Category Archives: Built Environment and Health
Earlier this year, when a federal task force convened to look at how to help Detroit pull out of bankruptcy and regain resident and business confidence, one of the first recommendations was to assess the many blighted areas of the city—typically created when residents leave an area in droves, or when a business moves out of a building and isn’t replaced by another—and begin restoring them for residential, business or green space use.
Blight matters. Beyond making a city ugly, abandoned areas become a haven for trash, toxic elements, drug sales and prostitution. In Dorchester, outside Boston, a space sold by the city for a parking lot was left vacant for years and became a trash dump with mounds of cigarettes, and cars and tires—all leaching toxins.
A growing number of communities are starting to clean up those lots. In Baltimore, flight from the city has left close to a million homes and apartment buildings vacant over the last few decades, leaving in their place empty, dirty spaces that invite crime and trash. Bon Secours Community Works—the foundation of the Bon Secours Health System with hospitals in Baltimore and other cities—supports initiatives aimed at creating stable housing, including a program called Clean and Green, which is a part of Bon Secours' Housing and Neighborhood Revitalization Department.
Clean and Green is a landscaping training program that has transformed more than 85 vacant lots into green spaces, and has also begun to initiate community arts projects such as large public murals and community gardens. The program is designed to teach green job development skills, as well as provide free cleanup and beautification services to Baltimore neighborhoods.
Each program team is hired for six months of on-the-job training in green landscaping, during which they learn how to use landscaping and gardening tools and then go out into the field to clean lots, plant trees, pick up trash and do weeding. As part of their training, each individual gives at least three presentations about some aspect of green landscaping that they’ve learned, further preparing them for job interviews and jobs in the field. Each summer, youth employees also join the Clean and Green team for six weeks, working alongside the adults to learn about green landscaping and giving back to a community.
Planners, public health experts, community development leaders, architects and many others have come together over the past decade to focus on housing as a framework for a healthy life. A report released earlier this year by the Robert Wood Johnson Foundation’s (RWJF) Commission to Build a Healthier America made the link between health and housing clear:
“Living in unhealthy homes and communities can severely limit choices and resources. Healthy environments—including safe, well-kept housing and neighborhoods with sidewalks, playgrounds and full-service supermarkets—encourage healthy behaviors and make it easier to adopt and maintain them.”
Housing also impacts health when people spend so much on their rent or mortgage that they don’t have enough left over to pay for critical expenses such as food and medicine. According to the MacArthur Foundation—which released its second annual “Housing Matters” survey last month—during the past three years more than half of all U.S. adults have had to make at least one sacrifice in order to cover their rent or mortgage, including:
- Getting an additional job
- Deferring saving for retirement
- Cutting back on health care and healthy foods
- Running up credit card debt
- Moving to a less-safe neighborhood or one with worse schools
Ianna Kachoris, a MacArthur Foundation program officer who oversees its How Housing Matters to Families and Communities research initiative, said that the quality and safety of a home make a significant impact on a person’s overall quality of life. Among the housing specifics that can impact health are lead or mold; the need to move frequently; having to live with many other people to make housing affordable; and concern over being able to afford the rent, the mortgage or needed housing repairs. The survey also found that accessing affordable quality housing in their communities is difficult for many people, including families with average income, young people just getting started in the labor force and families who want to live in quality school districts.
Allison Larr, 25, graduated from Columbia University’s Mailman School of Public Health a few weeks ago as a member of the 2014 Master’s in Public Health class and will soon start working at Citigroup in New York City as an analyst in the bank’s public finance division, which finances infrastructure projects.
“Infrastructure is central to maintaining a healthy population,” according to Larr. “If you don’t have a sewer system, public transportation and roads, you won’t have a healthy population.”
NewPublicHealth recently spoke with Larr about the path she took to her new career.
NewPublicHealth: How did you end up at Citigroup?
Allison Larr: As an undergraduate I studied neuroscience, and I was considering pursuing a career in academia or medicine. After my college graduation, I worked for a psychiatric research organization where I realized that I didn’t want to perform the traditional academic roles of creating and distributing knowledge or devote my life to being a physician, but I still wanted to work in a field related to health. By that time, I had developed quite an interest in the environment and in climate change, and so I thought why not connect these two by studying environmental health sciences and figuring out some sort of way that I could work in that field on large-scale problems related to health from upstream processes.
When I started my Master’s in Public Health at Mailman, I didn’t really have a clear vision of exactly what I wanted to do after graduation. I did know that I wanted to work on some bigger-picture environmental issues related to health, so I chose environmental health policy. I worked on a funding opportunity for electric vehicle infrastructure, and that was really the first time that I considered anything related to finance as related to health, because electric vehicle infrastructure would certainly increase electric vehicle uptake, which would have a positive impact on public health through reduced emissions. And in order to make that happen, you need to be able to pay for it.
That’s when the seed was planted that finance could be health related. Following that I worked at the New York City Department of Environmental Protection in the energy office, and when we were evaluating potential projects, part of my role was to evaluate how much greenhouse gas savings the projects would produce, as well as the payback period—investigating really whether it was a worthwhile investment from a financial point of view.
At this week’s Spotlight: Health conference at the Aspen Ideas Festival, Michael Murphy of the MASS Design Group will be part of a panel called “Buildings that Heal.” Murphy is a recent recipient of a grant from the Robert Wood Johnson Foundation (RWJF) for a two-year year research initiative to investigate effective and innovative models of health care facilities in Rwanda and other Sub-Saharan African countries. The goal is to gauge the implications for community health and economic development and then disseminate the findings in order to help improve facilities in the United States.
NewPublicHealth spoke with Murphy ahead of the Spotlight: Health conference.
NewPublicHealth: Tell us about the scope of your work.
Michael Murphy: I’m an architect and designer by training, and I launched MASS Design with my partner, Alan Ricks, around designing built environments to improve health outcomes. We have been working with a number of NGOs in the global south, thinking about the way that hospitals are designed and the built environment, and seeing very specific and direct links between our built environment and the health of our individual selves and our communities. We were struck by the direct links between the two, and how un-designed those environments are when they could be so easily shifted to improve people’s health.
NPH: Where have you done your work?
Murphy: We have an office in Rwanda where we built the Butaro Hospital in Northern Rwanda, together with the healthcare nonprofit Partners in Health. That first opportunity came about after meeting with the group and seeing that they were doing a lot of their work without the help of designers and architects. We were given the opportunity to assist their infrastructure team to help them rethink hospitals. We finished Butaro Hospital in 2011 and since then have brought this model to other countries, eight of which are in Africa: Tanzania, Uganda, Gabon, Liberia, Zambia, Malawi, the Democratic Republic of the Congo, Burundi and Haiti.
So, we have quite a bit of experience thinking about the health care environments that are affecting some of the more vulnerable communities in the world, and we encountered some real insights that could actually vastly improve the way in which we think about our health care environments back at home in the United States.
This Thursday at Spotlight: Health, the two-and-a-half day extension of the Aspen Ideas Festival, a number of speakers discussed the many facets that are integral to building a community that thrives. Speakers included Kennedy Odede, the Co-Founder, President and CEO of Shining Hope for Communities; Belinda Reininger, Associate Professor of Health Promotion and Behavioral Science and the University of Texas School of Public Health; Gabe Klein, Senior Visiting Fellow at the Urban Land Institute; and Gina Murdock, Founder and Director of the Aspen Yoga Society.
Although the communities they serve and the work they do vary greatly, all four presenters agreed on four key themes:
- The importance of listening to the community
- Working with the residents, rather than over their heads, to create what they believe will be a thriving place to live
- Measuring outcomes
- Setting goals
To the first theme, Odede explained that “people in the community must be ready for change and we can’t import it.” Growing up in Kenya’s Kiberia Slum, Odede went on to found Shining Hope For Communities—an organization that combats gender inequality and extreme poverty in urban slums by linking free schools for girls to holistic community services for all. By connecting these services with a school for girls, Odede and Shining Hope for Communities show that benefiting women has a positive impact on the entire community. The organization’s model relies on community input and solutions.
In Brownsville, Texas, a family-oriented town requires a family-oriented approach to improving health. Sitting in one of the poorest metro areas in the nation, the town is known for its low graduation rates and high prevalence of obesity and diabetes. However, the community had a goal of being one of the healthiest areas in the state and began chipping away at the obstacles by including all residents.
“Everything we do is driven by families,” said Reininger. “We wanted to be the healthiest area in the state, and to get there we all had to be part of it.”
Brownsville is beginning to see improvements across the community in physical activity and food choice. In fact, the thriving and changing community has been selected by the Robert Wood Johnson Foundation (RWJF) as one of this year’s Culture of Health prize winners.
Gabe Klein, who in addition to his work with the Urban Land Institute is a former Vice President of Zipcar, spoke about the importance of communication in affecting community change. “In Chicago, we never talked about bike lanes for the sake of bike lanes, we talked about opportunities for better health and ways to get where you’re going,” said Klein. “You have to communicate the larger vision.”
The session moderator, RWJF President and CEO Risa Lavizzo-Mourey, stressed the importance of goal setting and metrics. According to Lavizzo-Mourey, defining a vision is critical to success and measurements lead you to the outcomes you are trying to reach.
“At 10 a.m. on any given morning, the kids at low-income San Francisco schools are starting to fidget. Their teachers report they’re having trouble concentrating, asking how long ‘til they eat...Then the snacks arrive, delivered by volunteers from the San Francisco-Marin Food Bank. They serve string cheese one week; baby carrots, mandarin oranges or apple slices the next.”
Because of this and other programs, Marin County, Calif. tops the U.S. News & World Report’s new rankings of “America’s 50 Healthiest Counties for Kids,” part of its annual guide on the nation’s Best Children’s Hospitals. The new rankings, for children 18 and younger, are calculated in cooperation with the University of Wisconsin Population Health Institute, which also evaluates health data for the U.S. population as part of its County Health Rankings & Roadmaps program, a collaboration with the Robert Wood Johnson Foundation (RWJF).
The rankings analyze U.S. counties according to several key measures, including:
- Infant deaths
- Low birth weight babies
- Deaths from injuries
- Teen births
- Children in poverty
- Percentage of children without health insurance
- Air quality in most states
- Rates of adult smoking and adult obesity
- Access to physicians
- Exercise opportunities
In addition to the rankings, the U.S. News story also highlights six communities that have made significant advancements toward improving the health of their kids, including:
- Santa Clara, Calif., where a policy stipulates that 50 percent of food and beverages sold in countywide vending machines must meet nutrition guidelines.
- Washington County, R.I., where the policy organization Kids Count is dedicated to improving children’s health, education, economic well-being and safety.
- Middlesex County, Mass., which includes the city of Cambridge—one of RWJF’s Culture of Health Prize winners last year—and where fun physical education classes keep kids active while healthy school meals celebrate cultural diversity.
Read the full story, “America's 50 Healthiest Counties for Kids.”
One of the key lessons of Hurricane Sandy—which caused massive destruction in New York and New Jersey, two states that don’t usually see that kind of weather devastation—is that disasters can strike anywhere. That’s the thinking behind a new exhibit at the National Building Museum in Washington, D.C., Designing for Disaster, which brings together objects, video, photos and interactive components to show that policies, plans and designs can result in safer, more disaster-resilient communities.
A key goal of the exhibit is to share ideas for building and rebuilding. In a recent interview posted on the museum’s website, the exhibit’s curator, Chrysanthe Broikos, asks “as we face an increasing number of destructive and deadly natural disasters...should we have the right to build exactly what we want, where we want, no matter the risks? Should we give more thought to the long-term viability and protection of the structures and communities we build?”
Those are policy discussions underway right now, and some suggestions are being shared in a “disaster mitigation” blog launched to complement the exhibit. The blog invites building and disaster experts to post their ideas and thoughts on how to make us all more disaster-resilient.
The exhibit highlights current work by planners, engineers, designers, emergency managers, scientists, environmentalists, business leaders and community leaders, some viewable in a short video on the exhibit. For example, constructed just for the exhibit is a Federal Emergency Management Agency (FEMA) “safe room” that would be highly protective if a tornado struck. But the exhibit asks the necessary questions, as well. For example: What if requiring safer construction makes housing unaffordable for many?
While many of the exhibit designs are experimental, the museum’s website also offers resources to learn about steps individuals can take in their own homes and communities to prepare for disasters, remain safe and prevent damage. FloodSmart, for example, is a FEMA resource which lets users see how much damage flooding can cause, assess flood risk and learn about flood insurance.
>>Bonus Link: On June 24, the National Building Museum will hold a competition, Rebuild by Design, that challenges contestants to envision rebuilding designs for communities devastated by Hurricane Sandy.
A 2012 report from the U.S. Centers for Disease Control and Prevention (CDC) found that walking is hands-down the most common exercise activity in the United States—which only makes a new report showing the high rate of pedestrian fatalities and injuries that much more alarming.
The report, Dangerous by Design 2014, released by the National Complete Streets Coalition, a program of advocacy group Smart Growth America, finds that more than 47,000 people were killed and close to 700,000 injured while walking in the United States between 2003 and 2012. The report also found that the rates have been rising in the last few years, and that the majority of deaths and injuries could have been prevented with safer street designs such as crosswalks and traffic signs.
The report also ranks major U.S. metropolitan areas according to a Pedestrian Danger Index that assesses how safe pedestrians are while walking. The top four most dangerous cities—Orlando, Tampa, Jacksonville and Miami—are all in Florida and the other six are, in order, Memphis, Phoenix, Houston, Birmingham, Atlanta and Charlotte.
“We are allowing an epidemic of pedestrian fatalities, brought on by streets designed for speed and not safety, to take nearly 5,000 lives a year; a number that increased six percent between 2011 and 2012,” said Roger Millar, director of the National Complete Streets Coalition. “Not only is that number simply too high, but these deaths are easily prevented through policy, design and practice. State and local transportation leaders need to prioritize the implementation of Complete Streets policies that keep everyone safe.”
Complete Streets refer to “streets for everyone,” according to the Coalition, and are designed and operated to enable safe access for all users. People of all ages and abilities are able to safely move along and across streets in a community, regardless of how they are traveling. Complete Streets also make it easy to cross the street, walk to shops and bicycle to work, while allowing buses to run on time and making it safe for people to walk to and from train stations.
Rates of walking deaths and injuries are far higher for more vulnerable populations such as older adults, children and people of color, according to the report. For example, while just 12.6 percent of the total population is over age 65, that group accounts for nearly 21 percent of pedestrian fatalities nationwide.
It doesn’t really matter why you download a parking app this weekend. You might get a perch at the parade faster, make it to the grocery store before the steaks sell out or get that much closer to the restaurant front door. Using any parking app can reduce your driving around time, and, therefore, reduce the emissions from your car.
Studies reported by the Boston University College of Engineering have estimated that, on a daily basis, 30 percent of traffic in the downtown area of major cities is due to searching for parking spots. Over the span of one year in a small Los Angeles business district, cars cruising for parking created emissions equivalent to 38 trips around the world, burning 47,000 gallons of gasoline and producing 730 tons of carbon dioxide.
According to the Environmental Protection Agency, vehicle emissions contribute to air pollution and are a major ingredient in the creation of smog in large cities. Pollution has been linked to asthma and other respiratory conditions. In addition, a 2013 study by researchers at the Massachusetts Institute of Technology estimates that 53,000 premature deaths occur each year in the United States because of vehicle emissions.
Visiting a new city or driving around at home? Search for “parking app” and the name of the city and you’ll find apps dedicated to finding parking spaces with ease. For example, the recently released Park Chicago pilot app includes meter rates for various areas of the city and directions to the closest spot, as well as hours, prices and directions for hundreds of parking garages in the city.
Getting familiar with a parking app will put you on good footing for “smart parking,” a growing concept that places sensors in parking spots and lets you reserve and even pay for a spot from your phone. The benefit to the driver is less time on the parking prowl. The benefit to cities is the data collected on how frequently spots are used, which can help cities better allocate space. Parker, an app developed by smart parking company Streetline, can even identify spots for disabled drivers, and share that data with cities to help determine whether the spaces are located where they are most needed.
But you still have to pay the bill, and check the meter. Down the road, parking apps will also be able to alert law enforcement to ticket your car if you run out your clock.
Hurricane season—which officially starts in two weeks—has become a time of year for individuals, communities and organizations to assess their state of readiness for withstanding and surviving a disaster.
A recent Atlantic Cities article profiled a model to follow: the Providence Baptist Church in the Bayview community of San Francisco. Led by local pastor GL Hodge, who has both big box retail and crisis experience, the church has monthly resiliency meetings to establish a local response, and has provided CPR and disaster training to church members through the American Red Cross. The church has also worked to develop community trust by providing after school programs, weekly dinners, a weekly food bank and a shelter on the church grounds that sleeps more than 100 people every night.
Steps to help try to prevent large scale death and injury if an earthquake or other disaster hits include distribution of plastic bags to seniors to store their medicines and ID if they need to evacuate; placards that fit on door knobs indicating if they’re OK or need help in the event of a disaster; and a proposal that would use community development funds to train young men how to strengthen the foundations of senior’s homes, which would improve the chance that the structures would survive a disaster.
“We’re preparing a culture of preparedness,” says Hodge.
Read the full story here.
>>Bonus Link: Read a previous NewPublicHealth interview with Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health.