The “built environment” represents human-made structures such as buildings, parks and roads that comprise the neighborhoods and communities where people live, work, learn and recreate.
An updated AAP technical report describes how this environment influences multiple child health conditions, including asthma, mental health, obesity and injuries. An accompanying policy statement focuses on health-promoting community design solutions.
The documents The Built Environment and Pediatric Health, from the Council on Environmental Health and Climate Change and Section on Minority Health, Equity and Inclusion, are available at https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2023-064772 and https://doi.org/10.1542/peds.2023-064773 and will be published in the January issue of Pediatrics.
The importance of equity is central to both documents, as unequal access to health-promoting community design features contributes to racial, ethnic and socioeconomic disparities in child health outcomes. The policy statement suggests strategies that pediatricians can use to support families living in disadvantaged neighborhoods and to advocate for healthier built environments.
Characteristics of the built environment often impact specific populations negatively. Children from lower income homes and marginalized racial and ethnic groups are less likely to have access to parks and playgrounds and are more likely to live in homes with greater exposure to traffic-related air pollution, high heat exposure and flooding.
Discriminatory housing and lending practices, resulting in racially segregated neighborhoods characterized by systemic disinvestment, contribute to these inequities.
Children with disabilities and children with special health care needs are especially vulnerable to health hazards related to the built environment. For example, children with disabilities are more likely to be hit by motor vehicles than youths without disabilities. Well-maintained, accessible sidewalks, public transit and traffic-calming measures can protect safety and mobility. Eliminating disparities in child health outcomes requires addressing the very structures that support inequities.
Transportation infrastructure is among the most critical built environment features for many children and families. Numerous children miss health care appointments due to lack of access to transportation. In addition, traffic-related air pollution is one of the most deleterious influences on asthma, cardiovascular and neurocognitive outcomes.
Zoning practices that support equitable access to essential services and amenities, and more accessible, convenient and affordable public transportation could have multiple benefits for children, including better access to health care and less traffic-related air pollution and motor vehicle noise.
Health care institutions also are part of the built environment. As anchor institutions in their communities, they can catalyze positive change. By leveraging their purchasing, hiring and investment practices, health care institutions can support healthier and more equitable communities, addressing root causes of health disparities for children who live in historically disinvested neighborhoods.
Natural design features
Increasing access to greenspaces and natural features such as trees and greenery also is a beneficial child health strategy as studies have shown positive effects on physical activity and stress.
The built environment also impacts how children experience climate change. Impervious surfaces, such as roads and paved lots, increase the risk of high ambient temperatures and severe flooding. In contrast, trees and vegetation allow the ground to absorb more water and can reduce ambient temperatures. Additionally, utility infrastructure built to withstand extreme weather is important for all children and their families, particularly children with chronic diseases.
The policy statement outlines steps pediatricians and policymakers can take to advance healthy community design practices locally and nationally, and address the needs of children who lack access to health-promoting community infrastructure.
Importantly, the work of designing healthy and equitable neighborhoods must be done in partnership with communities that too often have been denied power and a voice. Prioritizing health and equity in the design of all communities will support the optimal health and well-being of all children.
Dr. White is a lead author of the policy statement and technical report.