grease, toxic chemicals, pesticides and heavy metals. These pollutants end up in streams, rivers and lakes, where they harm fish and wildlife, kill native vegetation, pollute drinking water, and damage recreation areas.26 Sprawl has the potential to expand the heat island effect in urban areas, particularly when development has included road construction and cutting down numerous trees.27 An analysis of the occurrence of extreme heat events (EHE) over decades found that the average number of EHEs each year increased across all cities. However, the rate of increase in EHEs in the most sprawling cities was more than two times greater than for the most compact cities.28 Extreme heat can contribute to fainting, swelling of extremities, cramps, heat exhaustion and heat stroke. Those at greatest risk of heat-related health concerns are seniors, the socially isolated, persons with certain health conditions or on specific medications, and persons living on higher floors of multi-story dwellings.29 In Delaware, projects like Plan4Health and Planners4Health are bringing together planners and health professionals to address obesity and chronic disease by identifying and implementing land use and transportation planning strategies that support healthy lifestyles by improving opportunities for active recreation, active transportation and access to healthy food. The final outputs of both projects have been informed by input from various stakeholders and community members to ensure the strategies fit within the community context. While dense, mixeduse development patterns have been shown to support healthy lifestyle behaviors by increasing walking and biking, this approach is not always feasible or even supported by residents. In some instances, other improvements on a smaller scale are feasible and can garner public support and make an impact. Examples include the addition of bike lanes on wide, low-traffic roads to create an interconnected bike route or the installment of recreational amenities within existing green space adjacent to a residential community. While intended primarily to encourage physical activity, these interventions can positively affect the environment
through lower emissions as increasing numbers of people bicycle and improve mental health as residents engage with other community members in the open space. These serve as examples that development can contribute to improvements across various health outcomes. References
1 Ewing R, Schieber RA, Zegeer CV. Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities. Am J Public Health 2003;93:1541-1545 2 Frumkin H. Urban sprawl and public health. Public Health Reports 2002;117:201-217 3 U.S. Environmental Protection Agency. Our Nation’s Air. Downloaded 12/18/17: https:// gispub.epa.gov/air/trendsreport/2017/#welcome. 4 U.S. Environmental Protection Agency. Air Quality Trends by City, 1990-2016. Downloaded 12/18/17: https://www.epa.gov/air-trends/air-quality-cities-and-counties. 5 American Lung Association. State of the Air 2017. Downloaded 11/22/17: http://www.lung. org/our-initiatives/healthy-air/sota/city-rankings/states/delaware/#show-tabs-2. 6 American Lung Association. The Terrible 10: Air Pollution's Top 10 Health Risks. Downloaded 11/20/17: http://www.lung.org/about-us/blog/2017/04/air-pollutions-top-10health-risks.html 7 Caiazzo F, Ashok A, Waitz IA, Yim SHL, Barrett SRH. Air pollution and early deaths in the United States. Part i: quantifying the impact of major sectors in 2005. Atmospheric Environment 2013;79:198-208 8 Caiazzo F, Ashok A, Waitz IA, Yim SHL, Barrett SRH. Air pollution and early deaths in the United States. Part i: quantifying the impact of major sectors in 2005. Atmospheric Environment 2013;79:198-208 9 American Lung Association. Children and Air Pollution. Downloaded 11/20/17: http://www. lung.org/our-initiatives/healthy-air/outdoor/air-pollution/children-and-air-pollution.html 10 Nemours Health & Prevention Services. 2017. Delaware Survey of Children’s Health: Childhood Asthma in Delaware. Data Brief #1. 11 American Lung Association. Disparities in the Impact of Air Pollution. Downloaded 11/20/17: http://www.lung.org/our-initiatives/healthy-air/outdoor/air-pollution/disparities. html 12 Centers for Disease Control and Prevention. Vital Signs: Motor Vehicle Crash Deaths. Downloaded 12/18/17: https://www.cdc.gov/vitalsigns/motor-vehicle-safety/index.html. 13 Frumkin H. Urban sprawl and public health. Public Health Reports 2002;117:201-217 14 Ewing R, Schieber RA, Zegeer CV. Urban sprawl as a risk factor in motor vehicle occupant and pedestrian fatalities. Am J Public Health 2003;93:1541-1545 15 National Highway Traffic Safety Administration. Traffic Safety Facts. 2017. Downloaded 11/21/17: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812375 16 Smart Growth America. Dangerous by Design 2014 Delaware. Downloaded 11/21/17: https://smartgrowthamerica.org/app/uploads/2016/08/dangerous-by-design-2014delaware.pdf 17 Governors Highway Safety Association. Pedestrian Traffic Fatalities by State: 2016 Preliminary Data. Downloaded 12/14/17: http://www.ghsa.org/sites/default/files/201703/2017ped_FINAL_4.pdf. 18 State of Delaware. Governor Announces Executive Order to Increase Pedestrian Safety and Walkability. Downloaded 11/22/17: https://news.delaware.gov/2015/10/14/governorannounces-executive-order-to-increase-pedestrian-safety-and-walkability/. 19 Centers for Disease Control and Prevention. Facts about Physical Activity. Downloaded 11/20/17: https://www.cdc.gov/physicalactivity/data/facts.htm 20 Centers for Disease Control and Prevention. Current Physical Activity Guidelines. Downloaded 11/22/17: https://www.cdc.gov/cancer/dcpc/prevention/policies_practices/ physical_activity/guidelines.htm. 21 Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med 2004;27(2): 87-96 22 Ewing R, Meakins G, Hamidi S, Nelson AC. Health & Place. 2013;26:118-126 23 Hruby A, Manson JE, Qi L, Malik VS, Rimm EB, Sun Q, Willett WC, Hu FB. Determinants and consequences of obesity. Am J Public Health. 2016;106:1656-1662 24 Frumkin H. Urban sprawl and public health. Public Health Reports. 2002;117:201-217 25 Frumkin H. Urban sprawl and public health. Public Health Reports. 2002;117:201-217 26 U.S. Environmental Protection Agency. Protecting Water Quality from Urban Runoff, 2003. Downloaded 11/20/17: https://www3.epa.gov/npdes/pubs/nps_urban-facts_final.pdf 27 Frumkin H. Urban sprawl and public health. Public Health Reports 2002;117:201-217 28 Stone B, Hess JJ, Frumkin H. Urban form and extreme heat events: are sprawling cities more vulnerable to climate change than compact cities? Environmental Health Perspectives, 2010;118(10):1425-1428 29 Frumkin H. Urban sprawl and public health. Public Health Reports 2002;117:201-217
Patti Miller, M.P.P., is a population health specialist at Nemours Children’s Health System, one of the nation's largest pediatric health systems. In this role, she works to advance policy, systems and environmental changes that promote optimal health and development for all children. She participates on various workgroups and steering committees to represent strategies for incorporating health and equity considerations as part of land use, transportation and recreation planning processes. She also has engaged in Nemours’ injury prevention efforts by spearheading the initiative to reduce pediatric all-terrain vehicle-related injuries by convening a multi-sector coalition, supporting establishment of an ATV safety training program, and advocating for a policy change to strengthen state regulations. Patti holds a bachelor’s degree in economics from the University of Delaware and a master’s degree in public policy from Harvard University’s John F. Kennedy School of Government. 35