In addition to physiologic and physical stress, discrimination directly impacts health through violence. Hate crimes against marginalized groups have occurred throughout our nation’s history and continue to occur today. Marginalized groups experience violence at significantly higher rates than The built environment—which consists of quality of housing; crime and violence; systems that provide water and electricity; recreational spaces; and infrastructure such as roads, bridges, and transportation systems—is a primary determinant of health (U.S. Environmental Protection Agency, 2024). Understanding how a community is defined or described can be helpful when assessing needs, prioritizing resource allocation, and implementing health promotion initiatives. Communities may be described or defined according to geography or location on a map. Other communities may be defined by the personal characteristics of a group. These are referred to as aggregate populations. For example, parents of disabled children or those diagnosed with breast cancer may consider themselves part of an aggregate population. As a healthcare provider, it is essential to understand a community’s defining characteristics and ability to provide safe drinking water; clean air; transportation; access to health services; and safe places to live, work, and play for its residents. Neighborhoods can have a significant impact on the health and well-being of the people who live in them. People who live in areas with unsafe water and/or air, high violence rates, and/or reduced access to transportation are more likely to experience poor health outcomes compared with people who live in areas without these issues. Low- income populations and racial/ethnic minorities experience these risks at higher rates. Government interventions must occur at the local, state, and federal levels to create neighborhoods that promote safety and health (Office of Disease Prevention and Health Promotion, n.d.). Where people live is one of the most significant indicators of health, with life expectancy varying by up to 20 years between zip codes in the same city. People who do not have access to adequate affordable housing experience significant health inequities. Housing instability and low-quality housing can impact the health of children by increasing the risk of respiratory diseases and developmental disorders, in addition to increasing the risk of preterm birth and low birth weight. Educational performance can be impacted as well, with poor quality housing being correlated with more missed school days and reduced school readiness, which can last even after housing improves. Iff Access to reliable public transportation can also impact health. Public bus and train lines can facilitate access to economic opportunities, impacting health through improved financial situations. Sidewalks and bike lanes can allow residents to safely exercise and travel using inexpensive modes of transportation. Public transportation to grocery stores can help people make healthy food choices. Areas considered to be long distances away from healthy food options, known as food deserts, can benefit from farmers markets to increase the availability of fruits and vegetables. In addition to housing and transportation, it is imperative to recognize the impact of toxins, whether in food, water, or air. Harmful environmental conditions such as pest infestation, lead exposure, and inadequate ventilation can lead to poor health outcomes, including infectious diseases, neurological damage, and chronic health conditions. Effects can be seen in general populations but may be more significant
their peers. Threats and injuries against transgender youth are reported at a rate 3.4 times higher than those against cisgender youth. Violence directly harms its victims and creates additional stress for individuals who believe they are at risk of violence (Davis, 2020). in individuals who are more vulnerable because of chronic illnesses such as asthma, renal disease, chronic obstructive pulmonary disease (COPD), and/or compromised immune systems (Johns & Rapfogel, 2023). Black and Hispanic youth are significantly more likely to witness violence and be victimized when compared to white youth. Exposure to violence in the community has adverse effects on behavioral, social, and health outcomes. Neighborhood stressors such as crime and violence have been linked to increased risks of depressive symptoms and psychological distress among youth. Safe, stable, nurturing environments and relationships can help prevent these adverse experiences (Foell et al., 2021). Evidence-Based Practice! Fowler and colleagues (2009) found that up to 60% of children living in urban areas are exposed to violence in their communities. The majority encounter less severe forms of violence, such as drug deals, which are still dangerous, but a substantial portion still face instances of more severe violent crimes such as physical assault and robbery. Repeat exposures to community violence have been found to lead to a variety of behaviors that vary in severity, depending on whether the violence was witnessed or experienced personally and the developmental age of the child. Studies have consistently shown that children and teens with exposure to community violence, abuse, or neglect develop a form of externalizing behavior that manifests as deviant and aggressive behavior; PTSD symptoms; engaging in risky behaviors as teens; and developing health problems as adults, including substance abuse, depression, obesity, and chronic diseases (Fowler et al., 2009). Safe, stable, nurturing environments and relationships can help prevent these adverse experiences. When caring for and interacting with individuals and families, including an environmental assessment that includes an appraisal of housing, social support, and safety can help healthcare providers gain insight into nonmedical issues that impact patients’ health. When working with individuals, whether in an acute care or a community setting, consider routinely asking such questions as: Do you have a steady place to live? Do you have problems with your home such as mold or lack of heat? Has a lack of reliable transportation kept you from medical appointments, work, or getting things you need for daily living? Equally important in making this type of assessment is being prepared to act on responses that require referrals to appropriate interdisciplinary resources. This leads to a discussion about the value of healthcare providers being knowledgeable about community resources. No matter the setting, it is crucial that healthcare providers understand how to access community resources for various vulnerable and at-risk populations. These may include the elderly, children, those living in poverty, the homeless, veterans, and the disabled. Be sure to routinely update contact information for resources that support aging services, food banks, homeless shelters, transportation services, medical services, social services that protect the elderly and children, housing services, and veterans’ benefits. Having a basic understanding of the services that are available in your community and knowing who to
NEIGHBORHOODS AND THE BUILT ENVIRONMENT
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Book Code: MTX1326
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