Post on 21-Jan-2017
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Zaheeda Darvesh Dr. Julie Cidell Transportation and Sustainability 465 12/10/2014
The influence of land use and transportation planning on obesity
Introduction
Obesity is a growing public health problem that has only recently attracted
widespread media attention. The dramatic increase in obesity has fostered interest among
researchers in analyzing whether and how individual behavior and the built environment
may have created an obesogenic environment. 1 Their research shows that in reducing
obesity, educating people on healthy lifestyles is not sufficient; the built environment must
enable and promote healthy behaviors as well.2 Within the built environment framework
land use and transportation planning components influence an individual’s opportunities
to food intake and physical activity. This research paper describes the impact of land use
and transportation planning on obesity prevalence.
Through this paper, as part of a larger overarching umbrella of the built
environment, I will explore the impact of land use and transportation planning on the
emerging obesity epidemic. Land use planning components--urban sprawl, street
connectivity, land-use mix and zoning--create surroundings that demotivate individuals to
be physically active, hence influence obesity. Likewise, transportation improvement
measures such as public transit, greenways and trails, pedestrian and bicycle facilities, and
efforts to manage car traffic can support or impede physical activity, hence impact health
outcomes. Land use and transportation planning components contribute to increasing
obesity prevalence which necessitates an emerging need to address interconnectivity
between the disciplines of urban planning, transportation planning and due to its
subsequent influence on obesity-public health. The following discourse entails the
evolution of research with respect to these disciplines.
1 The obesogenic environment comprises factors in our environment that support being obese. 2 (Perdue, Stone, & Gostin, September 2003)
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Figure1: Outline of the Research Paper
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Background
Obesity prevalence in adults has more than doubled from 1960 to 2010 from 13.4
percent to 35.7 percent.3 However as an emerging public health concern, it has only
recently garnered attention. The current high rates of obesity prevalence for children and
adults in the U.S. are primarily a result of genetics, individual behaviors and built
environment factors4 that lead to excess caloric intake and inadequate amounts of physical
activity.5 “Using the methods of inheritance studies, such as investigating pairs of twins,
researchers have concluded that inherited genes contribute about 40 percent and the
environment about 60 percent to whether a person becomes obese.”6 It can thus be
inferred that while obesity genes7 cannot be modified and altered, the built environment
components can be reformed to attenuate obesity prevalence.
Obesity is a national epidemic, causing higher medical costs and a lower quality of
life.8 It is a common manifestation of energy imbalance between energy consumed (by
food and drink) and energy expended through metabolism and physical activity.9 For
adults, overweight and obesity ranges are determined by using weight and height to
calculate a number called the "body mass index" (BMI)10 which correlates with the amount
of body fat.
• An adult who has a BMI between 25
and 29.9 is considered overweight.11
• An adult who has a BMI of 30 or higher
is considered obese.12
3 (National Institute of Diabetes and Digestive and Kidney Diseases, Overweight and Obesity Statistics) 4 Built environments-which are the totality of places, built or designed by humans, and include buildings, grounds around buildings, layout of communities, transportation infrastructure, and parks and trails, play an important role in affecting obesity, (Sallis, Floyd, Rodriguez, & Saelens, 2012) 5 (Factors Contributing to Overweight and Obesity, 2010) 6 (Genetics and Behavior, 2014) 7 (Echwald & Sørensen, 2001) 8 (Overweight and Obesity, 2012) 9 (Luma & Ahmad, May 25, 2011) 10 (Overweight and Obesity, 2012) 11 Ibid 12 Ibid
Table 1: BMI and Weight Status
BMI Weight Status
Below 18.5 Underweight
18.5 – 24.9 Normal
25.0 – 29.9 Overweight
30.0 and Above Obese
Source: Centers for Disease Control and Prevention
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Overweight and obese children and adults are at a higher risk for diabetes, high
blood pressure, high cholesterol, asthma, arthritis, and poor health status, thereby leading
to shorter life spans and increased medical costs.13 Hence it is very important to identify
and address the underlying factors that have resulted in increasing obesity prevalence.
Prior research on obesity in the 1970’s focused on physical activity as a means to
control obesity.14 The built-environment with its land use and transportation planning
measures were not included in this framework to mitigate obesity. Additionally, these
measures were independent of each other as either part of the urban planning or the
transportation planning realm. However new research from 2000 onwards suggests the
intertwinement between obesity and the built environment leading to emerging interests
on the convergence of public health, urban planning and transportation planning fields. By
coordinating efforts in land use and transportation planning, such as promoting compact,
mixed-use development, providing well-connected and walkable streets, efficient public
transit systems, reducing car dependency, providing designated bicycle paths, and more,
opportunities exist to increase physical activity, hence to mitigate obesity. Public health,
urban planning and transportation planning today must adopt policies and implement
projects that are symbiotic to each other in order to achieve desirable living conditions,
effective transportation systems and healthy public health outcomes.
How has the research concerning urban planning, transportation planning and
public health changed/evolved over time?
In the early 20th century, public health and urban planning were highly interrelated
fields. The spread of highly infectious diseases such as cholera in unsanitary and
inhabitable spaces during the industrial period reinforced the systemic linkages between
diseases and the organization of urban space. This reality led to the intersection of the two
fields. A general consensus among planners and architects of the industrial period was that
the industrial city was inherently unhealthy and incapable of being reformed.15 Hence
modernist planners and architects conceived the creation of an ideal city which had healthy
living and working conditions based on new, low-density and decentralized development.
13 (Causes and Consequences, 2012) 14 (Mann, August 1, 1971) 15 (Beauregard, 2002)
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Mass suburbanization seemed to be the solution to a host of problems, including those
involving health. Fordism--the industrialized and standardized form of mass production
and consumption of cars--supplemented by massive transportation infrastructure
developments through Roosevelt’s New Deal projects facilitated America’s
suburbanization. The suburban model seemingly eliminated the need to discuss public
health questions in the context of the built environment altogether and hence the period
from 1930 onwards marked the beginning of the divergence of the two fields.
During this time, transportation planning was isolated as well. Research connecting
the built form and travel behavior was mostly concentrated on the growing concern over
automobile traffic.16 For instance, walking and bicycling, like public transit, were mostly
considered to be alternative modes of transportation. However, automobile dependency
continued to escalate resulting in decreased use of these modes of transportation.
“Between 1977 and 1995, the number of all walking trips decreased by 32 percent, and
there was a similar decrease in trips made by adults walking to work.”17 Table 2 indicates
how his continues well into 2010. In light of this, researchers within the fields are now
suggesting the need to
reverse the declining rates
of walking and biking for
transportation, especially
for short trips, by viewing
these modes of
transportation as
opportunities for improving
health among children,
adolescents and adults.
Walking and biking now are not merely considered alternative modes of transportation,
but as a means to exercise. In combination with public health and urban planning
16 (Saelens & Handy, 2008) 17 (Active Transportation: Making the Link from Transportation to Physical Activity and Obesity, 2009)
Table 2: Journey to Work 2000 & 2010
Years
2000 2010
Car, Truck or Van 87.90% 86.30%
Public transportation 4.70% 4.90%
Motorcycle and other means 0.80% 1.20%
Bicycle 0.40% 0.50%
Walking 2.90% 2.80%
Worked at home 3.30% 4.30%
Source: United States Census Bureau, Census 2000 Summary File 3 (SF 3), Commuting Characteristics by Sex, 2010 American Community Survey 1-Year Estimates
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interventions, efforts to create walkable and bikeable communities and cities also have
social and recreational implications.18
Prior public health research, with respect to transportation implications, also mostly
focused on recognizing mostly asthma as a pressing health concern.19 Similarly, exercise
(e.g., walking) was considered primarily a mode of achieving the required physical
activity.20 Recently, however public health, like transportation planning, has embarked on a
multi-dimensional approach that conjoins efforts within the fields of urban planning,
transportation planning and public health.21
Modifying the built form and transportation systems is now seen as a means to
create environments that facilitate physical activity, hence curtailing obesity. Emerging
research suggests consistent associations between neighborhood design and walking and
cycling for transportation. 22 “Studies show that people who live in neighborhoods with
walkable designs spend an additional 30 minutes walking for transportation each week
and are more physically active than those who live in neighborhoods with less walkable
suburban designs.” 23
Prior to 2000 urban planning, transportation planning and public health were
distinct and disconnected. However, the plethora of research available now suggests the
need to unify efforts across these disciplines. Additionally, rapid increase in obesity
prevalence towards the end of the 20th century has provided researchers within these
fields the opportunity to explore the influence of the built environment and transportation
planning on public health outcomes. By collaborating to build synergism in research and
dissemination, public health, urban planning and transportation professionals can enhance
efforts to increase the number of communities that promote active living.24 Rather than
employing isolated, disconnected planning mechanisms like before, today urban planners,
transportation planners and public health planners can adopt mutual and conjoined
policies and projects that will achieve desirable living conditions, effective and efficient
18 (Southworth, 2005) 19 (A National Asthma Public Policy Agenda, 2009) 20 (Mann, August 1, 1971) 21 (Southworth, 2005) 22 (Frank, Engelke, & Schmid, May 23, 2003) 23 (Frank, et al., 2006) 24 (Hoehner, et al., September 2003)
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transportation systems and healthy public health outcomes.25 Two specific arenas for
intervention are discussed below.
Obesity prevalence and land use planning measures
Emerging views among public health and urban planning researchers demonstrate
the links between land use patterns and increase in obesity. Land use planning is a
mechanism within the built environment that controls, restricts and regulates land use and
development in an efficient and ethical manner. The following discussion throws light on
how land use planning components, such as urban sprawl, land-use mix, street
connectivity, zoning etc., can influence obesity.
Urban Sprawl influencing obesity
Today urban sprawl–a byproduct of land development–is a common feature of the
urban landscape in the United States. Urban sprawl can be defined as low density,
decentralized and automobile-centered development and is a result of a complex set of
interrelated socioeconomic and cultural forces. It can be attributed to three underlying
factors:
1) population growth resulting in the movement of people away from the urban
center,
2) rising income increasing the demand for space, hence facilitating this movement of
people to suburban areas where property values are lower, and
3) decreasing commuting costs and investments in transportation infrastructure that
facilitate this outward expansion of development.
Some of the consequences of sprawl are automobile dependent transportation,
decreased ability to walk to destinations, more infrastructure developments, increased
road space and decreased neighborhood cohesion. With respect to public health outcomes,
sprawl causes environmental degradation through greenhouse gas emissions which
increase asthma prevalence in adults and children. Sprawl also promotes a sedentary
lifestyle leading to physical inactivity and therefore exacerbates obesity.
25 (Green & Klein, 2011)
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Land-use mix influencing obesity
Land-use mix is a commonly used indicator to measure presence or absence of
different types of land uses in close proximity to each another. For example low density,
single-use developments reflect the unavailability of destinations to which residents can
walk or ride bicycles, and thus is likely to contribute to residents' inactive lifestyles that in
turn will influence their overall health and impact obesity. Furthermore, low density,
sprawled developments are not viable for public transit. Overdependence on automobile
leads to skyrocketing traffic flow and traffic congestion, resulting in more time being
consumed on travelling and very little available to exercise. The situation is further
worsened by limited accessibility to public parks and other recreational areas that create
environments not feasible for physical activity.
Street connectivity influencing obesity
Street connectivity can be defined as the number of intersections along a segment of
streets and connections between areas to create a well-connected grid network. Poor
street connectivity consists of fewer intersections and longer distances between different
points. It affects the directness of travel, making travel less efficient, resulting in longer
trips. As it makes other modes of transportation such as bicycling and walking unviable,
unsuitable and unsafe and decreases physical activity, it impacts obesity as well.
Zoning influencing obesity
Parking provisions as requirements to satisfy the city’s zoning codes also impact
obesity. It’s ironic how cities are trying to attract more people (centralize populations) by
urbanizing the city core, but have rigid rules pertaining to parking provisions. On one hand,
we want to facilitate mixed-use and encourage more public transit and pedestrian focused
use, but at the same time have stringent, less flexible parking rules and regulations that
focus on providing ample quotas of off-street or premise parking that worsen traffic and
demotivate the public to engage in walking and other forms of exercise, hence discourage
physical activity.
It can thus be inferred from all these urban planning components and more, that
land use planning influences obesity.
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What land use changes can reduce obesity prevalence?
1. Emerging research suggests that residents in denser, mixed-use areas are more
likely to engage in utilitarian physical activity (e.g., walking to shops) and are thus less
likely to be obese.26 In light of this fact, many communities today are turning towards
implementing mixed-use developments which allows mixing of residential and commercial,
as a means to promote walkability, reduce auto dependency, roadway congestion, and air
pollution. Studies suggest that a good land-use mix implies presence of “walkable
destinations” leading to increased physical activity, hence lower BMI.27
2. Street connectivity also impacts the walkability of a neighborhood, by promoting
walking and reducing car use. It therefore implies efficient and effective mobility and
accessibility.28 The Centers for Disease Control and Prevention (CDC) greatly emphasizes
the accessibility of recreational facilities to homes and schools by transit facilities to
encourage physical activity among people of all age groups. Benefits of better street
connectivity extend beyond improved mobility and accessibility. They facilitate shared-use
among pedestrians, bikers, transit and vehicle users, reduce congestion and inculcate
healthy behavior by promoting physical activity.
3. Zoning ordinances which require stringent parking for developments and buildings
must be relaxed. In line with the fact that zoning ordinances must be enacted in the interest
of public health,29 zoning can be used to restrict fast food outlets as a potential strategy to
combat obesity. 30Also, adopt zoning policies, such as allowing residential and commercial
uses near each other (mixed-use development), that promote active transportation to
destinations and make it easier to access physical activity and recreation areas
Obesity takes a tremendous toll on people’s health, and it costs the U.S. economy
billions of dollars. Hence, from a public health, financial as well as social perspective, it
becomes vital to address this distinct correlation between land use planning and increased
obesity through health-focused urban planning mechanisms.
26 (Lawrence D, Engelke, & Schmid, 2003) 27 (Brown & et al, December 2009) 28 Well-connected streets influence mobility which can be defined as the means (path) to an end (destination), hence make destinations accessible. 29 (Mair, Pierce, & Teret, October 2005) 30 Ibid
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Obesity prevalence and transportation planning measures
Automobile use has predominantly dictated the U.S. transportation scene. Along
with light truck, it has accounted for about 86 percent of passenger miles traveled in
2012.31 The dominance of an automobile-centered transportation system in the U.S. is
reflected in its current usage where the U.S. has less than 5 percent of the world’s
population, but 17 percent of the world’s cars. 32 To a user, cars represent freedom and
autonomy to operate on their own schedules without any time restrictions.33 Additionally,
automobile use facilitates economic and personal growth by widening the scope of job
opportunities, thereby increasing both mobility and accessibility. Furthermore, car reliance
shapes the social, spatial, temporal and technical conditions, and in so doing greatly
undermines other modes of transportation.34 These short-term benefits of car centered
transportation planning have in the long-term induced externalities such as pollution,
congestion, increased carbon footprint, increased infrastructure development, decreased
productivity and increased obesity.
Automobile dependency influencing obesity
Car centered transportation is sedentary as it displaces active forms of
transportation such as walking and bicycling. The U.S. Department of Health and Human
Services recommends that young people aged 6–17 years participate in at least 60 minutes
of physical activity daily.35 Also, it is recommended that adults partake in at least 150
minutes of moderate-intensity aerobic activity or 75 minutes vigorous-intensity aerobic
activity each week.36 However, less than half of all adults and less than 3 in 10 high school
students meet the physical activity requirements.37 Furthermore, research suggests that
each hour spent in a car results in a 6 percent increase in the likelihood of obesity and each
half-mile walked per day reduces those odds by nearly 5 percent.38 It therefore becomes
31 (Personal transportation, 2014) 32 Ibid 33 (Automobility, Car Culture and Weightless Travel: A discussion paper, 1999) 34 (Dixon & Hinde, 2005) 35 (Recommendations for Physical Activity, 2011) 36 Ibid 37 (Facts about Physical Activity, 2014) 38 (Stein, 2004)
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imperative to motivate people to use active forms of transportation such as biking and
walking rather than sedentary modes of travel such as cars and other automobiles.
Accessibility influencing obesity
Accessibility may act as a barrier to communities for living healthy lives. Some of
which are explained as below:
Food deserts
The proximity of individuals to nearby healthy food options and other heath related
goods and services influences health. One example is food deserts. Food deserts are defined
as urban neighborhoods and rural towns without ready access to fresh, healthy, and
affordable food. These communities have limited or no access to supermarkets and grocery
stores and are served only by fast food restaurants and convenience stores that offer few
healthy, affordable food options. The lack of access contributes to a poor diet and can lead
to higher levels of obesity and other diet-related diseases, such as diabetes and heart
disease. 39
Access to parks and recreational facilities
Some communities may not have access to recreational parks and facilities.
Proximity to parks and recreational spaces motivates individuals to partake in physical
activity. It has been suggested that access to parks, trails, open spaces, and recreational
facilities not only provides increased opportunities for children and adults to play and be
physically active, but these venues also influence other behaviors.40
Transportation infrastructure influencing obesity
Lack of resources allocated towards bicycling and walking infrastructure such as
designated bicycle paths and footpaths also demotivate people to use active forms of
transportation. Bicycling and walking-basic, fundamental forms of transportation-are
oftentimes overlooked due to over dependency on auto-centered development.
Transportation planning agencies should be proactive in investing in safe and adequate
biking and walking infrastructure that can reverse automobile dependency. A recent study
conducted to allocate funds towards biking infrastructure in Portland, Oregon suggests that
39 (Food Deserts) 40 (Blank, et al., October 2012)
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15 million spent on paving would save 50 million in the long-term. 41 Furthermore, this also
translates into higher rates of bicycling, hence increased physical activity, and reduced
obesity.
It is therefore important to implement transportation improvement programs such
as public transit, greenways and trails, pedestrian and bicycle facilities, and invest in efforts
to manage car traffic, as these measures can support or impede physical activity, hence
impact health outcomes such as obesity.
What transportation planning changes can reduce obesity prevalence?
1. Emerging research suggests that people who use public transit (buses, light rails,
subways etc.) are less likely to be sedentary than adults who don’t. 42 Additionally, physical
activity associated with transit use results in reduced medical costs and a higher quality of
life.
2. Walking and bicycling to school can help kids achieve their required physical
activity levels. However, road safety as well as increased car traffic has been pivotal in
demotivating parents to do so. Efforts promoted by programs such as the Safe Routes to
School, including building sidewalks, crosswalks and traffic-control devices around schools,
have been linked to both-increases in the percentage of students who walked to school and
reductions in the percentage of students being driven to school.43 Better quality of
sidewalks encourages pedestrian movement as well.
3. Building multi-use trails that connect population centers with desirable destinations
or recreation spaces can also be instrumental in inculcating a physically active lifestyle.
4. Cities that promote bicycling as a mode of transportation by providing allocated
bicycle lanes, exhibit higher levels of bicycle commuting. Additionally, facilities for bicycle
parking also motivate people to bicycle versus drive.
5. Often intersections are designed such that they facilitate speedy movement of cars,
which poses a threat to pedestrians and bicyclists. Hence, traffic calming and safety
measures such as curb extensions and speed bumps must be used to protect residents and
facilitate walking and bicycling.
41
(Anderson, 2014) 42 (Wener & Evans, 2007) 43 (Active Transportation: Making the Link from Transportation to Physical Activity and Obesity, 2009)
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Transportation improvement programs which promote walking, bicycling, and
reduce car use provide an opportunity to incorporate moderate physical activity as a daily
rhythm and a means to decrease physical inactivity for large segments of the population.
Through these transportation improvement programs, regular physical activity can be
incorporated as a life style change rather than a required chore. It can thus be an effective
mechanism in reducing the risk of obesity and can help people lead longer and healthier
lives.
Future implications of conjoined urban planning, transportation planning
and public health efforts.
The fields of public health and urban planning started as unified efforts, only to
bifurcate later and pursue individual and isolated goals. Urban planning started focusing
more on shaping the built environment whereas public health concentrated on disease
prevention and epidemiology. This resulted in complex wicked problems the effects of
which are visible today in the form of increased urban sprawl, segregated auto-oriented
development, increased infrastructure costs, congestion, poor air quality and increased
obesity prevalence. The past decade has seen a surge in coalescing efforts across urban
planning, transportation planning and public health disciplines to modify the built
environment to facilitate health. Various planning, transportation and public health
agencies are proactively pursuing endeavors to motivate individuals within these fields to
collaborate and work together in implementing policies and projects that will promote
health. The future seems promising. The federal government as well as private foundations
such as the Robert Wood Johnson Foundation and others are providing funds to state and
local communities to form coalitions consisting of urban planners, public health officials,
transportation planners and other diverse multi-disciplinary groups with assimilated goals
of building healthy communities. The focus of these funding outcomes is not restricted to
individual short-term project implementation but rather long-term systemic changes
through policy implementation that will be more sustainable going forward. The effects of
these long-term systemic policy level changes will be more valuable in how they affect
large population groups and communities by enabling them to adopt health enhancing
ways.
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Conclusion
The built environment affects health in a number of ways. Escalating obesity rates is
one of them. Recent research suggests that the built environment limits opportunities to
walk for utilitarian purposes, thereby contributing to this emerging obesity epidemic. It is
not sufficient to educate people regarding healthy lifestyles; the built environment must
promote, or at least allow for, engagement in healthy behaviors. There is definite
connection between obesity prevalence and land use and transportation planning
measures. Land use patterns and transportation investments collectively shape the desire
to walk, drive, or to travel via other means. In making conjoined efforts in land use and
transportation planning mechanisms such as promoting compact, mixed use development,
providing well-connected and walkable streets, efficient public transit systems, reducing
car dependency, designated bicycle paths, and more, opportunities exist to increase
physical activity, hence to mitigating obesity. Through these changes, the built environment
can be shaped to achieve healthy behavior. In order to address this global pandemic of
obesity, going forward urban planning, transportation planning and public health planning
must collectively adopt policies and implement projects that are symbiotic to each other in
order to achieve desirable living conditions, effective transportation systems and healthy
public health outcomes.
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