How Does the Built Environment Affect Public Health?
Trends show that Tennessee residents who fall below the poverty line are twice as likely to suffer from asthma than those who do not (CDC, 2002). Dr. Amir Alakaam and Graduate Research Assistant Emory Evans from the University of Tennessee Chattanooga's Master in Public Health program recently completed a report in partnership with the Kendeda Fund and green|spaces, reinforcing this fact. They examine the social and economic determinants of health (SDOH) associated with the incidence of chronic diseases in specific Hamilton County zip codes, and provide a review of data and literature that link SDOH to the health and well being of communities.
Scaling Regenerative Design: An Overview of Social Determinants of Health and their Impact on Chronic Diseases in Tennessee compares zip codes 37404 (Highland Park) and 37405 (North Chattanooga), whose residents differ in race, income, and education. Similarly, the rates of chronic disease, including asthma, are higher in 37404 — the neighborhood with lower income, less education, and more people of color.
They conclude that "to reduce poor health outcomes in Tennessee, structural adjustments must be made to lessen the development of chronic diseases and improve health status." An appendix cites several studies examining the association between the built environment and SDOH, health outcomes, and well-being.
The quality of the built environment has a well-documented relationship to the occurrence of asthma. Research suggests that residential factors may trigger up to 40% of asthma symptoms (Krieger, 2010). Rather than trying to fully manage these symptoms through medical care, actions such as mold remediation, air sealing, insulation, duct sealing, and carpet removal can directly address the causes of asthma.
"Adults and children spend 90% of their time inside their homes, where the air quality can be two to five times worse in pollutant concentrations than in outdoor air."
The authors note, "a simple action like...improving ventilation could add years to our life and may improve health outcomes in our communities." They add, "Adults and children spend 90% of their time inside their homes, where the air quality can be two to five times worse in pollutant concentrations than in outdoor air."
Even more alarming, Chattanooga has five of Tennessee's worst ten zip codes for asthma. In 2019, the city ranked 4th in the United States for estimated asthma prevalence and 21st in the top 100 most challenging cities in the United States to live with asthma (AAFA, 2019)
Dr. Alakaam and Evans's research highlights the social determinants associated with chronic disease. However, identifying the SDOH does not solve the lack of access to preventable measures, such as the built environment, reliable healthcare, and food security.
In response, green|spaces piloted two separate programs to address this inequity. In 2019, the Chattanooga Healthy Homes Pilot provided home improvements to 26 patients thanks to the Corporation for National and Community Service (CNCS) funding. green|spaces' Build it Green program and EPB's Home Uplift programs completed the home upgrades. Afterwards, several recipients experienced measurable improvements in their Asthma Control Tests, as reported by the local healthcare provider, LifeSpring Community Health.
Currently, green|spaces is collaborating with Erlanger Health Systems on the Nurse-Family Partnerships program. This is a free program for first-time mothers who receive home visits from a registered nurse through the first two years of a baby's life. green|spaces Build It Green team assesses the family's home, then completes the necessary home upgrades, such as insulation and mold remediation. Licensed contractors are hired to complete the work if the repairs are more advanced. Like the nurse visits, the home upgrades are free of charge. The goal is to ensure the home is safe for both mother and child.
To read the full report, download it for free. In addition, a presentation of Dr. Alakaam's work, in collaboration with Dr. Greg Heath, from green|spaces Regenerative Design Summit, can be viewed below.
Asthma & Allergy Foundation of America. “Asthma Capitals 2019: The Most Challenging Places to Live with Asthma.” 2019
Centers for Disease Control and Prevention. (2022h). PLACES: Local Data for Better Health. Retrieved May 20, 2022 from https://www.cdc.gov/places/
Gonzales, T., & Whalen, E. (2022). Easy breathing: A review of the impact of air quality on pediatric health outcomes. Journal of Pediatric Health Care, 36(1), 57-63.
Krieger, James. "Home is where the triggers are: increasing asthma control by improving the home environment." Pediatric allergy, immunology, and pulmonology 23.2 (2010): 139-145.