Public Health and the Built Environment

Dr. David J. Holcombe
Dr. David J. Holcombe

The relationship between the “built environment” and health outcomes has become a hot topic.  Research, some which comes from the Pennington Biomedical Research Center in Baton Rouge, has confirmed that the best approach to improving health involves a dual approach:  Education directed toward behavior modification, and environmental policies that promote enhancement of a healthy built environment.


What does this mean?  First, everyone has been bombarded with public service announcements for smoking cessation, increased activity, safe sleep, breastfeeding and obesity, which are directed at changing individual choices.  Second, these initiatives directed toward individual behavior, however, must be associated with environmental changes, often precipitated by policy change. Examples would be smoke free areas, promotion of breastfeeding, parks and other recreational amenities.


Asking people to increase their activity makes no sense if there are no places to exercise and no incentives to do so.  It has been demonstrated that people who live in proximity to parks are more likely to engage in physical activity.  Cities with adequate green spaces, bike trails, and walking trails, promote health in a more direct way than simply encouraging people to get up and move.  That being said, those individuals who live in low-income, high crime neighborhoods are less likely to benefit from the proximity of green spaces than those in high-income, low-crime areas.  From a purely policy prospective, initiatives such as reducing health insurance premiums for those with normal weights and who do not smoke, and who engage in regular health check-ups would be examples.


Progressive communities have seized on research findings and incorporate “public health in all policies.”  Baton Rouge has the “Mayor’s Health City Initiative,” which promotes healthy lifestyles, accessible quality clinical care and research into a triple faceted program.  Advisory boards head up the three parts of this initiative, which targets priorities as diverse as obesity, HIV/AIDS, mental health access and overutilization of emergencies rooms.  Given Louisiana’s health outcomes, all such projects can improve our standings compared with other states.


With respect to the “obesity priority,” Baton Rouge’s response has included, among other things, development of a mobile farmer’s market, improvement of school equipment and activity programs, promotion of the 5-2-1-0-10 program (5 servings of fruits and vegetables, 2 hours or less of screen time per day, 1 hour of exercise a day, 0 sweet drinks, and 10 hours of sleep), encouragement of farm to school fruit and vegetable use and the “Baton Rouge on the Geaux” van.   They have also completed an ambitious walking trail passing by the Mall of Louisiana and several of the major medical facilities.


This multifaceted program hopes to reduce obesity, especially among the 30% of Baton Rouge children who are already affected.  No single group and no single approach can be successful when the problem itself has so many diverse origins.  Alexandria, in collaboration with the Rapides Foundation and other entities, has embarked in similar initiatives to tackle similar health issues in our community and should be supported whenever possible.  Alexandria’s recent recreation summit represents another positive step.  The long-term health of our citizens is at stake.