Jul 8 2014
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Transforming Communities to Reduce Stress and Improve Health

Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar. 

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You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.

file Brita Roy, MD, MPH, MS

Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.

file Carley Riley, MD, MPP

Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.

We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress. 

But we don’t have to live like this. We can strategically shape our neighborhoods and our work environments to lower stress, build resilience, and promote health.

Seem like a pipe dream?

Well, while this may, at first blush, seem like a description of an unrealistic utopia as fantastic as The Truman Show, it is actually within reach. Communities can take action and change their environments to reduce chronic stress and promote health.

As an example, back in the 1970s, the residents of San Luis Obispo, Calif., started making changes to their city to promote well-being instead of commercialism. They closed one of their main thoroughfares to create a central plaza for people to gather and festivals to be held. They built large bike lanes and sidewalks, limited the size of signs, deliberately created accessible green space, and banned fast-food restaurants. Today, residents of San Luis Obispo enjoy some of the highest well-being in the country.

Other communities are also starting to transform their environments to make them less stressful and more healthful. Brownsville, Texas, recently rehabilitated old train tracks into an enjoyable trail to run, hike, and bike. Durham, N.C., has opened up streets and created bike lanes to increase physical activity and social connectedness, improve access to healthy foods and health care, improve education, and reduce unemployment. And Williamson, W.Va., has developed programs to promote healthy restaurants, community gardens, and outdoor tourism.

So if these cities did it, why can’t others?  What does it take to create a less stressful and healthier community?

Positive change requires invested leadership and collective action. Collaboration between local policy-makers and community organizations to begin improving environments is key: City or town officials, urban planners, public health officials, and even health care systems can work alongside community members to design neighborhoods that promote routine activity and social connection. State and national governments and organizations can bolster these efforts via financial incentives as well as with information and organizational support.

Imagine transforming communities across America into ones that mitigate stress and promote health. Instead of awakening to car horns, we might open our bedroom windows in the morning to breathe fresh air and hear people chatting. Perhaps it is a priority for one community that the majority of residents may easily walk or bike to work, school, or the market, making physical activity a routine part of the day. Or maybe it is getting residents into common spaces to allow more interaction, fostering friendships, tolerance, and trust, that would matter most. Or it may be that a community would most immediately benefit from better access to healthier foods, space for community gardening, or green space.

To start galvanizing community change, resources are available to guide the process. Communities should choose action items that are important to them and then track what is and what is not working—and share those lessons learned!  If communities across our nation analyze and disseminate the outcomes of these proactive transformations, we can all better understand what works where and why. Then one community may learn from and inspire another to create lasting, meaningful, positive change that allows more residents to live a lower stress, more healthful life. So, how would you start transforming your community?

Tags: Built environment, Clinical Scholars, Environmental health, Health Burden of Stress, Healthy communities, Human Capital, Voices from the Field