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Design For Health

When planning for health, low-income populations often need additional attention. The following information gives planners some tools to understand this population’s specific health issues and how planning can influence them.

Low-income populations have several specific health issues including:

  • Persons living in poverty are considerably more likely to be in fair or poor health and to have disabling conditions.1 Those that live in low-income neighborhoods may well lack services.
  • Low-income people have a myriad of accessibility limitations since they have fewer transportation options. They may have less access to healthcare services, jobs, grocery stores, financial institutions, social contacts, etc.2
  • Poor people often eat less nutritious food and have fewer nearby health-food options; however, it is unclear whether or not the reason poor people have less healthy diets is distance to food stores since there may be other potential explanations, including price and preferences.3, 4
  • Many people under age 65, particularly those with low incomes, do not have health-insurance coverage consistently throughout the year, compounding other disadvantages.1
  • In terms of exposure to environmental and household pollutants, there is some evidence that these impacts are inordinately borne by racial minorities and those with low incomes.5,6
    • Bullard’s (1996) work on environmental justice provides both case studies and empirical evidence of the disproportionate effects on disadvantaged populations.7
    • Several studies have found that poor communities and/or communities of color are more likely to live near and be exposed to environmental hazards, however, findings on whether it is race, class or both factors that determines these findings have been mixed.8, 9
    • Residential sources of lead, found in lead based paint and lead-contaminated dust and soil can increase lead levels in children’s blood. Children in low-income and minority families are particularly susceptible.10, 5 For more information about health issues for children, visit the special populationssection for youth.

Most of these disadvantages are not related to the built environment at the scale of the neighborhood, city or metropolis, but rather reflect individual and family characteristics. The domain of planning, however, can influence some health issues.

  • Accessibility—the ability to reach a variety of destinations—is critical to many dimensions of a healthy community. Particularly for the elderly, the young, people with disabilities or the financially disadvantaged, transit is the mode of transportation that provides such access (where walking or cycling is too burdensome).4
    • Providing for transit accessibility requires that: first, transit is available; second, the available transit service is of reasonably high quality; and third, transit is provided for different trip purposes.5
    • It also requires thinking about the design of these modes so that they are usable by as many people as possible, regardless of age, ability or circumstance, following the principles of universal design.11
    • Density is a critical dimension, though certainly not the only dimension to consider, for establishing service frequency and location.12
    • For those who rely on walking and cycling, having destinations close by is important.
  • Those living in high-poverty neighborhoods may also be particularly sensitive to air-quality impacts, as they often have higher levels of chronic diseases, such as asthma, that make them more susceptible to the impacts of air pollution.12, 13 Often their conditions can be exacerbated by exposure to poor indoor and outdoor air quality.
    • A study conducted in 1999, for example, examined the socio-demographic characteristics of people living near industrial sources of air pollution in three different areas in the United States. This study showed that African Americans and those living in households below the poverty line are more likely to live closer to these sources of pollution.15
  • Several studies, focused on environmental justice, have found that poor communities and/or communities of color are more likely to live near and be exposed to environmental hazards. However, conclusions as to whether it is race alone, class alone or both factors that determine these findings have been mixed.8, 16
    • Evidence is mixed as to whether or not nonwhites and those with lower incomes are more likely to live near polluting industrial facilities.9, 15, 17However, such residential proximity is a health problem regardless of cause.
  • In the United States, poor people often live in environments that, compared with middle- and upper-middle-class areas, are less likely to have access to supermarkets and other venues selling a variety of higher-quality food items.18, 19, 20, 21, 22, 23, 24
    • Poorer people have fewer transportation options and may be more reliant on local food sources than those with easy access to automobiles.25, 26
    • Typical Euclidean zoning separates communities into different land-use categories, often creating significant distances between residential areas and commercial services, such as supermarkets and restaurants. For those without access to transportation, this makes it difficult to reach supermarkets and make healthy-food choices.27, 18, 28

Where to Find Information in Design for Health Publications

Many of these topics are dealt with in the Key Questions Research Summaries and Planning Information Sheets. This includes:

  • The City of Boulder, Colorado, has prioritized maintaining and improving its multimodal transportation system within the transportation section of the Boulder Valley Comprehensive Plan. One of the policies focuses on accessibility: “The city and county will develop a balanced all-mode transportation system that provides transportation choices, services, and facilities for people with mobility impairments, as well as youth, older adults, and low-income persons.” 29, 30
  • The City of San Diego, California’s Land Use and Community Planning element promotes transit accessibility for specialized populations. Policies include: work with regional transit planners to implement small neighborhood shuttles and local connectors; and increase the supply of housing units that are in close physical proximity to transit and to everyday goods and services, such as grocery stores, medical offices, post offices, and drugstores.30, 31
  • The City of Riverside, California, addresses low-income populations in the air-quality element of the Riverside General Plan 2025. The stated objective is to, “Adopt land-use policies that site polluting facilities away from sensitive receptors and vice versa; improve job-housing balance; reduce vehicle miles traveled and length of work trips; and improve the flow of traffic.32 One policy to support this objective is to “ensure that all land-use decisions, including enforcement actions, are made in an equitable fashion to protect residents, regardless of age, culture, ethnicity, gender, race, socioeconomic status or geographic location, from the health effects of air pollution.”14, 32
  • The Community Food Security Assessment, developed by the U.S. Department of Agriculture’s Economic Research Service (USDA considers a range of issues including: effectiveness of local infrastructure for delivering federal food-assistance programs; adequacy of supermarkets, barriers to food shopping, modes of transportation, selection and price, and local markets; and income levels and number of persons in poverty, use of emergency-food system, and federal food-assistance programs.33, 24

DFH offers a number of measurement tools and checklists that cover specialized populations, such as children.

  • The Health Impact Assessment (HIA) Threshold Analysis, for example, discusses the importance of accessibility for specialized populations, including low-income residents.
  • The Comprehensive Plan Checklist asks whether or not food and accessibility issues are covered under the transportation and land-use sections of the plan. Two questions include:
    • Has a community food-security assessment (USDA ERS) been created to establish barriers to healthy food, income levels, lost farmland, community gardens and farmer’s market availability within urbanized areas?
    • Are there policies/plans that prioritize the transportation needs of underserved populations (e.g., seniors, children, persons with disabilities, low-income residents, etc.)?

Other Resources

  • Nutrition and Health
    The USDA web site has a helpful report on the health characteristics of low-income people.
  • Centers for Disease Control and Prevention (CDC)
    The CDC has a wealth of information, including statistics:

  • Minnesota Department of Health
    The department maintains a wide range of statistics including:

    • Vital Statistics State and Trends 
      This site includes an instruction document and highly formatted Excel workbook of basic demographic data, birth data (including premature births, prenatal cases, infant deaths) and death data (major causes, age-adjusted rates, ethnic breakdown).
    • Minnesota County Health Tables 
      These tables contain data on demographics; births and related infant health issues; deaths and causes of death; diseases, medical professionals, and health-related behaviors (under morbidity and utilization and under chemical health); and environmental health (e.g., lead poisoning). Diseases range from mumps to Lyme disease and lung cancer; behaviors include seat-belt use and driving under the influence.
    • Fee-based Statistical Requests 
      For a fee, the Center for Health Statistics will fulfill specific requests pertaining to state and county vital statistics data not readily available in the Center’s Minnesota Health Statistics Annual Summary or Minnesota County Health Tables.

*Special thanks to Amanda Johnson and Ashley Miller for their work creating this resource.

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