City parks and sidewalks play a role in health disparities
This article first appeared in the St. Louis Beacon, Nov. 7, 2010 - With plenty of trails for walking and jogging, biking and rollerblading, Forest Park stands out as one of the nation's largest urban green spaces for recreation. It's also safe and well-maintained, factors that explain why people find it an inviting, carefree place for putting their hearts and limbs through robust exercise.
But a research team from St. Louis and Washington universities found a different story when it surveyed conditions in many other area parks, particularly those in the city. The team looked at equipment, such as tennis courts, goal posts, slides and bike trails; it also reviewed physical disorder, such as garbage and graffiti. More than half of city parks were in the highest third for physical disorder, and only about 21 percent were in the highest third for good equipment, according to one of the researchers.
One researcher, Cheryl Kelly of the School of Public Health at Saint Louis University, also was the lead researcher for a separate St. Louis study, which looked at walkability issues, such as uneven sidewalks and other problems that may discourage people from walking for exercise in the city.
Although walking is viewed as an inexpensive way to exercise, it turned out to be much harder to do in black neighborhoods because their built environments did not support walking for recreation or transportation. Her study found that African Americans wanting to walk for exercise were a lot more likely to encounter uneven sidewalks, obstructions and physical disorder.
Kelly is not surprised by the state of some urban parks or sidewalks, but she is still alarmed because the numbers tell her a lot about other conditions in the neighborhoods. Like many other public-health experts, Kelly says broken-down park equipment and poorly maintained sidewalks give residents an excuse not to use them for exercise. That in turn could mean people are getting less physical activity in general, which Kelly says is a factor associated with health disparities, such as obesity and some chronic diseases and conditions.
Many public health practitioners say society needs to pay more attention to how environmental factors -- such as no safe places for exercise -- contribute to disease and focus, too, on making parks and sidewalks more attractive places for residents to exercise.
This issue may seem remote to those St. Louisans who get their exercise in safe and secure places, such as Forest Park, but it's in everybody's interest to promote physical activity to help prevent disorders, such as diabetes, says Julie Willems Van Dijk, a scientist at the University of Wisconsin's Population Health Institute. She says society has moral reasons to be concerned, along with the fact that unhealthy people and neighborhoods do not make for strong communities.
Beyond those reasons, she adds, are the higher costs, direct or indirect, to subsidize health care associated with such illnesses as diabetes.
"This issue is important to middle-class people," Van Dijk says. "Poor people are more likely to be on Medicaid and supported by tax dollars."
Just last week, the Centers for Disease Control and Prevention issued a projection on the rapid spread of diabetes and the cost. It said one in 10 adults now has diabetes, and that in four decades the number might increase to as many as one in three. The CDC study says the current cost of addressing diabetes is $174 billion a year, including $116 billion in direct medical expenses. Getting a handle on obesity is crucial because it can reduce diabetes. The disease, beyond the costs, causes a great deal of suffering with patients having to deal with amputated limbs, kidney disease, failing eyesight, heart attacks and strokes.
Debra Haire-Joshu of the Brown School of Social Work at Washington University says researchers began taking a closer look at the connection between disease and environment as Americans began developing diabetes and complications at younger ages.
"We started seeing disparities in certain racial and economic groups," she said. "It became clear that all this was preventable."
She realized as much as she began to look beyond the clinical setting to the natural environment, trying to understand where people lived, how that influenced what they ate and their other activities. Even if people were informed enough to know what to do, "they were in an environment that fought against them doing that," she says.
She adds that, "If someone lived in an area where there's high crime, broken sidewalks or no sidewalks at all, if the parks are in poor shape, then it's very difficult to be active because there are safety issues and concerns."
Last Sunday afternoon seemed like an ideal time for walking in O'Fallon Park. Except for one thing -- some people might have felt uneasy about using the walking path. Occupying it was a stray dog, a mixed pit bull, who probably was less menacing than she looked. Another section of the trail was controlled by a woman and child using the path as a race track for their go-cart. Likely both the go-cart riders and the animal would have politely stepped aside for walkers, but the presence of these two elements probably gave people disincentives for using the trail for walking.
In spite of the conditions of parks on the north side, there are places where residents can find safe places to exercise. One is the Monsanto YMCA, where Dr. Consuelo Wilkins, an associate professor at Washington University Medical School, hosts a popular physical education program for what is said to be the largest group of African-American elderly in the nation. Wilkins smiles when she says the program is for the elderly who assumed that getting old automatically meant they had to endure a lot of pain.
Her goal, she says, is to show these older adults that aging and illness don't have to go hand in hand. She's helping them learn that they can remain fit and independent and deal with health conditions that their bodies might have begun developing during a time when medical services were segregated and inequitable. The program is called CARE, which stands for Collaborative Assessments to Revitalize the Elderly.
The Y's membership fees range from $40 for individuals to $54 for a full family membership, but the agency says many members get subsidies. The agency offers one of the best, if not the best, exercise equipment and pool for residents living north of Delmar. Membership exceeds 4,000, Y officials say.
In addition to the Y, groups such as Trailnet sponsor many activities to make it possible for residents in underserved communities to get exercise in safe environments. One example is its Open Streets event earlier this month in the Old North St. Louis area. Trailnet was instrumental in getting the city to pass the first Complete Streets policy in St. Louis. The policy says the city must take into consideration all users -- the elderly, children, walkers and bickers as well as automobile users -- when it designs, builds or maintains a roadway.
Cindy Mense, director of community development at Trailnet, adds that St. Louisans can do much to revive north side parks that are shunned because they are perceived as being unsafe or in poor shape.
"People aren't going to feel safe if other people aren't out there," she says. "What's likely to bring people out is how clean it (the park) is and if you have programs and events to engage people."
An example, she says is Ivory Perry Park, which many St. Louisans might have perceived as unsafe at one time. Yet this park is one place where local artists, such as Denise Thimes and Kim Massie, host summer concerts that draw diverse groups of people.
"People start seeing things differently when you have programs and events," Mense says. The more a park is used for events, the more the perception about safety goes up. But if it's abandoned, the trail is empty and there's a stray dog running around, nobody's going to go there."
This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.
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