Planning Public Spaces to Drive Health Equity

By Jennifer Gardner and Sharon Roerty

Jennifer Gardner is a program manager at Gehl Institute, where she oversees the organization’s work on health and inclusion.

Sharon Roerty, AICP/PP/MCRP is a Senior Program Officer at the Robert Wood Johnson Foundation with thirty years’ experience in studying and implementing urban and environmental policy, planning and design initiatives.

Jul 24, 2018 | Infrastructure, Society | 2 comments

More than ever, we need our public spaces—those places that belong to everyone, regardless of who they are, where they’re from, or how young, old, or able they are—to work for us.

We need places like Folkets Park in Copenhagen, where colorful, creative play equipment and programs reflect the desires of families for safe places to play; and soft, discreet lighting and a bathroom with running water reflect the wishes of homeless people for privacy and anonymity at night.

 

Folkets Park, Copenhagen. Photo credit: Steven Johnson, Boundless

 

We need programs like those of Mexico City’s Laboratorio para la Ciudád, a new mayoral agency that brings citizens and government together to come up with creative ideas for what their city should look like and how it should work. Creating space for imaginative and inclusive processes is standard operating procedure, although the resulting projects and outcomes are anything but standard.

We need ways of working like Reimagining the Civic Commons, that recognize that public places, when revitalized, connected and open to all, can uphold human dignity and advance positive social outcomes—fostering civic engagement and trust, environmental resilience and more equitably shared prosperity. It’s a process of reinventing how communities work together to manage, operate and program civic assets such as parks, trails, libraries and community centers.

We need global perspectives like that of the Bernard van Leer Foundation’s Urban 95 program, which posits that the best measure of a vibrant, healthy and high-functioning city is the well-being of its families, babies, and toddlers. Like the universal design and aging-in-place design movements, Urban 95 embraces a strategy that considers social and physical needs not only of individuals, but of entire communities of people with shared needs.

We need organizations like the Greater Newark (N.J.) Conservancy, which has not only restored acres of polluted and neglected land to urban agriculture, but also helps formerly incarcerated people to re-enter the workforce with horticulture training.  This two-pronged approach ensures the success of restored farms and gardens as well as access to healthy and affordable food, and increases financial opportunity and viability for community members.

When we ask them to, our public spaces do a lot for us—for our own and our communities’ physical and emotional health. The problem is, we don’t always ask.

 

Folkets Park, Copenhagen. Photo credit: Steven Johnson, Boundless

 

Despite growing wisdom that place is integral to health, and that our shared public spaces can have big effects on how connected we feel to our neighbors, how physically active we are, or how healthy our environments are, many of our public spaces are not created or sustained with health or well-being in mind.

Up to 80% of our health outcomes are determined by social factors, many of which are tied to our physical and social environments. These are the social determinants of health, and are important for city and town planners, designers, and people in public office to consider because these are the factors that we can work to change. However, few resources are available to help planners, designers, advocates, and policymakers identify the evidence needed to make decisions about public space projects that contribute to individual and community health.

Guidelines for the built environment rarely focus on public space. Those that do tend to consider physical design as an issue of hard infrastructure, such as when designing a space to withstand climate change.

There’s more to design than that—a lot more, especially if your goal is to design and support public spaces that promote public health. There is, however, a lack of experience at this intersection.  We need more actionable strategies for building health equity into public spaces.

To address this gap, Gehl Institute, in collaboration with the Robert Wood Johnson Foundation, developed the Inclusive Healthy Places Framework. It’s a research-based tool designed to help practitioners build inclusion into their public space projects, improve community health, and evaluate the impacts of public space interventions on the social factors that affect health. The Framework represents a new way of looking at the connection between health and public space and then leveraging that connection to create places that restore a sense of belonging and dignity to populations that have been overlooked or excluded.

The social and environmental factors that influence our health do not play out in a linear way—they interact with and affect each other. We are each the product of our cumulative experience, and our health is the product of our cumulative exposures over a lifetime. For that reason, we sought to provide a holistic model for individual and community health and well-being. In giving shape to the Framework, we found that a simple checklist of indicators would not suffice. This model includes nearly three times as many indicators addressing social and community context, processes, and aspects of social capital and resilience as it does measures specific to the built environment and design.

It is essential to the work of health equity that these “other” factors aren’t overlooked or given short shrift.

 

Inclusion as a Tool for Change

We can see in virtually every city or town the evidence that not all places are created or maintained equally—or equitably. How do we know when public space supports health, and when a process that shapes public space is inclusive? When we find an opportunity to improve health outcomes in the public realm, how do we act on it?

It’s hard to devise a clear definition of inclusion against which to measure success. Inclusion is a complex concept. It is not the opposite of exclusion. It is both an outcome and a process, and it can be used as a tool for change, but it must be practiced with explicit intention.

As an outcome, inclusion means that all people who use a public space feel welcome, respected, safe, and accommodated—regardless of who they are, where they come from, their abilities, how old they are, or how they use a public space. Inclusion is a sense of belonging.

As a process, inclusion recognizes and respects the needs and values of people using the space as well as the assets in the place—even historical ones. Ultimately, it allows all members of the community to shape, achieve, and sustain a common vision for the space. Inclusion is active engagement.

As a tool, inclusion can help to direct time, energy, resources, and more toward the goal of this work—equity. Inclusion can help us share the responsibility for reducing the inequities stemming from long-term systemic discrimination and other barriers to leading our healthiest lives.

There are already many credible organizations and individuals approaching planning, urban design, architecture, policy, grassroots organizing, and public health from these perspectives. But it is time to deploy a broader range of strategies that enable us—as practitioners together with communities—to see the bigger picture when it comes to the impact that place and space have on our health.

The Inclusive Healthy Places Framework synthesizes research and experience from multiple fields under four themes, reconceived here as principles for planning and design practice.

 

Context and Connectivity

We should think and work beyond single, isolated spaces. We have to create parks, plazas, and squares as part of a whole, with the bridges, bike paths, sidewalks, street corners, and all the other physical elements connecting them. The health benefits of social stimulation and interaction can happen anywhere—why confine our thinking about them to public park programming strategies, when there are great urban design opportunities on every block?

Further, it’s essential to take stock of what’s already in a place, recognizing history and local assets. The effects of projects in the public realm can and should be considered at a larger network scale that acknowledges where the work is happening.

 

Process

A truly inclusive process or outcome says, “I see you; I am seen.” Promoting inclusion and well-being means leaving preconceived plans and solutions at the door and listening to people who live, learn, do business, play, and struggle in these spaces. Planners, city officials, designers, and others involved in making decisions about the public realm must take care to understand the stories already present and to identify shared values already in a place.

We have to cultivate processes that recognize and respect diverse needs, cultures, and identities. It’s not easy—lack of mutual respect and trust has derailed many a public meeting—but there are ways to forge ahead. Building community capacity to become co-owners of the process is one step. Developing trust, among neighbors and between citizens and government, is another. Considering participation as more than a name on a sign-in sheet is a third—going beyond seeing a problem to identifying and changing structural barriers to participation.

 

 

Designing Public Space

Typically, inclusionary design has focused on meeting guidelines, such as for accessibility. Public space must not just be accessible to all, it must be welcoming to all, and encourage a sense of belonging. Design has the ability to reflect values of social dignity, respect, and empathy. Even small details can make a huge difference for our shared experiences, like the positioning of a small shelf on municipal trash cans that allows people to deposit and collect bottles for refund without rummaging through the bin. This is standard practice in Copenhagen.

Encouraging use and interaction among diverse groups of people is essential for vibrant public life. It is possible to improve the quality of the public realm while respecting local context and acknowledging the needs of diverse user groups. Designers often present choices: basketball court or playground? The reality is that the menu of options does not always respond to the real needs of people in place. Instead of starting with what, designing and programming for inclusion in public space should start with who, with ongoing recognition that the who is often not static.

 

Invest in Social Resilience

The resources required to sustain public spaces are intensive. This is because public space—and the public life within it—is dynamic, just like other aspects of our cities. With constant change and evolution, the capacity of communities to adapt is important for sustained, long-term impacts of projects in the public realm. Social resilience is a characteristic of communities able to mitigate against negative outcomes that may arise from change—and of those able to ensure the benefits of change accrue locally.

This can be fostered when local communities have ongoing opportunity to lead. We measure stewardship as an indicator of local investment, but communities should not be left to fend for themselves, particularly if they are under threat from factors that might destabilize local power—for example, through displacement associated with gentrification. Sustaining public space over time requires shared investment in the people and processes that sustain communities.

 

Measuring What We Care About

When we look at people as our common denominator in planning, design, and policy, we can find ways to shift our priorities. If we care about health, we must look at what people need and want, if we are to co-create public spaces and programming that support a full range of well-being. If we care about health equity, we have to look to context and history to know where to direct efforts most effectively and sensitively. If we care about inclusion, we have to be intentional, ensuring that we work together to remove barriers to entry in the process of shaping and using public space. For each of us to live our healthiest lives possible, we have to ask our shared public spaces to better meet our needs.

Join the conversation with the Gehl Institute by visiting the Inclusive Healthy Places website.

Discussion

Leave your comment below, or reply to others.

2 Comments

  1. As I read through this really helpful blog post I’m reminded of a 2016 study from the World Health Organization showed some of the ways that urban green spaces deliver multiple health benefits.

    The link is here for those who want to read a short summary of the report: http://www.euro.who.int/en/health-topics/environment-and-health/pages/news/news/2016/11/who-report-shows-urban-green-spaces-deliver-multiple-health-benefits

    The full report is here:
    http://www.euro.who.int/__data/assets/pdf_file/0005/321971/Urban-green-spaces-and-health-review-evidence.pdf?ua=1

    The blog post helps encourage us all to look much more closely at these intersections — where health, public-space, sustainability, and government policy all converge.

    Reply
  2. So many communities are seeking ways to promote equitable, inclusive, cohesive, and healthy communities. Appreciated the links to tools and examples, and suspect the Public Life Tools on the Gehl website will make a valuable contribution (https://gehlinstitute.org/public-life-tools/). Project for Public Spaces is another resource for links between health and placemaking (https://www.pps.org/category/health), and equity and inclusion in placemaking (https://www.pps.org/category/equity-inclusion).

    Reply

Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Read more from the Meeting of the Minds Blog

Spotlighting innovations in urban sustainability and connected technology

Resilience Calls for Smart Planning and Great Leadership

Fear can spurn action but it can often be paralyzing. When it comes to “acts of God,” leaders can take a fatalistic or resigned approach. We can’t prevent earthquakes or hurricanes, so if the big one hits, what really can we do about it? The fallacy in this approach is an all or nothing perspective. The belief that if I cannot solve the entire problem, then why bother?

Fostering Innovation & Learning with the Teaching City

The world spends far more money on urban infrastructure than health care, and there are about four-times as many urban practitioners as health care providers, yet, up until last year, there was not a single teaching city. The City of Oshawa is hoping to start a new trend – similar to a teaching hospital. The City is now serving as a ‘teaching city,’ complete with urban interns and city-based research.