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The Retail Development Crisis: What Now? - Kelley CNU17
1. The Healthy Communities Agenda:
How We Can Work Together
Congress for the New Urbanism
June 13, 2009
Dee Merriam, FASLA
Community Planner
National Center for Environmental Health
U.S. Centers for Disease Control and Prevention
“The findings and conclusions in this presentation have not been formally disseminated by
the Centers for Disease Control and Prevention and should not be construed to represent
any agency determination or policy.”
2. U.S. Health Care Expenditures
as Percent of GDP Projections
Keehan et al:
Health Affairs
March/April 2008 27: 145-155
3. Injury -Vehicle Crashes
For every age group
from 3 through 33--
crashes were the No. 1
cause of death
4. Miles per capita– more than
doubled in one generation
Miles per Capita: 1960 to 1995 From 4,000 to 9,200
VMT per person
5. Disease in the 21st Century
• Mental Disorders: Depression,
Anxiety, Developmental, Substance
Abuse
• Macro-environment: Climate, Conflict
• Aging Populations
• Overweight: Chronic Diabetes II,
Heart Disease
6. Climate-
The European Heat Wave of 2003
Excess deaths
France 14,802
Germany 7,000
Spain 4,230
Italy 4,175
UK 2,045
Netherlands 1,400
Portugal 1,316
Belgium 150
TOTAL 35,118
Source: Earth Policy Institute
8. Recovery from surgery
• All cholecystectomies in a
Pennsylvania hospital, May-
October, 1972-1981
• Exclusions: age <20 or >69;
serious complications; history
of psychological problems
• Matched pairs: “tree view”
patients with “brick wall
view” patients
9. Recovery from surgery
Results: The “tree view” patients had
• shorter hospitalizations (8.70 days vs 7.96 days)
• less use of analgesic medications
• fewer negative nurse notes (e.g. “needs much
encouragement,” “upset and crying”)
Ulrich, Science, 1984
10. Trees and urban Life
Studies in Robert Taylor Homes,Chicago
• 28 identical high-rise buildings along a 3-mile
corridor
• Some have nearby vegetation, others do not
• Residents randomly assigned to apartments
• A “natural experiment”
University of Illinois
Human-Environment Research Lab
William Sullivan, Frances Kuo
http://www.herl.uiuc.edu/
11.
12.
13.
14. Robert Taylor Homes interview study
• 145 residents
• Asked about social
dynamics and
aggressive behavior
• Compared answers
from people living
with and without
nearby nature
15. Strength of Community
Positive Interactions
no trees
very
trees
quite
somewhat
a little No No No
Trees Trees Trees
not at all
Know People Know Next Unity / Cohesion
on Floor Door Neighbor
16. Strength of Community
Positive Interactions
no trees
very
trees
quite
somewhat
a little
No No No
Trees Trees Trees
not at all
Many Visitors Socialize Know People
Daily within Bldg. in Bldg.
17. Strength of Community
Positive Interactions
no trees
very
trees
quite
somewhat
a little
No No
Trees Trees
not at all
Acknowledge Help
Each Other Each Other
18. Aggressive behavior against partner
Negative Interactions
.6
no trees
trees
.5
.4
Proportion .3
Yes
.2
.1
No No No No
Trees Trees Trees Trees
0
spiteful threatened threw or threw at
to hit smashed partner
19. Aggressive behavior against partner
Negative Interactions
.6
no trees
.5 trees
.4
Proportion .3
Yes
.2
.1
No No No No
Trees Trees Trees Trees
0
Hit with Hit with Beat them Used gun
something fist up or knife
20. Aggressive behavior against partner
Negative Interactions
1.6
no trees
1.4
1.2 trees
Mean Values
1
0.8
0.6
0.4
0.2 No No No
Trees Trees Trees
0
Psychological Mild Violence Severe Violence
Aggression
Aggressive and Violent Behavior
21. Inactivity, Overweight & Health
Evidence links inactivity and overweight with…
Inactivity Overweight
Increased mortality
Cardiovascular disease
Cancers
Depression
Gall bladder disease
Osteoporosis
Dyslipidemias
Hypertension
29. “Problem” List
• Physical exam unremarkable
• Ht 54” (50%)
• Wt 115# (95%)
• BP 140/90
• Blood glucose elevated, urine normal
• Cholesterol 220
• Signs of Depression
30. Treatment Plan
• Weight loss program
• Referral to “overweight” clinic
• TV out of the bedroom; no soft drinks in
the house
• Exercise program; Encourage sports
31. "Outstanding in Its Field"
Hubbard Lake Elementary School, Hubbard Lake, Michigan.
34. Two Months Later…
• Lost One pound
• Can’t change the food at school
• Day is already too full
• No Time for exercise; “not good at
sports”
• No place to Walk
35. 2 months later our patient could
be taking:
– Antihypertensive
medication
– Oral Hypoglycemic
agent
– Cholesterol lowering
agent
– Antidepressant
• Monthly medication
costs: $385
37. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
5 states over 10%
1985
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 2001;286:10.
38. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
39. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
5 states over 15%
1991
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
40. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1992
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
41. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1993
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
42. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1994
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
43. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1995
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
44. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1996
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
45. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
3 states over 20%
1997
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
46. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1998
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
47. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
1999
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
48. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
2000
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
49. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Alabama over 25%
2001
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
50. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
2002
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
51. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
2003
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
52. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
2004
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
53. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
2005
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
54. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
2006
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
55. Obesity Trends* Among U.S. Adults, BRFSS
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Only
1 state under 20%
2007
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
56. BMI US Females 1988-1994
NHANES -- Measured
NHANES – In person interview-- self-reported
BRFSS – Telephone Interview
57. download from CDC at:
www.cdc.gov / nccdphp / dnpa / obesity / trend / maps
The data shown in these maps were collected through the CDC’s Behavioral Risk Factor Surveillance System (BRFSS).
58. Creating or improving access to places for
physical activity can result in a 25% increase
in the percent of persons who exercise.
•www.thecommunityguide.org
•AmJ Prev Med 2002
59. Walking
good for…
Obesity!
Heart disease!
Cancer!
Depression!
Diabetes!
Gall bladder!
Social life!
61. res sion
↓ Dep
↓ CO2 ↓ Air
emissions pollution
↑ Physical activity
↓ Osteoporosis
↓ Injuries
And by the way…
↓ Infrastructure costs ↑ Social capital