Sustainable Public Health: Walkable Neighborhoods, Obesity and Diabetes in the Bioregion

Jean McFarland, Edmonds Community College

Summary

What is the role of the bioregion (both the natural and built environment) in human physiology? In this activity students will explore the possible relationships among the following: the physical environment, activity levels (exercise or inactivity), obesity and diabetes. Students will examine local neighborhood, community and/or county, state, and national data and trends. Students will generate hypothesis regarding the causes and consequences of obesity. Based on these putative causes and consequences they propose sustainable solutions (e.g. walkable neighborhoods, community gardens, etc.) that would be appropriate for and effective in their bioregion (Snohomish & King Counties in Washington State).

Learning Goals

Edmonds Community College's college-wide abilities

  • Critical Thinking
  • Written and Oral Communication
  • Quantitative Skills (assessment example: graphing epidemiology data)
  • Group Interaction

Biology Outcomes

Students should be able to:
  • Understand the nature of science and appropriately use the scientific method to examine the health and disease data from their bioregion.
  • Explain the levels of organization of biological systems and apply their understanding to the analysis of specific human diseases and disorders in their bioregion (for example, understanding how the following may be related triglycerides, insulin, adipose tissue, energy metabolism, individual health and neighborhood design for walkability).
  • Become familiar with the basic anatomy and physiology of healthy human organ systems (including digestive, endocrine and skeletal-muscular systems and energy metabolism).
  • Study several human diseases and disorders (including obesity and diabetes).
  • Construct and interpret graphs.
  • Critically assess hypotheses underlying our understanding of human health and disease.

Sustainability Outcomes

Students should be able to:
  • Explain the concept of a bioregion and describe the bioregion in which they live.
  • Demonstrate an understanding of how attributes of a bioregion can affect between public health.
  • Apply sustainability concepts to public health issues.

Context for Use

Timeframe

4-6 hours

This activity was done late in the term (in the eighth week of a 10 week quarter). These activities took about four hours in class.

In my one-quarter course on the "Biology of Human Disease" students study both infectious disease and chronic disease. The first half of the quarter focuses on infectious disease. This exercise allows students to explore several facets of chronic disease as they explore the relationships between obesity, diabetes and the environment in their bioregion. In my class, this activity is followed by a more formal lecture on diabetes and the role of the hormone leptin in obesity.

In the first week of the quarter, the students do a two hour active-learning graphing exercise. They are given data tables (with interesting and relevant data) and graph, interpret, and assess their graphs in small groups and as a class. This exercise prepares them for later quantitative analysis and the graphing exercise in this unit builds on the previous one.

Please refer to:
"Teaching and Assessing Graphing Using Active Learning"
Jenny McFarland
MathAMATYC Educator, Vol. 1, No. 2, February 2010 pages 30-38

Description and Teaching Materials

Homework

In preparation, homework is assigned one week prior to the commencement of the learning unit. This homework requires students to walk in their neighborhood, go to walkscore.com and do a short write-up of their results. Students are also asked to complete a short worksheet on three important leading health indicators: physical activity, overweight & obesity and environmental quality. Finally, students are given two short readings on overweight prevention plans for King County and Moses Lake.

In Class Activities

  1. Discussion of "leading health indicators" worksheet in small groups
  2. Think, pair, share discussion of obesity
  3. Mini-lecture on concept maps
  4. Think, pair, share and concept mapping activity on causes of obesity
  5. Mini-lecture on obesity
  6. Walkability: students share "walkability" homework
  7. Graphing Snohomish County (bioregion) data
  8. Obesity & Diabetes in the Bioregion - King County data discussion
  9. Mini-lecture on epidemiology (national trends for obesity and diabetes)
  10. Solutions in Washington State
"What are the Leading Health Idicators?" Worksheet (Microsoft Word 37kB Nov8 11)
"Obesity" Small Group Activity with Mini Lecture (Microsoft Word 142kB Nov8 11)
Obesity Data from the Bioregion- Snohomish County Data Graphing Activity (Microsoft Word 26kB Nov8 11)
Obesity and Diabetes in the Bioregion- King County Data Discussion (Microsoft Word 31kB Nov8 11)
"How Walkable is Your Neighborhood?" Homework (Microsoft Word 29kB Nov8 11)
Solutions in Washington State: Readings (Microsoft Word 30kB Nov8 11)
Obesity Prevention Plan Rubric (Microsoft Word 41kB Nov8 11)

Teaching Notes and Tips

Inspiration:

At the November 2006 meeting, at The Evergreen State College Tacoma, I went to a presentation by someone from Sightline Institute and received a copy of the Cascadia Scorecard 2006 (with a focus on sprawl and health). This publication made several convincing connections between the built environment and health. Three maps made a deep impression on me "Walkable Neighborhoods in King County, Washington", "Where you can go: a one-mile walk in Seattle's Phinney Ridge neighborhood" and "Where you can go: a one-mile walk in Bellevue's Eastgate neighborhood" (pages 45-57). Accompanying these maps is a short section on "Walking" that discusses obesity, physical inactivity and neighborhood design. This inspired me to think about focusing student learning on this topic. I teach Human Anatomy and Physiology courses and classes in Human Biology (including Biology of Human Disease) for non-science majors. I plan to use this activity in my non-majors course and a modification of it in other courses.

Assessment

How will students and instructors gauge student learning throughout the activity?

Short individual student homework - summative

How "walkable" is your neighborhood? - HOMEWORK
Draft a plan for Snohomish County - IN CLASS & HOMEWORK

Individual work - formative

What Are the Leading Health Indicators? - WORKSHEET

Group work - formative

Obesity and disease - THINK, PAIR, SHARE
What causes obesity? - CONCEPT MAPPING
Snohomish County data - GRAPHING

References and Resources

Partnership for a Walkable America: http://www.walkableamerica.org/checklist-walkability.pdf
Students will take a walk in their neighborhood and use this checklist to score their walk. They will also be asked to suggest ways to improve this score.
"Walkscore": http://www.walkscore.com
Students will use walkscore.com to obtain a walk score for their neighborhood. They will discuss what this score means (and what neighborhood resources are considered of value for this score).
Map of Walkable King County: http://www.sightline.org/maps/maps/Sprawl-Walkability-CS06m

Feet First - Building Walkable Communities: http://www.feetfirst.info/
"Feet First is an advocacy organization building walkable communities." They have a great "Neighborhoods on Foot" map series (in Seattle). "we see maps as ways to both celebrate and transform your neighborhood."
CDC Obesity & Diabetes Maps: http://www.cdc.gov/nccdphp/dnpa/obesity/index.htm
This is a great resource for information on obesity including definitions, contributing factors, health consequences, trends and resources. There are maps of U.S. obesity data from 1985-2006, demonstrating the U.S. epidemic. There are also links to other prevalence data, including diabetes incidence maps in U.S. over several years (http://www.cdc.gov/diabetes/statistics/prev/state/index.htm).
Links to state-based nutrition and physical activity programs (http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm) can help students think about the prevention measures that individuals, communities or society could take.

Data from Washington State, King County and Snohomish County:

Public Health - Seattle & King County, Diabetes in King County, Public Health Data Watch, Volume 9 (Number 1), May 2007 http://www.kingcounty.gov/healthservices/health/chronic/~/media/health/publichealth/documents/data/diabetes_April2007.ashx

Snohomish Health District, How Big are We: A report on obesity in Snohomish County, May 2007 http://www.snohd.org/Shd_HS/Reports/ObesityReport.pdf

Washington State - Building a Healthy, Active Community
Moses Lake & Grant County - response & results
"Washington State - Building a Healthy, Active Community", 2005
http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/state_stories/wa_community_2006.pdf

Leading Health Indicators: http://www.healthypeople.gov/LHI/lhiwhat.htm
"The Leading Health Indicators will be used to measure the health of the Nation over the next 10 years. As a group, the Leading Health Indicators reflect the major health concerns in the United States at the beginning of the 21st century. The Leading Health Indicators were selected on the basis of their ability to motivate action, the availability of data to measure progress, and their importance as public health issues." 'Physical activity', 'overweight & obesity' and 'environmental quality' are three of the 10 leading health indicators.
UW - COR: http://depts.washington.edu/uwcphn/work/uwcor.shtml
The University of Washington's Center for Obesity Research (UW-COR) has data on obesity, overweight and physical activity for Seattle and King County. They also have links to national (U.S.) and Canadian data on obesity. This is a good resource for information on obesity including definitions, contributing factors, health consequences, trends and resources.
NIH Obesity Research: http://obesityresearch.nih.gov/health/public.htm
Although the NIH "cannot, by itself, solve this major public health problem" it "can and must be a key contributor to solving the obesity problem through scientific research." This site clearly states that many factors have contributed to this epidemic, including environmental, social, economic, behavioral and genetic factors and links to information about diseases for which obesity is a significant risk factor (including diabetes, heart disease, stroke, osteoarthritis, cancer, etc.). Students may be referred to this site to expand on the question "What complications, conditions and diseases result from this disease or disorder?"
NIEHS Obesity Research: http://www.niehs.nih.gov/research/supported/diseases/obesity/index.cfm
The National Institute of Environmental Health Sciences (NIEHS) has funded projects Obesity and the Built Environment to "investigate solutions for alleviating the burden of obesity and overweight in the US, thereby providing insights into treatment mechanisms or developing models for prevention." The list of grantees (institutions and project titles) gives students an idea of the wide range factors to consider and many possible solutions to this problem.
"Slim City": http://www.forumforthefuture.org/greenfutures/articles/slim-city
Willis, Ben and Roger East "Slim City" Green Futures 5 January 2006
This magazine articles talks about an intentionally designed walkable development in California (U.S.) and pedestrian and bicycle friendly redesign near Bristol (U.K.). At the end of the article there is a short list of ideas for the design of healthier neighborhoods.
"Concept Maps PowerPoint" by Clarissa Dirks: http://www.udel.edu/chem/white/teaching/ConceptMappingPresentation.pdf
I used a few of the slides from this PPT file to introduce (or review) concept maps for my students before asking them to do their first concept-mapping activity.

Evergreen State College