Design For Health

Collections of Tools for Measuring Active Transport

With growing interest in active transport practitioners and researchers have created a large number of tools to measure active transport behavior and environments. The following web sites provide lists or databases of such tools. If you want to measure AT, such sites can be a good place to start. Thye have been sponsored by such groups as the Robert Wood Johnson Foundation, the National Cancer Institite, and the Federal Highway Administration:

Pedestrians in suburban Paris. Photo: Ann Forsyth

Research Summaries: Some Links

For practitioners interested in integrating health research into planning and design, the task can be daunting. There are many articles that touch on the topic of the connection between people, health, and place but with varying levels of relevance, research quality, and cost (and many can be quite expensive to those who don’t have university library subscriptions). Into the gap have come a number of organizations creating practice-oriented research summaries.

Planning for Healthy Places with Health Impact Assessments


A screenshot of the online slide show
A few years back the American Planning Association in association with the National Association of County and City Health Officials created the online course Planning for Healthy Places with Health Impact Assessments at http://advance.captus.com/planning/hia2/home.aspx. Don’t be put off by the initial survey that you have to fill in to get into the site—it’s short and you don’t need to be an APA member to access it! Sponsored by the Centers for Disease control and Prevention the initial course was developed by Rajiv Bhatia, Laura Biazzo, MPH, Division of Nutrition and Physical Activity of the Centers for Disease Control and Prevention, Brian Cole, Andrew Dannenberg, Carrie Fesperman, and Candace Rutt.

With Christine Green
from APA and Nisha Bochwey from the University of Virginia I’ve worked to update the program (without changing the voiceover except for one short additional module!)—Christine is the maven of resources and Nisha did a stellar job on quizzes. There are a lot of new examples. The computer generated voice is a bit weird but the content is a good introduction to HIA—and thanks to the CDC it’s free.

Visuals: What Does a Rapid HIA Look Like?

This blog has dealt earlier with the logistics of doing an HIA but what does a workshop look like? One source is the Arden Hills Healthy City Planning Workshop Summary Report Appendices. This document contains images of each stage of the half-day workshop. Go to http://designforhealth.net/wp-content/uploads/2012/12/cases/HIA_ArdenHills_Appendices_3June2010.pdf and look at pages 33-36. More information about the process is available at: http://designforhealth.net/cases/ardenhillsworkshop.html.

Images from Arden Hills workshop. Photos: Design for Health.


Research: High Density and Overweight Adolescents

I typically don’t report on scholarly studies in this blog but recently came across a nicely designed study that makes a larger point—that the links between health and place are complex. Fei Xu, JieQuan Li, YaQiong Liang, ZhiYong Wang, Xin Hong, Robert S Ware, Eva Leslie, Takemi Sugiyama, and Neville Owen have produced a report  on the Nanjing High School Students’ Health Survey, published in the Journal of Epidemiology and Community Health in 2010 (64, 1017-1021, http://jech.bmj.com/content/64/11/1017). Titled: “Residential density and adolescent overweight in a rapidly urbanising region of mainland China” the study used data collected from 2,375 adolescents in 2004 to examine the relationship between (large-scale) district level densities and weight.

New high rise behind village
residences in suburban Shanghai, 2010

Densities are reported per square kilometer but in range from 5 persons per hectare to 307.  The study divided the sample into high, medium, low density residents. Youth in the middle and higher density areas (that is over > 35 person per hectare) were roughly  twice as likely to be overweight.

The relationship was reduced a bit but still significant after controlling for TV time, study time, recreation, age, gender, and parents education. Physical activity data came from self reports through a version of the International Physical Activity Questionnaire (IPAQ) that only asked about some kinds  of activities. Given a lack of data on overall physical activity and food intake the authors speculate on a number of reasons for this difference e.g. youth in higher density and potentially higher income areas eating more, higher density areas having less recreational space, or (and here I am paraphrasing quite loosely) that higher density areas may just be too convenient with too much internet access so youth don’t have to expend much energy getting places. The high densities in China are also quite high compared with the US and Australia in particular, where much research has been done. They are also increasing rapidly—the authors report overall densities in Nanjing, presumably including some rural districts, increasing from 14 persons per hectare in 1997 to 23 in 2007.

The study is interesting because in many studies of adults, those in higher densities walk more for transportation (though they may not walk more overall) and some find they are thinner (though not all studies measure this or find it to be true, including my own). In this study of youth, with a large group and fairly good measures, those in higher densities are chubbier. While it is important not to make too much of one study, this is yet another example of the complexity of the relationship between health and place, and the importance of social factors.

Mapping Health Issues with GIS: Participatory Approaches

Participatory GIS is a growing field. For those interested in integrating participatory GIS into healthy planning, several web sites provide helpful illustrations of the potential.

Public Participatory GIS based in a company called Vertices in New Brunswick, New Jersey, (http://www.ppgis.info/) provides illustrative maps on topics from bike crashes to a calculator for calories burned walking different routes. Not all maps are local, for example the public health maps rangr from alcohol sales places in New Orleans to food sales in Philadelphia.

Transparent Chennai (http://www.transparentchennai.com/), at the Institute for Financial Management and Research, uses GIS but with a focus on topics such as squatter settlements, environmental hazards, and other aspects of quality of life. What is particularly handy about this site is one can build a map from different kinds of information including environmental, political, infrastructural, and social issues: http://www.transparentchennai.com/buildamap/. This site really shows the potential for a fairly integrated yet still user driven experience that could be particularly helpful for those interested in working with communities on issues of health and place.

Part of a map from Transparent Chennai

Map Kibera (http://mapkibera.org/) started in 2009 by several NGOs in a large squatter settlement in Nairobi Kenya, reportedly was an inspiration for Transparent Chennai. The site has a lot of information apart from maps, showing how different kinds of information—spreadsheets, a blog, twitter, a wiki, and so on—can be linked.

For a more technical, expert-led approach to using GIS see the DFH Threhold Analysis HIA  and research oriented NEAT-GIS and LEAN-GIS protocols. These can however be used in a participatory setting. The Arden Hills Rapid HIA used similar maps as background information, for example (see report appendices).

My thanks to Azhar Tyabji, at the Institute for Financial Management and Research, for leading me to his colleague Nithya V. Raman (and her team’s) work on Transparent Chennai.


Integrating health into planning often uses the approach called evidence-based practice. An article on this topic by some of the folks from Design for Health, including me, is currently available for free: http://www.informaworld.com/smpp/content~db=all~content=a918403162~frm=titlelink. It was a finalist in the Association of European Schools of Planning Best Paper Prize: [link no longer active]

Details about the paper are below.
Is There a Role for Evidence-Based Practice in Urban Planning and Policy?
Authors: Kevin Krizek; Ann Forsyth; Carissa Schively Slotterback
Planning Theory and Practice, 2009, 10: 4, 459 — 478.

Can the craft of planning take advantage of a growing body of planning-relevant research? Evidence-based practice proposes a better connection between research and professional work, but raises several concerns about the character of valid evidence, the strength and clarity of planning research, and inequalities in the available resources for integrating research into planning practice. Much of planning practice is a reflective craft where skills of mediation, negotiation, listening, and framing are prominent. As part of the planner’s work employing these skills, however, there is a valuable role for research-generated evidence to inform decision making. Evidence-based practice needs careful implementation but it can enrich the field of planning by linking research to practice.

Technical Resource 2: InformeDesign

InformeDesign (http://www.informedesign.org/) is an online database of research on people and environments. With substantial funding from the American Society of Interior Designers, and based in the University of Minnesota Department of Design, Housing, and Apparel, the database emphasizes research at the building and component level. However, there is enough other work to make it worth a visit, even for urban planning scale investigations.

The site is basically a database of research summaries in a standard format: introduction, design issue or topic, design criteria or implications, key concepts or central ideas, research methods, limitations identified by the authors of the piece, commentaries on limitations noticed by the InformeDesign reviewers as well as additional information, and a full citation.
The site offers several navigation and search options though not all are obvious. A simple search window is on the home page. There is also an advanced search engine that I found to be well designed though results are listed by URL only and one has to click on the link to the summary to get more information such as titles. Also on the home page are buttons titled “space,” “issues,” and “occupants” that link to lists of subtopics that are further subdivided on later pages. When a user clicks on a subtopic, or a sub-subtopic, articles are listed by name and author and have check boxes to add to a personalized list.
For those interested in more general information about the project, a main menu links to useful information about the site, its sponsors, and the database. An online tutorial on Research 101 provides a refresher on research vocabulary and concepts.

Free Articles on Health and Environments

For those not at universities, finding research on the connections between health and places can be a bit tricky. However, a growing number of online resources are meeting these needs. The entry below lists just a few of  these:

Several research funders provide free access to journals:
Some government agencies who fund and use research have online databases, including free downloads:
  • The U.S. Transportation Research Board’s Transportation Research Information Service (TRIS) is a terrific database of transportation resources, some related to health and some of these available for free: http://tris.trb.org/.
There are a number of free online journals. Many are newer.

  • Examples of journals with where authors pay fees, include the International Journal of Environmental Research and Public Health (http://www.mdpi.com/journal/ijerph) and the International Journal of Health Geographics (http://www.ij-healthgeographics.com/). I have reviewed for the latter (for free) but have mixed feelings about this approach of charging to publish, although it is common in the sciences.
  • In planning the online journals with free submission and publication are in related areas such as transport and include the Journal of Transport and Land Use (https://www.jtlu.org/index.php/jtlu).
Other groups provide research summaries. Design for Health’s own research summaries provide accessible summaries of research on various health topics, as of 2007 and 2008: http://www.designforhealth.net/resources/researchsummaries.html. There are others that I will highlight in upcoming blogs.

Therapeutic Landscapes Network at http://www.healinglandscapes.org/


Garden landscape
(Photo by Ann Forsyth)

Focusing on gardens and other landscapes, with a particular emphasis on gardens in healthcare settings, the web site of the Therapeutic Landscapes Network is a well-designed and maintained resource. I have found the following sections to be particularly helpful:

The evidence-based design section at http://www.healinglandscapes.org/ resources-ebd.html includes online searchable databases, books, and articles.

The gardens overview at http://www.healinglandscapes.org/gardens-overview.html links to ressources on various kinds of healing gardens including those in healthcare, community gardens, prison gardens, and memorial gardens.
A section on art and health http://www.healinglandscapes.org/related-art-health.html [no longer available] provides a succinct overview of important resources.

For further reading, the Design for Health web site deals with planting and mental health at: http://www.designforhealth.net/resources/mentalhealthissue.html

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