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Planning for Health: Incorporating Health Considerations into Community Master Plans
New Jersey Planning Conference Hyatt Regency, New Brunswick
January 28-29, 2016
Panelists • Jennifer Senick PhD, Executive Director
Rutgers Center for Green Building Rutgers, The State University of New Jersey Phone: 848-932-2904 Email: [email protected] Web: www.greenbuilding.rutgers.edu
• Elizabeth Hartig, Project Coordinator Planning and Community Health Center American Planning Association Phone: 202.349.1003 Email: [email protected] Web: www.planning.org
• Jon Carnegie AICP/PP, Executive Director Alan M. Voorhees Transportation Center Rutgers, The State University of New Jersey Phone: 848-932-2840 Email: [email protected] Web: www.vtc.rutgers.edu
• Jeffrey Wilkerson PP/AICP, Principal Planner Division of Planning, City of Trenton Phone: 609-989-3502 Email: [email protected]
• James Brownlee MPH, Director/Health Off icer Department of Health and Human Services/Trenton Health Team, City of Trenton Phone: 609-815-2556 Email: [email protected] Web: www.trentonhealthteam.org
• Oliver Lontok MD/MPH, President New Jersey Public Health Association New Jersey Public Health Association Email: [email protected] Web: www.njpha.org
• Kevin McNally MBA, President-Elect New Jersey Public Health Association Email: [email protected] Web: www.njpha.org
Welcome!!!
• Introductions • Learning Objectives -
Agenda • Plan4Health Project Video
(permission form)
Learning Objectives (1 of 2)
• Learn how the Plan4Health project is reuniting the fields of planning and public health;
• Gain exposure to the research and tools developed by APA’s Planning and Community Health Center;
• Be introduced to the concept of Health in All Policies (HiAP) and Health Impact Assessment (HIA);
• Hear about lessons learned from the Trenton Health Communities Initiative and the Trenton Health and Food Systems master plan element;
Learning Objectives (2 of 2)
• Learn about sources of health statistics and community health improvement planning; and
• Explore how a model Health & Wellness plan element and other healthy community planning tools can be used locally here in New Jersey to further a Culture of Health
Release Form
Name Signature Date
Elizabeth Hartig, Project Coordinator
Introduction to:
• Planning and Community Health Center • Plan4Health
www.plan4health.us
National Centers
What is the Planning and Community Health Center?
Planning and Community Health Center • Active Living • Food Systems • Health in all Planning Policies
https://www.planning.org/nationalcenters/health/
Frederick Law Olmsted
Jane Addams
Planning and Public Health
Healthy Planning Resources https://www.planning.org/research/publichealth/
In partnership with the CDC, the PCH Center is conducting a multi-year research study to understand the role of comprehensive plans in promoting health: • National survey
• Plan evaluation
• Case study analysis
5. SERVICES • General • Accessibility to Health & Human
Services • Aging
6. SOCIAL COHESION & MENTAL HEALTH • General • Housing Quality • Green & Open Space • Noise • Public safety / Security
BROAD ISSUES
• Substantive Issues: Vision Statement, Guiding Principles, and Background data
• Procedural Issues
1. ACTIVE LIVING • General • Active Transport • Recreation • Injury
2. EMERGENCY • Climate Change • Natural and Human-caused
Disasters • Infectious Disease
3. ENVIRONMENTAL EXPOSURES • General • Air Quality • Water Quality • Brownfields
4. FOOD & NUTRITION • Access to food and healthy food
options • Water • Land use
www.plan4health.us
Our Community
What is Plan4Health?
www.plan4health.us
Overview
APA received three-year commitment from the CDC. $4.5 million sub-granted to 35 local coalitions.
Plan4Health is also part of a larger, national coalition: Partnering4Health.
Division of Community Health
97 coalitions across the country
Partnering4Health
www.plan4health.us
Key Partnership
APA’s Plan4Health project partner is the American Public Health Association. APHA is leading our evaluation efforts as well as providing public health expertise.
Overview
Shared Vision • Promote health equity • Reduce disparities in implementation,
access and outcomes Plan4Health’s Vision Full integration of planning and public health where people live, work, and play.
Goals
APA and APHA are working to:
• Increase collaboration • Increase community capacity • Increase messaging
Focus Areas Nutrition Increased access to environments with healthy food or beverage options. Physical Activity Increased access to physical activity opportunities
www.plan4health.us
Core Values
Plan4Health leverages cross-sector
collaborations and member
expertise to build local capacity for
the implementation of policy,
systems, and environment
strategies.
Coalition Partners
Peer Learning Network
The goals of the PLN are to: • Share experiences and lessons learned
within and across the Plan4Health cohorts
• Connect external peer experts to expand and strengthen the Plan4Health community; and
• Contribute to the movement of multi-sectoral professionals committed to creating healthier communities nationwide.
Coalitions
Where are these 35 coalitions?
www.plan4health.us
Plan4Health Grantees
www.plan4health.us
Health in All Policies and HIA Jeanne Herb, Associate Director Environmental Analysis and Communications (EAC) Group
The Problem So many daily policy decisions made outside of the health
sector have significant health implications that go unrecognized because health is just not on the radar screens
of decision makers.
Social Determinants of Health
Source: Dahlgren and Whitehead, 1991
Health in all Policies
A strategy that strengthens the link
between health and other policies,
creating a supportive
environment that enables people to lead healthy lives.
Urban Planning as a Tool to Promote Health & Wellness
Think of Health Impact Assessment (HIA) as … …a tool to understand the health implications
. . .of PROPOSED policies, plans or projects on communities.
Housing Air quality
Noise Safety
Social networks Nutrition
Parks and natural space Private goods and
services Public services Transportation
Livelihood Water quality
Education Inequities
How might the proposed project, plan, policy affect:
And potentially lead to
predicted health outcomes?
HIA in Action
Step 1: Screening Determine whether an HIA will add value.
Step 2: Scoping Develop a plan for the HIA.
Step 3: Assessment Identify current and predicted health impacts.
Step 4: Recommendations Identify actions that protect health.
Step 5: Reporting Communicate findings.
Step 6: Evaluation Monitor impacts.
Health Impact Assessment is…
• Predicts anticipated health outcomes using public health and scientific evidence
• Recommends balanced, well-informed decisions
• Weigh trade-offs, direct and indirect health impacts
• Includes strong engagement of community, business, decision-making body
…a structured, but flexible, process that
HIA is NOT… • Used to make the case for why a policy, program or
project should or should not be proposed.
• An assessment to understand the impacts of a program or policy after it has been implemented.
• A community assessment tool (i.e., MAPP & CHIP).
What Topics Have HIAs Addressed in the U.S.?
Courtesy of Health impact project
Planning for Health: Incorporating Health Considerations
into Community Master Plans
Healthy Plan Making &
The Trenton 250 Health and Food Systems Element
Jon Carnegie, AICP/PP Jeff Wilkerson, AICP/PP James Brownlee, MPH
Planning in the United States originated with a public health purpose. Planning was rooted in the need to reduce congestion, improve public health, and support social reform in housing and sanitation. Rapid urbanization resulted in overcrowded and often poorly constructed housing, noxious industrial and manufacturing uses, new levels of human and animal waste, and intensified outbreaks of infectious diseases. The planning and public health professions were joined by a shared focus on urban reform and a common goal to prevent outbreaks of infectious disease.
Active Living: • Active transport • Recreation • Injury
Emergency Preparedness: • Climate change • Natural & Human-caused Disasters • Infectious Disease
Environmental Health: • Air Quality • Water Quality • Brownfields
Food & Nutrition: • Access to Food & Healthy Food Options • Water • Land Use
Health & Human Services: • Access to healthcare and social services • Aging
Social Cohesion & Mental Health: • Active transport • Recreation • Crime and Public Safety
Economic Conditions: • Economic development • Access to well-paying jobs • Education and training
Other: • ??? • ??? • ???
Healthy Planning Topics
Adapted from: Healthy Plan Making, APA
Key Findings from a National Web-based Survey
• 900 completed surveys from local government planners • 31 percent of responding jurisdictions have comp plans
that explicitly address health topics • Top 10 cited public health topics were: recreation,
public safety, clean water, active transportation, clean air, emergency preparedness, active living, physical activity, environmental health and aging.
• Two models for incorporating health: – Standalone, voluntary health element – Include health-related goals and policy into existing mandatory
elements (Parks & Open Space, Transportation/Circulation, Urban Design)
Source: Healthy Plan Making, APA
Strengths • Active living was strongest across
all plans
• Environmental health well covered - especially water and trees
• Emergency Preparedness, when covered, was strong and specific
• Food & Nutrition, when covered, were strong with attention to equity and access for vulnerable populations
• Health was emphasized to a greater extent when plans included a stand-alone element
Areas for Improvement • Most plans had weak coverage of:
Food & Nutrition, Emergency Preparedness, Health & Human Services, and Social Cohesion/ Mental Health
• Limited use of imagery and maps
• Limited use of public health data
• Virtually no health-related performance metrics
• Most plans lacked specific implementation strategies
Source: Healthy Plan Making, APA
Results of 22 Plan Review
Seven Detailed Case-studies
Source: Healthy Plan Making, APA
Case Studies: Key Elements of Success
• Champions • Context & Timing • Outreach • Health Priorities • Data • Collaboration • Funding • Implementation • Monitoring and
Evaluation
Source: Healthy Plan Making, APA
Examples…..
Developing Trenton’s Health & Food Systems
Element
Trenton Healthy Communities Initiative
• Health and Food Systems Element (HFSE) for the Trenton250 Masterplan
• HiAP training for Trenton City decision makers and Departments
• Statewide knowledge transfer – Model Health and Food Systems Element – HiAP training for local decision makers in
integrating planning and public health
Trenton’s Plan4Health Coalition
• Initiative supported by: – Rutgers University
New Jersey Health Impact Collaborative – APA New Jersey Chapter – New Jersey Public Health Association – City of Trenton – Trenton Division of Planning – Trenton Department of Health – Trenton Health Team
Partnerships and Collaborations
Trenton Community Health Needs Assessment Process
• Community Advisory Board • Data Sharing and Data
Analysis • PICO interviews and forums • Validation, Verification and
Prioritization by Community • Creation of a unified TCHNA • Development of a unified
Community Health Improvement Plan
• TCHIP Dashboard
Community Health Priorities
POVERTY
Health Literacy
Safety & Crime
Obesity
SAMH
Chronic Disease
Health Literacy
Goals Align with goals of HHS National Action Plan To Improve Health Literacy: • Increase access for everyone to
accurate and actionable health information
• Deliver person-centered health information and services
• Support lifelong learning to promote good health
Strategies • Incorporate health literacy
improvement in mission, planning, and evaluation
• Support health literacy research, evaluation, training, and practice
• Conduct formative, process, and outcome evaluation to design and assess materials, messages, and resources
• Enhance dissemination of timely, accurate, and appropriate health information to health professionals and the public
• Design health literacy improvements to healthcare and public health systems that enhance access to health services
Safety & Crime
Goals • Reduce street-level violence • Increase residents’ perceptions
of safety • Implement Trenton Violence
Reduction Strategy (TVRS), an evidenced-based, public health approach modeled on Boston Ceasefire and CURE.
Strategies • Targeting resources to
individuals and communities most at-risk
• Enhancing data collection and analysis
• Building community and agency capacities trough collaboration and mobilization
• Buy-in and trust among key partners, including TCNJ and Trenton Prevention Policy Board
Obesity/Healthy Lifestyles
Goals • Increase Trenton residents’
access to and consumption of healthy foods
• Increase access to and practice of physical activity
Strategies • Creation of joint-use
agreements between TPS and City for opening of school parks outside of school hours
• Creation of Healthy Food Network – Seek funding for creation of
Healthy Food Network – Expand Healthy Corner Store
initiative of NJPHK – Increase availability of fresh
produce at food pantries • Offer cooking classes at
neighborhood schools
Substance Abuse & Mental Health
Goals • Improve access to quality
behavioral health treatment services
• Improve access and utilization of prevention services in Trenton
• Reduce barriers related to culture for behavioral health treatment
Strategies • Create a pilot “transitional”
outpatient clinic model – stopgap to decrease ER visits and engage individuals with treatment programs
• Develop “Ready Access” system for behavioral clients
• Develop resource for helping individuals pay for medications
• Expand SBIRT to additional settings
• Increase available information through social media
Chronic Disease
Goals • Reduce rates of diabetes, high
blood pressure, and cancer through evidence-based practices at the city’s clinics and improved self-management by patients
Objectives • Implement evidence-based
practice guidelines for diabetes and high blood pressure in each of the city’s seven clinics
• Engage a certified Diabetic Educator at each of the seven clinics
• Screening for tobacco use and Smoking Cessation counseling available at all seven clinics
Health Impact Pyramid: Affecting Change at Multiple Levels
LargestImpact
SmallestImpact
Socioeconomic Factors
Changing the Contextto make individuals’ default
decisions healthy
Long-lasting Protective Interventions
ClinicalInterventions
Counseling & Education
CHIP: Supporting Health Impact
Community Health Needs
Identified
Master Plan Framework – 5 Pillars of Sustainability
Supporting Docs – Plans, Reports, Studies, etc.
District Plans
The Planning Lifecycle
Putting the Plan to Work and Evaluating Progress
Trenton250 Vision Principle:
Cultivate a Healthy City
Trenton will be a clean city where there is access to natural
resources, fresh foods, and high quality
healthcare facilities.
Overview of HFSE
• Hybrid approach – Health-related vision and goals – Health-informed mandatory elements – Voluntary, stand-alone health element
• Incorporates health data and priorities • Focuses on addressing the social and
environmental determinants of health • Includes Action Plan with: Policy, Project,
Program, Partnership and Advocacy recommendations with responsibilities, timelines, milestones and potential implementation resources
HFSE Outline
• Introduction – Background – Purpose – Legal Authority
• Trenton Today – Current Health Status of Trenton Population – Social and Environmental Determinants of Health in Trenton
• Trenton’s Health Vision
• Nexus Between Health and Other Trenton 250 Master Plan Elements
– Economic Development & Education – Land Use & Housing – Circulation – Environment
HFSE Outline
Increase access to healthy foods
• Expand access to healthy
food outlets • Expand opportunities for
community-based agriculture
• Support school-based initiatives that promote good nutrition and healthy eating
• Use government policies and programs to increase access to healthy foods
HFSE Outline
Increase physical activity among
Trenton residents
• Improve access to parks and recreational programming
• Improve conditions for active transportation
• Promote physical activity through school-based programs
• Use government policies, programs and incentives to increase physical activity
HFSE Outline
Improve health literacy and access to
healthcare services
• Expand primary care provider capacity
• Expand healthcare access for children and adolescents
• Expand/integrate mental, behavioral and substance abuse services in primary care settings
• Improve transit accessibility to healthcare facilities
• Promote non-traditional settings for health care services
• Promote health literacy
HFSE Outline
Address unhealthy housing conditions
• Create healthy and green building guidelines for new and existing housing
• Improve the conditions of Trenton’s housing stock to promote the health of Trenton residents
• Improve the conditions of vacant and abandoned properties that are health hazards to neighboring properties
HFSE Implementation
• HFSE integrates with Trenton250 One Plan portal • Strong partnership with Trenton Health Team
and THT collaborators • Health in All Policies training for department
heads
+
Statewide Knowledge Transfer
• Model Health & Wellness Element • “How to” guide for local planners and public
health officials • Training webinars and workshops
Planning for Health Data resources
Presented by New Jersey Public Health Association Oliver Lontok, MD, MPH & Kevin McNally, MBA
Example: SES • 2010_Census_Data: Variables from the 2010 US Census Profile of General Population and
Housing Characteristics. • Housing Units and Vacancy • Household and Family Counts • Race/Ethnicity.
• Age_Sex_Pyramids_2010: Data from 2010 US Census, file: QT-P1: Age Groups and Sex 2010. • Age-Sex Pyramids organized by municipality
• Economic_Indicators: • Median Household Income (ACS 2010 5-yr estimates) • Unemployment Rates 2011 (NJ Department of Labor and Workforce Development)
• Education_Language: Data from New Jersey School Report Card 2011, Department of Education.
• List of (first) languages spoken at home of NJ students
• IRS_2008_data: Data from 2008 Tax Forms via Brookings Institution, compiled at the Zip Code level.
• Income data compiled at the Zip Code level
Source: Brownlee, Rutgers Center for State Health Policy
Example: Housing • Multifamily_Housing: Data on Multifamily Housing.
• Counts of properties, property units, and assisted units (source: Multifamily Assistance and Section 8 Contracts Database, HUD.)
• Counts of properties (& number of associated units) receiving failing score on most recent physical inspection (source: Multifamily Physical Inspection Scores, 2011, HUD)
• Public_Housing_pis_2011: • Count of public housing properties, count of properties
receiving failing score on most recent physical inspection (source: Public Housing Physical Inspection Scores, 2011, HUD)
Source: Brownlee, Rutgers Center for State
Health Policy
Example: Health Birth_Indicators: Queried at the municipal level. (New Jersey State Health Assessment Data, Center for Health Statistics, NJ Dept of Health and Senior Services)
• Infant Mortality Rate (2000-2008) • Mothers not receiving prenatal care (2004-2008) • Mothers not receiving prenatal care until their third trimester of pregnancy
(2004-2008) • Low birthweight (2004-2008): percentage of infants with birthweight <2500g • Very low birthweight (2004-2008): percentage of infants with birthweight
<1500g • Mortality_Indicators (2004-2008): Queried at the municipal level. (New
Jersey State Health Assessment Data, Center for Health Statistics, NJ Dept of Health and Senior Services)
• Average age at death • Death by age cohort
Source: Brownlee, Rutgers Center for State Health Policy
New Jersey Department of Health • Uniformed Billing data • NJ SHAD • NJ BRFS • New Jersey Department of Labor and Welfare
Source: http://www.nj.gov/health/
Source: http://www.nj.gov/health/
Source: http://www.nj.gov/health/
Source: http://www.nj.gov/health/
Source: http://www.nj.gov/health/
Other Resources Behavioral Risk Factor Surveillance System American Community Survey Kaiser Permanente The Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation County Health Rankings
Source: www.countyhealthrankings.org
Source: www.countyhealthrankings.org
Source: www.countyhealthrankings.org
The Henry J Kaiser Family Foundation
Source: The Henry J Kaiser Family Foundation, http://kff.org/statedata/
Local Community Health Needs Assessment Community Health Improvement Plan
Community Health Improvement Planning • State rules – Public Health Practice Standards of
Performance for Local Boards of Health – require every local health department in New Jersey to participate in a Community Health Assessment (CHA) and use the findings of that assessment to develop a Community Health Improvement Plan (CHIP).
• Assessment must be completed every 4 years. • The geographic area covered by the CHA & CHIP is the
county. • In counties with more than one local health department,
this planning is coordinated through a Governmental Public Health Partnership (GPHP).
• Engagement of the local community is required.
Community Health Assessments include both: • Quantitative data
• Secondary sources • Community surveys
• Qualitative data • Focus groups • Key informant / stakeholder interviews • Community meetings
Mobilizing for Action through Planning and Partnerships
• Community Themes and Strengths Assessment • Community Health Status Assessment • Local Public Health System Assessment • Forces of Change Assessment
CHA Examples • Ocean County:
http://ochd.org/SiteData/docs/OCCommunit/dab02d8b1fc8b20c/OC%20Community%20Health%20Needs%20Assessment%20Data%20Final%20Report2013.pdf
• Hunterdon County: http://partnershipforhealth.hunterdonhealthcare.org/docs/2013%20HC_CHNA_Final.pdf
NJDOH’s Office of Local Public Health website http://www.state.nj.us/health/lh/index.shtml has links to: • County CHIPs:
http://www.state.nj.us/health/lh/chip.shtml
• CHIP contact person for each county: http://www.state.nj.us/health/lh/documents/governmental_pub_hlth_partnerships.pdf
Hospital CHNAs • The federal Patient Protection and Affordable Care Act
(ACA) requires every non-profit hospital to do a Community Health Needs Assessment (CHNA)
• Frequency – every 3 years • Covers the hospital’s service area.
• Multi-hospital health systems may do 1 CHNA for their entire coverage area
• Same types of data as county CHAs • May also include data derived from their own patient records. • May be reported by municipality and/or zip code
Source: https://www.rbmc.org/wp-content/uploads/2015/07/RBMC-
CHNA_FINAL.pdf
Source: Chakravarty et al, Rutgers Center for State Health Policy, Decmeber 2012,
www.cshp.org
Meridian Health System http://www.meridianhealth.com/_Assets/documents/2015-PRC-Community-Health-Assessment-Report.pdf
CONTACT US
Jennifer Senick, PhD Executive Director Rutgers Center for Green Building [email protected] 848-932-2904 Jon Carnegie, AICP/PP Executive Director Alan M. Voorhees Transportation Center Rutgers University [email protected] 848-932-2840
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