For optimum health in an ideal world, we might all live in luxury mansions equipped with a swimming pool, spa, and carriage-house quarters for a personal trainer. Our electric-powered self-driving cars would carry us around town, for sure, but to the gym and juice store, as we burn through the caloric risk of diabetes and obesity.
However, most of us live an increasingly sedentary — and decidedly more downscale — lifestyle with the richer in America getting fitter and the poor getting fatter. The suburbanization of society following World War II, reversing in some areas with gentrification, comes with a systemic dependence on the personal car, meaning far less time walking during the day.
In studying Toronto, investigators found a significant health disparity among city residents based solely on the density of neighborhoods, with those in more walkable areas experiencing a 33 percent lower risk of developing diabetes and obesity. Neighborhoods given monikers such as Bridle-Path Sunnybrook and Morningside belie an urban environment less optimized for human health, with poor public transport and an overreliance on the personal car.
"Although diabetes can be prevented through physical activity, healthy eating, and weight loss, we determined the environment in which one lives is also an important indicator of one's risk," Dr. Gillian Booth, an endocrinologist and researcher with St. Michael's Hospital and co-author of the study, published in the online journal PLoS One Wednesday.
People who live downtown in Toronto in more densely populated neighborhoods near walkable destinations are twice as likely to walk, bike, or take public transportation, whereas those further from amenities were much likelier to drive.
Dr. Rick Glazier, who leads research at the hospital’s department of family and community medicine, says the problem is solvable. "We focused on density and destinations because they're potentially modifiable," he said. "Policy makers, planners, and public health officials can use either of these measures to inform urban design and improve community health."
In the study, the investigatory pair pulled data from Canada’s national census, a national health survey, and an urban transportation survey. The work supports their earlier research showing how residential neighborhoods — signifiers of wealth — are actually determinants of health. Among career findings, the investigators say the rate of diabetes is highest in areas with lower income and higher unemployment, in addition to more racial minorities.
A high prevalence of diabetes in North American society will cost Canada $19.9 billion per year by 2020, while the United States spends $176 billion every year on direct medical costs for some 26 million Americans, according to the American Diabetes Association. Following an announcement on Tuesday, the Preventive Health Services Task Force now recommends that all pregnant women receive a screening for gestational diabetes at 24 weeks of pregnancy.
“The number of women who have gestational diabetes is rising, and gestational diabetes has effects not only on the mother, but also on the baby,” said Dr. Virginia Moyer, vice president for maintenance of certification and quality at the American Board of Pediatrics, a member of the Task Force. “We want to prevent adverse outcomes for both of them.”
Interestingly, the rate of gestational diabetes varies greatly depending on the area of the country, ranging from just one percent to 25 percent of all pregnant women.
Source: Booth G, Glazier R. Living In Densely Populated Neighborhoods Can Actually Decrease Risk Of Diabetes And Obesity. PLoS One. 2014.