DFH

Design For Health

Children, Health and Planning*

When planning for health, children often need additional attention. The following information gives planners some tools to understand children’s specific health issues and how planning can influence them.

Health Issues

  • Children are at greater risk to lead exposure, which leads to hyperactivity, liver and kidney disease, and developmental delays, particularly in low-income households.1,2,3,4
  • Children, along with other specialized groups such as the elderly and low-income people, face greater negative health outcomes related to air pollution.5
    • They are especially susceptible to indoor asthma triggers of mold, mildew, cockroaches and dust mites.6,7,8
    • The younger set often experiences increases in outdoor asthma and other respiratory illnesses due to mobile sources of air pollution, which are often triggered by proximity to highly used roads.9,10,11
  • Children account for 23 percent of the U.S. population, which means that a large share of people potentially face the negative consequences of having poorly met accessibility needs. For example, an inability to access healthy foods or places that encourage physical activity can lead to nutrition and obesity concerns.12

Young people are becoming more obese, which leads to major public-health challenges and rising healthcare costs. Poor nutrition combined with minimum levels of physical activity, can lead to major public-health challenges and healthcare costs related to such chronic diseases and conditions as cardiovascular disease, hypertension, stress, cancer, diabetes, obesity, and anemia.13 Most of these problems are not related to the built environment at the scale of the neighborhood, city or metropolis but rather reflect individual and family characteristics. Some health issues can be influenced by the domain of planning. They include issues related to accessibility, physical activity, food health, safety, and air quality including:

  • Fast-food restaurants tend to cluster around schools.14
  • As mentioned above obesity is a growing concern. Planning has the opportunity to influence this issue through thinking about a series of complimentary issues.
    • Access to healthy foods (grocery stores, community gardens, farmers’ markets) and local production efforts is becoming an increased focus within the field, particularly in relation to land-use decisions and neighborhood planning.
    • Children have different accessibility needs for transportation, which planners consider when thinking about the design of streets and trails to safely accommodate bicyclists and pedestrians. This is at the heart of multimodal planning.
    • There is a variety of ways for young people to get the daily-recommended dose of physical activity. Planners, at various scales (neighborhood, city, and regional), consider whether or not residential areas can access parks and trails. In addition, the Safe Routes to School program works to get kids safely to school through non-motorized planning.
  • Increased levels of overall physical activity have many benefits for children.
    • Walkable environments are likely to have more of an impact among populations who must walk due to age or circumstance. This relates to how land-use, transportation, and urban-design elements of the built environment can support recreational or transportation-related purposes. It is important to note that for a variety of methodological reasons, it is unclear that these strategies raise overall physical activity levels.
    • “Complete streets,” a design strategy that is becoming more popular in the United States, accounts for all modes when planning for streets in order to create a right of way that is safe for all users, not just automobiles.
  • Respiratory illnesses, like certain types of asthma, is linked to both indoor and outdoor air quality.
    • For mitigating the effects of outdoor air pollution, planners often consider the distance between highly-traveled roads and the locations of schools, daycare center, playgrounds, and residential areas.15,16 Research shows that buffers between 200 m and 500 m are recommended distances to support healthy-air consumption.
    • Indoor health concerns, such as lead, mold, mildew, are not typically covered by the planning community; however, the field does use tools, such as building codes and development regulations, to cover such health issues.

DFH Resources

Many of these topics are dealt with in the Key Questions Research Summaries and Planning Information Sheets. These include:

  • The City of Chicago sponsored an ordinance called “Lead Bearing Substances” as outlined in the Environment and Housing Quality Information Sheet on p. 9.
    • The City of San Diego promotes special-population transit accessibility in its Land Use and Community Planning strategies found in the Accessibility Information Sheet, p. 11.
    • Saint John’s County, Florida, promotes bike and pedestrian access to schools through its comprehensive plan policies on p. 12 of the Accessibility Information Sheet.
    • Several cities have used tools such as the Community Food Security Assessment to increase success of children’s and special populations healthy-food access (i.e., School-to Farm programs, community gardens in school yards, farmers’ markets and the WIC program) found in the Food Access Information Sheet, p. 2-4.
  • DFH offers a number of measurement tools and checklists that cover specialized populations like children.

Other Resources

  • Children’s Health Protection 
    Sponsored by the U.S. Environmental Protection Agency (EPA), this Web site has a terrific search feature for looking up publications related to where children live, learn, and play.
  • Guide to Community Preventive Services
    This resource from the Centers for Disease Control and Prevention (CDC) provides a study titled “Community Interventions to Promote Healthy Social Environments: Early Childhood Development and Family Housing,” which gives recommendations from reviews of HUD Section 8 Housing Vouchers, Rental Vouchers and preschool programs based on early childhood development intervention success.
  • Effective Interventions to Tackle Inequalities in Children’s Health
    This London Health Commission report provides a summary of “what works” —or what appears to work—in relation to the aims and interventions proposed in the draft children and young people’s strategy; examines other interventions with strong evidence of effectiveness in reducing inequalities in child health; and identifies where there are gaps in the evidence.

Study Examples  

Please look to the following study examples for further information about children, health and planning:

  • Example: A study of 205 children in Rochester, New York, found that those who were Black, living in a single-parent family and residing in rental housing had higher levels of lead-contaminated house dust and increased lead levels in their blood. Time spent outdoors, which increases the likelihood that children will put soil or dirt in their mouths, also was associated with children’s blood-lead levels.2
  • Example: Lin et al.9 found that children hospitalized for asthma “were more likely to live on roads with the highest tertile of vehicle miles traveled (VMT) within 200 m (656 ft) and were more likely to have trucks and trailers passing by within 200 m (656 ft) of their residence.” These same variables were not significant at the 500 m (1640 ft) level (p. 73).
  • Example: A study of 613 fast-food restaurants and 1,292 schools in Chicago, Illinois, found “three to four times as many fast-food restaurants within 1.5 km (.93 miles) from schools than would be expected if the restaurants were distributed throughout the city in a way unrelated to school locations” (p. 1575).14
  • Example: A cross-national, cross-sectional study of 2,844 children (9 and 11 years old), in schools near three major airports in the Netherlands, Spain, and the United Kingdom looked at the effects of road traffic and air traffic on childhood development. Results showed that chronic noise exposure from aircraft impaired cognitive development. Aircraft noise and traffic noise did not, however, affect sustained attention, self-reported health, or overall mental health.17
  • Example: A cross-sectional study of data of trends in obesity among children aged 2-18 from 1971-2002 challenged previous data on low SES groups having the highest prevalence of obese children, and instead argued there is a “weakening association between SES and overweight.” Policy and planning must, therefore, be targeted at multiple race, ethnicity and SES groups (p. 715).18
  • Example: Ferreira et al.19 (2006) studied the effects of various home-, neighborhood- and school-level influences on physical activity. His findings point to social, policy and environmental factors that affect children and adolescent activity levels. Some of the more important physical factors associated with physical activity included access to facilities (and programs) within neighborhood and low-crime environments (p. 148).

*Special thanks to Amanda Johnson and Ashley Miller for their work creating this resource.

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