ral
Environmental Health: A Global
ssBioMed Cent
Access Science Source
Open Acce
Review
Obesity, physical activity, and the urban environment: public health
research needs
Russell P Lopez* and H Patricia Hynes
Address: Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Talbot 2E, Boston MA 02118, USA
Email: Russell P Lopez* - rptlopez@bu.edu; H Patricia Hynes - hph@bu.edu
* Corresponding author
Abstract
Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built
environment, physical activity, and overweight. Much of the focus of this research has been on the
design and form of suburbs. It suggests that several features of the suburban built environment such
as low densities, poor street connectivity and the lack of sidewalks are associated with decreased
physical activity and an increased risk of being overweight. But compared to suburban residents,
inner city populations have higher rates of obesity and inactivity despite living in neighborhoods that
are dense, have excellent street connectivity and who's streets are almost universally lined with
sidewalks.
We suggest that the reasons for this apparent paradox are rooted in the complex interaction of
land use, infrastructure and social factors affecting inner city populations. Sometimes seemingly
similar features are the result of very different processes, necessitating different policy responses
to meet these challenges. For example, in suburbs, lower densities can result from government
decision making that leads to restrictive zoning and land use issues. In the inner city, densities may
be lowered because of abandonment and disinvestment. In the suburbs, changes in land use
regulations could result in a healthier built environment. In inner cities, increasing densities will
depend on reversing economic trends and investment decisions that have systematically resulted
in distressed housing, abandoned buildings and vacant lots.
These varying issues need to be further studied in the context of the totality of urban
environments, incorporating what has been learned from other disciplines, such as economics and
sociology, as well as highlighting some of the more successful inner city policy interventions, which
may provide examples for communities working to improve their health.
Certain disparities among urban and suburban populations in obesity and overweight, physical
activity and research focus have emerged that are timely to address. Comparable research on the
relationship of built environment and health is needed for urban, especially inner city,
neighborhoods.
Published: 18 September 2006
Environmental Health: A Global Access Science Source 2006, 5:25 doi:10.1186/1476-069X-5-
25
Received: 24 May 2006
Accepted: 18 September 2006
This article is available from: http://www.ehjournal.net/content/5/1/25
© 2006 Lopez and Hynes; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 10
(page number not for citation purposes)

Environmental Health: A Global Access Science Source 2006, 5:25 http://www.ehjournal.net/content/5/1/25
Background
Persistent trends in overweight and obesity among adults
and children in the United States have alarmed health care
clinicians and public health practitioners. This heightened
concern has yielded a rapid research effort focused
strongly on the built environment, physical activity, and
overweight. While much of this research is still in its
infancy, certain disparities in obesity and overweight,
physical activity, and research focus have emerged that are
important to address.
This paper examines racial/ethnic disparities in obesity
and physical activity. It then summarizes the current state
of research on the built environment and health, which
has been predominately suburban in focus. Next it
explores the urban form – health relationship in the con-
text of inner city environments. The paper then presents a
paradox: research would predict that people of color and
low income individuals would have lower obesity rates
and higher physical activity rates because they live in
neighborhoods that promote healthier life styles. But con-
trary to what theory would predict, these populations are
less likely to be physically active and more likely to be
obese. The paper explores the reasons for this paradox. It
draws from and augments the framework of factors iden-
tified in studies of primarily suburban residential neigh-
borhoods in order to pose a set of research questions
concerning the nexus of built environment and public
health in inner-city communities. We link conditions of
the urban built environment to co-related social factors,
including poverty, income inequality, racial segregation
and economic isolation. These interlinked factors may
necessitate research on more holistic and multi-sector
public health policy responses and interventions in order
to improve minority health impacted by the built envi-
ronment of the inner city.
Disparities in Obesity and Overweight and
Physical Activity
US surveys including the Behavioral Risk Factor Surveil-
lance System (BRFSS) and the National Health and Nutri-
tion Examination Survey (NHANES) reveal that inner-city
residents are more overweight, less physically active, and
less healthy overall than the general population. Moreo-
ver, they suffer higher rates of diseases associated with
obesity, namely diabetes and cardiovascular disease [1].
Data from the National Health Interview Survey (1997–
1998) found that men living in center cities were more
likely to be obese (39.4%) than suburban men (35.5%).
Similarly, 20.6% of center city dwelling women were
obese vs. 19.1% of suburban dwelling women [2]. Urban-
suburban differences in physical activity were found
among all adults with the urban propensity for inactivity
The initial flux of built environment and health research
culminated in a series of articles in joint editions of the
American Journal of Public Health and the American Jour-
nal of Health Promotion in 2003 [4,5]. The research
hypotheses examined the role of sprawl, dependence on
the car, and the design and form of suburbs on physical
activity and overweight. The resultant findings were
largely suburban in focus. The role of urban environment
factors in overweight, physical inactivity and poor health
of urban and minority residents has been less studied [6].
Contextualizing research on overweight, physical activity
and the urban built environment within the reality of
political, social and demographic inequality of inner cities
has yet to be done.
Built Environment and Health: What Have We
Learned?
Studies on sprawl and public health have found that
increased levels of sprawl are associated with increased
obesity, decreased physical activity [7,8] and poorer
health [9,10], including the risk of motor vehicle and
pedestrian fatalities [11]. While studies on sprawl and
obesity have tended to control for race, ethnicity and
other individual factors, none has distinguished between
effects of sprawl on inner city and suburban populations.
Evidence is mounting that the design and form of many,
if not most, U.S. suburbs contribute to the growing preva-
lence of obesity and overweight among children and
adults. Certain features of the built environment – such as
the presence of sidewalks, streetlights, interconnectivity of
streets, population density and use mix – appear to
encourage physical activity and thus reduce the risk of
obesity and related health problems. Other factors – such
as cul de sacs, lack of parks, high speed traffic and auto-
mobile focused transport – may function to discourage
activity and ultimately increase obesity risk [12]. Studies
find that people who live close to parks are more likely to
use them and to be physically active than those who live
farther from them [13]. Neighborhoods with a mixture of
land use types including commercial, industrial, residen-
tial and office, also appear to promote physical activity
[14], while neighborhoods consisting exclusively of hous-
ing seem to dampen physical activity [15].
The built environment can affect social connectivity,
motivating and stimulating interaction with others, and
increasing people's trust in society and government. Alter-
natively, it can discourage connections with neighbors,
reduce social capital, and foster a distrust of neighbors
and government [16].
An Urban-Suburban ParadoxPage 2 of 10
(page number not for citation purposes)
greatest among low income people [3]. Given a built environment in many US inner cities and
urban neighborhoods that includes sidewalks and mixed

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land uses; that offers parks, playgrounds and public trans-
portation; and that has a traditional gridded street pattern
(small blocks with streets at right angles to each other)
which fosters connectivity, we might expect that rates of
physical activity and trends in obesity would be more
favorable in inner city neighborhoods. But there appears
instead a paradox whereby obesity, physical inactivity and
associated diseases of diabetes and cardiovascular disease,
are more prevalent among inner-city residents than
among suburbanites. Some, if not much, of this discrep-
ancy may be explained by other documented health risks
such as the stress of poverty, racism, and violence; dis-
crimination in health services; food insecurity; and so on.
We propose that other factors of the urban built and phys-
ical environment may undermine the positive potential
for being physically active in inner cities, even though
urban form may, in principle, facilitate being active. We
hypothesize that many factors of the environment in
inner cities – including built, physical and social factors –
may exert a net negative influence on the health of inner
city residents and that it may be mediated in ways that are
different or function differently from those in suburban
neighborhoods. These factors and conditions include
problem land use issues, such as waste sites; infrastructure
maintenance and investment issues; and social realities,
such as neighborhood crime, that can result in a neighbor-
hood environment where outdoor exercise and recreation
are risky or unappealing and are, thus, avoided (Table 1).
Research on the impediments to physical activity in inner
cities is needed to determine what barriers urban neigh-
borhoods share with suburban neighborhoods and what
barriers are unique to inner cities. Better understanding of
the potential interaction between social and built envi-
ronment factors would allow for a more fine-grained
examination of the role of the built environment on the
health of inner city residents. Further, research is needed
to determine if a different set of design and policy
responses are called for in inner cities than those aimed at
reducing the obstacles to physical activity in the suburban
built environment.
The issues raised in this paper are not all inclusive; nor are
they always exclusive to the inner-city. They are discussed
here in order to stimulate increased debate and more tar-
geted research that may ultimately assist inner-city popu-
lations.
Land Use Issues
The loss of commercial and industrial employers in cities
has increased the physical distance between inner city res-
idents and available jobs [17]. At one time, US metropol-
itan areas had strong downtown commercial districts
surrounded by dense residential areas with industrial
areas also close to worker housing. But decades of de-
industrialization and suburbanization have resulted in a
large transfer of jobs away from inner city neighborhoods
towards suburban employment centers [18,19]. The result
is that inner city communities are no longer close to
employment opportunities, a phenomenon that econo-
mists characterize as "spatial mismatch" [20]. One conse-
quence of this mismatch is that fewer inner city residents
can walk or take local public transportation to work. They
have long commutes, particularly the significant numbers
that do not own cars, which ultimately could leave them
little free time to be physically active or to socialize with
their neighbors. To a great extent, this mismatch is not the
result of zoning or government land use decisions that
separate land uses in suburban areas. Rather it is the result
of disinvestment and job loss in inner cities that has also
contributed to the impoverishment of inner city govern-
ments and residents. Many of these economic changes
have also resulted in a "loss of place" in that neighbor-
hoods take on a tooth-gapped appearance with empty
Table 1: A taxonomy of urban environmental issues
Type of issues Representative risk factors Potential pathways of effect
Land use issues
Business and job loss Lengthens commutes, reduces walking
Proximity of toxic facilities Pollution may discourage outdoor activities
Lack of supermarkets May be more difficult to access healthy diets
Abandoned buildings Reduces density, increases crime
Vacant lots Increases crime, discourages walking
Infrastructure, maintenance and
service issues
Sidewalks and street trees Lack of pedestrian amenities discourages walking
Lighting Fear of crime keeps people indoors
Transit projects Lack of transit makes people more dependent on driving
Social environment issues
Poverty and income inequality Poor areas suffer from disinvestment
Racial segregation May promote "redlining", the denial of loans to certain communitiesPage 3 of 10
(page number not for citation purposes)
Crime Unsafe areas may result in less physical activity, lower overall health status

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storefronts, abandoned buildings and vacant lots [21],
likely making them less attractive for walking or for chil-
dren playing outside.
In suburbs, solutions to the problem of special mismatch
might include zoning reform and design guideline
changes to allow mixed use development and encourage
the development of office and commercial properties
close to residential areas [22]. Inner city remedies, on the
other hand, may require a different set of policy solutions,
such as renewed investment in inner city neighborhoods,
greater training and educational opportunities to increase
skill match with existing jobs, and aggressive redevelop-
ment of brownfields (contaminated urban parcels) for
commercial/industrial development. Case studies and
evaluation research of inner city neighborhood and
brownfield redevelopment would help answer the ques-
tion of whether and how resident physical activity is
impacted by economic and neighborhood revitalization,
and would garner lessons from neighborhood develop-
ment models that are conducive to walking and other
forms of physical exercise.
Of the non-residential land uses remaining in inner cities,
many may well discourage walking and physical activity.
Numerous studies have documented that hazardous
waste facilities and factories that are required to report
their toxic releases to the federal government (i.e., larger
facilities) are disproportionately located in poor neigh-
borhoods and communities of color [23]. An early study
in Houston showed that solid waste dumps were more
likely to be found in Black neighborhoods [24]. Toxic
facilities in Los Angeles are more likely to be sited in
minority and working class communities than in more
affluent, white neighborhoods of the city [25]. A recent
study of hazardous and solid waste sites, power plants,
and polluting industrial facilities in Massachusetts cities
and towns, found that low income communities were
cumulatively exposed to environmentally hazardous facil-
ities and sites at four times the rate of high income com-
munities. For high minority communities, the rate was
twenty times that of low minority communities [26].
Comparative studies of inner-city neighborhoods by
health factors, such as exercise and prevalence of over-
weight, and by environmental factors, such as density and
type, size, and proximity of polluting facility, would help
identify the impact of local polluting facilities on resi-
dents' physical activity and overweight.
Coinciding with the health risk of physical inactivity in
inner cities is the reality of food insecurity. Many older
inner-city neighborhoods no longer have a local supply of
fresh, healthful food and they often lack transportation
more likely to sell low quality, non-fresh food and have
higher prices, a situation that would contribute to poorer
nutrition and lower health status [28]. The separation of
residential areas from commercial services and goods,
such as large supermarkets in inner cities, is not the result
of intentional zoning policy as in suburbs; rather it is a
consequence of social and economic trends, including
business flight, that have impoverished older urban
neighborhoods. Studies of diet and nutrition among
inner city residents need to include research on the preva-
lence of, proximity to, and transportation access to large
supermarkets, as well as comparisons of price and food
quality between urban and suburban food markets.
Decades of racial change, segregation, economic disin-
vestment and discriminatory lending and insurance prac-
tices have resulted in a severe reduction of the housing
stock in many urban communities, often accompanied by
new construction in distant areas [29]. The social effect of
abandonment has been termed "the broken window syn-
drome": Neighborhoods with broken windows and dilap-
idated housing encourage crime, pose safety hazards,
isolate residents and reduce trust in the ability of the
neighborhood to meet its challenges [30]. One study has
linked these factors of neighborhood quality to the risk of
acquiring sexually transmitted diseases [31]. Another con-
sequence of this constellation of risks from a moldering
environment would likely be reduced walking, physical
activity and recreation in public.
Comparative studies of building conditions, rates of chil-
dren's play out-of-doors and resident walking could reveal
a relationship between residential conditions and physi-
cal activity. Poor built environment conditions beg the
research question: What is the relationship between build-
ing condition, building tenancy, building abandonment
and rates of physical activity and obesity?
Even when abandoned buildings are demolished, the
resulting vacant land poses problems to the environment
[32]. If untended, these lots usually become overgrown
with weeds and covered with litter, an invitation for illegal
dumping (including demolition and construction debris,
hazardous chemicals and medical wastes), and foster
criminal activity. Does vacancy contribute to less walking,
playing, and other physical activity in the affected neigh-
borhood? This question, like its companion regarding
abandoned housing, has yet to be examined.
If low density is a factor implicated in physical inactivity
as some have posited it is important for policy implica-
tions to distinguish between lower density neighbor-
hoods caused by abandonment and those resulting fromPage 4 of 10
(page number not for citation purposes)
access to more remote supermarkets [27]. Supermarkets
are less likely to locate in inner cities and small stores are
zoning and land use decisions. While the latter is the
intentional result of government decision-making, the

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former is a consequence of a more complex mixture of
forces that include public and private sector lending and
insurance practices as well as social relations among races
in the United States. Solutions, which have centered
around increased investment, elimination of discrimina-
tory lending practices and the creation of new, beneficial
land uses in inner city communities, such as side lot dis-
position programs, community gardens, and housing
rehabilitation [33], ought to be evaluated for their poten-
tial impact on multiple forms of physical activity, such as
more time spent outdoors in walking, gardening, biking,
and so on.
Infrastructure, maintenance and service issues
The social context of the inner city environment, specifi-
cally inequity, can affect the quality of infrastructure and
how new improvements are planned and implemented
[34]. standardized tests over time for recreation, is result-
ing in less gym and recess in the school day. Cyclic decay
in urban parks and playgrounds has rendered some of
them un-useable and dangerous havens for criminal activ-
ity. The net effect is to reduce the utility of local recrea-
tional facilities for many inner city residents and reduce
opportunities for social interaction. These factors will
only be addressed by a change in government priority and
investment and by social mobilizing to preserve, maintain
and enhance physical activity opportunities. Evaluation
research is needed on the community health benefits of
restoring degraded parks and playgrounds with regular
recreational opportunities for children and adults in order
to support the lobby for more public investment in parks
and playgrounds.
The authors are familiar with programs that have restored
inner city schoolyard environments. The Boston School-
yard Initiative (BSI) is a creative example of private-public
partnership that has restored 60 Boston public school
playgrounds for recreation and play using community col-
laborative design [35]. While none of the renovated
schoolyards has been evaluated for change in physical
activity by amount or kind, the BSI does intend to meas-
ure activity change in students using a set of validated
questionnaires and observational tools.
A Harlem Hospital physician who documented the
increase in child injury on debilitated school and parks
department playgrounds and a gardener for the New York
City Department of Parks and Recreation developed a col-
laborative venture called The Greening of Harlem. They
renovated numerous school playgrounds, turning them
from cracked and jagged concrete and blacktop surfaces
with broken metal play equipment into safe and creative
performance and play spaces with vegetable and flower
projects and programs that are desperately needed and
inherently challenging to accomplish.
A related series of observational studies of the built and
natural environment in Chicago public housing, one of
the starkest of urban built environments, found that
greater numbers of people gathered in outdoor spaces
with trees than in those without trees [37], the distance to
each being equal. A companion study of Chicago public
housing play space found that children in highly vege-
tated spaces played more (by a factor of two) than chil-
dren in non-vegetated areas, and that they played more
creatively and interacted more with adults [38]. These
studies raise the question of the role and value of trees,
vegetation and nearby nature in inner cities in promoting
physical activity and play. Is their presence sufficient? Are
factors such as their condition and maintenance and their
proportion to the recreational space important in their
effect of promoting play and activity?
Over decades, unimproved sidewalks decay as utility
crews dig up concrete, tree roots push up paved areas, and
weather erodes surfaces. Many cities lack the resources to
repave or replace sidewalks as frequently as needed; and
many urban neighborhoods lack the political clout to
have their sidewalks prioritized for repair or reconstruc-
tion. As a result, urban neighborhoods frequently have
broken or impassable pedestrian sidewalks. While sharply
contrasting with the problem of no sidewalks in many
suburban communities, broken sidewalks in inner cities
likely have a similar outcome, less leisure walking [39].
Sidewalk replacement and repair in city neighborhoods
provides an opportunity to study the question of whether
passable sidewalks result in more local walking.
Street trees, along with other pedestrian amenities, have
been found to be a promoting factor in physical activity
[40]. In many urban areas, street canopies are disappear-
ing as disease, age, and lack of maintenance of new trees,
slowly reduce the number of trees. When cities suffer fiscal
constraints, the budgets of parks and recreation depart-
ments are generally the first to be cut; and replacement of
urban street becomes a low priority. Further, evidence sug-
gests that trees are more likely to be replaced in higher
income communities than in neighborhoods with more
poor households and people of color [41].
Solutions to the decay of street and sidewalk infrastructure
depend on improving the fiscal environment of inner cit-
ies [42]. Unless center cities have access to adequate capi-
tal and operating funds, the physical environment will
continue to decay. This decline in infrastructure is more
likely to be concentrated in poor and minority neighbor-Page 5 of 10
(page number not for citation purposes)
gardens [36]. Evaluation of inner-city interventions is
often sacrificed because scarce resources are spent on
hoods and has been documented for a wide range of serv-
ices including fire stations and hospitals [43,44].

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Traffic lights can both improve and inhibit pedestrian
activity. When they are well timed and placed to reduce
traffic flows and improve pedestrian safety, they may
encourage physical activity and social interaction. But
when they are timed to improve traffic speeds or are miss-
ing, they can discourage pedestrian activity [45]. Bus shel-
ters, public transportation and "traffic calming" can be a
net boon to pedestrian activity. Conversely, intersections
engineered for cars, increased speeds in residential and
commercial areas, and even large parking lots can result in
local people spending less time outdoors and doing less
physical activity [46]. Older cities are increasingly being
redeveloped with the same engineering standards of
newer, automobile focused suburbs rather than in keep-
ing with older, pedestrian-oriented communities. The
new roads and parking facilities do not promote physical
activity in the way older streets once did [47]. Policy
research on redevelopment in inner cities could examine
and reconcile the transportation design in inner city re-
development with emerging pedestrian-friendly design
guidelines for suburban development.
Transportation improvements, like other types of infra-
structure investments, take place in the context of political
and social decision making. To the extent that poor inner
city neighborhoods lack the ability to make their transpor-
tation needs a political priority, they can suffer from a
decline in services or a lack of access to new or existing
improvements. In Los Angeles, the Metropolitan Transit
Authority shifted investments to commuter rail and large
subway lines that served more affluent communities to
the detriment of the buses that had traditionally provided
services to lower income neighborhoods [48]. In Boston,
new suburban rail lines that will serve up to 5000 passen-
gers per day have received more funding than new public
transport for inner city communities designed to serve
50,000, even when investments were promised and owed
to inner city residents as replacement for the 20 year loss
of a pre-existing subway [49]. Increasing transportation
options for inner city residents, who are often the most
transit dependent population and less likely than subur-
banites to own cars, needs to be made at least as high a pri-
ority as suburban transportation investment. Research on
the impacts of local and regional transportation invest-
ments on physical activity and health will add evidence to
support more equitable transportation policy.
Federal highway construction that mushroomed together
with the suburban housing boom after World War II
bifurcated many older communities and devastated oth-
ers. In numerous metropolitan areas, neighborhoods with
large numbers of minorities, poor and working class were
specifically targeted for new highways that connected
state land taking under the power of eminent domain;
and the new highways functioned as physical barriers
within neighborhoods for those without a car. Miami's
Overtown neighborhood was devastated – churches
demolished, commercial districts destroyed and residen-
tial areas literally severed from each other – by the con-
struction of Interstate 95 [50]. Similarly, New Orleans's
black community suffered from highway construction
with neighborhood institutions destroyed, affordable
housing lost and residents displaced [51]. Wherever cities
make major transportation infrastructure changes, studies
of local populations are vital to document the impact on
their physical mobility and activity, their stress level and
quality of life.
Social Environment Issues
Both low income and increased income inequality have
been found to be associated with a decrease in physical
activity and an increased likelihood of poor health
[52,53]. Living in economic isolation, that is a neighbor-
hood with a high percentage of low income people, has
also been found to be a risk factor for poor health [54].
People with low incomes likely have less time to be phys-
ically active because they are working multiple jobs, and
because they are more likely to be concentrated in neigh-
borhoods without the amenities (or with deteriorated
amenities) found in more affluent communities [55].
Likewise, income inequality, which has been increasing
since the early 1970s [56], may result in poor communi-
ties having fewer recreational resources and ones of lower
quality than would be the case where income inequality is
less extreme. Assessing and addressing the burdens of ine-
quality, which fall most heavily on the poor and near
poor, can only help to improve the health of inner city res-
idents. Results can help identify underserved neighbor-
hoods and prioritizing them for physical activity
intervention programs.
Residential racial segregation, the physical separation of
people based on skin color or ethnic origin, has declined
slightly from its peak in the 1950s but continues to be a
substantial problem in many metropolitan areas [57].
Interestingly, the greater the Black-White segregation, the
more likely all residents, both Black and White, are to be
physically inactive or otherwise unhealthy [58]. Segrega-
tion has also been found to influence the impact of infec-
tious diseases, reducing overall health status and further
decreasing physical activity levels [59]. Segregation has
also been linked to increased air pollution, potentially
increasing risk to cardiovascular and respiratory health
[60]. Higher levels of segregation are linked with
increased exposure to violence, less time outdoors and an
overall increase in the allostatic load, that is the sum of illPage 6 of 10
(page number not for citation purposes)
expanding suburbs with existing downtowns. Neighbor-
hood businesses and affordable housing were razed by
health, as a result of increased stress [61]. Increased stress,
when sustained over time, is known to have immune

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related consequences and to increase the risk of cardiovas-
cular disease and other health problems [62]. Additional
research is needed regarding the impact of segregation on
rates of physical activity, obesity and access to recreational
resources and nutritious food.
Crime and the fear of crime are a reality in many inner city
communities. Crime erodes community trust, marginal-
izes residents, and further stresses people and the environ-
ment [63]. Fear of crime is likely to keep people indoors,
particularly the old and the young, and discourage physi-
cal activity. Results from a recent asthma research project
in one of Boston's most distressed public housing devel-
opments, which had also experienced a series of murders
in or near the development, revealed that 63 % of those
interviewed were afraid of violence in the neighborhood
and 60% did not allow their children to play outside
because of neighborhood violence. This was a signifi-
cantly higher response when compared with residents of
housing developments in other neighborhoods, which
had not experienced the wave of violent crime [64].
Increasing physical activity among inner city people may
hinge significantly on increasing people's sense of neigh-
borhood security. Many research questions arise here:
Does change in local crime rates affect change in rates of
local physical activity? Do positive neighborhood activi-
ties, such as community gardens, park cleaning, and crime
watch, result in changed rates of crime, leisure walking,
socializing, playing outdoors, and more walking trips to
local destination points such as library, stores, and so on?
Discussion
Given the overall burden of poverty, discrimination and
prevalence of crime in many older inner-city neighbor-
hoods, it is no surprise that health status is lower in these
communities. Built environment also may play a role in
poor health, by discouraging physical activity, recreation,
and social interaction and by limiting access to nutritious
food. Problems in the built environment may interact
with and compound other social and health issues and
thus magnify the community health effects [65]. The chal-
lenge is to identify the nature and extent of the activity-
and health-related built environment factors in inner-city
neighborhoods – many of which have been studied in
suburbs – and also to create new measures of the built
environment that incorporate the unique social and phys-
ical characteristics of urban inner city environments [66].
Improving the built environment in inner cities was cru-
cial before the recent public health awareness of the corre-
lation between built environment and obesity with its
health-related diseases. However, policy initiatives that
ments in inner city health [67]. Some policies, such as bet-
ter designs that encourage mixed use development and
traffic calming [68], may be applicable in both suburb
and city, especially in the context of urban re-develop-
ment. In fact, these design policies prevailed in original
inner city master plans. However, other needed interven-
tions are unique to urban cores. These include: investment
in inner city development that also builds social capital,
prioritizing brownfield redevelopment, renewing efforts
to reduce racial segregation and economic isolation, and
addressing the trend in income inequality in cities [69].
Government policies on urban renewal and redevelop-
ment have had the historical effect of displacing and iso-
lating people of color and reducing their ability to move
to healthier communities, a consequence of which is
severe health disparities between people of color and oth-
ers [70, 71].
Studies of the impact of sprawl on inner cities need to be
designed to identify specific effects on urban form and res-
ident physical activity, as has been done for metropolitan
areas and suburbs [72,73]. In addition, community-based
initiatives that can incorporate the energy and experience
of inner city residents, and the special knowledge of com-
munity based institutions are needed to assure that inter-
ventions and policy initiatives are effective in identifying
solutions to the epidemic of obesity and related chronic
disease in inner cities [74,75].
Effective research on urban areas must involve the people
and communities being studied. Community-based Par-
ticipatory Research (CBPR) provides a framework for
researchers interested in the urban built environment.
Briefly, the CBPR principles that should guide research
include: neighborhoods should have input into the types
of issues being studied as well as study design; researchers
should take care to communicate the results of these stud-
ies back to the neighborhoods where the research took
place; and studied communities should benefit from
research [76]. Using the expertise of residents can energize
research and neighborhood change. Research on inner
city communities has sometimes been seen as problem-
atic in these neighborhoods with problems ranging from
inappropriate burdens on time placed on already overbur-
dened individuals and institutions to research that
bypasses local residents all together. Consultation with
local residents can help researchers better target their
research and help find the right balance between involve-
ment and resource use.
Issues of scale and neighborhood definition complicate
efforts to research and intervene on the urban environ-
ment. Neighborhood definitions can be fluid, and even aPage 7 of 10
(page number not for citation purposes)
reduce barriers to physical activity in middle class and
affluent suburbs do not assuredly translate to improve-
given individual's concept of neighborhood can vary over
time, place or issue. Furthermore, neighborhoods do not

Environmental Health: A Global Access Science Source 2006, 5:25 http://www.ehjournal.net/content/5/1/25
exist in isolation but are subunits of larger city, county,
metropolitan, state, national or even transnational enti-
ties. Given the enormous potential impact of these other
scales, it is important to study the effects of neighborhood
in context. In practice, this may necessitate using multi-
level modeling or other techniques to fully capture local
and regional effects. In any case, researchers should be
explicit on their definitions of neighborhood and clearly
state the type of urban/suburban environment that is
being studied.
It is also important to remember that the current condi-
tions in a neighborhood reflect past policies, conditions
and events. Individuals and institutions sometimes carry
a memory of the past and sometimes neighborhoods
undergoing demographic change may no longer carry an
understanding of history. As part of the process of study-
ing or improving communities, researchers can help
neighborhoods learn the historical precedents of contem-
porary environments as well as utilize the knowledge of
current residents, particularly elders, to develop a more
thorough understanding of a neighborhood's history.
Gathering oral histories, searches of archival databases
(including public records), focus groups, or detailed ques-
tionnaires targeting key individuals can assist in these
efforts.
Studies of built environment – health interactions repre-
sent a reconnection of the intersection of public health
and urban planning. But these are not the only disciplines
that should be included in this line of research. To fully
utilize the potential of the built environment to better the
health of urban communities, it will be necessary to con-
sult economists, sociologists, anthropologists, education
specialists, among others. Landscape architects, urban his-
torians, traffic engineers and botanists all should be
involved in the effort to study and improve urban envi-
ronments. Multidisciplinary teams and transdisciplinary
research are best for addressing the multi-dimensional
issues confronting our urban areas.
Conclusion
Recent research on the health impacts of the built envi-
ronment has led to a better understanding of how con-
temporary land use planning may influence physical
activity, obesity and related chronic diseases. Much of the
focus of this research has been on suburban development
design and form. Comparable research on the relation-
ship of the built environment and health is needed for
urban, especially inner city, neighborhoods. The research
should be designed to include the web of social and polit-
ical factors that contribute to the conditions of the built
environment of inner cities, if the consequent solutions
Competing interests
The author(s) declare that they have no competing inter-
ests.
Authors' contributions
Both authors helped to draft the manuscript. Both authors
read and approved the final manuscript.
Acknowledgements
This publication was made possible in part by grant number 3 R25
ES012084-03S1 from the National Institute of Environmental Health Sci-
ences (NIEHS), NIH. Its contents are solely the responsibility of the authors
and do not necessarily represent the official views of the NIEHS, NIH.
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