Urban Health Midsemester Exam

Disaster

-A disaster exists when a hazard (i.e., flood, fire, famine, etc.) intersects with existing vulnerabilities of a population -Although key dates were provided in the preceding slide, a disaster involves a process - not just the initiating event -Vulnerabilities are socially produced, i.e., reflect different access to resources -Broader working definition: -Disaster = "A process leading to an event that involves a combination of potentially destructive agents from the natural or technological sphere and a population in a socially produced condition of vulnerability" -Disasters include earthquakes, hurricanes, tornados, typhoons, floods, mudslides, landslides and other extreme weather-related events, as well as fires, famines, wars, forced relocations, and forms of political violence including acts of terrorism. -Typically, not all subpopulations experience the same disaster in the same way -Usually differences by race/ethnicity, income or socioeconomic status, geography, and/or age

Physical properties- other safety issues

-Accidental injury from falls, drowning, poisoning and burns -Maintenance of railings, carpeting on stairs, walkways, window guards, lighting, etc. are very important. -Example: Stairs (walk-ups) and the elderly: -Physically taxing, increases risk of falling -Breaking a hip is a particular concern -Hospitalization and immobility increase the risk of respiratory infections or other complications, can result in death -Example: High rises, windows and children: -Window guards need to be in place to prevent children from falling out of windows -Crime is also reduced when lighting around doors and entrance ways are secure

Active Transport in Urban Areas

-Active transport = walking and pedal biking Benefits: -Both expend energy, increase physical activity, decrease obesity rates -Ideal way to meet current CDC recommendations for physical activity -Risks: -Safety! Requires special design issues to minimize accidents -Vulnerable populations require additional safeguards due to differences in walking speeds, reaction times, cognitive issues, etc.

City size

-Although mega-cities will continue to grow, most of the world's population growth will occur in smaller cities -Growth rate in mega cities will also continue to rise -Again, a higher rate of growth in developing economies than in developed economies is projected Calcutta, India: 1.9% vs. New York City: 0.4% -When the pace of urbanization is fast (or accelerating), we call that rapid urbanization

Cholera 1825-1930

-An acute diarrheal disease caused by the bacterium Vibrio cholera -Usually accompanied by vomiting and resulting in severe dehydration or water loss -Spread by contamination of water by fecal matter -Historically, spread around the world in epidemic waves -For much of its history, the cause of cholera was unknown -Known to kill rapidly, thus epidemics caused great panic and stopped commerce -Death rates of up to 70% have been observed during epidemics -Today, death from cholera is prevented with oral rehydration therapy -Proper sanitation and the availability of clean water is essential in its prevention -Not always available in the poorer areas of the world

Urbanization 1825-1930

-Between 1860-1910, the total urban population of the U.S. rose from 19% to 45% -Cities grew in size as a result of industrialization, rural-urban migration and the arrival of foreign immigrants -Large number of working poor now living in urban areas -Cities of this period seen as unhealthy and unsafe -Dramatic clustering of deaths from infectious diseases -Particularly cholera and tuberculosis -Rise of poor areas referred to as "slum districts" -Would become focus for public health reformers -Epitomized in case study of NYC during 1870-1920

physical properties: moisture and mold

-Buildup of moisture is often caused by leaks in roof or around windows, leaking plumbing lines, inadequate ventilation -Damage expensive to repair -Without temperature and humidity control, leads to mold -Mold is associated with chronic diseases such as asthma and other respiratory problems - can be severe -Mold growing inside of walls can be particularly difficult to detect -Remediation can be difficult and expensive and is often excluded from homeowner insurance policies -For tenants, landlord may have responsibility to clean up, but this may depend upon circumstances

New Urbanism

-By this time, infectious disease epidemics were largely under control in U.S. cities -Inspired by the work of Jane Jacobs -Interest sparked by rise of obesity epidemic in 1990s -Renewed interest in role of built environment, design of cities and public health Key concerns: -How to remake neighborhoods that were better for physical activity and social capital -Improve access to fresh food

Tuberculosis (consumption) 1825-1930

-Caused by a bacteria (Mycobacterium tuberculosis), it is usually a chronic infection, lingering for months and sometimes years -Infected individuals are not always aware they harbor the illness -Often lung infection, but many other bodily tissues or organs possible -Acute TB, which mainly strikes infants and young children, can prove fatal in days or weeks -Spread by airborne droplets or through contaminated food -Strongly associated with overcrowding, poor ventilation, poor nutritional status, and a weakened immune system -Once a top killer in the U.S. (c. 1900), still a top killer globally -Treatment involves a long course of several drugs -Antibiotic resistance is a serious and growing problem

urbanization

-Cities have grown more in the last hundred years than ever before in human history -Compare the percent of the world's population that currently lives in urban areas (approximately 50 %) with that in 1900 (5 %) -Globally, the world's population is expected to grow to approximately 5 billion people by 2030 -By that time, at least 60% of the world's population will live in urban areas -Amounts to about a million city residents will be added per week -By 2050, approximately 72% of the world's population is projected to live in urban areas (module 1 slide 20)

air quality

-Cities still generate around 80% of global carbon dioxide emissions and account for ¾ of industrial wood use worldwide -Atmospheric pollution is thought to affect more than a billion people, mostly in cities -Air pollution is thought to contribute to 3 million or more deaths globally per year, with 90% in less wealthy countries

physical properties: pests

-Cockroaches, rodents such as rats and mice, and bedbugs are top concerns in many US cities -Management often done with pesticides, but this results in contamination of home with unwanted chemicals -Often done as service contract - routine and repeated sprayings -Sprays and aerosols distribute toxins over a very wide area, buildup over time in environment -Recommended practice: Integrated Pest Management -Requires constant care, vigilant cleaning, vacuums with HEPA (high efficiency particle arresting) filters -Uses physical barricades to keep bests out when possible Approved pesticides used sparingly, applied as gels (limits release) -Bedbugs are a particularly challenging pest to get rid of

country socioeconomic status

-Consistent with findings related to community socioeconomic status -Research has also shown that individuals living in less economically developed countries are at far greater risk of experiencing poor health outcomes in a post-disaster setting than those living in more economically developed countries -These populations are likely to have greater post-disaster impairment

urban renewal movement

-Declared areas (communities) blighted and took properties by eminent domain -Relied on American Public Health Association's definition of a "health city" at that time -Bulldozed areas; many of these areas remain vacant today -In some areas, private developers constructed government, cultural, medical and educational facilities, and highways -Essentially pushed out the poor, displaced millions, many African Americans -Typically, this did not include construction of or relocation to better housing -Later, affluent childless households and single people moved back into select neighborhoods and cities ("gentrification"), contributing to local income inequality

Active Transport- improving pedestrian safety

-Desire to walk is highly dependent on built environment -Land use is key : people will walk if goods, services and/or work are within a reasonable distance -Area safety is a big concern : need sidewalks and buffers from high-speed traffic

Geography

-Due to weather patterns, natural environment -Some areas naturally more at risk than others -Recurrent disasters a problem in some areas -No solution for their total elimination -Geographic isolation of some areas may make response difficult Example: It took more than a week for domestic and international aid efforts to reach victims of the devastating 2005 earthquake in Kashmir region in which more than 80,000 people were killed.

Early Reform: 1840-1930

-Emergence of public health profession -focus on foul odors in cities -At this time, it was thought all disease spread through air (Miasma) -Sanitary surveys undertaken -Belief contributed to redesign and development of cities -Increase ventilation, sunlight, clean up open cesspools (human waste) -Known as the "Sanitary movement" -Sanitary movement lead to reduction in disease, but not necessarily for reasons undertaken -Some pathogens, like TB, need dark, damp environments to thrive -Ventilation reduced person to person transmission of infectious agent -Cleanup of cesspools reduced proximity and transmission of bacteria -Reform begins in Great Britain around 1848 -Worst slums are in tenement districts -Reform supported from growing middle class with significant ties to business -Reform beings in the U.S. just a few years later -1850 in Massachusetts - first public health department in country -Conducts sanitary survey -Focused on reducing infectious disease -Development of great urban parks -Seen as a "civilizing force", promoting health and nature in cities

Community Wealth and Assets holdings

-Encompasses many aspects including income, employment and educations levels -More broadly discussed as community "socioeconomic status" or "SES" -Research indicates that aggregate community socioeconomic status is associated with health, independent of individual socioeconomic position -Communities with low socioeconomic status are associated with poorer health outcomes including mental health, infant mortality, adult physical health including coronary heart disease

code enforcement

-Enforcement of housing laws and regulations usually falls under municipal or county government -Codes developed by national or international organizations -Allows for uniformity in training, compliance and enforcement -Adopted locally, sometimes with modifications, e.g: -International Building Code -National Fire Protection Association -Ongoing need to enforce housing regulations -Can be a contentious issue between property owners (tax payers) and local governments -Lower-income residents in low-quality housing particularly at risk -Non-compliance increases risk to residents, while enforcement of violations can result in their displacement or eviction

Demographic and political structures

-Establish parameters that shape many other factors influencing health after disasters -Includes things like taxation, federal-state relations, etc. -Type and stability of government can make a difference -Those with a history of state-failures and political upheaval may precede or predispose certain types of disasters -Research indicates that disasters occur more often in partial as opposed to fully democratic regimes

natural disasters in the US

-For the rest of this lecture we will focus on natural disasters and their response in the U.S., but many of these issues apply globally as well as to disasters that are human-made. -While high-profile disasters suggest these events are episodic and rare, general surveys of the U.S. population suggest that individual exposures to natural disasters is more common: -Approximately 10% of the U.S. population will experience a disaster during their lifetime -Globally, hundreds of millions of individuals have been affected by disasters over the past 30 years -In the U.S., response to natural disasters involves a mixture of public and private agencies: -Federal Emergency Management Agency (FEMA) -Acts only after a state requests assistance once a disaster is declared -State governments - Often have an agency that parallels FEMA -Local governments (usually, cities or counties) - tend to provide police, fire and other emergency responders -Non-governmental agencies, i.e. Red Cross, religious organizations -May assist during a disaster - provide food, water, medical assistance -Utility companies - responsible for restoration of local electrical and water services -Disaster response often includes: -Search and rescue operations, dealing with immediate threats to life and property -Provision of shelter and medical services -Distribution of food, water and electricity -Cleanup -Requires coordination and cooperation at many levels -Planning ahead and good communication during a disaster is essential -Immediate and long term health consequences: -May include injuries, heat- and smoke-related issues, contact with mold or sewage or other contaminants, post-traumatic stress disorder or other mental health issues -People with preexisting chronic illnesses may need medications and medical assistance, i.e.: Diabetes Cardiovascular disease Chronic Obstructive Pulmonary disease -It may take years for an area to recover from a disaster -Common problems include a surge in building permits, lack of building materials, shortage of skilled laborers -Funds are also a big issue: -The declaration of disaster makes local communities eligible for federal and state loans -Private donations and volunteer labor may also be needed

Historical Processes

-Globally, many disaster prone countries are in areas of the world were historically of little security interest to the U.S. or other developed countries. -Impacts amount of emergency funding available from these countries. -Historical colonial relationships may also influence disasters and their post-disaster response

homelessness

-Homelessness is a significant problem in the U.S., centered in urban areas -Only began being counted in Census during 1980s -Hard to have exact numbers, current estimates over 600,000 people - much greater than number of people living in shelters -Individuals most at risk of homelessness are: -Low-income/unemployed -Recently released from institutions -Veterans (see illustration on right) -Elderly -Have mental health issues -Handicapped -Affordability and lack of assistance programs contribute to the cause of homelessness -Health consequences: -Difficult to cope chronic diseases that require ongoing treatment, such as HIV, diabetes, hypertension (high blood pressure) -Increases risk of certain infectious diseases, like tuberculosis -Stress of homelessness also exacerbates many illnesses -Shelters may also increase this stress -Children, elderly and immune compromised are at particular risk -Addressing problem is complex, requires comprehensive set of programs focusing on prevention

The grid structure

-Layout along x-y Axis -Easy to navigate -Fit well with U.S. land survey systems -Allows for the most direct connections to goods and services -Historically in U.S.: -Philadelphia, Savannah are early examples -New York City later adopted the grid to handle growth about Houston street -The grid was also used to develop Washington, D.C. Today: known health effects -Improved, more distributed traffic flow, greater walkability -Also provides improved access for emergency responders

rural areas

-Less access to health services -Example: Travel time to hospital emergency rooms may be much longer; results in greater fatalities for heart attacks, accidents, etc. -Greater poverty, due to lack of industry, non-agricultural work -Greater distances to shopping areas for food, pharmacies -Often no or very limited public transport:People tend to drive, not walk, which is detrimental to health -Greater social isolation:Family and friends (social support) tends to be more spread out,Particularly difficult environment for the elderly who live alone and are unable to drive -This was not always true. Prior to around 1950, rural areas were healthier than urban areas in the U.S.

affordability

-Housing in urban areas tends to be fixed; New development tends to occur at the periphery -Expensive, time-consuming, related to development of transportation/commuting routes -Usually out of reach for low-income individuals -Role of federal vs. local government Federal government- strong role in housing finance, lesser role in enforcement of standards Local governments - tend to be responsible for housing enforcement, limited resources other than zoning to provide incentives to promote housing construction -Federal Housing Administration (FHA) -Began in U.S. during the great depression (1930s) -Improved housing stock by setting minimum standards in terms in order to quality for FHA-approved loans -FHA mortgage support lowered monthly cost of home owning -Initial guidelines results in denial of mortgages to people of color, anyone who wanted to buy in a mixed-race or African American neighborhood -Greatest beneficiaries were white, middle class, not in inner-cities -Discriminatory nature of initial programs had consequences for African Americans and other minorities, and anyone living in inner city neighborhoods -FHA Concept of appropriate housing (single family homes in suburban settings) made it difficult for inner city properties to quality -Contributed to decline of certain inner-city neighborhoods - known as redlined areas - denied access to loans needed to buy, maintain and upgrade homes and apartments -Guidelines broadened in the 1990s to include multi-family properties, condominiums and cooperatives, but there continues problems of access to mortgages and housing for inner city residents

housing and health

-Housing is a key issue in the history public health -Early reform efforts focused on health effects of dilapidated, crowded, unsanitary housing in working class and poor neighborhoods -Led to improvements in indoor plumbing, proper ventilation, occupancy codes, lead paint regulations, heating and cooling standards, fire safety -Many improvements in U.S. cities over time, but concern over negative effect of poor housing still remains -Substandard housing still exists and homelessness is problem -Both are associated with increased risk of or complications from infectious diseases, as well as the exacerbation of chronic illness -Housing fixes people in particular neighborhoods and communities - a setting for social life -Implications for access to opportunities and resources -More on this in future lectures -Must be considered in conjunction with transportation and mobility issues -Physical properties of housing have health effects -Moisture and mold -Pests -Toxins -Safety, as related to design features, appliances, maintenance

Case Study: Hurricane Katrina

-Hurricane Katrina Hurricane Katrina: The costliest natural disaster, as well as one of the five deadliest hurricanes, in the history of the U.S. -Katrina was a Category 3 hurricane, that hit the Gulf coast on August 29, 2005. It caused over 1,800 deaths, displaced between 700,000 - 1.2 million people, and cost billions of dollars of damage -Three state bore the burden of the storm: -Louisiana, Alabama and Mississippi -New Orleans was hit hard -Urban poor especially -Poorly handled, despite sufficient warning to officials at all levels of risk it posed -Confusion between states/local government and Federal Emergency Management Agency (FEMA) as to role and responsibility in first-line response -Evacuations delayed, hospitals and temporary shelters overwhelmed -Groups with pre-existing vulnerabilities before the storm were differentially affected -Race and poverty key predictors of physical and material damage -FEMA designated damaged vs. non damage areas: -Disproportionately black (45.7% vs. 26%) -Greater proportion of rental homes (45.7 % vs. 30%) -Greater proportion of people in living in poverty (20.9% vs. 15.3%) -Greater unemployment (7.6% vs. 6%) -More than 500,000 people had unmet mental health needs -Depression and other common disorders -Associated with hypertension, heart diseases, diabetes and increased rates of substance use and abuse -African Americans are less likely to seek care for mental health morbidities including posttraumatic stress disorder following disasters than other groups -Government response lagged until two days after Katrina landfall -"uncoordinated" and "hampered by ineptitude" -Confusion at multiple levels of government -Local government believed federal government would take primary responsibility -FEMA position was that states have primary responsibility for emergency preparedness, yet FEMA planning exercises simulating a disaster of this magnitude suggested the need for first-line federal response -Departmental changes within FEMA may have contributed to poor response Lessons Learned: -Much of New Orleans is below sea-level and the general area is sinking as sea-levels are rising -Protective infrastructure of levees, pumps and canals were poorly engineered and maintained -Inadequate evacuation plans -Poor, urban population did not have cars and could not respond to evacuation orders that did not include assistance for getting them out -Requires money, a place to go; coupled with fears of looting and vandalism of what they left behind -Individuals in frail health could not move themselves -Inadequate protective infrastructure -In addition to failure of levees, pumps and canals, the failure to protect the surrounding wetlands contributed to the problem -Protection of this area would have blunted impact of storm surge. Instead, storm could move closer to the city -Inadequate communication -In New Orleans, communications faltered/broke down -Responders appear to be unaware of what was transpiring, not used effectively -Evacuation plans should identify in advance who is at greatest risk, develop a plan to get them out safely -Anticipate the needs of the most vulnerable -Preserve coastal wetlands or other critical natural areas -Build and maintain effective infrastructure -Plan and test communication channels during disasters alternative ways of communicating during disasters -Alternative ways of communication may be needed (not just via TV, radio, phone or newspaper)

financial issues

-Impacts how and where residences are constructed, as well as who can afford to live in them -Direct and indirect health effects -Key issues we'll focus on here are: Affordability Displacement and Gentrification Segregation Abandoned properties Homelessness

Provision of health and social services

-In most wealthy countries, cities are often characterized by a rich array of health and social services -Yet sharp disparities in wealth between relatively close neighborhoods exist -This is associated with disparities in the availability and quality of care between neighborhoods -Often a difficult relationship to characterize because this varies between cities as much as within them -Certain subpopulations are most vulnerable in urban areas -These include low income individuals, the uninsured, the homeless, etc. -Put a greater burden on health system not adequately funded or prepared to care for them -Example: inadequacies of city health system to prevent and treat conditions such as malaria, dengue, and tuberculosis, whose spread is facilitated by high-density living

physical environment

-Includes various features of mainstream natural environment - soil, watersheds, forests, plants, animals, climate conditions -Often provides a medium and/or transport for air and water pollutants, radiation, etc. -Exposure to the physical environment is often influenced or modified by the built environment -Example: Individuals may live near factories, which may expose them to more polluted air

Large Scale Industrialization: 1825-1930

-Industrial revolution began in Great Britain in 18th century, spread to continental Europe and US in 19th century -Increased scale of cities to size never before seen -Changes in how they were built -Period of rising prosperity and technological developments -Rise of the factory, large scale manufacturing in urban areas -Rapid rise in environmental pollutants -Little understanding of hazards, no laws or regulations controlling discharges into air, water or land -The steam engine (module 2 slide 10) -Migration and immigration was fueled by employment needs -Workers moved from rural areas to urban areas for work (rural-urban migration) -Workers also recruited from other countries (immigration) -Cities became known for ethnic and cultural diversity, as well as tensions between groups -U.S.: large-scale immigration of foreign born during 1850-1915 -Workers often lived near work or worked at home -Houses next to factories, bone renders, tanneries, and other industries -Some work done at home, residences and workspace combined

Sanitary Movement

-focused on reducing the infectious disease burden in crowded cities, such as london, new york, philadelphia by improving built environment

Spatial segregation of different racial/ethnic and socioeconomic groups

-Many cities are highly segregated with multiple historical, logistical and practical barriers to mixing of social groups -This can have multiple effects, including enforcing homogeneity in resources and social network ties, suppressing diversity that may benefit persons of lower socioeconomic status -Segregation is associated with disproportionate exposure, susceptibility, and response to economic and social deprivation, toxic substances, and hazardous conditions -All of these have an impact on health

social environment

-Many features that result from or are a part of how humans interact with each other -Includes distribution of income, role of race in society, political power:Also discussed as "determinants of health" -Interacts with built environment in many ways -Example: Race can influence income or wealth, which can influence neighborhood choice, which in turn may limit access to other resources such as better food markets, increase exposure to hazardous wastes, medical services

Age of Reform: 1840-1980

-May be divided into two periods Early Reform: 1840 - 1930 Later Reform: 1930 - 1980 -Period gave rise to most cities in U.S. and increase in rise of role of government in maintaining public health -Protecting public health seen as legitimate concern of government that could override the rights of property owners

Commuting

-May be done in cars, mass transit, and/or active transport -None are health neutral acts -Risks associated with all, benefits with some -The length and predictability (i.e., given to interruption, delays) of the commute is a factor -"Extreme commutes" = take 45 minutes or longer -Health risks of commuting may include decreased physical activity and increased risk of obesity -Associated with illnesses including diabetes, cardiovascular disease, some cancers as well as cognitive decline -Current recommendations from the Centers for Disease Control and prevention (CDC) -Adults: 5 hours of moderate activity or 2 ½ hours of vigorous activity each week -Children: one hour of physical activity per day -Much easier to meet current guidelines for physical activity if they are incorporated into daily activities -Time spent commuting is key factor for many adults

Four main Movements and/or Philosophies in transportation planning

-Mobility (this has shaped many U.S. cities) -Conventional planning paradigm, does not involve land use planning -Focus on improving ease and connections for automobile based transportation -Demand management -Seeks to manage congestion with special fees, lanes and/ or metering, etc. -Accessibility -Considers how people live and work in communities, alternative transit modes and seeks to reduce need for travel -Transit-oriented development -Recognizes the importance of coordinating land use with transportation -Seeks to develop higher density housing, retail and other services within walking distance, reduce car use and increase pedestrian safety -Key issue in older, heavily developed cities: -Well-established residential and commercial areas -Difficult to make large-scale changes in existing land-use and transportation patterns -Small-scale changes typically easier to implement that promote alternatives to cars

making changes to modes of transit

-Most changes do not benefit all modes of transit -These basically increase safety for pedestrians, while reducing automobile transit: -Increase pedestrian zones -Improving intersection safety with signals timed for pedestrian safety -Curb laws - pedestrians have the right of way -Eliminating right-hand turn lanes -Drivers often turn right without stopping, dangerous for pedestrians as well as pedal bike riders -Traffic calming - deliberately slow speeds down -Physical methods:speed bumps, raised pavements, narrowing travel lanes and reducing right of way -These changes basically increase the ease/driving speed of automotive transit, while increasing risk to pedestrians -Elimination of one-way streets benefits automotive transit, but increases risks for pedestrians (two-way streets more dangerous to cross) -Implementation of roundabouts (circles) facilitates traffic flow and safety, but without signaling does not provide breaks for pedestrians to cross safely -Signal changes that are timed for automobiles and not pedestrians are a particularly bad problem on large streets -"Complete streets" : Streets designed to accommodate all potential transportation modes -Ideal, hard to achieve - invariably, tradeoffs -Generally beneficial to all modes of transit -Some common elements include wide sidewalks, medians, corner bulb-outs (see illustration, above), extensive signaling, aids for crossing streets -Other elements may favor pedestrians or pedal bike riders, such as use of special lanes -Obviously a problem to implement in older, heavily developed cities

health housing

-National Center for Healthy Housing -New criteria for enforcing housing quality -Seven features of healthy housing -Dry -Clean -Ventilated -Pest-free -Safe -Contaminant-free -Maintained

Disasters

-Natural (i.e., earthquakes, hurricanes) or man-made (i.e., war, terrorist attacks like 9/11/2001) -Urban populations particularly vulnerable -Increased proximity to hazards -Difficulty in obtaining/maintaining adequate water, food, housing, heat, etc.

Tenement case Study 1840-1930

-New York State Tenement House -Commission and Law Commission deemed tenements a menace to public health -1901 Tenement House Act: buildings must now be built with outward-facing windows in every room, open courtyard, proper ventilation systems, indoor toilets, and fire safeguards -Fueled the rise of the American public health movement -Address infectious diseases, pollution and worker safety -Tuberculosis in Lower East Side tenements and sweatshops were a rallying cry and focus for action -This period also saw the rise of Unions -Example: International Ladies Garment Workers Union Fought to abolish 'homework" Create sanitary standardized working conditions Various well-documented strikes

case study: New York City 1870-1920

-Population of New York City 1800: 60,000 residents 1850: 147,500 1900: 3,400,000 residents -Lower East Side the most densely populated area in the world -By 1890, 79% of all immigrants to U.S. passed through the Port of NY -Many remained in the area -By 1900, 4/5 of all NYC residents were foreign born or had foreign parents -The Lower East side in 1900 In most populated sections, over 500,000 people in one square mile -Tenements: three and four story walk-ups -Dark, cramped places, tremendous overcrowding, high rents -Functioned as residences as well as workspaces -Entire families living in one room -Slept in shifts while others worked -Inadequate sanitation and clean water -Conditions ripe for spread of many infectious disease -Vulnerable populations -Poor nutrition , long working hours -Low wages, high rent -Child labor -High childhood and infant mortality -25% of all infants died before age of one year in some areas -Killer diseases of this period include -Cholera, Tuberculosis, Typhoid Fever -Children: Measles and Diphtheria -Post-civil War in New York City saw the rise of the great industrial and commercial (financial) center -Abundant unskilled and semi-skilled immigrant labor -By 1914, 10% of all goods manufactured in US came from NY -Garment industry was the top NY industry -Sweatshops: overcrowded work space, dusty, poorly ventilated rooms -Long work day (10 hours or more) -Low wages -Employees often young women -Unsanitary conditions -1 Bathroom in hall, used by 2 to 4 families -Often 4 people to a room -Entire family worked, including young children -Underpaid, undernourished -Infectious diseases spread easily between family members sharing the same bed and living/work space -Death rates from tuberculosis were highest in the lower east side tenement district where they reached over 500 deaths per 100,000 per year

Robert Moses

-Power broker and polarizing figure -Power over construction of public housing and chairmen of Tri-borough Bridge Authority -Held view that cities should be comprised of superblocks, priority given to automobile over pedestrians, single used districts, large open spaces, favored development of the suburbs and modernist style -Demolished well known buildings including old Penn Station

Gentrification

-Process by which higher income households supplant lower income households in a given community -In some US cities, followed displacement described above during the 1970s -Racial component, often higher-income Whites displacing lower-income non-Whites -Varies in terms of how quickly process happens -Can intensify neighborhood/ethnic tensions -Both continue to be an ongoing issue in many areas

disasters and urban populations

-Projections indicate that the majority of the world's population now live in urban areas -Disasters in urban areas have particular risks -Rapidly growing areas may not have fully developed infrastructures, and typically contain large numbers of poor individuals -Many cities in Africa and Asia fall into this category -Lack of disaster planning in many cities sets the stage for a tremendous burden in the event of an urban disaster -In general, the same conditions that erode health in the pre-disaster setting usually increase vulnerabilities to hazards during a disaster, such as: Poor living conditions Food insecurity No active voice in political process

social and cultural context

-Refers to shared norms or beliefs for behavior -These may influence individual and community responses and consequences to disasters, including health-seeking behavior, mental health experiences, provision of resources by dominant group(s) -Research suggests that a belief in fatalism may alter both pre- and post disaster responses -Expressions of post-traumatic stress disorder and other mental health morbidity may vary by ethnic or cultural group -Likely to influence both formal and informal social networks, ability to mobilize in response to a disaster

built environment

-Refers to the many ways humanity builds or manipulates the world around us -Provides a framework for how our daily lives are constructed -Examples of the built environment include how homes are constructed, rooms are laid out, land uses in a neighborhood, how regions or areas connect with each other through highways or other roads -Influences health across life span -Represents important pathways through which an individual comes into contact with many health risks -Health effects occur on multiple scales, including housing, factories, streets, neighborhoods, metropolitan areas, regions, nations, and beyond -Different aspects of the built environment are linked to different health outcomes -Can influence both physical and mental health -Impacts conditions including asthma and other respiratory disease, cardiovascular disease, diabetes, child development, and psychological distress (module 1 slide 29)

urban social environment

-Research suggests a relationship between stress and social strain, mental and physical health -Individual social resources also play a role -In cities, the spatial proximity of one's network may help shape health -Social networks are associated with important range of health behaviors, including risk-taking behaviors

Segregation

-Residential Segregation is a large problem in U.S., particularly for African Americans -Historic roots: Great migration of African Americans from rural area to urban areas during 1918-1970 -Movement of individuals from south to north, particularly to the north east -Took place during a period of intense discrimination in housing markets, mortgage programs -Today: African Americans are more likely to live in substandard housing, pay a disproportionate portion of their incomes to secure housing (rent or own) than other race groups -Substandard housing has increased health risks including mold, safety issues, mental stress, etc. -Typically lack easy access to features protective of health such as parks, supermarkets, hospitals, etc. and closer proximity to undesirable land use with higher toxic releases -Many of today's cities remain highly segregated

physical properties: fire prevention and control

-Residential buildings: Must have evacuation routes (fire escapes, etc.), fire extinguishers, smoke detectors -Code enforcement, properly installed and inspected wiring and heating systems -Sprinklers: -Well-documented to reduce deaths, injuries and damage by fire, but costs a concern despite insurance premium discounts -Required in most high-rises and multi-unit residential buildings -In urban areas, fire control in row homes (adjacent residential buildings), mixed-use commercial space (highly flammable materials may be present), and high rises present particular challenges and concerns

Current Era: 1980-present

-Rise of the Healthy Cities movement, and impact of the World Health Organization's initiative in this area -Long-term international development initiative aimed to promote comprehensive local strategies for health protection and sustainable development -Advocates for community participation and empowerment -The first Healthy Cities programmes were launched in economically developed countries (i.e. Canada, USA, Australia, many European nations) starting around 1986 -Today, thousands of cities worldwide are part of the Healthy Cities network -According to the WHO, a Healthy City aims to create a health-supportive environment, achieve a good quality of life, provide basic sanitation & hygiene needs, and supply access to health care for its population -Evidence suggests that obesity and lack of physical exercise increase the risk for many of today's top killers including: -Heart disease -Stroke -Diabetes -Some cancers, including those of the prostate, breast and colon -Obesity also appears to be associated with urban sprawl -As sprawl increases, obesity increases -A controversial issue, mechanisms unclear

physical properties- safety

-Safety as related to design features, appliances, maintenance -Main concerns are fire and accidental injury -Vulnerable populations including children and the elderly at greatest risk of injury or death -Low-income communities also at higher risk -Fires are a leading cause of injury and death: -Smoking is a leading cause of fire-related deaths -Cooking is a leading cause of residential fires overall -In cities, common factors key related to higher fire rates were climate (i.e., less rainfall) and older housing stock

urban growth

-The pace of urban growth is expected to accelerate -It took London 130 years to grow from 1 million to 8 million residents -In comparison, it took these cities much less time to achieve similar population growth: Bangkok: 45 years Dhaka: 37 years Seoul: 25 years -The pace of urban growth is projected to differ by region of world -Most of the predicted global population growth will occur in less wealthy countries with developing economies (also called "less developed countries") -The most rapid pace is expected to occur in Asia and Africa

Later Reform: 1930-1980

-The recognized need for public housing gained ground during the Great Depression (c. 1930) and after -Existing construction usually exempted from new housing laws and regulations, so cheaper housing tended to be older, continued to be substandard -New construction in cities tended to be for middle/upper income, not for poor -Common view of this period was that public housing should not be made of highest quality, so residents would still strive to get out of it and preserve private housing market -During this period, cities in the U.S. were known for: -Increasing congestion with cars -Narrow streets -Deteriorating slums -The suburban dream of owning your own home comes to predominate in post-World War II (1945-) America -Marked by the exodus from the cities to the suburbs by the middle class and the wealthy -this forms the background to urban renewal movement and later gentrification Era is noted expanded role of government, public housing programs, highway construction, and improvements to sewers and water supplies Key conflict: -In 1941, Robert Moses proposed to put a 10-lane elevated highway through lower Manhattan ("LOMEX"), destroying Washington Square park and connections between neighborhoods -Lots of community protest; community activist Jane Jacobs played an important role in taking on Moses -Project was eventually cancelled in 1962

Automotive Transit in Urban Areas

-The rising use in U.S. was facilitated by the large scale construction of highways in inner cities during 1950s -Goal was to connect downtown business districts to more distant suburbs -Social impacts of inner-city highway construction: -Contributed to weakening of tax base, with move of upper and middle income families out of cities -Roads constructed along or through low income or minority communities destroyed and displaced many communities -Increased physical barriers between neighborhoods, destroyed walkability in some parts of cities -Increased risks for pedestrians in cities

Why look at urban health now?

-There is a growing importance of cities worldwide -The city is becoming the living norm for an ever-growing proportion of the world's population -Evidence and recognition that the social, physical, political or policy environments that we live in matters -They play an important in shaping population health -Better environments = health prevention -Prevention is a key focus and goal of public health

physical properties- toxins

-Toxins may be present in building materials, interior finishes, and consumer products including pesticides and cleaning supplies -They impact indoor air quality and have associated health risks, particular concern for children and other susceptible populations (more on indoor pollutants later in the course) -Example: older residences containing lead paint -Banned in household paint in US in 1978, but older structures still contaminated -Disproportionately effects poor and minority communities with old housing residing in those areas (aging housing in inner city areas) -Lead poisoning of children often occurs due to hand-mouth behavior or by breathing in particles. If poisoning happens during critical period (ages 1 to 3 years), it may result in permanent, lower cognitive abilities

Pre-industrial Era: before 1825

-Typically, cities in Western Europe were small compared with today London and Paris had the largest populations -There were some small cities in the U.S. before this date Mostly on east coast, along waterways -Older small cities became central cores of current metropolitan areas -U.S. cities developed later than those in Europe, and many developed around the grid structure -Cities of this era where characterized by Primitive sanitation systems -Human waste, animal manure, garbage dumped in streets, vermin -Overwhelming stench, poor road conditions -Periodic epidemics and poor health conditions -Life expectancy was low, infant mortality high -Dangerous places to live Violence common, fires, congestion (horse drawn carts) common

climate change:impacting ambient air temperature

-Urban "heat island" effect (see illustration, right) -Dark surfaces (i.e., pavement) and other parts of the built environment absorb health and have less ability to cool air through transpiration, this increases ambient air temperature -This in turn exacerbates certain medical conditions, increase hospitalizations and deaths -Some sub-populations particularly vulnerable -Inner city residents are often socioeconomically disadvantaged, live in hotter parts of the city, far from greenery, and have less access to air conditioning

Transportation

-Urban areas vary in transportation patterns and policies -Transportation in and out of cities is needed for: -Residents and other city dwellers, including workers and commuters -Shoppers accessing goods and services -Manufacturers and retailers dependent on the pick up and delivery of goods -Provision of emergency response services, including police, fire trucks, ambulance -Transportation modes includes: -Automobiles, including passenger cars and trucks -Mass transit, including railways, buses and subway -Active transport, including walking and pedal biking -All are associated with specific health risks and/or benefits, that may be direct (e.g., accidents or injuries from direct contact) or indirect (impacts physical activity level or environment) -These also have planning and policy implications

built environment

-Usually the most obvious and central features of any disaster -Directly influences the severity of a disaster, particularly natural disasters -Structures like buildings, bridges, etc. may be more or less vulnerable to disasters depending on construction Example: -Fatality rate after earthquakes in Kobe, Japan in 1995 (5,200 deaths) vs. Bam, Iran in 2003 (26,000 deaths) -Much of the difference in the death rates was attributed to differences in building quality -The built environment is an important focus for pre-disaster, public health planning -Infrastructure: Set of interconnected structural and technical elements that provide the framework that support a society, such as roads, bridges, water supply, sewers, electrical grids, and telecommunications. -A well-built infrastructure can prevent or reduce both morbidity as well as mortality during disasters -Also generally promotes health in pre-disaster populations

water quality

-Water scarcity and water pollution are serious concerns, particularly in less wealthy countries -In areas without safe drinking water, Water-borne diseases a particular problem, and results in high number of deaths per year - children particularly vulnerable -In rapidly urbanizing areas, maintaining fresh water and transporting sewage/other waste -Inadequate provisions for solid waste collection results frequently results in contaminated water bodies -Coupled with increasing population density Substantial risk for rapidly spreading epidemics -Waste from industries are also a problem

practice of urban health

-clinical, planning and policy work aimed to improve the health of urban populations -nested within the frame of public health -seeks to design, manage, research, educate, and evaluate the health of populations -long tradition of interest in the health of cities -also offers a useful framework for guiding local and global interventions

city

-complex environments -heterogenous population comprised of many subpopulations -they also range in size and organization: small, walkable vs vast, auto-mobile dependent. large areas are can be disconnected, pedestrian-hostile -different from one another and they also change over time -urban characteristics that are important in one city may not be important in others -limits generalization that can be drawn about how urban living influences health -over time, relative importance of different factors may also change -diverse experiences of urban environments

Jane Jacobs

-resident and activist of Greenwich village -In 1961, wrote "The Death and Life of Great American Cities" -Basic premise is that mixed land use within the city is good, density can foster interactions and community bonds, walkable cities are best -Her ideas helped change mainstream thinking about the city -Inspired the New Urbanism Movement that emerged in 1990s

urban areas

-todays cities may be healthier or unhealthier than the rural areas in their countries depending on their pollution levels and a host of other factors -health status is not a fixed property of urban life -It can get better or worse over time depending on policy, planning and resources -And within urban areas at any point in time, health status will usually vary by subpopulation, i.e., race/ethnicity, age, income groups, etc.

air pollution

Air pollution is a major environmental public health issue- Directly affects wellbeing and quality of life Air quality in urban areas is of great concern Historically, a big problem in western industrial cities Laws and regulations have greatly reduced problem over the past 40 or so years, though problems still remain Globally, areas that are undergoing rapid urbanization are currently facing major problems in controlling air quality Air pollution refers to contamination by pollutants, such as Criteria Pollutants, Hazardous Air Pollutants and other sources, including environmental tobacco smoke There are differences between Indoor vs. outdoor sources, as well as seasonal trends Contaminants in the air may also be deposited in the water and soil One of the main exposure routes into the body is through inhalation: Breath in gases, vapors, dusts and aerosols Irritants come in contact with bronchi in he lungs Particles (depending on size) may get deposited in bronchi/alveoli The smallest particles may enter the bloodstream through the lungs

particulate matter

Also called particle pollution or particulates Term for mixture of solid and liquid droplets found in the air Key sources include: Industrial processes Fossil fuel combustion Electricity generation Road dust Fires, both naturally occurring as well as residential wood combustion On road vehicles Waste disposal Particulates may be made up of hundreds of different chemicals, from different sources. Two main types: Primary particles - emitted directly from a source, including construction sites, unpaved roads, smokestacks and fires Secondary particles - formed in complicated reactions with sulfur dioxide and oxides of nitrogen that are emitted from power plants, industries, and mobile sources These make up most of the fine particulate pollution in the U.S. The size of the particle is a key determinant of where in the respiratory tract it will come to rest when inhaled. See next slide The EPA regulates both PM10 and PM2.5 ; it does not regulate PMs larger than 10 micrometers in diameter. Larger particles are generally filtered in the nose, but small particulate matter on the order of ~10 micrometers or less, referred to as PM10, can settle in the bronchi and lungs. Very small particles may pass through the lungs to affect other organs, and are associated with tumors (cancer). The smallest particles (<0.1 micrometers) are associated with cardiovascular diseases

reducing impervious structures

Areas paved with concrete or asphalt do not absorb water- Increases storm volume, increases risk of flooding Mitigate by using pervious rather than impervious surfaces for sidewalks and parking areas Built playgrounds - promotes physical activity and reduce obesity, social space (community interaction), aid in cognitive development for young Benefit for Low-income populations Maintenance and safety essential

Mass Transit in Urban Areas

Background: -Prior to 1991, federal government only provided grants for highways and a few nonautomotive related mass-transit projects -Intermodal Surface Transportation Efficiency Act (ISTEA) broadened this, but federal funding for mass transit still less (comprises only 20% of federal transportation budget) -Federal $ for mass transit is more competitive than for highways -Majority of $$$ needed for construction, maintenance and operation of mass transit is from state and local governments -Harder to raise large sums, limited capacity to expand -Cut backs during recessions a big problem

brownfields restoration

Brownfields = Abandoned or underutilized sites with known or suspected contamination Historically, liability concerns limited interest in redevelopment Many states now have programs to encourage redevelopment including grants for site assessment, low-cost loans for cleanup, limits for post-cleanup liability

earthquakes

Cause of death usually due to building and soil failure Unreinforced masonry Certain styles prone to structural failure Ground floor opened up for windows or parking Soils made of fine clays or poorly consolidated fills in areas with high water tables prone to liquefaction

Floods

Caused by heavy rains, hurricanes, snow melt, etc. Major cause of property damage and deaths Key problem: rising floodwater picks up contaminants along path. During flood: Risk of toxins and spread of waterborne infectious diseases (fecal matter) After flood: Mold a key problem - expensive, health hazard 100 year flood maps may no longer be a good predictor of risks as extreme weather events are occurring more frequently FEMA flood zone maps also not 100% accurate

active transport- improving safety for vulnerable populations

Children -Parents most concerned with safety -May be best addressed by parental, drive and child education programs The elderly and/or persons with disabilities -Carefully monitoring curb heights -Improving legibility of signage -Raising crosswalks at intersections -Generally increases walkability for everyone

active transport- improving safety for pedal bikers

Community level approach: Interconnected bike lanes -Lanes should protect bicycles from moving and parked cars -Special signally at intersections and bike friendly road surfaces -Very extensive in some European cities Issues: -May be opposed by both car advocates and bike riders who favor 'street riding' -Lack of political pressure to accommodate bikes compared with pressure to accommodate cars Personal approach: Helmet use -Lower cost, less political than community approaches, but does not lower rate of accidents -Tends to be favored in U.S.

Automotive Transit- Health Effects

Commuters: -Decreased time spent on physical activity, increased obesity associated with more time spent in car -Increased psychological stress (including road rage) -Greater exposure to pollutants -Increased risk of accidents -Increased social isolation -Decreased amount of time for other things that may alleviate some or all of the above, including family and friends City Dwellers: -Increased air pollution -Higher levels of diesel particulates, carbon monoxide, nitrogen dioxide, and others -Traffic congestions, idling increase pollution -Air flow may be particularly limited due to density of surrounding buildings -Associated with increased morbidity (illness) from asthma, cardiovascular disease, and certain cancers -Increased noise pollution -Higher levels of ambient noise associated with increased stress, may contribute to risk for chronic illnesses

Abandoned Properties

Due to: -Loss of residents in center-city neighborhoods -Failure to pay property taxes and/or mortgage Many problems: -No longer maintained -Neighborhood blight - attract crime, illegal dumping, depress property values in neighborhood, increased risk of fire -Process to condemn and demolish may takes years, also may have environmental impact (i.e., asbestos, lead) -Today there's a Shrinking City movement - return vacant land to agricultural purposes -Problem is that vacant land is often surrounded by occupied residences -Nice idea, difficult to implement -Community gardens a possibility, funding an issue

displacement

In the U.S., intentional government programs of the 1950s-70s resulted in the demolishment of low-income housing and ethnic enclaves (see earlier lectures on "urban renewal"). This contributed to rise of homeless problem

Extreme Temperature Events

Includes heat waves as well as cold temperatures Chicago, 1994: 600 deaths, in Europe, 2003: 35,000 deaths Elderly are at particular risk Physiological vulnerability to heat, may also be due to certain medications Likely to have chronic illness such as heart disease, diabetes; these events increase their risk of heart attacks and stroke Often poor - May lack air-conditioning Be afraid to leave the home or leave windows open May have no one to help

Early focus on housing and building form- England takes the lead 1840-1930

Key issue: Great desire to reduce or eliminate tenement areas in cities, improve health through better housing -1860s Model Tenement movement (England) -Demand greater than supply, not a huge success due to lack of government subsidies -1890s Garden cities or model suburbs proposed as solution for overcrowding in London by Ebenezer Howard -Satellite communities, connected by rail to center city -Spacious and well ventilated homes -Eventually to include cultural amenities and other sources of employment within walking distance -never totally solved problem of inner-city tenements in England; ideas used in U.S., Brazil and Australia -Zoning also used as tool for racial segregation in some cities -Baltimore - passed race-based zoning laws in 1910 -Later found to be unconstitutional due to unnecessary restriction on rights of property owners -Discrimination and segregation against African Americans intensified during 1919 and 1950 -U.S. cities are still shaped by what occurred during these eras

Development of Sewers 1840-1930

Key issue: Need to handle waste water, including human waste Few cities had sewers, those that did used them for storm runoff -Early fix was to resize storm sewers to collect waste from area and dump it into nearby river Lead to great Cholera outbreak in 1854 London -Later on, cities developed dual drainage systems also called combined sewer overflows

Development of Public Water Works 1840-1930

Key issue: safe secure water needed for drinking, industry and fire control, but aquifers under cities and adjacent rivers were often badly polluted from industry -Addressed by tapping distant water supplies and bring them in cities -Dramatically reduced water-borne diseases such as cholera, typhoid fever, and other diarrheal diseases -Example: The Croton Aqueduct or Old Croton Aqueduct -Constructed between 1837-1842 to bring fresh, clean water from Westchester county into Manhattan -Increased the amount of safe water available -Superseded in 1955 by New Crouton Aqueduct

Hurricane Katrina

Louisiana State Epidemiologist's report: -Examined bodies collected in Louisiana, Mississippi and Alabama, and Louisiana residents who died in other states in the month after Katrina, Aug. 27 to Oct. 31, 2005, -1,698 total deaths -Leading cause of death: 40% drowning, 25% injury/trauma -Victims by age and race: The average age was 69, ~ 50% were 75 or older 2% were younger than 18 51% were black; 42% were white -Information on place of death was available for 877 victims; 36% died in homes 22 % died in hospitals 12 % died in nursing homes 25%+ found elsewhere, including the Convention Center

Triangle Shirtwaist Factory Fire

March 25th, 1911 -146 deaths from fire on 8 and 9th floors -Garment workers, mostly young women -Horrific spectacle: rather than burn to death, 62 people jumped to death -Tenements prone to fire; this event inspired and mobilized additional workplace reforms -Many codes and zoning ordinances adopted in NYC in 1916 regulating how space could be used - Protecting public health at core of legal basis

river restoration

Natural channels, including rocks and other barriers slow down the speed of currents Curves in rivers also slow down the velocity of flood waters Also benefits local wildlife

ozone

Ozone is found in two regions of the atmosphere: Upper regions - protects earth from sun's harmful rays ("good ozone") Ground level - main component in smog ("bad ozone") Created by chemical reaction between oxides of nitrogen (Nox) and volatile organic compounds (VOCs) Likely to reach unhealthy levels on hot sunny days in urban environments Can also occur throughout the year in southern or mountain regions Can be transported long distances by wind, so rural areas may also be affected Even low levels of ground level ozone can have an impact on the respiratory system, trigger chest pain, coughing, throat irritation, congestion Can reduce lung function, inflame the lining of lungs, repeated exposure can scar lung tissue Children at greatest risk, typically because they play outdoors and are more likely to have asthma than adults Throughout the U.S., additional programs are being put into place to reduce ground ozone Cut NOx and VOCs emissions from mobile and stationary sources Reducing pollution by reformulating fuels, consumer/commercial products, such as paints or chemical solvents containing VOCs

mass transit- health effects

Risks: -Long commutes on mass transit can be stressful, reduce time for other things such as physical activity, interactions with families and friends Benefits: -Often associated with increased walking to and from mass transit location, which has a definite health advantage for the commuter -Lower greenhouse gases per passenger mile traveled -May also use cleaner fuel than diesel, reducing local air pollution (requires conversion) -In general, greater overall benefits than riding in a car for commuters, but local air pollution for city dwellers is an issue

public and publicly assisted housing

Takes two forms - owned by branch of government or private owned. Examples that typically provide quality housing include: -Low-income housing for senior citizens -Lets seniors stay in their long-term neighborhoods, little public opposition -Must quality, rent usually set in proportion to income (often, just Social Security) -Mortgage subsides to private sector developers of low-income family housing, usually nonprofits -Demand is greater than the number of units available from these programs -Section 8 rental assistance -Local Housing Authority (LHA) guarantees rent payment on specific units if units are rented to qualified low-income families. -Or, low-income families given a voucher or certificate that promises a landlord a certain amount of rent (tenant pays a portion). -Inspections required, so generally safe and healthy housing Downside: Limited availability, long waiting lists -U.S. Dept of Housing and Urban Development: Sets rent level for section 8 housing in some metropolitan areas -If set too low - landlords will not rent to tenants with Section 8 certificates (get much more with private market tenants) -If set too high - other families may be priced out of the market, making problems worse -Bottom line with affordability: What a household pays in rent affects the amount of money available for other necessities, such as food -A much bigger issue with direct and indirect effects on health -Typically, higher priced rents = safer neighborhoods, proximity to mass transit or other services, but other associated costs can be high

wildfires and mudslides

Tend to occur on fringe of urban areas Due to loss of buffer zone, disruption of earth/erosion Important issue in arid and semi-arid areas of U.S. Patterns of dry weather series of fires, followed by mudslides when wet weather returns Smoke from fires may also drift to urban areas, causing respiratory problems and visibility issues

regulatory framework in the US

The built environment plays an important role in shaping health risks associated with pollution in both outdoor and indoor air: Outdoor air quality is affected by hazardous air pollutants and other toxic releases. In the U.S., the federal-state regulatory framework requires a certain level of monitoring. Indoor air quality is affected by ventilation system, off-gassing of building materials and furnishings, tobacco use, etc. It is very important, but much less regulated, except for tobacco use in public places Sources of air pollution from the built environment include mobile and stationary sources: Mobile sources = from motor vehicles, and our exposure is influenced by many factors, including proximity to highways, and density of traffic. Urban sprawl increases daily miles driven, which in turn increases traffic and pollution from mobile sources Stationary sources = sources such as factories, power plants or other industrial facilities. In some cities, residential housing may also emit air pollutants. Example: waste incinerators may be present in large apartment buildings In 1963, Clean Air Act was signed into law in 1963 Dense, visible smog in many U.S. cities helped promote passage Designed to control air pollution on the national level Several major amendments to date Required Environmental Protection Agency (EPA) to develop and enforce regulations protecting the public from airborne contaminants known to be hazardous to human health 1970 amendments established National Ambient Air Quality Standards for criteria pollutants and the National Emissions Standards for Hazardous Air Pollutants 1990 amendments addressed acid rain, ozone depletion, toxic air pollutants. It also included permits program for stationary sources There are many possible pollutants of outdoor air May can also travel indoors, where they also pose health risks Health effects may be acute (short term) or chronic (long term) Best known are the Criteria Air Pollutants Widespread and common pollutants Science-based Air Quality standards set and regulated by EPA (federal government) States required to adopt enforceable plans to achieve and maintain air quality standards Six criteria pollutants: particulate matter, ozone, sulfur dioxide, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead Measured at monitoring stations throughout the U.S. Lots of progress over the past three or four decades, yet many people in U.S. still live in counties with unhealthy air

zoning

Use zoning to restrict building in vulnerable areas, such as flood zones Many public agencies now requiring areas at-risk areas not be built upon Existing structures: reinforce to avoid future problems (see next slide - FEMA) or pay steep increase in premiums Or, enforce no rebuilding after disasters Building and preserving protective barriers - including wetlands, barrier islands, seaside dunes - Added bonus: protects local wildlife

health risks with natural disasters- hurricanes

Wind - damage/destroy buildings Heavy rains - overflow of river banks, flooded streets Storm surge - the most deadly aspect Rise in coastal waters that can exceed 10 to 15 feet, drives water far inland, results in high-powered waves smashing into buildings Many older, urban areas in U.S. developed along coast/ major waterways

Urban Health

broad definition:"study of the health of urban populations" principle aspects: -description of populations as a whole as well as subgroups -subgroups often include specific racial/ethnic groups, the elderly, children, and individuals with special needs such as the homeless -understand the determinants of population health in cities -how cities themselves may affect the health of their populations

community

collection of individual people in an area, their collective power to effect change as well as their individual characteristics and group interactions

Sustainability

concept of equity, broadened to include the future. the longer term impacts of development of the built environment on future populations

urban infrastructure

how a city provides water, disposes of garbage, provides energy to residents

health

the ability of an individual to fully participate in the social interactions of a community, more than just the presence or absence of disease

environmental health

the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. -this includes both the assessment of as well as the control of environmental factors that can potentially affect health -typically focuses on issues that are involuntary, arise outside the body, and are caused by non-biologic agents (module 1 slide 11)

equity

the distribution of risks and assets between groups as well as the distribution of diseases and good health