The Built Environment and Health

by Isatu Crosby on February 20, 2014

Town of Roxbury, MA

Where you live can impact your health. To some, this may be old news, but to many the detrimental results of the poor construction of one’s physical living environment are shocking. The U.S. Department of Human Services’s Healthy People 2010 defines the built environment, as it relates to health, as “all the physical, chemical, and biological factors external to a person, and all the related behaviors.” On a daily basis, we constantly interact with our environment. These interactions impact our quality of life and contribute to socioeconomic and sociocultural variance in health outcomes. Healthy People 2020 states that approximately 25% of all deaths and total disease burden can be traced back to environmental factors, including the built environment and nutritional deficiencies. It is from variations in the physical construction of a community’s living space, from the number of supermarkets in the neighborhood to the availability of green space for recreational activities that lead to the ethnic/racial health disparities we see today between communities.

One of the most cited consequences of living in an inadequate built environment, the human modified places where we live, work, play, shop etc. is overweight and obesity. The ways in which we construct our environment influences our lifestyles and in turn contributes to increased rates of overweight and obesity. In general, research finds that primarily middle-aged, female, low socioeconomic status, ethnic minority women living in particular neighborhoods are more likely to be obese or overweight. African American and non-white Hispanic individuals are at highest risk.

Although overweight and obesity are due in part to genetics, research has repeatedly shown that the rapidly increasing morbidity rates are due to more than one’s inherited factors. Individuals at risk of being overweight or obese or who currently suffer from overweight or obesity are at greater risk of cardiovascular problems, type 2 diabetes, various types of cancers, and psychosocial problems. Many African American and Hispanic neighborhoods lack the resources they need to adequately fulfill their nutritional requirements. These neighborhoods are often low-income communities that have limited or no access to full service grocery stores or supermarkets. In fact, nationally, approximately 50% of black neighborhoods lack this service. It is evident that there is an unequal distribution of healthy foods, open spaces, and nutritional resources within cities, and it is important to address these issues and work toward resolving them.

In Boston alone, Roxbury has some of the highest rates of obesity, directly linked to the community’s deficiencies in the built environment in terms of nutritional resources. Approximately 27% of the adult population in Roxbury is obese compared to only 21% for Boston overall (BPHC, 2011). As some of the consequences to these increased rates of obesity, Roxbury also reports increased average annual rates for heart disease hospitalizations (14.7%) and for diabetes related hospitalizations (4.7%), compared to Boston’s overall average rates of 11.2% and 2.3% respectively. According to the Health of Boston 2011-2012 report, Roxbury’s community assets include one supermarket, one grocery store, and 20 small convenience stores. As a result, individuals are primarily provided with the inexpensive, low quality, unhealthy foods that contribute to these increased levels of obesity.

It is clear that change is needed, and implementing this change is indeed possible. Public health workers need to focus on creating communities that are conscious of environmental health impacts such as those experienced by the Roxbury community. We need to provide communities such as this with the tools they need to achieve, or at least work toward sustainable development. Improving a community’s built environment should be and must be a priority in the social fight to eliminate health inequity.



Boston Public Health Commission. (2013). Health of Boston 2012-2013: A neighborhood focus. Retrieved from <…/HOB12…/HOB12-13_FullReport.pdf>

Roxbury Community Alliance for Health, The Boston Public Health Commission, and The Boston Alliance for Community Health. “2009 Health of Roxbury Report.” Boston Public Health Commission. N.p., May 2010. Web. 20 Sept. 2013. <>.

Saarlos, D., Kim, J.E., and Timmermans, H. (2009). The built environment: Introducing individual space-time behavior. International journal of environmental research and public health, 6, 1724-1743. doi: 10.3390/ijerph6061724

Smedley, B., Jeffries, M., Adelman, L., and Cheng, J. (2007). Race, racial inequality and health inequities: Separating myth from fact.


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