This week is the 49th International Making Cities Livable Conference, taking place this year in Portland, Ore., which will explore how cities can be built and re-shaped in a way that increases opportunities for residents to be active, social and healthy. This year's conference focuses on the theme of "Planning Healthy Communities for All," through inclusive design.

Between 350 and 400 delegates will convene in Portland, "consistently ranked as one of the most livable cities in the United States," to collaborate across the spectrum of fields that play a role in creating healthier communities, including elected officials, urban planners and designers, public health officials, architects, transportation planners, land use developers and more.

Some of the public health speakers on the docket include Richard Jackson, MD, MPH, Chair of the Department of Environmental Health Sciences at UCLA, who recently pioneered a documentary series exploring the development of healthy communities; Andrew Dannenberg, MD, MPH, Professor at the School of Public Health at University of Washington, who will present on health impact assessments; and Lou Brewer RN, MPH, director of the Tarrant County Public Health department in Fort Worth, Texas, who will offer a local "how-to" guide on developing healthy planning policy.

If you couldn't make it to Portland this week, check out the Livable Cities blog, which has interesting articles such as:

• Tips for launching a successful bike-share program.
• A post about why young people aren't buying cars.
• A guest post from Zurich on how most cities are livable—if you're male, older, wealthy and have a car.

>>Read more on building healthier cities.

Defining and measuring what makes a community healthy is a key component of the County Health Rankings & Roadmaps program, which helps create solutions that make it easier for people to be healthy in their own communities, focusing on specific factors that we know affect health, such as education and income. The 2012 Rankings were released last month, and this year includes the Roadmaps to Health Prize for communities working at the forefront of population health improvement.

Creating healthier places is a conversation every town, city and state is having now. To help advance that conversation, NewPublicHealth spoke with Howard Frumkin, MD, MPH, PhD, dean of the School of Public Health at the University of Washington, and a former member of the County Health Rankings Metrics Committee.

NPH: What does a healthy community look like? Are we getting there?

Dr. Frumkin: There ought to be places where the inhabitants of a community can thrive and do well. That’s your metric of success. People need certain things in order to thrive. They need some privacy, but they also need contact with other people. They need clean air, clean water and healthy, uncontaminated food. They need contact with nature, and they need beauty and inspiration. We could go on and on, but most of us would probably agree with what that core list of needs looks like. And then you can work with the community members to ask whether their community provides those needs for people, and we haven’t been doing that well over the last 50 years.

NPH: Why haven’t we been doing that well?

Model practices were the focus of a session, “Building Partnerships for Healthy Places,” on the first day of the Weight of the Nation conference. Bringing diverse groups together to improve community health was a common element of each of the presentations.

Chris Danly of Vitruvian Planning in Boise, Idaho, talked about his firm’s recently completed health impact assessment (HIA) on the Haywood County (North Carolina) Community Bicycle Plan—which aimed to determine what projects, policies and programs were needed to foster a bicycle-friendly community, through a collaborative process with diverse partners such as County officials, the Recreation and Parks Department, the Department of Transportation, bicycle clubs and the local general store. The HIA found the plan would have positive health impacts on community health, including making virtually all members of the community aware of bicycling as an option for recreation and transportation, and also for drivers to be more aware of bikers on the road.

Danly also suggested to conference-goers that they work on both short- and long-term goals with partners when it comes to the built environment: “It’s a great long-term vision to have everyone walk or ride, but in the meantime existing conditions needs to be fixed.”

Danly’s other suggestions:

• Identify places where people are active and build on those small areas to get your long-range vision.
• Get excited about small victories such as kids walking two blocks to the pool, instead of driving.
• Near-term improvements can include sidewalks, pedestrian lighting, landscaping, crosswalks, bike racks, public art and lighting for tracks to make them usable in the evenings.
• Partnership opportunities include citizen’s patrols, site sharing, joint use agreements and organized runs.

The County Health Roadmaps project, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute, includes efforts to build connections within and between local communities and national partners, including grants to coalitions across the U.S. The grantees will build on the County Health Rankings model, which highlights the critical role that education, jobs, income, and other aspects of the community in influencing health.

Roadmaps to Health grantees are working to create healthier places to live, learn, work and play. One such grant was recently awarded to the PedNet Coalition in Columbia, Mo., and NewPublicHealth spoke with several health leaders who will be implementing the grant—Stephanie Browning, health director of the Columbia/Boone County Department of Public Health and Human Services, Stacia Reilly, a health educator for the health department, and Michelle Windmoeller, assistant director of PedNet.

NewPublicHealth: Tell us about the PedNet Coalition and its mission.

Michelle Windmoeller: The PedNet Coalition was formed in April of 2000 with the mission of establishing an interconnected set of trails and walkways and basic infrastructure to encourage people to bike, walk, even use a wheelchair for their transportation needs. Since then, PedNet has evolved to be engaged in a lot of different health aspects. We have some grants that deal with healthy food and food production in the community. We have grants that deal with public transportation and we still have our basic programs that encourage biking and walking like our walking school bus and our bicycle education classes.

NPH: And can you tell us about the scope of the Roadmaps to Health Community Grant you received?

In response to burgeoning national interest in using health impact assessment (HIA) as a tool to factor health into policy decisions, the Health Impact Project and other leading health organizations will convene a first-ever National HIA Meeting this week from April 3 through April 4 in Washington, D.C. Policy-makers, public health professionals, community-based organizations, researchers and elected and appointed officials from across the country will hear the latest on how HIA can be used to inform policy decisions outside health in areas such as planning, transportation, housing, agriculture, energy, education and the environment. Community leaders and policy-makers want to protect the health of their communities, but they need sound, objective data to identify what could help or hurt people’s health in order to guide their decision-making.

The meeting is being organized by The California Endowment, the National Network of Public Health Institutes, the Centers for Disease Control and Prevention Healthy Community Design Initiative and the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project.

NewPublicHealth: The first ever national HIA meeting is coming up. Who is coming to the conference, and what do you think the key sessions will be?

Aaron Wernham: Well, we really aimed for a broad audience. HIA practitioners as well as people who have been interested in starting to use HIA but just haven’t really begun will all be in the audience. A lot of people from related public health fields will be coming. We’ve also created programming that will be relevant and interesting to people outside the health sector because HIA is really a bridge that aims to help practitioners collaborate with people in a great many sectors, such as transportation planning or housing or energy policy.

NPH: What do you think some of the hallway conversations might be?

The first national meeting on Health Impact Assessment begins April 3 in Washington, D.C., and interest is so high that registration has been at capacity for weeks. The meeting capitalizes on the growing interest in health impact assessments (HIAs) and will convene policymakers, public health professionals, HIA practitioners and anyone with an interest in learning more about the value of health impact assessments.

In advance of the meeting NewPublicHealth spoke with Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the Centers for Disease Control and Prevention. The Initiative is helping to plan the upcoming HIA conference.

NPH: What is the overarching goal of the Healthy Community Design Initiative?

Trust for America’s Health and the Robert Wood Johnson Foundation today released their eighth report on “Investing in America’s Health,” which examines public health funding and provides key health facts for states across the U.S. Investing in disease prevention, according to the report, is the most effective way to improve health. It can help spare millions of Americans from developing preventable illnesses, reduce health care costs, and improve the productivity of the American workforce.

Read an excerpt from the report by James Rhodes, Planning Director of Pitt County, N.C., on community health initiatives that have been a comprehensive part of life in the county for over three decades.

People talk about prevention initiatives such as shared use policies and farmers markets as if they are new and maybe they are for them. However, that’s not the case for Pitt County, as we have been, apparently, on the forefront of these initiatives for some time.

In 1978, the county created a shared use policy to open school sites for recreational and community activities. It quickly became how we were brought up.

The first national meeting on Health Impact Assessment begins April 3 in Washington, D.C., and interest is so high that registration has been at capacity for weeks. The meeting capitalizes on the growing interest in health impact assessments (HIAs) and will convene policymakers, public health professionals, HIA practitioners and anyone with an interest in learning more about the value of health impact assessments.

In advance of the meeting NewPublicHealth spoke with Arthur Wendel, MD, MPH, team lead for the Healthy Community Design Initiative at the Centers for Disease Control and Prevention. The Initiative is helping to plan the upcoming HIA conference.

NewPublicHealth: What started your interest in helping to create healthy communities?

Arthur Wendel: When I was in eighth grade I wrote a research paper on alternative transportation and fuels of the future, and through that process I learned about alternative fuels and some of the impact it was having on public health. I started there. When I went to college, I did a public policy and chemistry degree and I wrote my thesis on air pollution and public health. I simultaneously got my MD and MPH degrees and worked on another project that was related to alternative fuel vehicles and public health and saw that one way policies could change was through public health efforts and I wanted to be a part of that. So here I am.

NPH: What is the overarching goal of the Healthy Community Design Initiative?

Arthur Wendel: Our mission is to understand and improve the relationship between built environment and public health. We deploy very traditional public health tools and practices towards that mission, thinking about the essential public health services. One thing we’re working on now is an evaluation of walking to transit—how much people walk to transit, how many minutes of physical activity do they get. We've also looked at the impact of hybrid vehicles on pedestrian fatalities to see whether or not they’re different than their conventionally fueled counterparts, given that they’re quieter and some people may have trouble hearing the hybrids approaching.

NPH: Tell us about the Initiative's interest in health impact assessment (HIA)—a tool that looks at potential health impacts of policies and projects in other sectors?

Arthur Wendel: We’ve been engaging in HIAs since 2003, and we funded one state to develop an HIA capacity-building pilot program in 2008, added three states in 2009... We are now funding 6 HIA programs throughout the U.S. In 2008, we published a research article that showed 27 completed HIAs in the U.S. and by 2010, we had worked with organizations like Pew to track 150 HIAs that were either completed or in progress, so that it’s growing by leaps and bounds almost to the extent that it’s hard to keep up with the all the HIAs that are going on in the U.S.

We work with the Health Impact Project extensively. We’ve worked with them to develop good methodology and deploy that.

NPH: What is your role in the Inaugural HIA meeting next month?

Arthur Wendel: We’re partial funders and we have an HIA grantee preconference meeting with Health Impact Project on April 2, the day before the conference begins. Our grantees and their grantees are going to meet for the first part of the day separately, do our own thing, and then the second part of the day, we’re going to have a joint session between the two grantee groups to be able to talk about what’s going on in the different regions and specific topic areas of interest among the partners. So we’re intermingling the grantees so they can learn from each other. For the main conference, we’re helping with the planning and moderating the HIA 101 session and we are fielding session speakers.

NPH: What HIA subset does the Initiative focus on?

Arthur Wendel: We’ve tried to focus on healthy community design, though the full practice of HIA is of interest to us in general and we’re helping to develop good strategies for engaging in health impact assessment across the U.S.

NPH: How does the work of your office break down?

Arthur Wendel: At this point 10-15% or so is research. Another 10-15% is trying to improve surveillance and assessment activities, engaging with other partners that are doing surveillance work such as surveys where we can include built environment questions. A substantial chunk of our work – perhaps half, is on health impact assessment, particularly, being able to think about how to translate some of the evidence and surveillance information to inform policy. And then the last part is the evaluation component, and in that phase we engage with organizations such as Safe Routes to School and Complete Streets.

NPH: How far along are you in terms of making stakeholders aware of what’s available to improve health in communities?

Arthur Wendel: That’s part of the reason why we’re engaging in the health impact assessment arena. Because it is a mechanism for communities who are interested in engaging in these issues to do something applied and real, and so for the six communities that we’re funding, which include some states, it allows them to try out working in this area and to do a health impact assessment along those topics. After an HIA, once those partnership relationships are established, it can provide options for other working experiences.

NPH: Who are your early adopters for the built environment concept?

Arthur Wendel: It is different people community to community. In general, planners tend to be pretty involved and on the ball with some of these issues. We’ve had a relationship with the American Planning Association (APA) for some time. One of the things that we do with them is sponsor a health impact assessment online training module and it’s the most popular online training module that APA has. So that’s a group that tends to be a little more engaged in these issues. It does vary from community to community. With local public health departments, some will see this as an important issue to help move their community forward in some of their outcomes and some are still trying to sort out exactly what HIA means.

NPH: Given that the US is made up of urban, rural, suburban and hybrid communities, are there some overarching design principles for the built environment?

Arthur Wendel: There are some design principles that kind of overarch that whole area and I think that there have certainly been examples of good approaches even in rural areas of implementing solutions that work. I can think of a – safe routes to school program that happened in an area about twenty miles from my rural hometown where they built an asphalt sidewalk from basically the general store to the K-12 school that facilitates walking from that school to the population center in the “downtown” in a town of about 200. So, there are certainly some challenges with rural environments. The farms, for instance, are going to be difficult to have the infrastructure for walking and biking. But for most of the population, there are opportunities to build healthier communities and even in rural settings, there are some opportunities for changes.

NPH: When you start with school children, can you build the built environment into their thinking from a very early age?

Arthur Wendel: Yes, and that’s why I think the safe routes to school concept is a critical piece. It brings together youth who have got eighty years of their life ahead of them, potentially. It brings together transportation, it brings together public health and kids can’t drive on their own, so if they’re going to take ownership of their own transport, they have to do something that’s either walking or bicycling or rollerblading. We’ve partnered with the Safe Routes to School National Partnership and the National Center for Safe Routes to School. That’s a critical component for improving community design.

I deal with this a little bit in my own neighborhood. I’ve got a first grade son we walk to school and there are no sidewalks. It’s a challenge. Cars are going by at 35-40 mph even though it’s a 25 mph residential area. It does not feel safe and I worry about what that’s going to do for kid’s physical activity as they get older. I see my own son, when he doesn’t get enough physical activity, he doesn’t behave as well and I think about that on a population level. And motor vehicle crashes are the leading cause of death for that age group, and so, making sure that they have got a way to walk to school safely is critical.

NPH: How much has the recession impacted on progress of the built environment?

Arthur Wendel: Well, it’s a double edge sword, isn’t it? Because it also increases demand for things like transit and walking and bicycling, which are cheaper forms of transportation than driving your car when gas is $4 a gallon? So there tends to be some popular enthusiasm for better community design. It’s an opportunity in an economically constrained environment to try and be able to think strategically about what we can and can’t do and how to make decisions that will help for the next time there’s a recession so that environment is composed in such a way that it makes it easier for people to get out of that financial bind.

NPH: Why are destinations for the walkers, bikers, runners, so pivotal to the built environment?

Arthur Wendel: when we originally created our zoning laws, they were done to separate noxious industrial pollution from residential areas. Because we’ve got environmental laws in this country and because we’ve shifted some of our economy away from heavy duty industry to commerce and other sorts of industries, we had the opportunity to put these things back together in a way that won’t adversely impact the population’s health through environmental pollution. By thinking strategically about how to do that we can start to think about how to improve physical activity, reducing motor vehicle injuries and essentially make our society more livable.

NPH: Many new walkable communities seem to cater to the highest incomes. How can the concept be more inclusive?

Arthur Wendel: Demand is so high, that’s why prices are going up. People see this as a need, something that they want. But I also think it’s an opportunity for communities that can afford this to take advantage of that increased demand by implementing policies that facilitate the inclusion of affordable housing units or other ideas to try and minimize as much displacement as possible and help keep communities intact and make sure things are equitable as their neighborhoods are developed. I think that, overall if we want to improve health in the U.S., we’ve got to move towards communities that allow healthy choices to be the easy choice, but there are some policy crutches that we can do to make sure that equity is not challenged at the same time. There has to be the right mix of jobs and services in the area that support people of all income scales. You can’t always have a high end grocery in one place; you have to have something that has affordable, healthy food as well.

NPH: When do you want participants to take away from the Inaugural National HIA Meeting?

Arthur Wendel: I think the most important thing that they should leave knowing is who to go to in their community to partner with to make it better. Whether it’s their planner who came to the meeting, or their local public health department. In addition, we’d like them also to feel comfortable with their respective partner on how to move things forward in their community and potentially have a tool that they’ve heard about, and something they’ve learned at the meeting that they can use to test out the waters. Health impact assessment is an opportunity to do that.

In this country we spend about $2.6 trillion on healthcare costs, and the majority of that is public dollars in some shape or another. I’ve often heard said that physical activity, if you could bottle it, would be one of the best drugs to be able to give to people to help prevent a myriad of illnesses from diabetes to heart disease to some types of cancer. Obviously, we can’t bottle physical activity; you can’t even put it in the water so everybody just drinks it. But we do have the opportunity to change communities, to get people physically active, to provide an opportunity for them to engage in activity safely, and to help improve the likelihood that people won’t be run over or killed as they’re going from place to place. And I think that health impact assessments and other policy changes around community design are critical ways of going forward.

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?

Got five minutes? Spend it viewing a recent video on walkability from Dan Burden, a reigning expert, who took NewPublic Health on a walkability audit of San Diego during the recent New Partners for Smart Growth Conference. Burden is executive director of the Walkable and Livable Communities Institute.

The video is a veritable travelogue for walking as the best possible way to get around locally. Burden discusses metrics, safety features and fixes to current streets while video scenes, including happy walkers of all shapes and sizes, flash on screen. Burden makes some pivotal points about walkability, including creating destinations for walkers, adding landscaping to enhance the enjoyment of the walk, and making changes to traffic technology such as replacing some lights with traffic circles to improve safety for drivers, walkers and bikers.

Walkable 101: The Basics from Martin County CRA on Vimeo.

How walkable is your community? Try this checklist from the Pedestrian and Bicycle Information Center, a national clearinghouse.