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Bridging the Gap Between Smart Growth and Public Health
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Florida Florida Department of Department of
HealthHealth
Division of Division of Environmental Environmental
HealthHealth
Daniel Parker, MSP
Division Operations and Management Consultant
Bridging the Gap Between Public
Health and Urban Planning
Protocol for Assessing Community Excellence In Environmental Health (PACE EH)
http://www.myfloridaeh.com/programs/PACE-EH/PACE-EH.htm
• No sidewalks
• No bike paths
• No street lights/Insufficient lighting
• Not safe
• Dilapidated housing/Uncared for property
• Forgotten by leaders
• Drinking water/ well contamination
• Cut off from other neighborhoods.
• No fire hydrants
• Heavy Traffic
• Hazardous waste
• Sanitary nuisances
• Solid waste issues
• Sewage/septic issues
• Frequent flooding
• Water Quality
• Drowning
• Crime
• Noise
•Air contamination/ pollution
• Leash ordinance
Florida PACE EH Project Community Feedback
What do you want your City or County to look like in 10 or 20 years?
• 1926, Village of Euclid vs. Ambler Realty Co.• Public health protection a basic responsibility of
local government• Zoning to separate homes from industry and
pollution.• Given a legal mandate to restrict or control land
use decisions in a community
Public Health and Planning
Definition of Environmental Health“In its broadest sense, environmental health comprises those aspects of human health, disease, and injury that are determined or influenced by factors in the environment. This includes not only the study of the direct pathological effects of various chemical, physical, and biological agents, but also the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture.”
-- CDC Healthy People 2010
Built Environment• The built environment encompasses all of the
buildings, spaces, and products created, or at least significantly modified, by people.
• Health Canada, Health and Environment, 1997.
Land Use (industrial or residential)
Buildings (housing, schools, workplaces)
Public Resources (parks, museums)
Zoning Regulations Transportation
Systems
How might the built environment influence human health?
• Access to medical and other health care
• Quality of and access to schools
• Healthy food outlets• Economic opportunities• Ease of social interaction
and resulting social capital
• Air and water quality• Opportunities for physical
activity
The Burden of Physical InactivityThe Burden of Physical Inactivity
Rich Bell, Project Officer, Active Living by Design*, UNC School of Public Health
*A National Program of The Robert Wood Johnson Foundation
Email: Email: [email protected]
Web: Web: www.activelivingbydesign.org
Emergence of aSedentary Society
Emergence of aSedentary Society
Rich Bell, Project Officer, Active Living by Design*, UNC School of Public Health
*A National Program of The Robert Wood Johnson Foundation
Email: Email: [email protected]
Web: Web: www.activelivingbydesign.org
According to the Center for Disease Controls' Healthy People 2010
Report, the definition of Environmental Health may include housing, urban development, land-
use, and transportation.
Submit Clear
A) True
B) False
Rand Corp Data
Prevalence of Overweight and Obesity Among US Adults, Age 20-74 Years*
47
32
15
56
33
23
61
34
27
65
3431
73
34
39
0
10
20
30
40
50
60
70
80
Obese BMI ≥30.0
Per
cen
t
BMI = body mass index.*Age-adjusted by the direct method to the year 2000 U.S. Bureau of the Census estimates using the age groups 20-34, 35-44, 45-54, 55-64, and 65-74 years.
NHANES II1976-80
(n=11207)
NHANES III1988-94
(n=14468)
NHANES 1999
(n=1446)
NHANES III1999-2000(n=4115)
Projected2008
Overweight or obeseBMI >25.0
Overweight BMI 25.0-29.9
“It is the occupation of a child to
immerse herself in her environment".
“Lowly, unpurposeful and mundane as they appear, sidewalk contacts are the small change from which a city’s wealth of public life may grow.” Jane Jacobs, The Death & Life of Great American Cities
“There is much more to walking than walking.” Jan Gehl, New City Spaces
Quotes
The Big Picture
Residents of west Ocala complain that unkempt lots lower the value of their property.ERICA BROUGH/STAR-BANNER
By SUSAN LATHAM CARR, STAFF WRITER, Star BannerBy SUSAN LATHAM CARR, STAFF WRITER, Star Banner
Unkempt properties, pollution cited in west Ocala survey
http://www.myfloridaeh.com/programs/PACE-EH/PACE-EH.htm
Indian River County PACE EH Project
What is PACE EH?
Submit Clear
A) The Packers and Cubs Exchange
B) Principles of Community Eating
C) Protocols for Assessing Community Excellence in Environmental Health
Smart Growth Principles
• Mix land uses• Take advantage of compact building design• Create a range of housing opportunities and
choices• Create walkable neighborhoods• Foster distinctive, attractive communities with a
strong sense of place• Make development decisions predictable, fair,
and cost effective
Smart Growth Principles(Cont’d)
• Preserve open space, farmland, natural beauty, and critical environmental areas
• Provide a variety of transportation choices• Strengthen and direct development towards
existing communities• Encourage community and stakeholder
collaboration
• 38% of study participants who live in the most walkable neighborhoods met government-recommended activity levels.
• Only 18% of the residents in the least walkable neighborhoods met US Surgeon General recommendation of 30 minutes of moderate activity every day.
• All study participants wore accelerometers• 3 walkability factors: mix of shops, homes, and
schools, residential density, and number of connecting streets.
- American Journal of Preventive Medicine, February 2005
Create Walkable Neighborhoods
Provide a Variety of Transportation Choices
• Students 4 times more likely to walk to schools built before 1983 than those built more recently (South Carolina study).
• Even children within 1.5 miles of schools are bused due to safety concerns.
• Loss of neighborhood anchor.• State education policies.• http://www.lgc.org/transportation/schools.html
• US average= 73 mins/day of driving
• One-fourth of all trips made are one mile or less, but three-fourths of these short trips are made by car
• Children between the ages of 5-15 walk/bike 40% less in 1995 than in 1977
• For school trips one mile or less, only 31% are made by walking; within 2 miles, only 2% are made by biking.
• In the US, 6% of trips are by walking/biking. In contrast, Italy is 54%; Sweden, 49%.
• Allen Dearry, Ph.D. National Institute of Environmental Health Sciences NIH, DHHS October 2, 2003
0
2
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10
1977 1983 1990 1995
Per
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80
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86
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1977 1983 1990 1995
Per
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Walk and Bike Trips
Automobile Trips
Travel and Reduced Physical Activity
27
American Journal of Public Health, October 2004• Streets not well connected• Areas far from each other (schools, malls)• Walking and bike riding difficult or dangerous
American Journal of Public Health, September 2003 Studies show association between deteriorated physical environment and higher rates of crime. Safety influences activity.
Transportation Research Board/Institute of Medicine, January 2005
Does the Built Environment Influence Physical Activity? “Universities should develop interdisciplinary education programs to train professionals in conducting the recommended research and prepare practitioners with appropriate skills at the intersection of physical activity, public health, transportation, and urban planning.” http://trb.org/publications/sr/sr282.pdf
Forward Thinking Professionals
Fear of Walking
• City and county planning and zoning often ignore pedestrian traffic
• Few incentives exist to design communities to be walkable, to enhance biking and moving
• Crime and safety concerns are critical issues
• Examines the interface of urban planning, architecture, transportation, community design and public health.
• Loss of social capital. • Asthma rates among children doubled between 1976-1995
(CDC) (And 3X higher among blacks).• Obesity doubled between 1976-1994 (CDC).• Antidepressant prescriptions tripled during the 1990’s.• 14% of gross domestic product goes to medical expenditures
(2001).• Land use and community design may be critical contributing
factors for health disparities. Urban Sprawl and Public Health, by Frumkin, Frank, and Jackson, 2004
Public Health Connection to Land Use
30
• Trust for America’s Health (2005)• Florida ranked 38th in the U.S. in highest rate of adult
obesity at 20.7%.• 64.5% of adult Americans overweight or obese.• “….Decisions about where we build new houses and
highways or schools and sidewalks can mean the difference between giving people more or less opportunity to participate in physical activity.” – Parris Glendening, former Governor of Maryland, president of Smart Growth Leadership Institute.
• Need smarter design, including evaluation of health impacts of new building efforts, updating existing development, and encouraging design that promotes and integrates space, sidewalks, public transportation…in new development.
http://healthyamericans.org/
An Ounce of Prevention…
An Ounce of Prevention…
• Consider Hurricane Katrina• Cost to reinforce the walls vs. Cost to
rebuild New Orleans• Cost to promote smart growth vs. cost of
obesity (Obesity cost estimate is $100 billion) 29 Colditz, GA. Economic costs of obesity and inactivity. Medicine and Science in Sports and Exercise, 1999; S664-5.
Pick the Smart Growth Principles in this List
Submit Clear
A) Mix Land UseB) Put assets in New CommunitiesC) Create New Roads for Faster Access to DestinationsD) Provide a Variety of Transportation Choices
E) Encourage Community & Stakeholder Collaboration
Fear and the Built Environment• One study examined environmental
variables, such as the presence or absence of sidewalks, heavy traffic, hills, street lights, unattended dogs, enjoyable scenery, frequent observations of others exercising, and high levels of crime.
• Positive environmental determinants of physical activity included enjoyable scenery (presence associated with more activity), whereas the greatest perceived barrier was the lack of a safe place to exercise.
• Research indicates that two of the main reasons given for not exercising are lack of structures or facilities (such as sidewalks and parks) and fears about safety.
• Overall, higher levels of perceived neighborhood safety are associated with higher levels of physical activity.
King AC, et al. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women; Health Psych 2000:19(4):354-64. CDC.
Neighborhood safety and the prevalence of physical inactivity-selected sates, 1996. Mor Mortal Wkly Rep 1999:48(7):143-6.
Pate RR, et al. Physical Activity and Public Health: A recommendation from the CDC and the American College of Sports Medicine. JAMA 1995;273(5):402-7.
• KB Homes Market Research– Research of Tampa home buyers– Asked what they valued most in their home and community.– More space and a greater sense of security.– 88% want home security system.– 93% want homes with more streetlights.– 96% insists on deadbolt locks or security doors. – Safety always ranks second, even in communities where
there is virtually no crime.
• As reported by Rick Lyman in NYTimes, August 15, 2005. “Living Large by Design, in the Middle of Nowhere”.
Fear and Public Health
• New York Academy of Medicine, 2004– 60% of citizens surveyed said they would not go to a
public vaccination site in a smallpox outbreak.– 40% would not shelter in place for as long as told in a
dirty bomb explosion.– Only 20% believe disaster planners know concerns
and needs.– Only 50% confident they would receive help.– Only 30% believe public can have a lot of influence on
disaster plans.--Lasker RD. Redefining Readiness: Terrorism Planning Through the Eyes
of the Public. New York, NY: The New York Academy of Medicine, 2004. Website: www.cacsh.org
Fear, Public Health, and the Built Environment
• USA Today, December 2004.• “The freedom and adventure of walking to school has
been replaced with overscheduled and oversupervised kids. As Royce Yeater of the National Trust for Historic Preservation puts it, consumers demand free-range chickens for their table but won’t let their kids out of the house.” – USA Today, 1/25/2005, Trek to school not like it used to be, by Martha Moore
http://www.usatoday.com/news/nation/2004-12-21-walking_x.htm
Fear and Urban Planning
Website: http://www.pps.org/info/placemakingtools/placemakers/dappleyard
• New York Times Editorial, October 6, 2005
• “Our sense of happiness is created by many things that are not easily measured in purely economic terms, including a sense of community and purpose, the amount and content of our leisure and even our sense of the environmental and ecological stability of the world around us …A clearer understanding of what makes humans happy-not merely more eager consumers or more productive workers-might help begin to reshape those assumptions in a way that has a measurable and meliorating outcome on the lives we lead and the world we live in.”
• http://select.nytimes.com/gst/abstract.html?res=F60B11FF35540C758CDDA90994DD404482
• http://www.mcdonough.com/
Life, liberty, and…
Website: http://www.gpiatlantic.org/conference/papers/obrien.pdf
The Greatest Threat to Public Health and Urban Planning is….
• Copyright © 1996 by The American Prospect, Inc. Preferred Citation: Robert D. Putnam, "The Strange Disappearance of Civic America," The American Prospect vol. 7 no. 24, December 1, 1996 .
Paradigm Shift for Public Health and Environmental Health
Community Design Matters
Transportation Matters
Social Capital Matters
Public Health
What does happiness have to do with public health?
Submit Clear
Specific Activities in Florida
• Renewed Interest in Health Impact Assessments
• MOA between different state Departments on Smart Growth concepts
• Meet with health promotion staff within health department (safe ways to schools, injury, data)
• Broader definition of EH• History of Planning/Health• Frame land use as a public health issue
• We need a community by community assessment approach to complement programmatic services.
• We need to train ourselves for broad, cross-cutting thinking.
• Must address the Fear Factor.• Need real public health outcome data from
community assessments.
Bridging the Gap Between Public Health and Urban Planning
• Public health take a role on local planning / zoning boards, planning commissions, metropolitan planning organizations, etc.
• Planners give public health a review niche (HIA).• Let the Communities Speak.• Support more research into mental health to overall
well-being, and its connection to the built environment.• Research into changes in the built environment and the
effect on public health.• Planners, remember your roots in public health
protection!
Bridging the Gap Between Public Health and Urban Planning
What will be your legacy?
Florida PACE EH Pilot Project 2005 Vision Award Winner, Association of State
and Territorial Health Officials
2005 Jim Parker Award Winner for Public Health Leadership, National Association of City
County Health Officials
http://www.myfloridaeh.com/
