Global Roadmap for Healthy Longevity (2022) / Chapter Skim
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5 Physical Environment Enablers
5 Physical Environment Enablers
Pages 129-172
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The discussion in each section touches on the cross-cutting issues of achieving equity and of best practices and promising interventions for promoting a healthy physical environment. The built environment influences human health in complex 129
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. The physical environment's effects on health and well-being are evident across the life course, with negative effects accelerating as people age.
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The commission believes that the key targets discussed in this chapter can positively influence people of all ages, setting them up for a more positive trajectory toward longer, healthier life spans. KEY TARGET: HOUSING Housing is a primary component of the physical environment that can influence a person's ability to achieve healthy longevity.
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Finally, the proximity of a living space to food and resources will also play an important role in influencing healthy longevity. Universal Design One means of achieving independent and autonomous living for adults as they age is universal design, defined as intentionally developing environments and products to be easily accessed and used by a wide range of people (Farage et al., 2012)
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As found in a study in Mexico, for example, housing arrangements in middle age have been found to predict housing needs in older age. Overcoming typical limitations of not having long-term data, the researchers found that typical living arrangements for adults at age 50 predicted their future living arrangements, with the potential to inform public health and other urban design policies (Huffman et al., 2019)
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. This lack of access to basic services can also have negative effects across generations, setting individuals up for challenges across the life course.
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Using this measure, researchers found positive associations among community dwellers 60 years and older between adverse conditions of the built environment and respiratory, urinary, and gastrointestinal conditions, as well as headaches and visual impairment (Blay et al., 2015)
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One key aspect of healthy longevity is a healthy diet of nutritious food. But lack of access to and availability of nutritious food can be a challenge for people across the life course depending on their circumstances, particularly income level and geographic location.
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Inequality in access to nutritious food is also seen in low-resourced environments, such as informal settlements or refugee camps in low- and middle-income countries. A HelpAge International study conducted in Kenya found that more than 50 percent of people aged 60 and older living in refugee camps were in need of nutritional support as the result of a lack of access to food rations and a low-diversity diet (Fritsch and Myatt, 2011)
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Without food security, people are at risk of several comorbidities, such as dementia, depression, and functional dependence. Studies have found a high prev alence of food insecurity in older populations across several countries, affecting women more than men.
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Research Questions While an abundance of evidence has been generated over the past few decades on the importance of the physical environment and its relationships to health and longevity, questions remain about how a community's context or the implementation of interventions, such as housing for older adults, may influence the strengths or characteristics of relationships. A study in England found an implementation gap between existing policies and actual housing options for older people in a region with a high proportion of older adults (Robinson et al., 2020)
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Box 5-2 presents a case study in Lima, Peru, highlighting these three characteristics, in which local government transformed underused parking lots to a vibrant public space. Green Space Green space, including public parks, playgrounds, and residential greenery in urban environments, has positive health benefits across all ages, ranging from improved physical and mental health to reduced mortality (Braubach et al., 2017)
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In particular, SDG Target 11.7 calls for "universal access to safe, inclusive and accessible, green and public spaces, particularly for women and children, older persons and persons with disabilities" (UN, 2022)
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. Indeed, Target 11.7 of the UN SDGs states that by 2030, countries should "provide universal access to safe, inclusive, and accessible green and public spaces, particularly for women and children, older persons, and persons with disabilities" (UN, 2022)
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Public spaces in low-income areas are often unsafe for reasons that range from increased traffic exposure to elevated crime rates. Safety in public spaces is relevant for all people but is particularly important for older adults, who are especially vulnerable to feeling unsafe and less likely to be mobile than younger people.
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Levers for Empowering Change "Given the complexity of the built environment, understanding its influence on human health requires a community-based, multilevel, and interdisciplinary research approach" (Srinivasan et al., 2003, p.
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, traffic aids at crossings, and crosswalks -- has the potential to improve perceptions of safety in neighborhoods. Intentional incorporation of evidence-based factors that promote well-being in the design of holistic physical environments can support healthy longevity for all people, including older adults, as described in Vision 2050 (see Chapter 2)
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However, new designs and innovations can positively impact the physical environment within a community, often at reasonable cost, to promote healthy longevity as people age and depend on different transport methods. This section explores how public transit, driving, and automated vehicles may improve healthy longevity.
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In addition to being carbon-efficient and accessible, public transit systems generally require physical activity (walking, climbing stairs) for access to stations or transit stops.
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. Like housing, discussed previously in this chapter, emerging AV technologies can be made more friendly for older adults through incorporation of such aspects of universal design as low-floor vehicle designs for easy entry, comfortable seat
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Finally, economic incentives in the form of travel subsidies have been shown to increase use of public transit. Finding 5-5: Safe and accessible transportation options can give older adults the opportunity to enjoy independent mobility around their com munity instead of avoiding social activities and becoming isolated and lonely.
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Many of the advances described in this and the earlier chapters in housing, social engagement, and transportation are also contingent on access to reliable internet and familiarity with digital devices. The COVID-19 pandemic highlighted the importance of internet-based communication within families and social groups at a time when in-person gathering was deemed
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. Considering the intended users of digital technologies during the design and development process and jointly designing systems with users will improve usability to older people and support efforts to reduce ageism, health inequities, and the digital divide.
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"This includes: the use of libraries, schools, and other public buildings to broadcast accessible, 24 hour wireless networks; the use of vehicles, such as school buses, to create mo bile hotspots, including during nonoperating hours; and installing wireless access points in public parks, light poles, and other public spaces." These interventions are especially important in neighborhoods where network service is unavailable or simply unreliable. Public access points can be impactful in low-income neigh borhoods and communities of color, where residents may not have in-home or wireless subscriptions.
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For example, PHAROS -- a robotic system developed to enhance older adults' physical activity by recording their exercise performance, categorizing the exercise performed, and recommending physical exercise periodically -- showed high accuracy of exercise detection among its older users (Costa et al., 2018)
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. Levers for Empowering Change Whether through expanded broadband access, videogame platforms, interactive robots, or use of technology in everyday life to access transportation, evidence shows that narrowing the digital divide between older and younger generations can have positive effects on quality of life, connection to social networks, and healthy longevity.
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3. Promote opportunities for peer-to-peer training, where older adults who are actively engaged in the digital society help to train older adults who have not yet embraced digital technologies.
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Low-income and rural households are especially likely to lack broadband access, which greatly influences their equitable access to other resources and their ability to work remotely and stay connected to social networks. Conclusion 5-5: Broadband is essential infrastructure for achieving Vision 2050.
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. Health-promoting physical environments can enable healthy longevity throughout the life course, yet across the globe, factors in the current built environments in many urban and rural settings pose multiple barriers to, and opportunities to improve, healthy longevity (see Figure 5-3)
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Climate change promises to intensify exposures to extreme weather events and more extreme temperature variations. These changes, in part, can also contribute to increased opportunity for infectious disease spillover from animals to humans and increasing incidence of new diseases in regions where they have previously not been endemic.
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Harmful exposures through out the life course, such as exposures to heavy metals or cancer-causing chemicals, affect the speed of biological aging and timing of the onset of chronic conditions later in life. The consequences are amplified by the cumulative effects of multiple exposures.
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It also has raised awareness within communities of the need to reduce waste burning and develop green public spaces. Environmental staff in Ghana can now "continuously monitor particulate matter and black carbon in multiple areas of [Accra]
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Additionally, the United Nations recommends best practices from several countries, including engaging older adults in preparedness and disaster risk reduction strategies, providing them with financial support and extended social protections following emergencies, and specifically developing recovery strategies geared toward reintegrating them into normal life following disasters (UN, 2020)
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Conclusion 5-7: In their climate change planning and mitigation efforts, cities and countries need to consider the amplified impacts on older adult populations, as well as necessary monitoring and response ac tions. Systems for locating and evacuating vulnerable older people when necessary, as well as embedded designs in buildings and public spaces that reduce temperatures, could help augment other efforts.
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But these changes need additional evaluation and implementation in varying contexts, especially in low- and middle-income countries, to advance understanding of how they can be optimized to have the greatest effect on achieving healthy longevity for all. The commission believes that to achieve the goal of creating physical environments and infrastructures that support functioning and engagement for older people, the key targets of housing, public infrastructure, transportation, digital access, and environment need to be intentionally designed, properly resourced, and shaped for healthy longevity.
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2021. Walkability and its relationships with health, sustainability, and livability: Elements of physical environment and evaluation frameworks.
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2016. Elderly victimization and fear of crime in public spaces.
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2017. Expanding implementation of universal design and visitability features in the housing stock.
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2020. The hidden wealth of cities: Creating, financing, and man aging public spaces.
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2019. Green spaces and mortality: A systematic review and meta-analysis of cohort studies.
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2003. Creating healthy communities, healthy homes, healthy people: Initiating a research agenda on the built environment and public health.
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2021. Rethinking the urban physical environment for century-long lives: From age-friendly to lon gevity-ready cities.
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2008. The effects of socioeconomic status and indices of physical environment on reduced birth weight and preterm births in eastern Massachusetts.
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