Physicians and the Built Environment: Out of the Exam Room and Into Healthy Communities

The built environment, or the physical elements of our communities that are shaped and maintained by human effort, affects both our daily choices and the health outcomes of those choices. The way in which our streets, buildings, neighborhoods, and parks are designed either encourages or discourages physical activity and healthy eating. Physicians can make important contributions to advocating for healthier built environments. This study attempts to go beyond sharing stories of successful physician involvement in the communities and provides an analytical framework to define a physician's role in the decision-making process. I conducted a systematic review of literature, a review of current health system and community examples, and semi-structured in-depth interviews with six physicians and three non-physician planners and public officials to identify common themes. Essentially no evidenced-based literature exists on the topic. Physicians have a special credibility and can use it to play a dual role of storyteller and scientific authority when speaking to policymakers. Lack of time and lack of training are the two largest barriers to advocacy work in this field. Several health systems such as accountable care organizations, large group practices, and federally-qualified health centers have promising components to support this support among physicians, but fee-for-service payment methods in their current form will make this work a challenge.Master of Public Healt