an interesting question.  Is virtual social capital the same as in person social capital?  Can social networking promote health?

Health researchers have long known that social capital is connected to improved health outcomes.  While some types of social networks can be detrimental to health, participating in a gang, for example. Participating in social organizations, churches, knowing your neighbors, having close relationships with family member and friends are generally associated with fewer risk behaviors and lower risks of morbidity and mortality.  Social isolation is bad for health.

Does Facebook offer the same protections?  Are those wall postings, pokes and updates about others virtual farming activities also protecting health?   So far, we don’t know.  There is some evidence that spending  too many hours sitting at a computer is bad for both physical and mental health. But as yet, we have no studies on whether regular contacts, done in moderation, promote, inhibit or are irrelevant for health.

Landscape urbanism and health

Thursday, February 10th, 2011

Probably one of the most important emerging ideas in urban planning and the design of cities is landscape urbanism.  Arising from the landscape architecture profession, it traces its roots to a number of key thinkers including Ian McHarg.  As yet, there are too few constructed projects to evaluate how landscape urbanism projects might impact health.  As you may know, public health has pretty much adopted new urbanism principles as its own, promoting many of its features because they are associated with increased walkability, physical activity and social capital.  But new urbanism predates the reconnection of public health with urban planning and new urbanist themes were developed without health input.

Some of the underlying ideas of landscape architecture might be powerful for understanding how the built environment affects health.  For example, landscape urbanism looks at an area’s landscape as a substrate and organizing foundation upon which an urban area arises from.  It maintains that the horizontal reference is as important as the vertical dimension and that only a landscape lens of analysis can connect all the features of  modern society.  Its concern for drainage and storm water control and its respect for groundwater recharge is commendable.

One of its important texts is The Landscape Urbanism Reader, edited by Charles Waldheim.  While interesting, some of its shortcomings are a concern.  A discussion of re-imagining  Detroit, for example, does not mention its residents.  An  essay on urban highways does not include what building these highways meant for the people displaced.  Nowhere in the book is there  a discussion of health.  With little regard to history, health, or social justice, the developing movement has the potential for perpetuating current inequalities in health and the social environment. The concern is that landscape urbanism might only end up reproducing suburban Atlanta with better storm water management.

So at this moment, there can only be questions about landscape urbanism and health.  These include:

What are common idioms produced by landscape urbanism?  Once these emerge, they can be evaluated and assessed by health researchers.

What might be the best pattern of landscape and built up form for health?

How  might landscape urbanism be used to reshape already developed communities?

Can landscape urbanism be used to address inequalities and reduce racial disparities in health?

Stay tuned.