Environmental Interventions to Help Address the Obesity and Asthma Epidemics in Children

I. INTRODUCTION Childhood obesity and asthma rates in the United States have soared over the past three decades, raising both human suffering and economic health costs for today's children and the adults they will become. While the causes of these increases are complex and not yet fully understood, research indicates that environmental factors related to the built environment (1) may play a significant role, with poor community design and transportation systems that discourage physical activity contributing to obesity, and roadside air pollution contributing to asthma. Although reversing these epidemics will require interventions in many different arenas, a critical part of the solution will be addressing the negative impacts of the built environment on children's health. A number of policies currently under consideration can provide benefits to children's health while also reducing greenhouse gas emissions and other environmental ills. Promoting policies that encourage opportunities for physical activity, reduce air pollution, and improve land use and transportation choices can create a healthier environment for children. Strengthening air quality standards can similarly protect youth, a particularly sensitive subpopulation. Funding federal research and supporting health impact assessments can also have a positive effect on our understanding of the link between health outcomes and the environment. These strategies and practices cannot by themselves prevent the incidence and severity of childhood obesity and asthma, but they can help address these epidemics and evaluate the effectiveness of current interventions. Improving the built environment can make a substantial difference in children's quality of life and the economic and social costs associated with children's health care. II. THE ROLE OF THE BUILT ENVIRONMENT IN THE CHILDHOOD OBESITY EPIDEMIC Numerous studies in the last few decades have shown a profound increase in childhood obesity. The Institute of Medicine of the National Academies recently reported that obesity rates in the last thirty years have nearly tripled among children ages two to five and twelve to ninteen years. (2) During the same period, obesity rates have more than quadrupled among children ages six to eleven years. (3) Today, one in every three American children is obese or at risk of becoming so. (4) Obesity-related illnesses, such as diabetes, asthma, sleep apnea, and 'gallbladder disease, have also risen sharply among children in the past few decades, causing the number, length, and economic cost of hospital stays for children with obesity and obesity-related diseases to accelerate. (5) According to a 2002 study published by the medical journal Pediatrics, the total days of care required by patients ages six to seventeen with obesity-related illnesses more than doubled over a twenty-year period, increasing from 152,000 days in 1979-1981 to 310,000 days in 1997-1999. (6) During the same time frame, the proportion of hospital costs dedicated to these patients jumped nearly fourfold from 0.43 percent (or $35 million) in 1979-1981 to 1.7 percent (or $127 million) in 1997-1999. (7) The rising costs associated with obesity are felt not only by hospitals, but also by families and schools; which experience great strain due to medical bills, student absences, and disrupted daily routines. Although a combination of factors contributes to this obesity epidemic, one significant cause for its prevalence is physical inactivity among American youth. Increasing obesity rates demonstrate that fewer children are achieving a healthy balance between the calories they consume and the calories they expend. (8) Partially responsible for this imbalance are decreasing opportunities for physical activity in schools and the popularity of sedentary entertainment, such as video games, computers, and television, but a variety of built environment factors also keep children from exercising. …