U.S. Health in International Perspective Shorter Lives, Poorer Health (2013) / Chapter Skim
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7 Physical and Social Environmental Factors
7 Physical and Social Environmental Factors
Pages 192-206
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From page 192... ...
in isolation from the environmental contexts that shape and sustain them. In contrast with traditional environmental health approaches that focus primarily on toxic substances in air, water, and soil, this more recent approach conceptualizes the environment more broadly to encompass a range of human-made physical and social features that are affected by public policy (Frumkin, 2005)
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From page 193... ...
QUESTION 1: DO ENVIRONMENTAL FACTORS MATTER TO HEALTH? Many aspects of the physical and social environment can affect people's health.1 Spatial contexts linked to regions or neighborhoods are among 1 Although analytically distinct, physical and social environments may also influence and reinforce each other: for example, physical features related to walkability may contribute to social norms regarding walking, which may in turn promote more walkable urban designs and community planning.
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From page 194... ...
Increasing attention has focused on the implications for health behaviors and social interactions that are created by the built environment. The 2 Much early work on the spatial patterns of health used variables such as aggregate summaries of area socioeconomic or race/ethnic composition or measures of residential segregation by various attributes as proxies for a range of broadly defined environmental factors that may be relevant to health (see, e.g., Diez Roux and Mair, 2010)
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From page 195... ...
. An important difficulty in comparing results across countries is that the proxy measure for the local food environment is often the type of food stores or restaurants available (such as supermarkets or fast food outlets)
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From page 196... ...
. Social Environmental Factors Factors in the social environment that are important to health include those related to safety, violence, and social disorder in general, and more specific factors related to the type, quality, and stability of social connections, including social participation, social cohesion, social capital, and the collective efficacy of the neighborhood (or work)
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From page 197... ...
. 9 Although findings have not always been consistent, levels of safety, violence, and other social environmental features have also been found to be associated with walking and physical activity (Foster and Giles-Corti, 2008)
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From page 198... ...
Other Environmental Considerations The panel focused its attention on the role of local physical and social environments as potential contributors to the U.S. health disadvantage and did not systematically examine whether other contexts, such as school or work environments, differ substantially across high-income countries.
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From page 199... ...
QUESTION 2: ARE ENVIRONMENTAL FACTORS WORSE IN THE UNITED STATES THAN IN OTHER HIGH-INCOME COUNTRIES? There is scant literature comparing social and physical environmental features across countries.
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From page 200... ...
, violence and drug use may be indirect markers of social environmental features that affect other health outcomes. As noted in Chapters 1 and 2, homicide rates in the United States are markedly higher than in other rich nations.
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From page 201... ...
However, it remains unclear whether sprawl helps explain differences in levels of social capital, or health, across countries. Spatial Distribution of Environmental Factors Research in the 1990s demonstrated that people of low socioeconomic status were more likely to experience residential segregation in the United States than in some European countries (Sellers, 1999)
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From page 202... ...
. Although studies of residential segregation do not directly assess environmental factors, to the extent that segregation is related to differences in exposure to environmental factors, countries with greater segregation may also experience greater spatial inequities in the distribution of environmental factors, resulting in greater health inequalities and possible consequences for overall health status.
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From page 203... ...
Obesity, Diabetes, and Cardiovascular Disease Environmental factors that affect physical activity (primarily through their effect on active life-styles, including walking) and access to healthy foods (rather than calorie-dense foods)
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From page 204... ...
A physical environment that promotes and incentivizes automobile transportation also reinforces social norms regarding travel, which complicates efforts to modify the patterns. The existing land use patterns and reliance on private automobile transportation not only contribute to traffic volume and injury fatalities, but probably also contribute to physical inactivity, air pollution, and carbon emissions.
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From page 205... ...
health disadvantage are worse or are more inequitably distributed in the United States than in other high-income countries. It is plausible to hypothesize that factors in the built environment related to low-density land development and high reliance on automobile transportation; environmental factors related to the wide availability, distribution, and marketing of unhealthy foods; and residential segregation by income and race (with its social and economic correlates)
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From page 206... ...
examining directly the contribution of environmental factors to health differences between the United States and other high-income countries; and (5) studying national, regional, and local country policies that may curb levels of adverse environmental exposures, reduce the extent to which they are inequitably distributed, or buffer their effects.
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