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 essay asserts “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.” This is easy to agree with.
What I don’t understand is the benefit of government planners treating these health factors as a unified set for some sort of unified attention, as contrasted with understanding that there are a series of health issues in any government jurisdiction that should be measured and assessed by professionals and if problematic made the focus of intense, specialized effort by professionals with a specialized professional education and on-the-job training and experience. I don’t see how clean water, clean air, healthy food, and promoting adult physical activity, nor crime prevention, traffic safety, phys-ed in public schools, earthquake preparedness, working smoke detectors, and mandatory inoculations should be the focus of unified attention by planners as a generalized bundle labeled as “healthy community planning.” Except maybe for a politician’s “action plan” to get elected.
Or do I need to understand that “comprehensive planning” is a theory and practice of how local government should deal with everything that matters in one office?
In response to John Niles, our field of comprehensive planning has for many decades included a discipline known as Advocacy Planning. This theory is part sociology, and part city planning.
What Mr. Vasquez and the newer generation of planners are helping to evolve in California, is the revival of the historic impetus for zoning and urban planning in the USA, which was “to address the egregious public health issues of slum tenement housing in New York City”. Today we may call it “social equity” or “healthy communities planning” but improving the health and welfare of the general public through policy and the built environment has always been part of our charge as city planners.
I appreciate your comment. Here is what I can offer as a response:
1. The profession and practice of planning continues to evolve in response to the complexities of our current societal systems. As such, urban planning is no longer a technical profession concerned with just land use and environmental impacts for the sake of economic development. The discipline is increasingly becoming more concerned with the social implications of the quantity, quality and distribution of land uses that provide opportunities for people to thrive.
2. In many respects, the built and natural environments are responsible for our healthy and unhealthy behaviors. If planners do not intentionally plan for health, the chances that a community will reflect positive health outcomes will be uncertain. In other words, healthy community planning is a prescription for individual and community health.
Lastly, to stay relevant, planners–and the elected officials–must be champions of public health. A good place to start is by collaborating with the local public health department on projects such as affordable housing, safe routes to destinations, climate change and resilience, equitable development, etc.
I hope this is helpful.
The elaboration in the previous two comments following my comment are helpful to understanding the meaning of the essay at the top of the discussion ensuing here. Thanks to the authors.
Unfortunately, there is a throw-spaghetti-at-the-wall-and-see-what-sticks implication in my reading of what is claimed in the essay and the comments so far to be the scope of community health concerns.
Perhaps other readers are interested like me in understanding the process by which vast amounts of available data on community health (point 3 in planner MAV’s essay) is translated in a world of limited government resources set by the size of the taxpayer’s wallet into high priority improvement/intervention programs that work effectively within the long-evolved course of community development and day-to-day crisis management that is inherited by a government planning staff trying to do something different and better in the name of community health.
Let me suggest an example of a sharp focus that surely hits an important issue in urban California and where I live in Seattle — homeless people living in encampments, a highly visible land use. How does this specific public health problem work into the modern, new generation community health planners’ agenda?
One often overlooked evaluation criteria for a healthy city is the degree to which a downtown core is being “revitalized” and “activated” using events and hospitality and entertainment industry tactics to draw people downtown.
These are easy tactics to overuse and doing so impacts health on many levels (e.g. noise, sleep interruption, over imbibing, investment–in the form of intellectual horsepower, money, public space, etc.–is dedicated to enlarging the party instead of other pursuits, street level rents go up and are artificially kept aloft, etc.) which lead to marked declines in any city’s overall health.
Balance is the watchword but sadly it is typically invoked by the organizations mounting the most overdone programming of our cities. Every inch of public space does not need to be programmed and activated by professional planners in the city managers’ offices and parks departments and economic development offices, event organizers, so called public private partnerships taking over our parks, and others who have a bottom-line self-interest which is often placed before the public interest.
Healthy cities respect the health of the people living and working in them.
The current trend is the homogenization of our cities, street level retail spaces, and demographics and the over committing of our public space to commercial purposes.
Mall and food court type amenities do not make a healthy city. Planning the next downtown sports stadium and mixed-use entertainment zone instead of a world class library + learning center, along with world class medical campus are signs that economic opportunity and healthful living are being crowded out by interests which do not have city heath or public health at the top of their priority lists.
Will Marks: Well said, a statement on priorities and public choices. Thanks.