The Topography of Wellness: Mechanisms, Metrics, and Models of Health in the Urban Landscape

Abstract

Within the past 10 years there has been a rapid growth in studies addressing the link between the built environment's relationship to physical activity and chronic disease. However, even in a time of rapidly expanding spatial data, researchers still struggle with how best to measure the built environment within this context. In the past, disease mapping and an etiologic approach to public health often led to the elimination of entire neighborhoods (and the relocation of vulnerable populations within). Today, the origins of these "man-made" illnesses are often a confluence of genetic, biologic, and small-scale environmental factors, exacerbated by today's urban landscape--an environment that is in no way accidental. Through the lens of current research on walkable neighborhoods and an eye towards health equity, this dissertation examines larger questions regarding both the historical and present relationship between urban landscape and health. To begin to address these complex interactions not only between individuals and neighborhoods, but between parts of the built environment itself, this research also proposes an alternative model for built environment measurement that maps multiple opportunities and barriers to well-being in the urban landscape. Studies still often rely on coarse measures such as density and land use to judge the walkability of a neighborhood, and often neglect more nuanced features of the built environment. The promised effectiveness of "walkable neighborhoods" also still relies on certain foundational concepts that proved to be pitfalls in past movements focused on health and the built environment. Proponents of walkable environments advocate for a one-size-fits-all framework of the influence of the built environment. This overlooks the fact that vulnerable populations, such as the elderly and youth, tend to feel the effects of the environment more acutely, or that low-income populations don't have the same amount of leisure time available for physical activity. Another is the premise that all can choose to live in a neighborhood deemed healthy, a confounder often referred to as "self-selection" in the literature--a premise that is disconnected from today's economic landscape. It is also unclear how the plethora of research on built environment and physical activity will become realized while avoiding the mistakes of past movements centered surrounding health. This dissertation traces the historical and theoretical foundations of health and the built environment to the current state, as well as possible implications of contemporary study. Using lessons learned from a case study of how active design research has become policy in Sacramento, California, I propose a flexible model of built environment measurement for chronic disease outcomes. These multiple mappings of the city can reveal where risk of illness and opportunities for well-being lie in the built environment for focused and thoughtful interventions.

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