Health Effects of the Built Environment

Richard J. Jackson, Los Angeles, CA

ABSTRACT: Codes Red, White and Blue
We are confronting absolutely urgent threats. The time for action is upon us.

The first thing we learn at the hospital is Codes. Code Blue is when someone is dying. Code Red is a fire or a trauma, a natural disaster. Code White is a pediatric medical emergency. I think we are dealing with Codes Red, White and Blue.”

Code Blue: A ten year old boy comes into the doctor’s office for a physical exam. He is 95th percentile for weight, his blood sugar and cholesterol are too high, he shows signs of depression. He is sent to an overweight clinic – nothing changes. Two months later, the child is on $400 worth of medications.

25 years ago no State had more than 15% of its adults obese. Today, no State is less than 20%. And 6 states are over 30%. We have seen a tripling of obesity in teenagers since I was a young pediatrician, a quadrupling of young school age children. Being obese raises many risks, but most profound is the risk of diabetes. We are setting ourselves up for heart disease, lung disease and a whole lot of problems by the weight we are taking on.

Part of the problem is that we have medicalized the problems that children are confronting. We have medicine trying to deal with poor structures. The environment has been rigged against our children, and it has been rigged against the doctors and the people who try to take care of the problem.

Code white is a natural disaster: the melting of the glacial ice caps. Atmospheric levels of CO2 on planet earth in my lifetime have gone from about 300 parts per million to 385 parts per million. Any doctor who ignored a patient who was retaining this much CO2 would be guilty of malpractice.

Code red: death rates by car crashes in various cities across the US. If the whole country had the same fatality rate as New York we would save 24,000 lives per year. So you need to combine good urban spaces with good public transportation and good walkability. If the whole country had Atlanta’s fatality rate we would kill 15,000 more people per year. How you build things has huge implications.

The Academy of Pediatrics has issued a statement that children need to grow up in communities that promote physical activity so that they can engage the world and have increasing autonomy. We have to change the American consciousness. The focus at this conference on creating places for children is absolutely what we need to be doing. Kids need to go back to walking and biking to school. It means redesigning communities, it means getting out of school buses, it means small local schools and a whole series of changes. When you put together safe routes to school, sidewalks, crosswalks, walking school buses, it means social engagement, it means engaged parents, engaged principles, engaged PTA. It does work.

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