Connecting the social and built environment to health and health inequalities

Philippa Clarke

Research Professor and Director, Social Environment and Health Program

Professor, Department of Epidemiology

Research Professor, Survey Research Center, Institute for Social Research

Research Professor at the University of Michigan’s Institute for Social Research, and Professor in the University of Michigan’s School of Public Health, Dr. Clarke received her Ph.D. in Public Health from the University of Toronto in 2000. Her research interests are in social epidemiology, social gerontology, life course perspectives, models of disability, and population health. Her current work examines the role of the built environment on mobility disability, cognitive function, and social participation; the effect of the urban environment on disability trajectories over time; the health and social factors influencing the use of assistive devices; and cross-national disparities in disability and psychosocial resources (comparing data from the US Health and Retirement Study and the English Longitudinal Study on Ageing). She has used geographic information systems (GIS) to examine the relationship between the built environment and disability progression in vulnerable older adults in the Detroit area. She has used various methods to capture characteristics in the built environment, including the use of secondary data sources (e.g., Census, Info USA), in-person neighborhood audits (using Systematic Social Observation), and virtual web-based neighborhood audits (using Google Street View). She has compared the reliability and validity of these different methods, publishing one of the first papers on the use of Google Street View for this purpose.

Research Projects

  • Cognitive Resilience and Community Context: Examining The Role of Neighborhood Built and Social Environments For Slowing the Progression of Dementia Among Older Americans

    (NIH/NIA RF1AG057540-01)

    PROJECT SUMMARY
    Previous research has identified multiple biological, genetic, and behavioral factors that are associated with cognitive impairment and decline. Recently, a parallel literature has looked beyond individual-level factors to consider the role of the social and built environment. Findings suggest that residence in socioeconomically advantaged neighborhoods may promote cognitive function and/or buffer cognitive decline in part through their greater density of physical resources (recreational centers, gyms, parks, walking paths, healthy food stores) as well as social and institutional resources (libraries, bookstores, community centers, social clubs) that promote physical activity and facilitate mental stimulation (e.g. social interaction) that may buffer cognitive decline with age. However, these relationships have not been empirically tested with national population-based data. This study examines the role of neighborhood built and social environments for age-related cognitive decline in a national, racially-diverse sample of Americans followed since 2003. We are identifying how features of the social and built environment are related to rates of decline in cognitive function among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a national longitudinal cohort study of over 30,0000 Black and White individuals age 45+ ongoing since 2003. In addition to being a longitudinal study collecting prospective data on cognitive function at annual intervals, the study also tracks residential locations through geographic coordinates that we are linking to multiple secondary sources to characterize the surrounding social and built environment. The aims of this 4-year project are to i) characterize the built and social environment for respondents in the REGARDS study with respect to the physical and social resources that could mitigate cognitive decline; ii) use longitudinal data to examine the relationship between neighborhood resources and rates of cognitive decline over time; and iii) determine the extent to which built and social environments explain racial disparities in cognitive function. By augmenting this existing NIH-funded longitudinal cohort study with neighborhood characteristics, this study will provide a critical opportunity to examine the role of neighborhood built and social environments for preventing cognitive decline in Americans as they age.

  • Rehabilitation Research and Training Center (RRTC) on Promoting Healthy Aging for People with Long-Term Physical Disabilities

    (Administration for Community Living / DHHS 90RTHF0001-01-00)

    PROJECT SUMMARY
    The aim of this National Rehabilitation Research and Training Center (RRTC) is to identify environmental factors that are associated with healthy aging for individuals with long-term physical disabilities from diverse backgrounds, particularly those from low income and racial / ethnic minority communities. To date, there has been little research on environmental factors to guide interventions and treatments to improve the health of persons aging with long-term physical disabilities. This project will begin to fill this gap in knowledge by examining the role of characteristics in the social and built environment as they interact with underlying impairments and activity limitations to either hinder or promote the full participation of individuals with physical disabilities in society. The end goal of the Center is to develop interventions to modify environmental factors to enhance the health, functioning and participation of individuals aging with long-term physical disabilities. The Center serves as a national resource center by providing information, training, and technical assistance to a variety of groups / stakeholders. We engage key stakeholder groups, particularly disability and aging related organizations, to bridge programs and practices for older adults and people with disabilities and maximize the relevance and usability of the new knowledge generated by the RRTC.

    https://cdh.medicine.umich.edu/research/ideal-rrtc

  • Socio-Environmental Factors Associated with Healthy Aging after Spinal Cord Injury

    (Funded by the Craig H. Neilsen Foundation)

    The average age of people living with early-acquired spinal cord injury (SCI) is increasing. Advances in medical care and technology have contributed to an increasing number of individuals living into older age with SCI. A review of the rehabilitation literature shows that there has been little research on environmental factors to guide interventions and treatments to improve the health of persons aging with disabilities. This project will begin to fill this gap in knowledge by examining the role of characteristics in the social and built environment as they interact with underlying impairments and activity limitations to either hinder or promote healthy aging with SCI. As the number of adults aging with SCI grows, understanding those factors that contribute to healthy and positive aging is becoming an increasingly important area of research.

Key Publications

  • Clarke PJ. When can group level clustering be ignored? Multilevel models versus single-level models with sparse data. Journal of Epidemiology and Community Health 2008;62:752-758. DOI: 10.1136/jech.2007.060798.
  • Clarke PJ, Ailshire JA, Bader M, Morenoff JD, House JS. Mobility disability and the urban built environment. American Journal of Epidemiology 2008;168:506-513. DOI: 10.1093/aje/kwn185.
  • Clarke PJ, Nieuwenhuijsen ER. Environments for healthy aging: A critical review. Maturitas 2009;64:14-19. DOI: 10.1016/j.maturitas.2009.07.011.
  • Clarke PJ, Ailshire J, Melendez R, Bader M, Morenoff J. Using Google Earth to conduct a neighborhood audit: Reliability of a virtual audit instrument. Health and Place 2010;16:1224-1229. DOI: 10.1016/j.healthplace.2010.08.007.
  • Clarke PJ, Ailshire J, Nieuwenhuijsen E, de Kleijn – de Vrankrijker M. Participation among adults with disability: The role of the urban environment. Social Science and Medicine 2011;72:1674-1684. DOI: 10.1016/j.socscimed.2011.03.025.
  • Clarke PJ, Marshall VW, House JS, Lantz P. The social structuring of mental health over the adult life course: Advancing theory in the sociology of aging. Social Forces 2011;89:1287-1314. DOI: 1353/sof.2011.0036.
  • Clarke PJ, Ailshire J, House JS, Morenoff JM, King K, Melendez R, Langa K. Cognitive function in the community setting: The neighborhood as a source of “cognitive reserve”? Journal of Epidemiology and Community Health 2012,66:730-736. DOI: 10.1136/jech.2010.128116.
  • Clarke PJ, Gallagher NA. Optimizing mobility in later life: The role of the urban built environment for older adults aging in place. Journal of Urban Health. 2013;90(6):997-1009. DOI: 1007/s11524-013-9800-4.
  • Clarke PJ, Morenoff J, Debbink M, Golberstein E, Elliott M, Lantz P. Cumulative exposure to neighborhood context: Consequences for health transitions over the adult life course. Research on Aging 2014;36:113-140. DOI: 10.1177/0164027512470702
  • Clarke PJ, Latham K. Life course health and socioeconomic profiles of Americans aging with disability. Disability and Health Journal; Special Issue: Aging with Disability. 2014;7(1, Supplement): S15-S23. DOI: 10.1016/j.dhjo.2013.08.008
  • Clarke PJ, Yan T, Keusch F, Gallagher NA. The impact of weather on mobility and participation in American adults. American Journal of Public Health 2015;105(7):1489-1494. DOI: 10.2105/Ajph.2015.302582.
  • Clarke PJ, Weuve J, Barnes L, Evans D, Mendes de Leon C. Cognitive Decline and the Neighborhood Environment. Annals of Epidemiology 2015;25(11):849-854. DOI: 10.1016/j.annepidem.2015.07.001.
  • Clarke PJ, Hirsch JA, Melendez R, Winters M, Sims Gould J, Ashe M, Furst S, McKay H. Snow and Rain Modify Neighborhood Walkability for Older Adults. Canadian Journal on Aging2017;36(2):159-169. DOI: 10.1017/S071498081700006X.
  • Gomez-Lopez I, Clarke PJ, Hill A, Romero D, Goodspeed R, Berrocal V, Vydiswaran VGV, Veinot TC. Using Social Media to Identify Sources of Healthy Food in Urban Neighborhoods. Journal of Urban Health, 2017; 94(3):429-436. DOI: 10.1007/s11524-017-0154-1.
  • Clarke PJ, Twardzik E, Meade MA, Peterson MD, Tate D. Social Participation among Adults Aging with Long-Term Physical Disability: The role of Socio-Environmental Factors. Journal of Aging and Health (In Press).

Curriculum Vitae (PDF)

Email Philippa Clarke