Category Archives: Community development
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?
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?
Spring has sprung in the nation’s capital, and while the Cherry Blossoms are the most heralded bloom, the city is also awash in yellow forsythia, white apple blossoms, purple lavender and shovels and hoes at small and large plots of land across the area. One of those is a brand new garden at the Columbia Heights Educational Campus, a D.C. middle and high school.
The new garden is one of hundreds of People’s Gardens established by United States Department of Agriculture (USDA) Secretary Tom Vilsack three years ago. The Columbia Heights garden has funding support from the D.C. Daughters of the American Revolution and planting expertise from volunteers at USDA. Students have been studying and preparing to plant their garden for a year, and it will include gathering spaces, a wildlife habitat garden and a fruit and vegetable production area. The produce will be used at school and donated locally.
Read a USDA blog post about the new garden.
Weigh In: How is your community supporting first-time gardeners?
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?
Will The Lorax, a film version of the Dr. Seuss book, which opens tomorrow, prompt kids everywhere to plant gardens and eat healthier? That’s the hope of Kelly Meyer, the founder of American Heart Association Teaching Gardens, a project that teaches kids how to plant seeds, care for their plants and harvest the produce. The Lorax tells the story of a boy in search of his young love’s “heart’s desire,” a truffala tree, only to find that all the trees have been chopped down to create a new invention. A theme of environmental preservation and connection with nature runs throughout the story, and ends with a single seed meant to rebuild the forest.
NewPublicHealth spoke with Meyer, who brought a group of young gardeners to the film’s premiere in Los Angeles last week to showcase a special Teaching Garden that will be donated to local schools.
NewPublicHealth: How did the Teaching Gardens program come about?
Kelly Meyer: For me, it was a wonderful opportunity to address a health issue, childhood obesity, while connecting kids to nature and teaching them about a food source in a real, three-dimensional way. And so, I started the program with just one garden, and had the good fortune to have the program adopted by the American Heart Association. Now we’re in over 100 schools across the country and I have a real infrastructure to help push this program forward.
>>Read more on childhood obesity from the Robert Wood Johnson Foundation.
NPH: What have you seen the kids get out of the experience?
Kelly Meyer: They learn what it takes to grow food that’s healthy for you and they learn teamwork. They have a much more real-life picture of science. We had one child in the program who was tasting a clementine from a tree she helped plant. She had never tasted one before, and when you see the expression on her face—she was prepared for it to be sour and awful, and instead it was sweet and juicy and beautiful. When we harvest the garden and prepare salads, I think the kids are shocked at how good it tastes.
>>Watch a video on the Teaching Gardens program, including footage of the young girl trying a Clementine for the very first time.
And the kids take [the message] home to their parents. I’ve gotten so many photos from kids who’ve gone home and made a little bit of space in the back and planted a tiny garden of their own. They take ownership.
NPH: How did the association with the film come about?
Kelly Meyer: I have a relationship with Universal Pictures and with the producer of the film and they gave us this opportunity to set up a beautiful garden at the premiere, and the kids got to plant and then they went to the movie and they learned it’s ultimately just about that one seed, whether it’s the literal seed for growing the last tree or the seed of an idea and its growth and how important it is to protect that.
When the movie was over, the kids ran and they couldn’t get back to the garden fast enough, and they wanted to plant more. And then, when we left the garden, we sent them all home with seedlings and I got many emails that kids had planted gardens with their parents and now they’re going to be growing vegetables together in their back yard. That was really exciting.
NPH: What’s next for you?
Kelly Meyer: I’m going to continue to focus on the Teaching Gardens because I want it to be successful. It’s not automatic. You don’t just ship it off and it’s done, it requires a lot of attention. I’d also like to broaden the concept that maintaining your environment and the environment of your body is directly related and connected to our general health.
A major theme at last week's New Partners for Smart Growth Conference was "co-benefits." Many sectors and interests were represented at the conference and each took a different tack on the benefits of smart growth, or building communities so that they are walkable, affordable, generate jobs and help people get to where they need to go, including to fresh food markets, to work and play and to green spaces. The co-benefits of this kind of growth include better health, a cleaner and more sustainable environment, and a stronger economy.
The benefits to the economy were the focus of a Friday session at the Smart Growth conference, led by Lee Sobel, Real Estate Development and Finance Analyst at the Office of Sustainable Communities for the U.S. Environmental Protection Agency.
Mitchell Silver, AICP, Planning Director of the City of Raleigh, NC and President of the American Planning Association quoted Chattanooga Mayor Littlefield with an important maxim for smart growth: "If you aren't a city where people want to live, you aren't a city where people want to invest."
Younger generations will demand a different lifestyle, said Silver, and separate office parks will play no part in it. More integrated, mixed land-use areas where people can walk or take public transit to work are becoming more and more attractive to employees—and, importantly, to employers.
While young people used to find a job and then a place to live nearby, more young people today start by finding a city or community they love and then looking for a job where they want to live, said Silver. That means employers want to be where people want to live.
Beyond attracting employers, dense growth means more tax revenue for cities. It would take 150 acres of 600 single-family homes to equal the tax value of Raleigh's Wells Fargo Capitol Center, which sits on 1.2 acre land, said Silver.
A report from Active Living Research, a national program of the Robert Wood Johnson Foundation with direction and technical assistance provided by San Diego State University, found that green spaces have economic pay-offs as well. The existence of a park within 1,500 feet of a home increased its sale price by between $845 and $2,262 (in 2000 dollars). Additionally, as parks increased in size, their impact on property value increased significantly, according to the report.
This builds on parallel research finding that preventive health efforts are sound business decisions:
- The Healthier Americans for a Healthier Economy report showcases several states and cities that have found that better health for their citizens can also improve their bottom line, in collaboration with local businesses. Read more on the report and a Q&A with Tom Mason, President of Alliance for a Healthier Minnesota, on the business perspective on prevention.
- An investment of $10 per person annually in proven, community-based public health programs could save the U.S. more than $16 billion within five years—a $5.60 return for every $1 invested. Read more on the report on the return on investment of prevention.
- Companies that sell "better-for-you" foods perform better financially. Read a Q&A with the report author.
>>Follow our coverage of the New Partners for Smart Growth Conference.
"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?
Tomorrow, Leadership for Healthy Communities will be hosting a webinar called Making the Connection: Linking Economic Growth to Policies to Prevent Childhood Obesity. The webinar will highlight the important links between economic growth and public health, and look at ways to implement policies that improve both. In advance of the webinar, NewPublicHealth spoke with Harriet Tregoning, Director of the Washington D.C. Office of City Planning , about efforts to make the district "a walkable, bikeable, eminently livable, globally competitive and sustainable city."
NewPublicHealth: How did city planners come to view health as part of their mission, and why is that important?
Harriet Tregoning: City planners increasingly take a broad view of their purview. So it’s not just the physical layout of the city, but also what kind of results for cities and their residents do plans produce. It’s clear that obesity is a growing epidemic, and for municipalities, in most cases, one of the most quickly rising costs is health care. So figuring out how to plan cities for the best health outcomes is on the agenda of most city planners.
NPH: What city planning activities are now underway in Washington, D.C., that address childhood obesity prevention?
Collaboration between the community development and health sectors is critical and beginning to gain greater traction to improve lives—particularly in low-income neighborhoods—according to Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation (RWJF) and Sandra Braunstein, director of the Federal Reserve Board’s Division of Consumer and Community Affairs, writing in the November issue of Health Affairs. The journal issue, produced with support from RWJF, features several articles on emerging collaboration between these sectors to improve health. Access the articles here.
>>Recommended Reading: For an overview of the articles included in the Health Affairs issue, check out this post from the County Health Rankings blog.
Also this week, the Federal Reserve Bank of San Francisco, the Pew Charitable Trusts and RWJF hosted a day-long conference, “Building Healthy Communities,” to discuss next steps for these shared new efforts.
The conference builds on a series of regional meetings held in the last year and attended by experts in community development, finance, urban planning, housing, government, business, academic, philanthropy and health sectors to help lay the groundwork for innovative new ideas and public and private partnerships with shared goals—such as creating safe and accessible places to exercise, preventing chronic diseases, and building safe, affordable housing. View the webcast or participate in the discussion on Twitter at #FedHealth.
“Greater opportunities lie ahead,” writes David Erickson, PhD, Manager of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, who is both a co-author in the current Health Affairs issue and a coordinator of this week’s conference. “Many of those opportunities involve better coordination. Moving beyond coordination to integration will require the health sector to see community development as its partner in addressing the 'upstream' factors that influence health.”
NewPublicHealth spoke with David Erickson about the developments this week and next steps in the intersection between community development and health.
NewPublicHealth: How did this week’s conference build on past regional conferences?
David Erickson: Previous Healthy Communities conferences have focused on "consciousness raising”—making the case that health care and community development are both necessary prescriptions for better health. This conference attempted to not only surface new ideas and partnerships, but also to drill in on three specific areas of systems change—finance, data, and policy—necessary to fully integrate population health work and community development. As the day unfolded, a consensus emerged that a new business model is needed to incentivize collaboration and capture downstream health care cost savings resulting from strategic community investments.
NPH: Can you give us a strong example of a recent community-building collaboration?
A movement to improve health at the community level has been gaining traction, including new efforts to improve not only access to health care but also access to resources that promote health, such as safe housing, farmers’ markets and recreational facilities.
A major force behind this effort is an emerging collaboration between the public health, health care, community development and economic development industries. The Federal Reserve System has been convening leaders from these industries to discuss collaboration to reduce health disparities and create healthier communities for all.
To date, the Federal Reserve Banks of Boston, New York and San Francisco have held regional meetings. On September 28, the Federal Reserve Bank of Dallas will host “Healthy Communities: the Intersection of Community Development and Health” at its Houston Branch. NewPublicHealth talked with Elizabeth Sobel Blum from the Federal Reserve Bank of Dallas to learn why the Dallas Fed is involved in this movement and to hear about her expectations for this conference.
NewPublicHealth: Why is the Federal Reserve Bank of Dallas interested in health?
Elizabeth Sobel Blum: At the Dallas Fed’s Community Development Office, our role is to support the Federal Reserve System’s economic growth objectives by promoting community and economic development and fair and impartial access to credit. Our constituents serve low- and moderate-income individuals, often by providing or facilitating affordable housing, personal financial products and services, small business development products and services and community facilities.
The individuals community developers reach are the same individuals who face major health disparities. While access to health care is one component that explains these disparities, the social determinants of health – where people work, live, learn and play – can play a strong role as well. The more opportunities individuals have to make healthy choices, the more likely they can live longer and healthier lives. These social determinants of health are the nexus of the community development and health sector’s joint interests. It is in this space that collaboration is imperative. And the health of our country and economy depend on it: in general, wealthier people are healthier and healthier people are more economically productive.
NewPublicHealth: Why are you focused on healthy communities now?