A community's design has a big impact on the health of children and teens living there, from the air they breathe to whether they can walk safely to school or eat nutritious foods. Policies that have driven community design have led to health disparities by limiting access to safe places to live, learn, work and play.
In an updated policy statement, "The Built Environment and Pediatric Health," the American Academy of Pediatrics (AAP) describes the impact of community design on child health, and how pediatricians and policy makers can advocate and partner with communities to improve it.
What is the built environment?
The statement and an accompanying technical report, published in the January 2024 Pediatrics, describe the "built environment" as human-made structures such as buildings, parks and roads.
"Pediatricians and policymakers can take steps, large and small, toward community design solutions that have great potential to reduce the prevalence of obesity, allergies, asthma and mental health disorders and improve child health equity," said Michelle J. White, MD, MPH, FAAP, co-author of the policy statement.
"For pediatricians counseling patients, this begins with an understanding of how their recommendations are achievable within the context of the communities where they reside," Dr. White said. "For instance, a pediatrician counseling a family on providing nutritious meals might share information about a local food pantry or other community resources."
The AAP Council on Environmental Health and Climate Change and the AAP Section on Minority Health, Equity, and Inclusion wrote both the statement and technical report, which update guidance last provided in 2009.
Healthier communities by design
The AAP offers recommendations for the health care sector and pediatricians, as well as for government and planning organizations. These include:
Counsel families about active transportation. Where available, encourage participation in local programs that promote walking or cycling safely to school.
Advocate for shared-use agreements between schools and other organizations with recreational facilities, particularly in areas where safe recreational spaces are sparse, limiting opportunities for physical activity.
Design, implement, and maintain complete streets that include traffic calming measures, support safe walking and bicycling, accessibility and safety for individuals with disabilities, and equitable access to efficient public transit.
Promote equitable access to healthy, affordable food by incentivizing grocery stores, farmers markets, and community gardens in low-income communities.
Incorporate community perspectives (including children and youth) into community planning decisions, including zoning, transportation, and housing and in the design and ongoing evaluation of shared spaces for recreation and play.
Health equity and the built environment
"The COVID-19 pandemic revealed the extent to which inequities are related to the built environment, with some communities more harshly impacted by grocery store closures, affordable housing shortages and decreased access to healthcare," Dr. White said.
"Moving forward, it's important that we support economic investment that offers lasting improvements in the health of our children, our communities and our climate."
Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.