The built environment influences health and well-being at the individual to community scale. I sought to understand if retail environments are associated with local health by testing hypothesized relationships using a novel geographic-information system (GIS) approach.
First, I conducted a scoping review to identify and synthesize linkages between U.S. retail environments and health. I reviewed outlet-specific literature on food, alcohol, tobacco, and marijuana outlets. At the neighborhood-level, retail environments are linked to health through facilitating physical activity, social cohesion for vulnerable populations, community crime and violence, and noise. Understanding the specific influences of retail environments on health remains challenging. Many studies have methodologic inconsistencies limiting comparison. Through focusing on only one outlet type or health outcome, most literature on retail environments and health does not provide a cohesive framework for tying together findings from diverse disciplines. To understand the composite retail environments’ influence on health, future research should evaluate multiple retail outlet types concurrently.
To systematically study cities across the United States, I developed a static kernel density-based GIS method to identify the presence and outlet mix of retail areas, or business districts, in each city. In a random sample of fifty cities, I identified 1,416 business districts of varying sizes and assigned each a health score based on presence of thirteen types of outlets known to influence health. I found that health outcomes were consistently and significantly associated with business district scores to a moderate degree when controlling for census region and city size. Relationships between health outcomes and district scores were stronger in communities with the least social vulnerability, indicating additional variables may be needed for assessing retail areas in socially vulnerable communities and addressing health disparities.
Our findings align with built environment literature that found relationships between health and place. While retail environment literature remains mixed in its focus, methods, and overarching conclusions, this work is a methodological advancement in understanding the role of the retail environment in U.S community health. Future research should adapt methods described in this work to study a broader range of retail environments in varied social contexts over time.
