Now Viewing: Built Environment and Health

Research Designed Through the Eyes of Youth

Mar 17, 2015, 12:30 PM, Posted by Alonzo L. Plough, Dwayne Proctor

There's power in giving youth the means to document what they see as the barriers to their community's health. This project from Charlotte, N.C. shows us how this innovative research design can be a step to addressing local disparities.

Last year, we at the Robert Wood Johnson Foundation asked our community a bold question: What was considered the most influential research around identifying and eliminating disparities? In our first-ever Culture of Health reader poll, a winning research paper emerged in Por Nuestros Ojos: Understanding Social Determinants of Health through the Eyes of Youth, published in the Summer 2014 edition of Progress in Community Health Partnerships. The research project equipped young people in Charlotte, N. C., with cameras to identify and document environmental factors that impact health in their Latino immigrant community. What really makes this paper resonate for us—and, it seems, for many of you—is that it provides a clear example of how community-based participatory research (CBPR) is an important approach to understanding the multiple factors underlying health disparities.

We wanted to learn more about this interesting example of participatory research and how the Por Nuestros Ojos project is helping advance health equity in Charlotte. Recently, our blog team had a conversation with three of the study’s authors to find out how employing a participatory research model can help enormously in understanding and eliminating disparities in marginalized communities. Below is an interview with Johanna (Claire) Schuch, research assistant and doctoral candidate at the University of North Carolina at Charlotte (UNCC); Brisa Urquieta de Hernandez, project manager at the Carolinas HealthCare System and doctoral student at UNCC; and Heather Smith PhD, professor, also at UNCC.

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Creating Open & Sacred Spaces To Improve Health

Jan 21, 2015, 7:23 PM

In 1995, Tom Stoner and his wife Kitty discovered a tiny urban park in the middle of a busy London neighborhood that had been used as a refuge during World War II. On the backs of many of the park’s benches, the Stoners found loving thoughts and peacetime memories that had been etched by Londoners during the horrors of war. They realized that if an urban park could be a source of quiet and solace during a time of bombing and destruction, then similar natural environments could certainly offer spaces for reflection, recovery and respite for people dealing with the stress of modern life. With that idea the Stoners created the TKF Foundation to support the creation of urban green spaces.

“The speed, violence and alienation that characterize our current period in human history create an important need for open spaces, sacred places,” says Tom Stoner.

In 2010 Tom and Kitty began the National Nature Sacred Awards Initiative, designed to support the creation of public greenspaces to serve as demonstration and research sites to study the impact of nature on the human spirit. NewPublicHealth recently spoke with Tom Stoner about the intersection of green space and improved health and lives.  

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RWJF Pioneering Ideas Podcast: Episode 6 | What if? Shifting Perspectives to Change the World

Oct 20, 2014, 9:00 AM, Posted by Pioneer Blog Team

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RWJF's Pioneering Ideas Podcast is on iTunes! Don’t miss an episode—click to subscribe.

Welcome to the sixth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can help build a Culture of Health. Your host is Lori Melichar, director at the foundation.

Ideas Explored in This Episode

Sharing Health Care Providers’ Notes (3:08) OpenNotesTom Delbanco and Jan Walker talk with RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation–and where their work is headed next. Here’s a hint: what if the  3 million patients who now have easy access to their clinician’s notes could co-write notes with their providers?

Rethinking How We Solve Poverty (18:46) – Kirsten Lodal, founder and CEO of LIFT, talks with RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being. In a thought-provoking conversation, Lodal connects the dots between improving the well being of those living in poverty and building a Culture of Health.

A Historian’s Take on Building a Culture of Health (27:58) – Princeton historian Keith Wailoo and RWJF’s Steve Downs discuss how deeply held cultural narratives influence our perceptions of health, and how today’s “wild ideas” are often tomorrow’s cutting edge innovations.

Sound bites

...On opening up health care providers’ notes and what’s next:

“What I would like to do is spread the responsibility for health beyond the health care system. The health care system is good; I hope that it gets better, but there are so many other parts of our lives that contribute to our well being.” – Jan Walker, OpenNotes 

“It will be a very different world in the future. And we do think that OpenNotes is kind of giving people a peek into it. It's a first glimmer that this kind of transparency, this kind of approach to things, while it's passive now, it just opens up an enormous amount of possibilities for the future. And that's what really excites us.” – Tom Delbanco, OpenNotes

...On rethinking how we solve poverty:

“People's lives are like rivers... they flowed before coming into contact with us, and they will flow after having contact with us. And so the opportunity that we have, the privilege that we have is of most positively affecting the trajectory and the velocity of that flow. But if we forget that–if we get too swept up in having to own everything that happens in a person's life–then we won't build the best solutions, because we won't build solutions that provide people with the support they need to navigate the flow of that river over the long term.” – Kirsten Lodal, LIFT

...A historian’s take on building a Culture of Health: 

“Our concern with aggregate trends is an important one in tracing the shifting demographics of health in our country, but to understand what health actually means involves actually putting the data aside and thinking about lives and thinking about individuals and thinking about what these trends mean on an individual level.”– Keith Wailoo, Princeton University

Your Turn

Now that you’ve listened – talk about it! Did anything you heard today get you thinking in new ways about how you can help build a Culture of Health? Do you have a cutting-edge idea you’d like to discuss? Comment below or tweet at me at @lorimelichar, or consider submitting a proposal. Be sure to keep the conversation and explorations going at #RWJFpodcast.

Join the Conversation

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The Ever-Evolving Traffic Light Could See More Changes Ahead

Sep 26, 2014, 2:24 PM

A one-of-its-kind pedestrian traffic walk signal recently turned heads in Portugal with a dancing figure that entertained people as they waited for him to tell them when it was safe to cross the street.

The signal—not planned for mass circulation anytime soon—was developed by the manufacturer Smart to advertise its cars’ safety features. And if it saves lives along the way, it’s in sync with the U.S. Department of Transportation (DOT), where the National Highway Traffic Safety Administration (NHTSA) has found that 4,432 pedestrians died in traffic crashes in 2011, up 3 percent from 2010. More than a quarter of the accidents resulting in death happened at traffic intersections, both at marked crosswalks and intersections with traffic lights. Andrea Gielen, PhD, head of the Johns Hopkins Center for Injury Research and Policy at Johns Hopkins University, says the school’s research shows that many of these accidents occur because pedestrians are distracted by music in their earphones or by speaking or texting on cellphones.

NHTSA began a campaign to keep pedestrians safer last year and highlights community projects that improve pedestrian safety in a stories section on its website on pedestrian safety. One project, developed at University of California, San Diego, was a presentation at a low-income elementary public school in San Diego, Calif. The English- and Spanish-language presentation demonstrated dangerous scenarios and how to prevent them, such as kids dressed in only dark clothing, which makes them difficult to see at night. NHTSA is updating the site regularly to help communities develop their own safe walking programs.

As for traffic lights themselves, makeovers could be ahead. The Transportation Research Board of the National Academies of Sciences has a traffic light subcommittee that presents new research on traffic signal safety at the board’s annual meeting each January. Upcoming topics of interest are likely to include computerized traffic signals that can respond to traffic flow by switching to green sooner when there’s no congestion ahead, as well as a recent study from the Massachusetts Institute of Technology (MIT) that found that traffic lights are easily hacked, which could lead to traffic jams and collisions. Preventing some of the hacking could be as simple as strengthening the passwords of the engineers who control the traffic signals, according to computer engineers at MIT.

Wendy Landman, executive director of the pedestrian advocacy group Walk Boston, says intersections could be safer if city agencies talked more. She said the deciding factor for how long a traffic signal should be green for pedestrians is often based on how quickly traffic experts think drivers want to be back on the gas pedal—but that may be too short for many pedestrians, especially at intersections on main roads.

>>Bonus Content: Read a previous NewPublicHealth interview with Andrea Gielen.

This commentary originally appeared on the RWJF New Public Health blog.

Reducing Environmental Risks for Kids in Schools

Aug 28, 2014, 12:09 PM

Most parents send their children off to school expecting they’ll have their minds enriched and expanded—they don’t expect that their kids’ health to be jeopardized.

But the reality is that the environmental conditions in aging or deteriorating school facilities can harm kids’ health and compromise their ability to learn. This is partly because children may be exposed to a variety of environmental hazards—such as lead, asbestos, molds, radon and volatile organic compounds—as well as toxic chemicals and pesticides at school. Half of U.S. schools have problems with indoor air quality, according to the Environmental Protection Agency (EPA), and research suggests that the poorest children in the poorest neighborhoods have schools that are in the worst condition.

Sixty percent of kids suffer health and learning problems that stem from the conditions of their schools, according to the Coalition for Healthier Schools’ Towards Healthy Schools 2015 report. Children are especially vulnerable because they’re smaller; their organs are still developing; they spend more time on the ground; and they breathe more air and drink more water per pound of body weight than do adults, according to the EPA. They also may not be able to identify obvious hazards and move away from them.

Reducing environmental risks in schools offers significant payoffs in multiple domains. Improving indoor air quality can reduce asthma attacks by nearly 40 percent and upper respiratory infections by more than 50 percent, according to the 2006 report Greening America’s Schools: Costs and Benefits. What’s more, a study weighing the costs and benefits of developing green schools for Washington State estimated a 15 percent reduction in absenteeism and a 5 percent increase in test scores, according to the Towards Healthy Schools 2015 report.

“A healthy school has a building that promotes health and learning—it will be clean, dry, and quiet. It will have good control of dust and particulate matter. It will provide good ventilation and good air quality,” said Claire Barnett, founder and executive director of the Healthy Schools Network Inc., a non-profit organization dedicated to children’s environmental health and safety in schools. “This also assumes there’s no lead in the pipes, no PCBs in lighting or other old building materials, and no routine spraying of pesticides indoors or out. It shouldn’t be hard to have a building that meets these standards but it is. Parents shouldn’t take it for granted that a school facility is healthy.”

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The Walking School Bus: A Safe and Active Way to Get Kids to School

Aug 26, 2014, 1:23 PM

With research indicating that fewer children are walking or biking to school than in decades past—and with the childhood obesity epidemic in full swing—health experts have been brainstorming solutions that would address both issues. In recent years, a simple but effective concept has been gaining traction at the grass-roots level: Why not organize a “Walking School Bus”—a group of kids who walk to school with one or more adults, so that kids can get exercise on their way to and from school?

A Walking School Bus is “just like a regular school bus, but without the walls and seats, and instead of wheels, we use our feet,” explained LeeAnne Fergason, education director for the Bicycle Transportation Alliance in Portland, Ore., which has a thriving Walking School Bus program. Other communities around the country that have well-established Walking School Bus programs include Chapel Hill, N.C.; Sacramento, Calif.; Burlington, Vt.; Columbia, Mo.; and Duluth, Ga. In the Fall of 2014, many more schools—including Grand View Elementary in Manhattan Beach, Calif.; Greenacres Elementary in Scarsdale, N.Y.; Madison Elementary in Redondo Beach, Calif.; and several elementary schools in Spokane, Wash.—will be joining the trend.

Created by the National Center for Safe Routes to School, these programs help kids sneak some extra physical activity into their day while also addressing parents’ concerns about getting their kids to school safely. It can be as simple as a few neighborhood families taking turns walking their kids to school. Or it can be more elaborate, with prearranged routes, timetables and stops along the way to pick up more “passengers”; with this model, there’s usually an adult “driver” at the front and an adult “conductor” bringing up the rear. A variation on this theme, the bicycle train, in which two or more adults accompany and supervise kids as they ride their bikes to school, has also become popular.

Viewed as a way to fight childhood obesity, improve school attendance rates and ensure that kids get to school safely, the Walking School Bus concept is garnering positive reviews from public health experts. In July 2013, Michelle Obama voiced her support of these programs in her remarks to mayors gathered at the White House.

“I've heard more and more of this kind of walking school bus happening all over the country—so that kids can get exercise on the way to school, kind of like we did when we were growing up," she said. “It’s about people all across this country coming together to take action to support the health of our kids.”

Besides providing an opportunity for movement, the Walking School Bus also allows kids to socialize with their peers, gain a bit of independence and learn important road safety skills. All of these benefits are also important for children’s health and wellbeing.

This commentary originally appeared on the RWJF New Public Health blog.

Healthy Communities: The Building Blocks of a Culture of Health

Aug 25, 2014, 9:15 AM, Posted by Jamie Bussel

What do Corvallis, Ore.; Baldwin Park, Calif.; and Buffalo, N.Y. have in common? It certainly isn’t their weather.

Hint—the commonality is something much more relevant to RWJF’s newly refined mission. These three cities are building a Culture of Health for all their citizens. They are tapping into the skills and resources of a diverse group of partners to ensure everyone has access to healthy choices. It’s their collective efforts, along with dozens of other communities supported by the Foundation’s Healthy Kids, Healthy Communities (HKHC) program, that make me so optimistic about our organizational goal.

My strong belief that environments—physical, social and educational—play a prominent role in our individual health and well-being is what initially drew me to RWJF. So, in 2008, I excitedly embraced the opportunity to be the national program officer for HKHC, which addressed the root causes of childhood obesity by transforming the physical activity and food environments in which children and their families live, learn and play.

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Google Hangout Convenes Culture of Health Prize Winners to Discuss Lessons Learned in Creating Healthy Communities

Aug 19, 2014, 5:55 PM

Watch the recording of the August 14 Google Hangout where three RWJF Prize winners discuss what it takes to build a Culture of Health.

This past June, the Robert Wood Johnson Foundation (RWJF) announced the six winners of its 2014 Culture of Health Prize, which honors communities that place a high priority on health and bring partners together to drive local change. Each community, selected from more than 250 across the nation, received a no-strings-attached $25,000 cash prize in recognition of their accomplishments.  

Last week, RWJF brought together representatives from two of this year’s winners and one from last year in an online discussion, “Building a Culture of Health: What Does it Take?” Each community representative spoke about the barriers they’ve faced, how they overcame them and the role partnerships play in their ongoing success.

The discussion was moderated by Julie Willems Van Dijk, co-director of the RWJF County Health Rankings & Roadmaps and director of the RWJF Culture of Health Prize.

Alisa May, executive director of Priority Spokane and representing 2014 winner Spokane County, Wash., said that as a largely rural community of 210,000 people they’ve placed an emphasis on improving education at all levels. And they took a data-centric approach.

“Priority Spokane—which is a collaboration of community leaders—looked at the data, pulled community members together to talk about the issues that were most important to them, and educational attainment rose to the surface,” said May.

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Health Beyond Health Care: Q&A with Matthew Trowbridge, MD, MPH

Jul 18, 2014, 1:32 PM

In 2012, a new campus was constructed for the Buckingham K-5 public school in rural Dillwyn, Va., replacing the original middle and high school buildings that had stood since 1954 and 1962.

The Charlottesville, Va., architectural firm VMDO Inc., which constructed the campus, says the sites were transformed into a modern learning campus with the aim of addressing the growing concerns of student health and wellbeing. New facilities include a teaching kitchen; innovative food and nutritional displays; an open servery to promote demonstration cooking; a food lab; a small group learning lounge; scratch bakery; dehydrating food composter; ample natural daylight; flexible seating arrangements; and outdoor student gardens. 

The firm took advantage of the school’s natural setting surrounding a pine and oak forest and wove them into the design and construction to showcase the “active landscape.” The school’s project committee and design team worked collaboratively to create a total learning environment in order to support learning both inside and outside the traditional classroom. Each grade level enjoys age-appropriate outdoor gardens and play terraces, which encourage children to re-connect and spend time in their natural surroundings. Inside the schools, in addition to core classrooms, each grade level has small group learning spaces that transform pathways into child-centric “learning streets” that have soft seating and fun colors that communicate both collaborative and shared learning experiences.

To study the impact of the healthy design features, VMDO teamed with Matthew Trowbridge, MD, MPH, an associate professor at the University of Virginia School of Medicine, with a special interest in the impact of the built environment on public health to study how health-promoting educational design strategies can support active communities and reduce incidence rates of childhood obesity.

NewPublicHealth recently spoke with Trowbridge about the project.

NewPublicHealth: How did the project come about?

Matthew Trowbridge: Through a collaboration between me and Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors. 

file (Image courtesy: Tom Daly)

One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.

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2014 RWJF Culture of Health Prizes — Celebrating Communities’ Innovative Public Health Efforts

Jul 17, 2014, 11:37 AM

Building a Culture of Health means building a society where getting healthy and staying healthy is a fundamental and guiding social value that helps define American culture...and it’s a mission that communities across the country are eagerly taking on. They include the six communities honored by this year’s Culture of Health prizes from the Robert Wood Johnson Foundation (RWJF), who are coming together today and tomorrow at RWJF’s Princeton, N.J. campus to celebrate their efforts and share the lessons learned. Picked from more than 250 submissions, these six communities are leading some of the nation’s most innovative public health efforts. 

The RWJF Culture of Health Prize was launched to further the work of the County Healthy Rankings & Roadmaps program, which aims to educate the public and policy makers on the multiple factors that influence community health—such as education, economic conditions and the physical environment—and to provide solutions that will improve community health. The prizes honor communities that place a high priority on health and bring partners together to drive local change.

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