Health Environmental
The Built Environment and Public Health
Chapter 11: Mental health, stressors, and health care environments
Learning objectives
Describe the role of the developing field of sociology in the early twentieth century in understanding how cities might affect mental health
Discuss the association between immigration and health
Define biophilia
Compare the relative health impacts of urban versus rural living
Assess the contribution of density to health
Describe the concept of defensible space
Define evidence-based design
Identify the potential impacts of gentrification on health
Beginnings
Immigration and urbanization was believed to be a contributing factor to the breakdown in mental health and social order
The Chicago School of Sociology
Studied tenement districts
Helped define the impact of immigration to cities on mental health
Helped establish sociology as a profession
Anomie
The dislocation of people from traditional environments
Disestablished social norms
Thought to contribute to urban social problems
Immigration today
Acculturation
Immigrants adapt to their new country
Lose health practices and beliefs from their prior country
This may expose immigrants to new risks
Discrimination
Acculturation less of a factor in a globalized world
It is the influence of discrimination that leads to adverse health outcomes
Healthy immigrant effect
The Latino paradox
Mexicans in the US who were born in Mexico have better health outcomes and lower mortality than predicted by other factors
Their children are less likely to have these health advantages.
Latino Immigrants in the US: Key Health Indicators
< 5 Years in US Obesity Currently Smoking Diabetes Hypertension Cardiovascular Disease 16.100000000000001 15.3 6.9 13.4 3.5 5 or More Years in US Obesity Currently Smoking Diabetes Hypertension Cardiovascular Disease 22 13.8 7.5 19.8 5.4Source: CDC
Age Adjusted Percent
Biophilia
The hypothesis that people have an innate attraction to or need for nature
Some evidence to support this
Roger Ulrich’s hospital view studies
Other studies which measure biological responses to pictures of open space
Some evidence that children with ADHD are more attentive after nature walks
Which is healthier, rule or urban living?
Urban areas:
Social problems appear to cluster in cities, related to clustering of unwanted land uses
Lack of open space, higher pollution levels
Rural areas
Social isolation
Tend to have higher rates of poverty
Difficulty accessing hospitals and food sources
Urban residents walk more, rural residents less.
Density and health
1960s studies on rats appeared to demonstrate that high population densities lead to a breakdown of social order and “behavioral sinks”
Reevaluation of these studies found that it was not overcrowding but withholding of food that led to behavioral problems
Little evidence that high density communities in other countries foster social and mental problems
Many of the most problematic communities in the US have lower densities than areas with less crime
Defensible space
Areas that are most unsafe feeling tend to be those where no one is watching or where no one seems to be in control of them
Areas that are private or semi-private tend to be better maintained and have fewer crime issues
Architectural modifications to promote defensible space:
Private entries
Private yards
Windows on streets
Stressors and allostatic load
Continued exposure to stressors can lead to increased risk of morbidity and mortality
The allostatic load represents the amount of stressors that have been affecting an individual over time
A way to quantify cumulative risk and the constant day-to-day exposure
Noise exposure and health
Exposures to high noise environments can lead to health problems
Example: stimulates the nervous system and creates a distress-like response
Health facilities design
Based upon the work of Ulrich and others
Uses medical outcomes to assess the built environment
Also being used to assess educational outcomes