Medical Geography, The built environment

Question 1

Introduction

Answer 1

-Place matters in this instance as this involves the contextual factors of each area such as air quality and the level of health care available in the area. So therefore place would have a large effect on the health of someone. (Castellini et al.)

Question 2

Water quality

Answer 2

• In the Victorian era, public health was synonymous with improvements in the built environments typically to combat infectious diseases.
• John snow identified mode of transmission of cholera
  1) Maps helped support his evidence
  2) Clustering of deaths around one particular pump near a sewage network.
• Changes to sewage networks alleviated the problem of cholera
• Diarrhoea most common water borne disease globally (1.8million deaths per year)
• Schistomias, parasisitc worms enter the body. WHO estimated 257 million at risk.
• Flint, Michigan changed its water source in 2014 from Lake Huron to save money, lead pipes led to lead poisoning in children.

Question 3

Air quality

Answer 3

• 5.3% of all deaths in England associated with long term exposure of particle matter
• Vehicle exhaust emissions, distance decay effect from road, children within 3m of road exposed to 80% of th e chemicals.
• Not just overall patterns but localised events, e.g. Bhopal, India in 1984 had a chemical leak of methyl locynate and hydrogen cyanide
  1) 2000 dead within 24hrs
  2) 15 weeks later 38% burning eyes
  3) 3 months later 39% respiratory problems
  4) 10 years on severe respiratory problems, rise in miscarriages

Question 4

Air quality (part 2)

Answer 4

• The 5% estimate makes air pollution the largest environmental risk linked to deaths every year (Vardoulakis,S. 2015)
• Long term exposure to particulate air pollution has an effect equivalent to around 25,000 deaths (Vardoulakis,S.2015)
• Evidence started to emerge that small particles emitted to the air form of various sources such as road transport, industry, agriculture and domestic fires were still a considerable effect on health (Vardoulakis,S.2015)
• If you live by a busy main road, or near a site disposing of hazardous waste, you may be more at risk of illness than others who do not. (Gatrell,A and Elliot,S.)
• Poverty tends to cluster in the east due to westerly gales blowing pollution over to the East. (TheGuardian.2017)
• Houses therefore cheaper in the east and the poor have no choice but to live there as economically they can’t afford to move elsewhere.

Question 5

Green space

Answer 5

• Mitchell and Popham, 2008. Found that people with greater exposure to green space had a Lower mortality rate.
• Therapeutic landscapes, landscapes with reputations for physical, mental or spiritual healing.
• The idea of therapeutic landscapes, this is the type of place that have achieved long lasting reputations for providing physical, mental and spiritual healing (Kearns and Gesler. 1988)
• These reputations may be built upon the qualities of the physical environment that these areas posses such as clean, air or clean water.

Question 6

Noise Pollution

Answer 6

• Living in noisy areas can be damaging to health
• Associated with elevated blood pressure over long periods of time.
• Hansell, 2012. Found higher rates of cadiovascular diseases associated with people living by the effects of noise from Heathrow, in particular night time noise.

Question 7

Housing

Answer 7

• Overcrowding facillitates the spread of disease
• Maintaining a warm house important for body temperature, functioning and encourages some health conditions to exist.
• People with more money can afford a bigger house with a larger garden a more space, however the poor living in absolute poverty in areas such as a shanty town like Roccinha in Brazil where homes are packed on top of each other in conditions where disease can spread quickly.

Question 8

Walkability

Answer 8

• Walkability on neighbourhoods- the design of built environment to be pedestrian friendly that encourages residents to walk.
• Evidence that adults tend to be more physically active when the live in higher density, mixed use neighbourhoods with destinations such as shops and parks within walking distance (Sallis,JF. Et al. 2016)
• Services within 1KM such as retail shops and services provide frequently used destinations that stimulate regular walking. Therefore stimulates some form of exercise. (Sallis,JF.Et al.2016)
• Design of urban environments has the potential to contribute nearly 90min/week of physical activity, which is 60% of the 150min/week recommended in physical activity guidelines (Sallis,JF. Et Al.2016)
• These potentially large effects of built environments were reported to apply similarly across ten diverse countries, indicating that urban design should be globally relevant to public health priority. (Sallis,JF. Et al.2016)
• Features of a walkable environment:
  1) High residential densities
  2) Mixed land use
  3) Connected street networks
  4) Aesthetics
  5) Perception of crime in the area

Question 9

Obesogenic neighbourhoods

Answer 9

• The sum of influences that the surroundings, opportunities or conditions of life have on prompting obesity in individuals or populations
• Obesity not just based on biology or behaviours but on the wider environment.
• Recent studies have shown, that dietary patterns and obesity rates vary between neighbourhoods, with living in a low income or deprived area associated with the prevalence of obesity and the consumption of a poor diet. (Cummins,S.2005)
• Poorer neighbourhoods have 2.5 times more fast food outlets in Melbourne Australia (Cummins,S.2005)

Question 10

Obesogenic neighbourhoods

Answer 10

• Correlations between obesity rates and the prevalence of fast food outlets have been found for U.S states and account for 6% of the variance in obesity (Cummins,S.2005)
• Poorer neighbourhoods tend to have more access to fast food and more advertisement for unhealthy foods in their regions (Cummins,S.2010)
• Studies in the U.S and Canada have shown neighbourhood differences in the price and availability of food, with healthier foods generally more expensive and less readily available in poorer communities. (Cummins,S.2005)

Question 11

Fast food

Answer 11

• Neighbourhood food environment
• Burgoine, 2014. Individuals who (A) lived (B) worked (C) commuted through areas with high density of fast food outlets consumed higher amounts of fast food and subsequently had higher BMI’s
• Work environment can be the largest influencer, time element the key.
• People who live near the areas consumed 15% more fast food each day.
• Policy engagement, Waltham Forest in 2009 banned new planning applications of hot food takeaway restaurants within 400m of the school, youth facility or park.
• Food deserts, geographical areas with no or poor access to healthier foods. This can be in the case of there being no shops.
• 65% more energy dense than the average diet (Cummins,S.2005)

Question 12

Alcohol

Answer 12

• Accessibility to alocohol outlets also important; on trade (alcohol purchased and consumed on site e.g. pubs) and off trade (alcohol purchased but consumed away from premise e.g. off licenses, supermarkets)
• On trade- strongest association with assaults
• Off trade- strongest association to acute and chronic health now
• Number of pubs drastically falling since 1980.

Question 13

Tobacco

Answer 13

• Shortt et al, 2016. Greater density of tobacco outlets associated with higher odds of adolescents smoking (similar for adults)
• Luke et al, 2000:
  1) Not just simply or accessibility but also advertising
  2) Tobacco advertising is banned in neighbourhoods now but didn’t used to be
  3) effective and heap way at reaching customers
  4) Strategic locations, found in poorer neighbourhoods.