THE BUILT ENVIRONMENT AND CHILDREN'S HEALTH

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The quality and design of a child's physical environment can cause or prevent illness, disability, and injury; therefore, a high-quality environment is essential for children to achieve optimal health and development. Although pediatricians are accustomed to thinking about health hazards from toxic exposures, much less attention has been given to the potential for adverse effects from “built environments,” such as poor-quality housing and haphazard land use, transportation, and community planning. In fact, children spend little time in natural environments compared with the time they spend indoors and in neighborhoods.

As children grow and mature, the scope of their environment predictably expands from the womb to the wider community to the broadest reach of the planet. The child's built environment is a central factor in this progression. Known and newly emerging diseases are linked to risk factors within the built environment, including injuries, lead poisoning, and the current epidemics of asthma and obesity. Building and land-use policies can undermine or promote safety, health, and optimal development while preserving future resources. This newly evolving field is ripe for future research. Pediatric advocates who can speak out effectively for children's needs within this broad arena are needed urgently. This article reviews and summarizes the negative and positive impact of the built environment on children's health.

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OBESITY, ASTHMA, AND INJURY

Childhood obesity and asthma have increased dramatically in the past 2 decades21, 26, 92 and are exacerbated by factors in the modern built environment. In addition, recent reductions in childhood injury are linked directly to the introduction of safety measures to housing construction and community and roadway planning. This section summarizes the trends in occurrence of these diseases and their links to risk factors in the built environment.

Obesity is an important predictor of pediatric

HOME AND SCHOOL

Faulty construction or neglected maintenance are the primary causes of structural hazards in homes and schools. Faulty construction leads to building defects that increase the likelihood of structural hazards and fires, which in turn increase the risk for falls, burns, and other injuries. These defects also lead to inadequate ventilation and moisture accumulation; both factors increase the levels of asthma triggers in the home.38, 52 Poor ventilation, especially of tightly sealed homes, can

CHILDHOOD LEAD POISONING

No children's environmental health problem is associated more closely with the condition of the home environment than childhood lead poisoning. Over the last 30 years, there has been a sustained effort to eliminate this disease. This effort is a model for broader programs to address the child health consequences of substandard housing. This section summarizes the epidemiology of childhood lead poisoning and the recent efforts to eliminate it.

Lead is a systemic toxicant to children and adults

FROM HEALTHY HOME TO HEALTHY COMMUNITY

Quality land-use planning and urban design protect human health and quality of life and preserve essential natural resources, such as open space, forests, and clean drinking-water supplies. With the projected doubling of the US population over the next century,4 protection of water sources, underground and surface water (lakes and rivers), is no longer solely an aesthetic issue but a crucial health-protection need as well.

Forests sustain the planet because they provide shade and cooling and

RESEARCH NEEDS

There are still few researchers documenting the damage to health caused by poor neighborhood design. For example, although we know that exercise helps to control weight and people walk more in cities designed to encourage walking, there is no research evaluating whether approaches to urban design that promote walking reduce overweight. Only limited research has evaluated whether transportation planning and efforts to reduce automobile use actually lower exacerbations of asthma. The scope of

SUSTAINING HEALTHY COMMUNITIES INTO THE FUTURE

When considering the range of issues encompassed by the interaction of children and their environment, two worlds come in to play: (1) the tangible world the child is touching, tasting, and experiencing daily and (2) the future world into which the child is growing. Ensuring that a child's proximate world is safe is straightforward through actions such as covering electrical outlets and putting toxic chemicals out of reach.

This same mindfulness must be brought to a child's whole world, right

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    National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA

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