Developing Health Oriented Neighborhoods

Research Suggests Walkable Places Enhance Public Health

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Matthew Lambert is a partner at DPZ Architects and Town Planners.

Brett Van Akkeren is senior policy analyst for the U.S. Environmental Protection Agency.

Posted: Wednesday, July 6, 2016 8:13 am

Say you’re driving through a city you don’t know well – or maybe even your hometown - and you discover a new neighborhood.

The shops and restaurants look interesting, the sidewalks are wide, people are out and about, and it looks inviting.

You park the car, get out and wander around. "I could be happy living here," you think.

You probably would be healthy living there, too.

The neighborhoods where people live are part of what determines health outcomes, new research shows.

People long believed that keeping active kept people healthy, but the data wasn’t freely available to prove it.

Now, with Fitbits and other devices, activity can be traced and results measured.

“Recently the Centers for Disease Control, universities, and healthcare systems have begun analyzing the information at their disposal and correlating health outcomes with place,” said Matthew Lambert, partner at DPZ Architects and Town Planners. “For years, we have made assertions that healthy lifestyles are affected by the physical environment around people. If someone lives in a place that is conducive to walking within meaningful destinations nearby, then they will tend to walk more.... For those living in environments not conducive to walking, they have to make a conscious choice to achieve health goals each day, choices which compete for time in our busy lives. While more devices like Fitbits and smart watches help people keep on the path towards a more active lifestyle, living and working in walkable places makes the active lifestyle a part of everyday life. Newly available data has proved this hypothesis, and driven groups like the CDC to support walkable places,” Lambert said.

Sometimes even solutions to complex issues start with a single step, said Lambert, who spoke at a New Partners for Smart Growth Conference in Portland, Ore., in February.

“This is step one of health oriented neighborhoods, to make them physically conducive to walkability. Going beyond the basics, we need to make walkable neighborhoods conducive for people with a broad range of abilities. For instance, some individuals may require places of rest along their walking routes while others may benefit from exercise stations. Parks and playgrounds need to be integrated with housing, retail, and workplace, and structured to promote walking and biking, active time outdoors, and social interaction. Combining these elements with a well-structured built environment creates a health oriented neighborhood,” Lambert said.

So benches let people take a break, if they need it. Removing any barriers to access and use is also a hallmark of a healthy environment. Sometimes the solution is simple, such as making sure sidewalks are complete on both sides of the street and crosswalks are safe.

“Things tend to be solved by providing easy access to destinations” by walking or other alternatives to cars, Lambert said.

Promoting walking groups and hiking trails can also lead to better health outcomes, along with open spaces and parks. Hospital campuses can have walking possibilities that connect them to the neighborhood.

Health care is moving from caring for the sick to keeping people well – from sick care to health care. It is moving from in-patient to out-patient care, so hospital’s and clinic’s roles are changing. Part of that means assessing and addressing health needs of the community.

Giving people the resources to age in place is another need. It helps keep neighborhoods multi-generational, and as many as 90 percent of people hope to stay in their own homes as long as they can. Shuttles to health care services can help.

Affordable housing, public transportation and safety are all necessities.

“A health oriented neighborhood is a place that incorporates a health facility as an anchor that advances health across the entire community,” said. Brett Van Akkeren, senior policy analyst for the U.S. Environmental Protection Agency. “Health oriented neighborhoods create an environment of total wellness for the residents and employees of the neighborhood. They use a combination of community design and targeted programs to improve health outcomes for everyone.”

The EPA is identifying national best practices related to the design and development of health oriented neighborhoods. Applying the principles of smart growth to the siting and design of medical facilities and their surrounding areas can improve health, environment and economic outcomes.

“Our intent is to work with government and non-profit partners to use this knowledge to support communities in their efforts to create neighborhoods that are healthier for people and the natural environment,” Van Akkeren said.

So a medical center might occupy a vacancy in a neighborhood strip mall.

The EPA says the concept is evolving. Placing primary care facilities in neighborhoods is relatively common. Having the facility focus on wellness rather than disease prevention is becoming more common. Integrating wellness into the broader community through facility siting, community design and other strategies is still relatively new.

It is different than an urgent care center within a big box store.

Urgent care focuses on disease control. Health oriented neighborhoods focus on primary care and wellness in the whole neighborhood.

According to the EPA, features of a health oriented neighborhood include:

* Accessible and affordable healthcare with a focus on disease prevention and a healthy lifestyle

* Healthy eating with access to fresh, local foods at grocers, farmers markets, or community gardens and training on how to shop for, cook, and eat a healthy diet

* Healthy homes work to reduce indoor exposure to lead, allergens, toxins, radon and carbon monoxide in people's homes, with a priority focus on disadvantaged households.

* Protection from environmental health hazards outdoors, including air and water pollutants, toxins, and contaminated lands.

* Physical fitness opportunities, which can be enhanced by:

  • Designing communities to include sidewalks, trails and bike lanes to encourage walking and biking.
  • Supporting vibrant neighborhood centers with a variety of businesses that allow residents to meet most of their daily needs on foot or by bike.
  • Providing transit services that enable residents to achieve a significant part of prescribed daily physical activity just by walking and biking to and from the bus or rail stop.
  • Investing in parks, recreation centers, pools, and other facilities that allow for play-based exercise. Communities can also negotiate share use agreements with the local school system so playgrounds can be used when school is not in session.

* Psychological well being, with access to nature and opportunities for both planned and spontaneous social interaction in the community.

  • Access to nature is shown to reduce depression and anxiety. Providing parks and access to waterfronts and other natural areas can improve mental health outcomes.
  • Creating informal gathering places outside of home and work, such as cafes, bars, bookstores, etc., provides space for spontaneous social interaction and promotes social well-being.

* Economic opportunity through medical and other health oriented enterprises. Creating a local economy around health and well-being provides jobs in one of the fastest growing sectors of the economy and provides business opportunities for local entrepreneurs. This may include jobs to support local medical facility needs as well as jobs created around local food and wellness.

There are many components to the Affordable Care Act (ACA) that support communities' efforts to build health oriented neighborhoods. Some examples provided by the EPA include:

* Support for medical facilities - By providing more individuals with insurance, ACA is creating a demand for more primary care facilities.

* Emphasizing wellness over disease control means more resources are available for the wellness components of the neighborhood. For example, the ACA requires all hospitals that want to maintain a non-profit status to conduct a Community Health Needs Assessment (CHNA) and invest in the community to address the health needs that the assessment identifies. This can mean more resources to implement components of a health oriented neighborhood.

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