Systematic assessment of built environment disparities: The Multnomah County Built Environment Atlas project

Despite increased interest in built environment issues by public health agencies, public health practitioners and the general public have limited experience at evaluating these issues at the local level. Comparative assessment between geographic areas is an important part of this work, because built environment conditions contribute to health disparities between groups. To examine relationships between built environment and health and to demonstrate the variations in conditions within the jurisdiction, the Multnomah County (Oregon) Health Department developed a Built Environment Atlas. We used geographical information systems (GIS) software to aggregate vital statistics, demographic, economic, and land use data to locally meaningful geographic units, ranging from Census tracts in rural areas to neighborhood association coalitions in urban areas. We then produced a series of maps illustrating conditions in these sub-county districts on built environment themes including food access, tree canopy, and opportunities for recreation and active transportation. For each theme, districts were ranked based on the presence of features associated with positive health outcomes, allowing for the identification of areas in need of intervention. The project was facilitated by the existence of a robust local data repository managed by the regional government and the availability of sufficient technical expertise in the Health Department's built environment research group. Technical challenges included designing an atlas useful to both practitioners and laypeople and developing an appropriate dissemination plan. Application challenges included identifying feasible interventions and developing recommendations to suit the diverse types of communities in the County.