I'm Following Whom?
This post is part of an ongoing series of Voices from the Field by scholars, fellows and alumni of RWJF Human Capital programs. The author, Gina S. Lovasi, Ph.D., M.P.H., is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program, an assistant professor in epidemiology at the Columbia University Mailman School of Public Health and an investigator with the Built Environment and Health Project at Columbia.
A few weeks ago, I had both the great honor and the arguable misfortune of presenting my latest health disparities research to a gathering of the RWJF Health & Society Scholars at the National Institutes of Health. The honor part is obvious: As an alumna of the program, I was thrilled to spend time with fellow scholars, and to get their thoughts on my work. The misfortune part? That had to do with a bit of intimidating scheduling: I ended up on the program immediately following a giant in the field, Sir Michael Marmot.
In case you’re not familiar with him, Marmot is regarded as a true rock star by health disparities researchers. Perhaps his best known contribution was chairing the World Health Organization’s Commission on Social Determinants of Health from 2005 to 2008, but before and since, he’s reshaped the contours of the profession, and inspired researchers across the globe to pursue health disparities research.
For better or worse, I didn’t know I’d be following him until that morning, sparing me additional pre-presentation anxiety. And the actual event went just fine. His broad theme that day – and indeed, the theme that runs throughout his work and the work of the Health & Society Scholars—is that health disparities are not inevitable, that we can address them.
Marmot believes that with concerted effort that does not require a radical reshaping of society’s economic arrangements, we can bend the “social gradient” on health and health care so that being poor does not mean one must live in poor health and die prematurely.
All of the scholars at the session are engaged in researching some patch of the larger quilt that Marmot describes. In the research I presented that morning, I’ve focused on the relationship between obesity and the “walkability” of one’s neighborhood, asking how the built environment contributes or detracts from people’s health, and how that relationship might vary across different socioeconomic groups. It makes intuitive sense that the more walkable a neighborhood is, the more its residents will walk, and that as a result, they’ll be less prone to obesity. Of course, not every neighborhood qualifies as walkable. The ones that do tend to be densely built, have a mixture of land uses, feature well connected street networks, and have ready access to public transit.
Using data specific to New York City, my colleagues and I at the Built Environment & Health Project at Columbia University have looked at these issues in detail. What we’ve found is that in some socioeconomic groups, walkability does indeed seem to have an impact on residents’ weight, but not in all. Specifically, walkability is only associated with a lower body mass index (BMI) among advantaged populations.
Digging a little deeper, we found clues as to why that might be. Sometimes the built environment – dense, well networked and marked by a variety of uses though it may be – discourages walking in other ways. A neighborhood might simply be unattractive, unsafe or disordered, or it might offer no amenities that would prompt one to walk within the neighborhood rather than just through it.
Isolating those factors, we found an association between BMI and several measures of street aesthetics, including the presence of street trees. Surprisingly, we found no association between BMI and safety, as measured by homicide rates and pedestrian-auto fatalities. Neither did we find a relationship between clean streets and BMI.
The point of the research isn’t to impose some one-size-fits-all urban design template on the nation’s urban and suburban neighborhoods. Rather, by paying attention to the impact that the built environment has on the health of people who live in it, planners can help nudge people’s health in the right direction.
That’s consistent with Marmot’s message as well. He notes, for example, that while economic inequalities are at the root of a number of health disparities, we needn’t aim at eliminating economic differences if the goal is to improve people’s health. Rather, targeted interventions can help bridge the gaps—interventions such as addressing the deficits of poor neighborhood environments for supporting physical activity.
So while I wouldn’t have chosen to follow a rock star to the lectern, I have to admit, he was a great opening act!
Read more about the Health & Society Scholars annual meeting.
Learn more about the RWJF Health & Society Scholars program.
For an overview of RWJF scholar and fellow opportunities, visit www.RWJFLeaders.org.