SHAPING THE CONTEXT OF HEALTH: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases

Abstract

Given the growing attention on how environmental and policy interventions can affect chronic disease burden, our objectives are to describe (a) effective and promising interventions to address tobacco use, physical activity, and healthy eating and (b) lessons learned from the literature and practice experience in applying environmental and policy approaches. A total of 17 interventions were reviewed, organized across 3 domains affecting the physical environment/access, economic environment, and communication environment. Many of these interventions are effective. Several lessons are important to consider, such as the need to start with environmental and policy approaches, intervene comprehensively and across multiple levels, make use of economic evaluations, make better use of existing analytic tools, understand the politics and local context, address health disparities, and conduct sound policy research.

Food Insecurity, Neighborhood Food Access, and Food Assistance in Philadelphia

“…Recently, considerable resources and research have been directed towards improving diet in low-income communities by increasing neighborhood access to fruits, vegetables, and other healthy foods. 9 However, it is unknown if programs to increase food access also reduce food insecurity, as food insecure families may be unable to purchase even conveniently located food.…”

“…While food assistance programs are experiencing funding cuts, programs aimed at increasing food access are becoming a major part of local, state, and national public health policy, as well as non-profit organization activity. [9][10][11] Prior research has found that residence in neighborhoods with better food access (e.g., more full-service supermarkets) is associated with healthier diets and less risk of obesity. [12][13][14] However, if local food remains out of reach due to economic constraints, there may be a ceiling beyond which improved food access cannot improve diet or health.…”

Environmental Audits of Friendliness toward Physical Activity in Three Income Levels

“…To fill this obvious gap in the literature, we conducted walking, street-scale environmental audits of selected neighborhoods to assess differences by income level (low, middle, and high) among four environmental, neighborhood factors most associated with physical activity: [17][18][19][20][21][22][23][24][25][26][27][28] population density (defined as the number of people per square mile, apportioned to the size of the block), land use diversity (defined as the mix of commercial destinations and residential land uses in an area), street design (defined as the extent to which neighborhoods are pedestrian-and bicycle-friendly, e.g., by having sidewalks, bicycle lanes, traffic calming features, etc. ), and physical disorder/incivilities (defined as the extent to which litter, graffiti, stray dogs, and other unpleasant attributes are present in the environment).…”

“…The best environment for promoting physical activity has population density, land use diversity and street design conducive to activity and low levels of physical disorder/incivilities. [17][18][19][20][21][22][23][24][25][26][27][28] From the relevant literature cited above, we formulated four hypotheses: 1) Population density and income are negatively related. 2) Land use diversity and income are negatively related.…”

“…Furthermore, we chose the most consistently identified environmental features related to physical activity. [17][18][19][20][21][22][23][24][25][26][27][28] …”