Category Archives: Community Development
Jo Ivey Boufford, MD, president of the New York Academy of Medicine, was a keynote speaker this week at the National Network of Public Health Institutes (NNPHI) Annual Conference in New Orleans, La.
>>Watch Dr. Boufford in a video series on working together to make communities healthier places to live:
NewPublicHealth spoke with Dr. Boufford about the conference theme, “Leveraging Public Health Institutes for Systems Change.”
NPH: The theme of the conference is leveraging public health institutes for systems change. What systems do you think need changing to improve population health?
Dr. Boufford: I think there are really two major components to a public health system. One of them obviously is the governmental public health infrastructure—the public health agencies at state and local levels that are really charged to assure the health of the public, by detecting illness and promoting health information and trying to change environments so people can live in healthier communities. A lot of reports have shown that that part of the health system has historically been very under-invested in, and it needs to be shorn up. I think the national public health institutes should be strong advocates and partners of the governmental public health agencies in leveraging resources to improve population health.
The other part of the system is the personal health care system, which is and potentially will be undergoing dramatic change with the Accountable Care Act (ACA). There are a number of opportunities to get better population health impact out of the personal health care system, such as looking at the role of community health centers, of medical homes, of accountable care organization models to improve the health of a geographic community or particular population over time. So I would say those are the two big opportunities, and public health institutes in states need to work closely to take full advantage of the opportunities for populations.
NPH: What other key roles do you see public health institutes playing in improving population health?
The National Network of Public Health Institutes (NNPHI) Annual Conference kicks off today in New Orleans, La. Public health institutes are nonprofit entities that serve as partners and conveners to improve population-level health outcomes and help to foster innovations in the public health system. They serve as hubs of innovation, provide technical assistance, and offer a neutral point of convening to governmental public health agencies as well as other critical stakeholders.
This year's conference theme, "Leveraging Public Health Institutes for Systems Change," will share examples of public health institutes working in close collaboration with state and local health departments and a broad range of other partners to support opportunities for systems change. There are some new and interesting developments at this year's Annual Conference, which has seen an uptick in registration from around 120 attendees in previous years to more than 200 attendees this year (impressive in an era when travel budgets are scarce).
NNPHI also recently released a new call for proposals, with funding support from the Robert Wood Johnson Foundation, to enhance the performance of the public health system by supporting additional states to use the public health institute model to help address their pressing health challenges. The project will fund up to two states to advance efforts to establish a public health institute that meets NNPHI’s definition, with an ultimate goal of improving these states’ public health systems.
NewPublicHealth spoke with Christopher Kinabrew, MPH, MSW, Director of Government and External Affairs for NNPHI, for some highlights of this year’s conference:
- David Erickson, PhD, Manager of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, will be a keynote speaker and continued NNPHI collaborator in discussing the potential around keeping the relationship between public health and community development alive.
- Work is underway to determine the feasibility of developing a national tribal public health institute that addresses the needs and concerns of the 565 federally recognized American Indian tribes in the United States. The group spearheading this effort will be at the NNPHI conference for the first time this year.
- A Community Health Assessment Town Hall with representatives from the Hilltop Institute, United Way Worldwide and several public health institutes, will explore opportunities for collaboration around assessments, such as between public health and hospitals around new community benefit requirements.
>>Continue to follow NewPublicHealth coverage of the NNPHI Annual Conference this week.
Safe, vibrant neighborhoods are vital to health. The community development industry—a network of nonprofit service providers, real estate developers, financial institutions, foundations and government—brings together public and private funds and directs them into investments that transform impoverished neighborhoods into better-functioning communities.
Last week, Nancy O. Andrews, President and CEO of the Low Income Investment Fund, recently moderated a panel on “Healthy Communities” at the National Interagency Community Reinvestment Conference, a premier biannual conference for community development professionals. Andrews previously moderated several sessions on the intersection of community development and health at a series of “Healthy Communities” conferences co-sponsored by the Federal Reserve Bank of San Francisco, The Pew Charitable Trusts and the Robert Wood Johnson Foundation. [Watch an archived video of the “Capital Systems Change” session at the Healthy Communities Conference in November 2011 here.]
NewPublicHealth: What is the connection between community development and human development, particularly when it comes to health? Or, how does investment in a community actually improve the health of the people living there?
Nancy Andrews: Human development, community development and health are inseparable. There is a growing body of knowledge that makes it clear that the communities we live in can help us or hurt us in every conceivable way. The effects of living in poverty can be life-long and can affect one’s ability to be physically, mentally and emotionally healthy. Just in the last six months there have been new data from a 10-year study by the Department of Housing and Urban Development that demonstrates that living in quality housing in a good community reduces obesity and diabetes by as much as 20 percent – that’s an impact a great as a medical intervention! We also know medical interventions can solve only about 10 percent of our health issues. Much, much more of a person’s health outcomes are a result of our environment, our upbringing and our habits. It is almost impossible to overstate how important the environment is on our ability to lead healthy, quality lives.
NPH: You recently led the "Healthy Communities" panel at the National Interagency Community Reinvestment Conference. What did this session cover?
In Detroit, Michigan, the Joy-Southfield Community Development Corporation has developed a targeted approach to promoting health equity, based on the four factors measured by the County Health Rankings: health behaviors, clinical care, social and economic factors and physical environment. Despite its location in one of the most racially segregated cities in the country, with poor public transportation, high poverty and unemployment, and vast food deserts, the Joy-Southfield neighborhood has become a hub of partnerships and activities aimed at long-term health improvement. Several community groups and funders have collaborated to empower youth through mentoring and community garden projects; renovate vacant properties to attract new businesses; improve community safety; provide job training and foreclosure prevention services and more.
NewPublicHealth spoke with David Law, PhD, Executive Director at Joy-Southfield, about the program.
NewPublicHealth: Tell us about the Joy-Southfield Community Development Corporation. How did your priorities evolve, and how did the County Health Rankings help shape them?
Mobilizing Communities Toward Better Health, Income and Education: Q&A With United Way's Brian Gallagher
United Way Worldwide has evolved from its roots as a fundraising organization to a critical community convener that mobilizes local partners, including businesses, community leaders, public officials and community residents, to expand opportunities for people to live healthy, quality lives. United Way focuses on three key building blocks: a quality education that leads to a stable job, enough income to support a family through retirement, and good health. With support from United Way Worldwide, 12 United Ways across the country have formed the United Way network’s first Health Mobilization Group. This peer-learning community will use the County Health Rankings framework to work with the residents, external experts and stakeholders to drive systems change to improve health and health equity in their communities.
NewPublicHealth will conduct an in-depth series on the work of United Way on the ground to improve health, education and income. The series will include Q&As with thought leaders as well as those advancing initiatives at the community level: the leaders in local United Way organizations and their communities. We kick off this series with a conversation with United Way Worldwide President and CEO, Brian Gallagher, MBA, about the organization’s priorities, key partners and methods for mobilizing communities for social change.
NewPublicHealth: United Way focuses on three key issues: education, income and health. Why are these the most critical issues, and how do they work together to impact quality of life?
While at the New Partners for Smart Growth Conference, we took the chance to talk to some of the meeting attendees and get their thoughts on the conference and the intersection between public health and building better communities.
Senior Health Educator
What brought you to the conference?
I love the intersect between health and planning. For me [this conference is] about peer learning to see what many of my colleagues are doing across the country and how we can take some of the best practice models and apply them to where we are. I’m also such a staunch advocate for health that I think that merging the two worlds of land use and public planning along with public health seems like a nice fit.
Who are your critical partners for smart growth?
Multitudes. On the ground, grassroots, the community residents who live in those areas, and their children and young teens who are taking a real interest now. I work with several government agencies who are realizing that the way we do business doesn’t work anymore. We’re having to look at different approaches to sustain the work we do. I also work with local city planners.
What is some of the work that you’re doing in the health community?
I look at how to improve health, especially for those in low-income communities, in areas that might be considered food deserts or food swamps. Through the public health department when I worked there, we looked at organizing farmers' markets in low-income areas, bringing access to good quality, locally-grown produce. In order to establish the farmers’ market, I had to understand what were the ordinances or the zonings to allow this to happen in a residential area. I also work with city planners to look at health language in their general plans. I work at organizing workshops in which we bring all the county agencies together so that people on the ground can understand what we need from them and what they need from us. I also look at worksite wellness and the policies we develop around lactation and vending machines, creating healthier places and making sure all those policies are infused county-wide, so all the county agencies are on the same page when it comes to promoting a healthy workplace. One of the projects I want to take on is healthy corner store conversions, and that was a really good model presented here.
What I like about this conference is that each year it grows to be more diverse. I like to see public health here. It’s really important. The conference is fairly young, but it’s growing fast and gaining the attention and momentum it should. There are so many of us now making the fight for the connection between health and the environment.
Public Health Prevention Service Fellow
What brought you to the conference?
I’m trying to kick off a strategic planning process for a built environment program at the Richmond City Health District.
Who are your critical partners for smart growth?
Our city planning department, economic and community development, the department of transportation, our local transportation system (the Greater Richmond Transit Center), private partners and some of the local non-profits.
How does your work impact the health of your community?
Getting all of the siloed sectors talking to each other about how they can impact the community in a bigger way—not just with health, but with equity, more resources, and a healthier and more vibrant community in general.
Robbyn Lewis, MPH
Public Health Researcher
What brought you to the conference?
I came for a couple of reasons. Firstly, the reason that I’m even able to be here is because I was awarded a diversity scholarship. The second reason is that I am a public health professional. I work mostly with infectious disease research, but I am very interested in sustainability and the environment, and working as a volunteer to change, transform and improve my neighborhood. I knew that I could learn a lot at this conference. I wanted to be here partly for professional development, but also for education – to learn strategies and ideas that I can take back to my home and apply to my community in Baltimore. I want to continue that volunteer work that I’m doing, but do it in a better way.
The third reason is networking. As a public health professional and researcher who is interested in the built environment, I love the field so much that I’ve been looking for ways to redirect my profession in ways that allow me to be paid for my work in the environmental and sustainability. I’m looking to broaden my network and make contacts.
Environmental and Emergency Management Specialist
What brought you to the conference?
This is the only conference that I know that is devoted specifically to these issues. I am interested to meet the fans and see what they think about it. I want to learn and compare my knowledge with people of different perspectives to see what’s new, what’s going on, and what direction people are looking to.
[Note: All statements here are from the individuals featured and do not necessarily represent the views of the organizations they work for.]
This weekend at the New Partners for Smart Growth Conference, NewPublicHealth attended a walkability audit of downtown San Diego with the inventor of the tool and "Johnny Appleseed of walkability," Dan Burden. In 2001, TIME magazine named Burden one of the world’s six most important civic innovators. He is currently a senior urban designer and executive director of the Walkable and Livable Communities Institute, and previously co-founded Walkable Communities, Inc., and the Bicycle Federation of America. Burden has worked in more than 3,000 communities and led more than 4,000 walking audits throughout North America.
Walking audits have been happening for about 25 years now, though they are a skill and a field now coming into their pinnacle—the first official course on walkability audits was taught recently in Tucson to a mix of health, planning and engineering professionals. “A very big part of the walkability audit is to start to break down the walls between disciplines. It really helps open people’s eyes. It’s been a very powerful tool.”
A walking audit is an assessment of the walkability or pedestrian access of the built environment in a community. Burden created this tool to help communities understand how their environment encourages or discourages its residents from walking.
“America became something different. We lost our focus. We stopped designing cities for people,” explained Burden.
Dan Burden began to run walking audits about 25 years ago during his tenure at the Florida Department of Transportation. He realized that the engineers never went out and walked the streets they’d designed. “As we went out, we realized more and more how wrong the designs were.”
In his presentation, Burden shows photos of places that make you want to stay inside your house (or get in a car) rather than walk anywhere—deteriorating or no sidewalks, dangerous intersections built for cars that leave scarcely enough time for a healthy person to cross, acres of asphalt littered with bottles and trash with no green space in sight, and unlit alleyways that seem built to shelter crime.
“Over 80 percent of Americans want to be able to seamlessly switch modes of transportation,” said Burden. “That’s not what we’re funding.” In fact, he said, less than 1 percent of federal transportation dollars go toward supporting walking and biking infrastructure, and even those scarce funds are under threat.
Burden typically takes anywhere from one to 100 people with him on his walkability audits (though he recommends a group of 30 for less seasoned walkability gurus), inviting city planners, elected leaders, citizens, advocates, police officers, persons with disabilities and public health officials—anyone with a vested interest in creating a better community.
Before he brings in the whole group, though, Burden tries whenever he can to take a first pass through a neighborhood on his own to connect with residents, kids and local retailers to get their take about what’s working and not working in the community. One six-year-old told him all she wanted to do was to walk to school and play with her friends, but she was afraid to be outside by herself. The goal of the walkability audit is to find out what steps the community needs to take to get it to be a place its residents can be proud of and happy to live in.
The components of a walkability audit get very nitty gritty: the exact width of the “walk-and-talk zone” of a sidewalk (ideally four feet, leaving another two to four feet on either side as a buffer and a place for sidewalk “furniture” such as benches, bus stops and street lamps), the number and width of lanes for cars, the average speed of cars and average traffic volume on each block, and more. But what’s most critical is not the sidewalks or traffic patterns—it’s how the land is used, how connected are the hubs of activity, and how much open space there is. While sidewalks are important, they’re useless if they don’t lead somewhere people want to go, said Burden.
While the walkability audit of San Diego at the Smart Growth conference was quite literally, at times, a walk in the park on a beautiful, sunny day, that’s not always typical. Burden’s longest audit spanned 16 miles on a day when the temperature peaked at 120 degrees. Another audit could only be conducted 10 minutes at a time because the temperature dipped below a frigid –54 degrees. Yet on the 16-mile, 120-degree day, a woman in a wheelchair stuck it out for the entire audit to help show her community the challenges she faced daily in navigating a city that simply was not built for her.
What makes a community work? Five key aspects, said Burden:
There’s both an art and a science to walkability. The science involves a set of measures and ratings, described in detail in the Environmental Protection Agency’s Walking Audit tool, co-designed by Burden (and admittedly still “in beta”—more will likely be added to the tool as it is continually tested and refined).
Though health is not the primary goal of a walking audit, it is a critical outcome of a walkable community.
>>Read more NewPublicHealth coverage from the New Partners for Smart Growth Conference.
Town and city streets are an important part of the livability of communities, says Barbara McCann, Executive Director of the National Complete Streets Coalition and a presenter and moderator at this week’s New Partners for Smart Growth conference in San Diego. McCann says streets ought to be for everyone, whether young or old, motorist or bicyclist, walker or wheelchair user, bus rider or shopkeeper. “But too many of our streets are designed only for speeding cars, or worse, creeping traffic jams.”
But in communities across the country, a movement is growing to complete the streets and these communities are asking planners and engineers to build road networks that are safer, more livable, and welcoming to everyone.
Instituting a complete streets policy, according to McCann, ensures that transportation planners and engineers consistently design and operate the entire roadway with all users in mind. NewPublicHealth caught up with McCann in advance of this week’s conference.
NewPublicHealth: What is the scope of Complete Streets?
Barbara McCann: Complete Streets is about getting communities around the country to adopt policies to ensure that streets work for all users, and we have focused quite a lot on policy adoption. We’re seeing success in more half of the states and in about 300 local communities. And now we’re turning our attention towards implementation. What do communities need to do once they have a policy in order to actually make changes on the ground that creates a safer environment for walking and bicycling and taking the bus and other really active transportation?
NPH: How quickly have you seen changes recently?
Barbara McCann: Well, certainly in policy adoption it’s been going great guns. We’ve pretty much doubled the number of policies adopted every year for the past three years, from close to zero where we started this in 2006. So the policies are really, really spreading. Implementation of actually seeing change on the ground is a long haul process in most places because Complete Streets policy must make sure that every future project is done differently, and so that means that you’re not going to see an overnight change in your community, but it does mean that as investments move forward, every transportation investment will start to make a difference.
There are communities that have been doing this for a number of years and we do see improvements in facilities, we see public support or some of the innovations that are happening on the roadways really rising. We see safety improving and we see an increase in biking and walking in some of the places that have taken this approach.
NPH: What community would you hold up as a model for Complete Streets?
"Designing Healthy Communities,” a four-part series funded in part by the Robert Wood Johnson Foundation, debuts this month and next on many Public Broadcasting stations. The program looks at the impact the built environment has on key public health problems such as obesity, diabetes, heart disease, asthma, cancer and depression. In the series, host Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, connects bad community design with burgeoning health costs, then analyzes and illustrates what citizens are doing about this crisis by looking upstream for innovative solutions.
NewPublicHealth recently caught up with Dr. Jackson, who will also be a featured speaker at the New Partners for Smart Growth Conference in San Diego next week, leading a session on “Health as a Messaging Tool.” Dr. Jackson received the New Partners for Smart Growth Lifetime Achievement Award in 2008.
NewPublicHealth: What prompted the "Designing Healthy Communities" series?
Dr. Jackson: My background is that I’ve worked in environmental health in one form or another for over 30 years. I started out as a pediatrician and have become more and more focused on the whole mix of environment and health and the outcomes and the impacts on our population, acute impacts such as asthma, car injuries, all the way through to chronic diseases, cancer and birth defects, and I’ve investigated all of them. And then beyond chronic diseases, long-term health impacts such as endocrine disrupters in the environment and health effects of global climate change.
I spent nine years as the Director for the National Center for Environmental Health and I was State Health Officer for California for a year and a half, and I’ve become increasingly convinced that I’m sitting at the end of the disease pipeline waiting for somebody to come in the door with obesity-related diabetes, with injuries related to a bad urban design or for that matter a lack of adequate crosswalks. Asthma and even heart disease are related to very poor air quality. That it is not feasible for the future of our country. When I was a young doctor, seven percent of all the money in the United States that was going to medical care. It’s now more than 17 percent, and the U.S. is still ranked about number 50 in life expectancies worldwide.
So, we’re not doing something right, and I would assert that what we’re not doing right is we’re failing to really operate in the realm of prevention. We’re not going far enough upstream in thinking about what things are affecting our health. What I would assert is a big driver that’s affecting our health but it’s also affecting our happiness, our prosperity, and our future is how we have built America. We have built it for the needs of cars and other short-term needs, maximizing sale of commodity foods of various kinds and we have not built it with an eye towards people and an eye towards future generations.
I co-wrote a book ten years ago called “Urban Sprawl and Public Health,” and then became much more focused on these issues of built environment and co-wrote a textbook, where we very deeply document the impact of the built environment on everything that you would imagine, but also further upstream to obesity and lack of fitness, and even further upstream to unhappiness, to depression, and we began to think that just as this damaged environment can have multiple negative health outcomes, creating health environments should have positive health outcomes. And that’s why the television series is called “Designing Healthy Communities."
Ten years ago there really was very little recognition of this issue, but that’s changing. There were almost 300 sessions that either had the words “built environment” or “land use” at the last American Public Health Association National Meeting in early November in Washington, DC.
NPH: What’s driving that increasing interest?