Built Environment and Health among Urban Residents

Abstract

and the odds of atopic dermatitis increased by 1.08 (1.01 – 1.15) times if the road density increased by 13,120m2 within 300m of place of residence. For the children living on the tenth floor and higher, the prevalence of asthma and allergic rhinitis was higher for those living closer to major roads, but its effect was not consistent. Discussions In this study, the effect of urban BE measure regarding accessibility, density, and distance on walking practice and health results such as obesity and atopic eczema were analyzed by applying spatial analysis on public health monitoring data. Based on the results of analyses, the following implications were drawn: (1) the recently diminishing amount of physical activities exercised by urban residents could be significantly improved through increased neighborhood walkability, and one of the methods for improvement may increase adjusting accessibility to public transport from the place of residence

(2) because obesity of urban residents is affected by neighborhood diet environment, additional intervention from the public health discipline must be considered simultaneously

and (3) higher proximity to roads indicate higher air pollution in the neighborhood and it may trigger other health issues such as allergic reaction and atopic eczema especially for those with restricted activity perimeter, e.g., children. To sum up, adjusting access in BE will increase physical activity level, and thereby, effectively reduce noninfectious disorders such as obesity, but it may also increase the prevalence of noninfectious disorders in a certain population with vulnerability. Therefore, to improve the health issues in our cities, we must first adequately test various urban planning concepts formulated in Western urban environments and need better awareness and proactive intervention from the public health perspective.

Background A neighborhood environment is comprised of a physical environment and a socioeconomic environment and influences human health in a range of ways. Within a physical environment, all the human-made surroundings are referred to as built environment (BE), and it substantially influences the health of people living in an urban setting, more so in cities with higher population density. Interests and intervention from the public health perspective on health and wellness in the BE as a remedy against communicable diseases diminished after the 19th century but began to resurface in recent years to get to the bottom of noninfectious disorders relating to physical activities. Unfortunately, most studies conducted in this area focused on increasing quantity of physical activities of the general population and the scope of dialogue needs to be much expanded to deal with various health issues and effect on a vulnerable population. In South Korea, the demographic convergence in the Seoul Metropolitan Area is on the extremely high side, making it one of the most densely populated regions in the world. Accordingly, a multilateral evaluation in public health on its BE is very important. Especially, to overcome the numerous problems materialized due to the rapid expansion of cities in the past few decades, it is imperative to deliberate urban renewal programs regarding public health. However, the previous studies verified individual environmental factors, that was evaluated in Western cities, in connection with physical activities, and most of them were in the field of urban planning. A continuous health surveillance system is indispensable to determine and evaluate health effects of BE, and it is important to first determine whether the regional data from public health surveillance system are compatible with this study. Furthermore, applying spatial analysis and geographic information system will facilitate determining the relationship between urban planning components and its public health impact in a more extensive geographical region.

Objectives The purpose of this study is to explore the urban built environmental factors that affect public health through spatial analysis using regional public health surveillance data, determine correlation among those factors and present basis stemming from the public health perspective for healthy urban renewal. This study aimed to evaluate the effect of urban BE on healthy activities and health results. Applying three aspects, density, distance, and accessibility, for measuring BE out of the available 5, the following analyses were performed:

Analysis 1: Correlation between accessibility to public transport and walking practices in adults Analysis 2: Correlation between fast food outlet density and prevalence of obesity in adults Analysis 3: Correlation between distance to a major roads and allergic diseases in children

Methods Information on individual health behaviors and diseases prevalence was collected from public health surveillance data, more specifically, the Community Health Survey data (2011-2014, 92,357 subjects) for adults of 19 years of age or higher and the Seoul Atopy-Friendly School Survey data (2010, 24,040 subjects) for children. The built environmental factors influencing them were analyzed using a geographic information system, which required very precise location information. To achieve this, the participants of the Seoul Atopy-Friendly School Survey were geocoded on their home addresses. Those of the Community Health Survey were geocoded on regional representative location based on their type of residence (detached house, apartment) and geographically censored information of their home address at the community level (424 dongs in 2014). Of the many elements to the BE, accessibility to public transport by a community, density of top 5 fast food outlets (McDonald's, Lotteria, Burger King, KFC, Popeyes) by county, distance to major roads from residential address were used in analyses 1, 2 and 3. As for the impact of BE, walking duration (minutes) per week, obesity as defined by BMI of 25kg/m2, and prevalence of allergic and atopic diseases (atopic eczema, asthma, allergic rhinitis) were determined in each analysis. Results Accessibility to public transport and weekly walking duration had a nonlinear relationship, where the walking duration for those who lived between 1.0 to 1.5km from a subway station increased by 28.5 minutes (95% CI=16.7 - 40.2) but for those who lived 1.5km or farther away from a subway station decreased by 1.9 minutes (-19.9 – 16.1). The density of fast food outlets, when adjusted with personal and regional factors, had an insignificant correlation with obesity in a county-level (male: Odds ratio=1.01, 95% CI=0.97 – 1.05

female: 1.04, 0.99 – 1.09). Because the density of fast food restaurants closely correlated with regional socioeconomic level, when the effect was determined after adjusting the financial independence of the region, there was some discrepancy between the regional socioeconomic level and gender, but overall it had an insignificant correlation with obesity. The odds of atopic eczema were higher for children living on less than 4 floors and 150m, 150-300m, and 300-500m away from a major street than those living over 500m away, respectively by 1.15 (1.01 – 1.32), 1.17 (1.03 – 1.34) and 1.16 (1.01 – 1.34) times