That lifestyle and social behavior directly affect health is a widely accepted fact. Not only do poor nutrition and fitness choices account for nearly half of early deaths, but health also can be strongly influenced by the community in which an individual lives.
In communities where people can easily walk and bike to work, school, stores, parks and restaurants, for example, an average of nearly a half hour per week is added to one’s lifespan. Sadly, communities without such amenities as parks and active lifestyle programs are often the poorest.
The powerful link between poverty and health is undeniable. With this in mind, civic leaders have a significant opportunity to impact public health in a tangible way. From neighborhoods to the regional level, opportunities abound to positively impact the quality of life and health of the public through an array of solutions, including wellness programs, education, job training, environment and air quality improvements, transportation and more.
Seeing and evaluating the effects of the physical and social environments on health and wellbeing is supported by the ability to identify the right series of solutions to maximize impact. These solutions include establishing explicit connections between public health and the planning and design of the physical environment. Finding the right strategic mix of solutions requires an integrated matrix of partners who work together to evaluate stakeholder needs and develop holistic plans that enhance public health, economic development and financial sustainability.
Here are several strategies civic leaders can consider to create a holistic upstream approach to promoting wellness in their communities.
Healthy Community Challenges
In Travis County, Texas, as in many areas around the nation, the risk factors of tobacco use, poor nutrition and lack of physical activity have led to a cluster of chronic diseases underlying most of the county’s deaths. Though everyone is affected, the toll is heavier on low-income and minority communities. According to the Centers for Disease Control and Prevention, African Americans are 23 percent more likely to die of heart disease and 31 percent more likely to have a stroke than are whites. African American, Hispanic, American Indian and Alaska Native adults are twice as likely as white adults to have diabetes.
In response, the city of Austin, at the heart of Travis County, created a comprehensive city plan – Imagine Austin – composed of 10 priority initiatives, one of which is “Create a Healthy Austin.” Urban planners developed short- and long-term goals for increasing healthy behaviors, educating the public on healthy lifestyles and promoting healthy foods. More long-term goals include expanding urban farms and community gardens, as well as increasing the safety and amenities of parks, trails, playgrounds, bike paths and recreation centers.
The city was able to secure grants from the CDC and various sustainable community organizations to help make the plan – currently in program development – a reality. One key innovation has been the integration of public health staff with planning and development review staff, allowing for sharing of information and resources that instills a much stronger understanding of how community wellness and planning and design are inherently connected.
Every community has a host of challenges to improving quality of life. The headlines often dwell on crime and violence, insufficient affordable housing and limited access to resources. Beyond these major problems, other weaknesses lurk: spotty transportation, untended parks, inaccessible health care, low health knowledge and education, as well as poor habits in health and nutrition. Although policy decisions can provide the environment to make healthy choices, individual preferences, which can be influenced by many personal, cultural and socio-economic factors, have a huge impact on the decisions that individuals make.
To create a healthy community, these challenges must be addressed and integrated:
1. Safe, quality affordable housing.
2. Improved access to affordable healthy foods.
3. Expanded opportunities for safe recreation and amenities that support physical activity.
4. Increased access to nutrition and health education.
Planning Solutions for Better Living
How does a plan look beyond nutrition in order to develop a healthy community? Knowing that obesity is related to limited access to healthy foods, increased opportunities for safe recreation also needs to support the effort. The connection of the two solutions must have a direct correlation within the physical design.
The Healthy Austin program envisions a strong local food system in which food production, processing, distribution and consumption are integrated. Revisions to land development ordinances are in progress, and will make it easier to produce and access healthy, sustainable food, leading to a more active lifestyle growing and tending fresh vegetable gardens. The plan also will implement joint-use agreements for public facilities to be used by residents for recreation and physical activity.
In its first year, the Healthy Austin program has created a roadmap to addressing “food desert” issues by planning a regional food network for improved distribution, nutrition and access through community gardens. City-owned land also is being used for non-commercial urban farming.
Programming and safety strengthens these solutions by linking people to the use of physical spaces. The best and most beautiful park can be built, but if there aren’t programs to encourage people to use it for specific activities and it is not a highly used, safe space, people will not be as likely to use the park. Programs like a senior walking group, a bike club and/or a youth basketball league are essential.
Sleuthing Resources and Partnerships
A good set of data can help identify community needs and track progress. Sources can include health data from local health agencies, information from city or municipal governments, census data and surveys designed to get insight from the population being served. For specific affordable housing developments, the public housing authority should have data on its residents. Developing targeted surveys or interviews with residents is critical. Smart sleuthing can unearth surprising information.
In Camden, New Jersey, although 97 percent of those living in a surveyed public housing development reported having access to health insurance, 40 percent said they used the emergency room as their primary form of healthcare access. Additional examination through focus groups and one-on-one discussions revealed that, because of long wait times, difficulty scheduling appointments and the perception that providers were insensitive to their needs, residents felt emergency rooms were an easier place to access timely care. As a result of these findings, the Camden Health and Wellness Plan includes strategies to increase the communication and understanding between patients and healthcare providers to provide easier access to same-day appointments.
In a survey of residents living in a north central Philadelphia public housing site, 43.8 percent of respondents cited health issues as the primary reason they were unemployed. Although the Philadelphia Housing Authority’s mandate is to provide affordable housing to residents with limited income and is not a healthcare provider, if their residents are healthy enough to work, they can pay their rent and support the broader goals of the agency.
In conducting interviews and surveys, the key to success is in how questions are researched and phrased. Begin with interviews, talking to different residents or users, and follow with surveys, going door to door to validate existing statistics. To get more nuanced responses, try to avoid asking questions that will illicit a yes or no answer.
Interviewers and surveyors also should understand the actual issues involved. For Samuel Rogers Community Health Center, a publicly funded center located across from Chouteau Courts, a public housing development in Kansas City, Mo., the rate of usage was low compared to residents going to the emergency room at the nearest hospital. Planners discovered residents didn't understand that Medicare and Medicaid would cover services at the health center, and many residents thought the center was intended only for immigrants. The healthcare many residents were receiving in the emergency rooms was ineffective, with no ongoing care. By recognizing these patterns, interviewers could ask more focused questions about Samuel Rogers and go directly to the issue of perception – which health center leaders hadn’t known was a problem.
Based on interview results, a strategy was devised to bring Samuel Rogers Health Center to the Chouteau Courts public housing site through a mobile clinic on certain days of the week. The goal was to help residents feel more confident about seeking care at the center and to build trust for future access. The plan also called for a Community Health Navigator, a trained community health worker, to be based within the public housing development to direct residents to appropriate primary healthcare and resources.
Measuring the Impact
Metrics, capacity, staff to do work and sustainable institutions are all necessary in partnering to create a successful plan for a healthier community. Sustainable institutions have good leadership and are able to continually get funding through grants and private foundations. Strong leaders are those who can get their visions accomplished.
The result of a truly integrated matrix of partnerships is that, through the planning process, different agencies addressing crime, transportation, housing and healthcare are brought together for the first time at one table. Breaking down the silos is key.
No single simple solution exists for these community challenges. A complex array of factors influences community health and wellbeing, so effective solutions must be multi-faceted. But at the end of the day, if all stakeholders understand the benefits and cost savings that an integrated community health strategy can bring, a significant opportunity to impact public health and enrich lives in a tangible way can be achieved.
Garlen Capita is a senior associate and urban designer with the Philadelphia-based firm of Wallace, Roberts, and Todd (WRT). Capita leads community driven neighborhood revitalization efforts in cities around the country. She received her bachelor’s degree in Landscape Architecture from Cornell University and a Master in Urban Design from the University of California Berkeley and is a member of the American Planning Association and the Philadelphia Chapter of the National Organization of Minority Architects. You may contact her by emailing gcapita@WRTdesign.com
Nancy O'Neill is an associate planner at WRT in Philadelphia. Her work is primarily focused in comprehensive and regional planning, community revitalization, growth management and community engagement. She received a bachelor’s degree in Political Science from Arcadia University and a master’s degree in City Planning from the University of Pennsylvania. She is a member of the American Planning Association, the American Institute of Certified Planners and the Delaware Valley Green Building Council. You may contact her by emailing noneill@WRTdesign.com