A study released by the Amherst Wilder Foundation last week documents the powerful influence of income and race on longevity, which varies by up to ten years or more among Twin Cities neighborhoods. The analysis cites evidence that health care and individual behavior accounts for only half of overall health outcomes.
The rest is determined by other influences: Education, race, income and other factors. These determinants play out in geographic patterns, with the shortest average life expectancy observed in zip codes in the core cities of Saint Paul and Minneapolis. The findings' gravity will both challenge and embolden those of us in real estate development, urban policy and health promotion who believe that the design of physical places represents a high-potential way to improve public health. We build our environment to reflect certain priorities, and then our environment influences our behavior. Addressing the social and economic costs of poor community health is by necessity a priority in America, and thinking through the relationship of land use to health will only become more essential in light of an aging population and obesity trends. A few examples:
- The availability of full-service grocery stores is growing more consistent across the region, but remains uneven. A 2006 article reported that some areas of the metro area have twenty times the number of grocery stores per capita than others. While changing competition and introduction of smaller stores have likely reduced this disparity, residents in the two primary cities are less likely to live near a full-service grocery and less likely to have a car to reach one. The result: Higher prices, fewer food choices, which influence health.
- The region's transportation system is increasingly offering competition to the car, with expansion in light rail and bicycle/pedestrian infrastructure in particular. Not only can more transportation options better connect people to jobs and services, but studies suggest we'll be healthier for it.
- Places can be reshaped to encourage families and children to walk to school. Only 13% of children age five to 14 walk to or biked to school in 2009, compared to 48% in 1969. Minnesota's school choice policy certainly produces other benefits, and perceptions of childrens' safety have changed. But the health costs - both in missed activity for kids, and in the traffic and pollution impacts of car and bus transportation of students – are substantial.
Community design won't eliminate health disparities, but a national discussion is underway about using our physical landscape more effectively to support citizens' living of a long and healthy life. This is not only a moral imperative but an economic one.
