Q&A: What's the 'built environment?'

Civic leaders are sizing up their transit systems, trails and parks to make sure their neighborhoods encourage residents to get moving. It's not enough to give a community green space, health experts say residents need to feel comfortable using it. Changing the “built environment” to promote physical activity is part of a national plan to combat childhood obesity.

Health reporter Taunya English spoke with built environment expert Richard Killingsworth. He is deputy director at Nemours Health and Prevention Services and studies how community design affects health and the physical activity choices people make.

What's the problem?
We've had a rapid expansion of obesity. Not just for adults but for children as well, much of that, we believe, is connected to the way we've designed our communities and how we travel. In essence, we have designed for convenience instead of activity.

What's the 'built environment?'
It's buildings, it's streets, it's sidewalks. It's how communities are laid out to accommodate the decisions we make, not only how we travel from destination to destination, but whether we are physically active.

The U.S. now has a National Physical Activity Plan and one strategy is to support transportation and land use decisions that enhance choices for people to be more physically activity.

How's Philadelphia doing?
Philadelphia is built on infrastructure that clearly supports decisions to walk or bicycle. It has sidewalks, a fairly robust transit system, but the overall network is largely designed for the convenience of people traveling in cars. We've largely designed for one mode of travel versus healthier modes of travel – walking, bicycling, and transit.

The next step is to get people thinking about alternative choices that will lead them to be more active. One example is getting parents thinking about their children walking to school. Often community design, traffic, and perceptions of crime are barriers, but all could be resolved through community action.

What keeps Philadelphians from walking and biking more?
The common barriers in most large cities are safety and proximity. People wonder: 'Is it safe for me to get out and be active?' The reality might be that most places are safe, but the perception for many is that be outside or walking in unfamiliar areas will expose them to crime. Often that's not the case but that might be the perception.

How do you dethrone the car as king?
We are challenging planning organizations and engineers to design in ways that minimize traffic congestion and increase opportunities for active transportation and living. The idea is to create an environment where — from the time you walk out the door of home, work or school — the message of the environment is: “You can be active here. You can be safe here, You can be healthy here.”

But Americans don't like to walk, do we?
Outside of places like Seattle, New York and San Francisco, a quarter mile – about three to five city blocks — is the threshold for how far the average American feels comfortable walking to do something, such as errands. For the most part, Americans have adopted the idea that walking is mainly for recreation, not transportation.

That suggests a need to market walking opportunities differently and to create very compact neighborhoods where services and amenities are close by. It's getting back to the idea of a village built around a local economy and resources.

For decades, we've designed our environment around the car drive; a convenient drive is about 15 minutes. So in many towns, you can find a dry cleaner or grocery store 15 minutes away in any direction. Think about how things could change and improve if that orientation were based on a 15-minute walk.

So what's the answer?
There are many solutions. Health care and public health need to have a greater presence in community and city planning. The initial call to action is for health providers and health care organizations – such as hospitals — to take on a stronger leadership role on this issue. It could be one of the most important health promotion strategies of our time. It is important for health providers to be at the table with urban planners, transportation engineers, architects, and others to discuss solutions to the design challenges before us.