For example, a recent review of studies from the late 1990s to mid-2000s found a consistent inverse relationship between airborne particulate matter and birth weight in Australia, Brazil, Canada, France, Italy, the Netherlands, South Korea, the United Kingdom, and the United States ( Parker et al., 2011a). The effects of particulate matter on mortality appear to be consistent across countries. Research has identified specific physiologic mechanisms by which these exposures affect inflammatory, autonomic, and vascular processes ( Brook et al., 2010 Tzivian, 2011). A large body of work has documented the effects of exposure to particulate matter (solid particles and liquid droplets found in the air) on cardiovascular and respiratory mortality and morbidity ( Brook et al., 2010 Laumbach and Kipen, 2012 Mustafić et al., 2012 Tzivian, 2011). The environment can affect health through physical exposures, such as air pollution ( OECD, 2012b). The factors in the physical environment that are important to health include harmful substances, such as air pollution or proximity to toxic sites (the focus of classic environmental epidemiology) access to various health-related resources (e.g., healthy or unhealthy foods, recreational resources, medical care) and community design and the “built environment” (e.g., land use mix, street connectivity, transportation systems). This chapter, like others before it, focuses on three questions: This chapter focuses on both the physical and social environment in the United States as potential contributors to its health disadvantage relative to other high-income countries. These reinforcing processes by which environmental factors and individual-, family-, and community-level factors reinforce each other over time may also play an important role in generating cross-national differences in health. ![]() Thus, individual and environmental factors may be part of a reinforcing cycle that creates and perpetuates health differences. ![]() Moreover, environmental factors linked to space and place may in turn contribute to and reinforce socioeconomic and racial or ethnic health disparities ( Bleich et al., 2012 Laveist et al., 2011). This evidence suggests that broad environmental factors may play an important role in health. However, evidence suggests that regional and neighborhood differences in health persist even after adjusting for these socioeconomic and demographic factors ( Diez Roux and Mair, 2010 Mair et al., 2008 Paczkowski and Galea, 2010 Pickett and Pearl, 2001). A key contender is the spatial sorting of people based on their socioeconomic position, race, or ethnicity. Several factors may explain the strong spatial patterns that are observed within countries. Understanding the reasons for the spatial patterns of health within countries may shed light on environmental factors that may contribute to differences across countries. Strong spatial variation is present for a large range of health outcomes, including many of the outcomes for which there are cross-national health differences, such as noncommunicable diseases, associated risk factors, injuries, and violence. These patterns are present across countries and across regions within countries, as well as at smaller scales, such as across urban neighborhoods ( Center on Human Needs, 2012b Kawachi and Subramanian, 2007). Indeed, a major motivation for the research on environmental determinants of health has been the repeated observation that many health outcomes are spatially patterned. Thus, they are key candidates as explanatory factors for health differences across geographic areas, such as countries. These economic, social, urban or rural, transportation, and other policies that affect the environment were not traditionally thought of as relevant to health policy but are now attracting greater attention because decision makers are beginning to recognize their health implications ( Cole and Fielding, 2007).īy definition, environmental factors affect large groups that share common living or working spaces. In contrast with traditional environmental health approaches that focus primarily on toxic substances in air, water, and soil, this more recent approach conceptualizes the environment more broadly to encompass a range of human-made physical and social features that are affected by public policy ( Frumkin, 2005). health disadvantage, but it has been increasingly recognized that these health determinants cannot be fully understood (or influenced) in isolation from the environmental contexts that shape and sustain them. ![]() The previous chapters of this report focused on health systems and individual and household-level risks that might explain the U.S.
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