3 Guidelines for Prioritizing Healthy Communities in Urban Planning
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Ten years ago, I found myself immersed into a branch of urban planning that at the time was just beginning to emerge at the local, state and national levels: Healthy Communities Planning. At the Riverside County Department of Public Health; now known as the Riverside University Health System—Public Health (RUHS-PH), my role entailed transforming the way planners thought, viewed and applied public health considerations into their practices. For a number of years, leading public health thinkers and practitioners such as Dr. Richard Jackson and Dr. Tony Iton made the case that the built environment can have more influence on individual and community health than our own genetic makeup. As such, under such a premise, planners have a central role in improving the health of our communities through planning and design. Many of them, however, have yet to discover that potential.
A few prominent efforts enable me to navigate this uncharted territory. First, RUHS-PH forged a non-traditional collaboration with the County of Riverside Planning Department to prepare and include a Healthy Communities Element into the General Plan (also known as the Comprehensive Plan or Master Plan).
Second, the Board of Supervisors adopted a Healthy Riverside County Resolution directing all county agencies and departments to adopt preventive measures to address obesity and chronic diseases.
Third, through a Building Healthy Communities grant from The California Endowment, we worked directly with the City of Coachella during its General Plan Update, specifically on the preparation of the Health and Wellness Element. We were also working with a coalition of health advocates to elevate quality of life in the eastern Coachella Valley. These efforts were unique and bold at the time, to the extent that Michael Osur, one of the masterminds behind this work, earned top accolades from the American Planning Association (APA) in 2013.
Around the same time, the California Governor’s Office of Planning and Research (OPR) also began updating its General Plan Guidelines which considered public health as a new topic, and APA released the results of a survey revealing the extent to which planners were including health considerations into their planning documents and policies. Both of these efforts materialized into the inclusion of guidelines for preparing a Health Element into the General Plan and the APA’s Healthy Communities Policy Guide respectively in 2017.
These examples illustrate how a network of organizations and individuals championing healthy communities planning continues to grow, connect and making a difference. Very slowly, however the paradigm shift–where health in all policies is a natural consideration– is happening. In order to prioritize it, planners, decision-makers, health advocates and the community at large must recognize–and hopefully master– the following three considerations.
1. Places are a Determinant of Health
Anyone involved or interested in solving the most pressing and challenging issues of our time should be familiar with the Social Determinants of Health (SDOH) concept.
According to the Office of Disease Prevention and Health Promotion, the SDOH are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.” In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins.
For urban and regional planning purposes, the SDOH represent the vital signs of a community or a region and for that reason, planners and decision-makers should understand their implications. The California Planning Roundtable published a paper on the subject to introduce the concept to members of the American Planning Association California Chapter and beyond.
2. Thinking and Acting “Upstream” is an Essential Component for Healthy Community Planning and Development
Upstream intervention, a widely known public health concept, is the idea of taking preventive actions that would steer away from potential detrimental health effects such as chronic diseases, injuries, and premature death. To put it in simple terms, all things being equal, staying physically active, eating healthy foods, drinking clean water and breathing clean air, can prevent a whole host of chronic diseases such as diabetes, asthma, heart and lung diseases and cancer. Upstream intervention can be expressed as enacting policies to ensure access to a clean and complete environment of health.
The Bay Area Regional Health Inequities Initiative (BARHII), a coalition of the San Francisco Bay Area’s eleven public health departments, offers a framework suggesting that the most upstream point of action to achieve a healthy community starts with addressing social inequalities resulting from discrimination and implicit bias that may be embedded through policy or custom in our institutions and reflected in our communities’ living conditions.
3. Data is Crucial for Elevating Healthy Communities as a Priority
If the health of cities and regions depend on individual health and their behaviors, planners should be aware of the health status of the communities they are planning for. Only then can a valid healthy community plan can be developed. Today, a plethora of health data sources can be found on the internet. Sites such as the Robert Wood Johnson Foundation County Health Rankings, the National Equity Atlas, the Healthy Places Index and CalEnvironScreen (California only) are a few examples of reliable and credible sources of SDOH data that can be used for assessing health status, trends and for devising preventive measures and interventions.
To conclude, I depart with the following reflection: as our communities continue to grow and continue to be influenced by demographic and markets shifts, technology invention, and innovation and a new era of mass information platforms, the challenges ahead appear to be greater than ever. Healthy community planning may be the approach that can help us retain and elevate the very essence of our humanity. It must be prioritized.
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This article was originally published on September 8, 2020.
Update for April 20, 2021:
After the murder of George Floyd we wrote this article as a kind of blueprint, a beginning to a new way of working with equitable resilience in our cities and beyond. Now, as the trial of Derek Chauvin comes to a guilty verdict in Minneapolis and the whole country reflects on the legacy of that verdict, we have to remember another senseless murder – another young Black man, Daunte Wright, at the hands of law enforcement, just miles from the courthouse. Again, Minneapolis is all of us. We have protested, we have voted. We stood up, we spoke out, we have raged about the anti-Black racism. We have seen people come together, we can feel a shift in this country. But there is so much more to do. No equity, no resilience.
-Ron & Stewart
Housing that is affordable to low-income residents is often substandard and suffering from deferred maintenance, exposing residents to poor air quality and high energy bills. This situation can exacerbate asthma and other respiratory health issues, and siphon scarce dollars from higher value items like more nutritious food, health care, or education. Providing safe, decent, affordable, and healthy housing is one way to address historic inequities in community investment. Engaging with affordable housing and other types of community benefit projects is an important first step toward fully integrating equity into the green building process. In creating a framework for going deeper on equity, our new book, the Blueprint for Affordable Housing (Island Press 2020), starts with the Convention on Human Rights and the fundamental right to housing.
Since the Great Recession of 2008, the housing wealth gap has expanded to include not just Black and Brown Americans, but younger White Americans as well. Millennials and Generation Z Whites are now joining their Black and Brown peers in facing untenable housing precarity and blocked access to wealth. With wages stuck at 1980 levels and housing prices at least double (in inflation adjusted terms) what they were 40 years ago, many younger Americans, most with college degrees, are giving up on buying a home and even struggle to rent apartments suitable for raising a family.
What makes it hard for policy people and citizens to accept this truth is that we have not seen this problem in a very long time. Back in the 1920s of course, but not really since then. But this is actually an old problem that has come back to haunt us; a problem first articulated by Adam Smith in the 1700s.