COMMENTARY

Safely to school?

The quality and design of a child's physical environment can cause or prevent illness, disability, and injury; therefore, a high-quality environment is essential for children to achieve optimal health and development. Although pediatricians are accustomed to thinking about health hazards from toxic exposures, much less attention has been given to the potential for adverse effects from “built environments,” such as poor-quality housing and haphazard land use, transportation, and community planning. In fact, children spend little time in natural environments compared with the time they spend indoors and in neighborhoods.

As children grow and mature, the scope of their environment predictably expands from the womb to the wider community to the broadest reach of the planet. The child's built environment is a central factor in this progression. Known and newly emerging diseases are linked to risk factors within the built environment, including injuries, lead poisoning, and the current epidemics of asthma and obesity. Building and land-use policies can undermine or promote safety, health, and optimal development while preserving future resources. This newly evolving field is ripe for future research. Pediatric advocates who can speak out effectively for children's needs within this broad arena are needed urgently. This article reviews and summarizes the negative and positive impact of the built environment on children's health.