Category Archives: Smart Growth
Marissa Sheldon, MPH, a Public Health Prevention Service Fellow at the Centers for Disease Control and Prevention who is temporarily working at the Manatee County Health Department in Bradenton, Fla., spoke at a session today during the APHA annual meeting on working with non-traditional partners to improve community health. Sheldon heads the county’s APHA Power of Policy Complete Streets Work Group. The health department is developing guidelines for a complete streets policy with implementation planned for 2013. Such a policy ensures that transportation planners and engineers consistently design and operate the entire roadway with all users in mind – including bicyclists, public transportation vehicles and riders, and pedestrians of all ages and abilities.
>>View a related infographic on the connection between transportation and health.
NewPublicHealth spoke with Marissa Sheldon just before the meeting.
NewPublicHealth: Who were the partners on the complete streets project?
Marissa Sheldon: There are so many different benefits to the project that it is important to include multiple people with multiple interests. From the health department perspective we are interested in obesity prevention, getting people out walking and biking, and injury prevention. Then you have people from the planning department or public works who are more interested in making sure that the traffic flow is going well and there isn’t a lot of congestion and that there aren’t a lot of accidents. The school board is concerned about kids who are walking to school. We have people who are bicyclists and pedestrians themselves who just want to make sure that they are safe when they are out on the roads and we also have been in contact with fire and rescue and the sheriff’s department who are the people who are responding to accidents on the roadways. So, it’s really a big effort of several different groups of people who are all interested in the same project, but for different reasons.
NPH: How close are you to completion?
The health upside to a new casino can be the increased quality of life and life expectancy associated with new jobs. But, it can bring health downsides too, including the fallout associated with gambling addiction. Those are some of the key findings in a new health impact assessment (HIA) from the Kansas Health Institute (KHI), released this week. The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, and conducted by KHI together with the University of Kansas School of Medicine-Wichita.
“Our first HIA intended to inform the discussion of potential casino development…” says Robert F. St. Peter, MD, who is KHI’s chief executive officer. “In many cases,” says St. Peter, issues like these may not seem to have direct connections to health, making them a good fit for [a] health impact assessment.”
The results of the new HIA suggest that there may be positive impacts of casino development related to new jobs; the negative impacts would be related to increases in pathological gambling, which is also associated with nicotine dependence, substance abuse, depression, insomnia, and domestic violence. The HIA offered recommendations including:
- Train physicians to screen for problem gambling behaviors
- Eliminate smoking within and around casino buildings
- Strengthen local services to treat and prevent gambling addictions and related conditions
- Operate a “safe ride” program for patrons and residents
- Use a “loss limit” strategy to prevent substantial financial losses among casino visitors
Read a recent NewPublicHealth interview with Tatiana Lin, KIH senior analyst and strategy team leader, who was the director of the Casino HIA.
Martin Fenstersheib, MD, MPH, director of the Santa Clara County Public Health Department in California led a session on safe outdoor activity for kids and adults at the 2012 Public Health Law Conference. NewPublicHealth spoke to Dr. Fenstersheib about what is keeping our communities from safely getting outside to play—violence, blight and communities built for cars—and solutions grounded in evidence-based public health law.
NewPublicHealth: You presented at a key session on making outdoor physical activity opportunities safer. What makes this an important issue for you?
Dr. Fentersheib: Often when we talk about physical activity, we hear people say that all we need to do is convince kids to go outdoors. A lot of us then say, “when we were kids, our parents let us out of the house in the morning and we came back at nighttime and all was well.” There wasn’t any problem with that. But, of course, we’ve all become aware of safety as a barrier to outdoor physical activity. And the issue has to do with not only criminal or violence safety, but safe streets generally. Do cars in an area make it less safe for example? And, is our environment built in a way that it is safe for kids to walk to school? My presentation will be an overview of the benefits of physical activity, and what some of the barriers are.
We’ll also look at the legal side of the issue, including a study on mixed use land zoning. I think the bottom line is that safer neighborhoods will have more of a mixed use flavor so that you don’t have to go far to get to work or play or to recreational areas. In such neighborhoods, there are stores and other places for you to go, and you’re closer to public transportation. The data to be presented will show that the crime rates in those areas are lower than in pure industrial areas or areas where there isn’t mixed use. Mixed use is helping to improve the built environment in the communities in which we live by having more eyes on the street, by having people basically looking out for one another and be more of a community.
NPH: What are examples in Santa Clara of new plans to create safer outdoor spaces for children and adults?
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health.
We all know that living in a walkable neighborhood is good for your health. The more surrounded we are by trees, water and parks and the more we are within walking distance of meaningful places for daily needs, the more likely these destinations are a part of our day-to-day lives. In a recent op ed for the New York Times, Christopher Leinberger comments on a new Brookings Institution study he co-authored with Mariela Alfonzo, PhD, a research fellow at Polytechnic Institute of New York University, which shows that more walkable neighborhoods also fare better economically. In this Idea Gallery for NewPublicHealth, Leinberger expands on the benefits of walkability for a community.
The takeaway from our report is that there’s been a structural shift in how we build the built environment. This is not a cyclical change caused by a periodic recession. This is a structural shift. The last time we had this was after the Second World War. We’re building fundamentally a different America.
Before you build it you have to be sure that you have the strategy and management structures in place to make it happen. Generally in this country, walkable urban development is illegal—there is no zoning in place to allow it to happen. Plus it works best when the place has a strategy and management entity in place, generally taking the form of a non-profit building improvement district (BID).
There is then the possibility of achieving the triple bottom line: 1) make money, 2) be responsible to the environment, and 3) be socially equitable.
On social equity, certain jurisdictions in this country have said we want a mix of incomes in our neighborhoods, and I believe this is the proper approach. The price premiums telling the real estate industry to build more also portend an inability for working- and even middle-class buyers to live in walkable urban places.
The August Centers for Disease Control and Prevention Vital Signs monthly report on health indicators focuses on adult walking and finds that 62 percent of U.S. adults get their physical activity by walking at least once for ten minutes or more per week, up from 56 percent n the 2005. However, close to 50 percent of adults don’t get enough physical activity to improve their health, the report finds. The 2008 Physical Activity Guidelines for Americans recommend at least 2.5 hours of moderate intensity aerobic activity per week, such as brisk walking.
“Having more places for people to walk in our communities will help us continue to see increases in walking, the most popular form of physical activity among American adults,” says CDC Director Thomas Frieden, MD, MPH.
“People need more safe and convenient places to walk,” adds Joan M. Dorn, PhD, branch chief of the Physical Activity and Health Branch in CDC’s Division of Nutrition, Physical Activity and Obesity. “People walk more where they feel protected from traffic and safe from crime. Communities can be designed or improved to make it easier for people to walk to the places they need and want to go.”
The Vital Signs report offers suggestions to provide better spaces and more places for walking:
- State and local governments can consider joint use agreements to let community residents use local school tracks or gyms after classes have finished.
- Employers can create walking paths around or near the work place and promote them with signs and route maps.
- Residents can participate in local planning efforts that identify best sites for walking paths and priorities for new sidewalks.
>>Read more on smart growth for more walkable cities.
North Little Rock Mayor: It's About Giving People a Reason to Want to Live Here; Health is Added Inspiration
Pulaski County, Ark., home to the city of North Little Rock, ranked 21st out of 75 counties in the state in the 2012 County Health Rankings. North Little Rock Mayor Patrick Hays recognized need to take action to improve the health of his residents, so he and his colleagues began an employee wellness program in earnest. As Mayor Hays and Alderman Beth White wrote in a recent blog post, “The benefits of employee wellness programs are clear: reduced healthcare costs, increased productivity and healthier employees. With those benefits in mind, the City of North Little Rock is an example of how a city government’s commitment to health and fitness benefits both employer and employee The city’s Fit 2 Work program offers employees healthier workplaces that offer greater options for getting and staying healthy, including healthier vending machines and discounts at community centers that offer physical fitness programs.
Fit 2 Work is just one component of the overall Fit 2 Live program, which aims to create an environment that empowers the community to adopt healthy life choices. This initiative, supported by grants from the National League of Cities’ Institute for Youth, Education & Families, which is funded by the Robert Wood Johnson Foundation, and a CDC Communities Putting Prevention to Work (CPPW) grant, includes safe routes to school efforts, joint use agreements, built environment improvements such as walking and biking trails, and school wellness improvements.
NewPublicHealth spoke with Mayor Hays and Fit 2 Live Coordinator for the City of North Little Rock, Bernadette Rhodes, about their efforts to create a healthier city.
NewPublicHealth: Tell us about the Fit 2 Work program for the City of North Little Rock.
Mayor Hays: I have been here at City Hall about 23.5 years. I’m very proud of a lot of things we’ve done, but this has to be pretty much at the top of the list. These are things we’ve long understood to be a priority. I’ll give you a little bit of background—75 percent of my budget goes toward employee benefit costs. The old adage of “follow the money” is absolutely true. I’ve got 900 folks who work directly for me. We, like many in the country, are experiencing fairly significant increases in premiums in our medical costs. We tried to be as sensitive to preventive efforts to keep our employees healthy as we could be. About eight years ago, the city wrote a check for $300,000 to form its own health clinic. We wanted to have health screenings, and options for our employees with a great deal of accessibility to annual physical exams, screenings, blood work and more.
We are focusing on our workforce to give them the options to be healthy. We’re also trying to be a little creative with our employees to allow them to join a 10-week Weight Watchers program—that was 16 pounds ago that I was a beneficiary of that program—as well as discounts at our excellent community and senior centers.
NPH: The Fit2Live initiative includes a broad set of programs to create a healthier city. Why is it critical for a growing city to make health a priority?
Mayor Hays: We are serious about both our employees as well as our community having healthy options at vending machines, through the use of walking paths and in other aspects throughout the community. About 20 years ago I started building trails in North Little Rock because I wanted to make sure it was a place people wanted to live. We had been flat in population since the 1960s. People were moving to the suburbs, not unlike what was happening all over the country, but I made the decision that I wanted to do things to make people want to live here. We started out with trails, improving our parks and building sidewalks. I’m proud to say some of the dirt paths I walked through as a kid are now sidewalks and trails. We felt that competing for young people’s time was something we need to do, and what better way to do it than creating options for recreation—so we put a basketball court under an interstate overpass. We lit it, and sometimes we have midnight basketball.
Our inspiration was more geared toward wanting people to live in the community and giving them reasons to do it than it was because of the health epidemic. Now the health side of things has certainly taken on an added inspiration over the last five to 10 years. We like to think we were ahead of the game. We’re excited about what’s happened and where we are.
We received a $1.5 million Communities Putting Prevention to Work (CPPW) grant from the CDC to fight obesity and other health-related issues. We of course are partnering with our high schools and other organizations throughout the community to make this happen.
>>Read more on the North Little Rock CPPW grant.
NPH: What changes are you hoping to see in six months or a year?
Mayor Hays: The thing I want to ensure is that what’s in my head has been institutionalized so it’s not up to any one person. We need to ensure the foundation has been laid, and we do feel we’re there. We’ve got a built environment committee when it comes to utilization of trails and buildings and other things that together create a healthier community. We’ve got the Fit2Live leadership team.
All of this will be carried on in this city after my term is up because of the foundation we’ve laid and the enthusiasm of the staff and leadership. That together with the funding we secured has laid the groundwork to make healthier lifestyles and choices an institutionalized part of the way our city works.
NPH: Who were some of your important partners, and what is the overall role of partnerships in your work?
Mayor Hays: We formed a coalition of teams, and collectively if you’re at the table you have more likelihood to buy in to the outcome, and that’s been a big part of the success of our programs. I would include our employees themselves as one of our key partners, as well as the state, the Department of Health, Chamber of Commerce, Department of Parks and Recreation and others.
Bernadette Rhodes: The neighborhood associations have also been critical in getting the word out about what we’re doing. For example, the built environment committee organized a tour and discussion of a new bike and pedestrian trail that’s going to be paved and built in an abandoned railroad spur.
Hays: These pedestrian trails are not only good for physical activity, they also promote interaction. Social integration is absolutely critical. People need to see each other in ways other than hollering at each other through a car window.
NPH: What are some of the milestones in what has been achieved with the CPPW grant?
Rhodes: We’ve had the grant for almost two years now. In our community action plan we identified quite a few ways in which we wanted to combat obesity. The first one is in schools. We partnered with the school health coordinator for the district and worked with her to revise the school district wellness policy and to draft a district employee policy. Those policies have been drafted and reviewed by the superintendent and approved to go on to the school board for a vote. It strengthens the existing wellness policies a lot. Schools were required to have a wellness policy, but a lot of times they were just bare bones. For example, vending machines would have to be at least half healthier options, and the signage on the front of the machine has to be water or 100% fruit juice and not a soft drink. It also says food is not to be used as a reward with the kids. Another big thing is implementing SPARK PE, a national evidence-based program that incorporates physical activity and nutrition education, and that was implemented across the board with all PE teachers as well as city community after-school programs.
The second thing is healthy food options. We passed guidelines through the City Council to encourage all departments within the city to change the way they offer food, whether it’s in meetings or catered events and of course vending machines. We adopted a model called “Go, Slow, Whoa” and per the guidelines, half of those foods offered should be “Go” or “Slow.”
The third thing is joint use agreements. We had some money to renovate existing facilities around the city—community centers, parks and schools. For example, a lot of elementary schools had basketball courts but the nets were gone and there was no way to play on them. We went through and refurbished all of those so they’re usable. We’ve also been ordering signs to put up in the parks and around walking trails to say they’re open for use to the public at certain times, and one lap equals a quarter of a mile—to ensure people know these facilities are available to them for use.
NPH: How do you measure progress?
Rhodes: We have an evaluator who’s been working on getting hard numbers on all of our vending machines. He created a baseline and went around and categorized existing foods in the vending machine using go, slow, whoa. After these guidelines are implemented, he’ll go around and measure the changes that have taken place.
With joint use agreements, the evaluator will measure the quality of those facilities and the usage both before and after. They have a tool that allows you to observe the usage of the facility and the type of physical activity they’re engaging in.
At the International Making Cities Livable Conference held in Portland, Ore., last month, Lou K. Brewer RN, MPH, director of the Tarrant County Public Health in Fort Worth, Texas, led a session about a toolkit she and a colleague are creating to help communities track health indicators and the progress made on improving them. The toolkit should be available by the fall and is likely to be a very valuable tool for many departments starting to track indicators in their community as both a resource for key measures and an adaptable tool largely ready to use. But Brewer’s experience as part of a Texas team shaping the future of the state around smart growth, community development, land use and transportation is equally valuable as a blueprint for collaboration to bring health to the table as communities across the country look ahead in creating their development plans.
NewPublicHealth: What brought you to the Making Cities Livable conference?
Lou Brewer: The presentation was about a set of indicators that I and a planner in a neighboring region created. We researched existing health indicators and decided to create a useful toolkit for planners and health professionals, using materials that were already available.
NPH: Why is a toolkit necessary?
Lou Brewer: Well, I’ve been part of Vision North Texas classes, run by planners and the Council of Governments to look at what stakeholders—including elected officials, planners, health educators and citizens—want the area to look like in 2030. Our population is supposed to double and that brings with it lots of challenges and opportunities, and so they’ve done an extensive visioning process, including a yearly summit.
We invited ourselves to the table as a public health entity, and we really wanted to be able to also ask the questions of the impact on health of whatever decisions were made. So we developed a health research team with wide representation and one recommendation was for this health indicator set [to measure progress on health impact], and then we decided we probably needed a toolkit as well. I also have a personal interest in all this because I’m a doctoral student in urban planning and policy, and that’s because I really see an incredibly strong connection between the built environment and health.
NPH: Who else was on the team?
Lou Brewer: We had the immediate past State Health Commissioner for Texas and the current Medical Director of Blue Cross Blue Shield. We had the Assistant City Manager of one of our larger municipalities who’s also a planner and the organizer for the Vision North Texas process. We also had two hospital representatives, a CEO and a community planner, someone from the School of Nursing faculty, and from the Texas Health Institute, and, of course, members of our own public health agency.
NPH: What critical steps did you take as you researched the toolkit?
Lou Brewer: We didn’t want to reinvent the wheel if it was already out there, so we really spent a lot of time going through the literature and looking at websites, and we borrowed heavily from the San Francisco Department of Public Health. They’ve done extensive work in health impact assessments and developing indicators. We also looked at materials from the state of Michigan and the National Association of County and City Health Officials and the American Planning Association. The health research team told us to really concentrate on physical activity and access to nutritious foods, and so we reviewed the literature again to pick out indicators that supported those two objectives and so that’s what helped us come up with them.
Indicator examples include: How far do people have to walk to transit, to schools, to grocery stores? We’re looking at vehicle miles traveled. And we’re looking at the ratio of bicycle routes to vehicle routes—lots of different things that all speak to and support physical activity and access to nutritious foods.
NPH: What response did you get when you spoke about the toolkit?
Lou Brewer: I had a lot of people come up to me afterwards wanting to get a copy. It’s in the draft stage, so I told people who asked that I’d send them a copy, but really wanted them to review it and give me feedback. We’ll have a final version to release soon.
NPH: What were some of the lessons learned?
Lou Brewer: We tied our work to the annual summit and that’s a long time to wait to keep people’s attention. We could have expanded the role of the health research team earlier.
And, while we had representation from faculty, which was great, I think I would have also asked for some student involvement and perhaps they would have had some time and interest in helping us develop some of this.
I’m glad we did involve Vision North Texas, and they in turn are some of the decision-makers for the region, so I think we had support early on. I think they were very respectful of the health piece of this, and I think they were also very glad to have another layer on their argument. We were always asked to be part of any funding opportunities and to make our case there, and so that’s been really great, because there is still a group out there that the light bulb hasn’t quite gone off yet for them in terms of why is health at the table.
NPH: What’s next for the toolkit?
Our next step is going to be feedback from this conference. and feedback from a few more people in the region and we’ll either post the toolkit it to our website sometime this summer or wait for the Vision North Texas Fall Summit and introduce it at a workshop. And then we’ll ask people for feedback on usability and modifications at the summit.
Weigh In: Have you been invited, or invited yourself, to key stakeholder conversations that didn’t have health in the title?
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.