Design For Health

Health in the Green Economy


One of the reports in the series

A new WHO briefing paper series on Health in the Green Economy proposes links between climate change mitigation and improved health. There are a number of related publications dealing with housing and transportation. For example, the housing report highlights the health consequences for non-communicable diseases of extreme heat and cold, dampness, and ventilation problems that may be associated with climate change. It also points out the potential rise of vector-borne diseases. Indoor air quality is a key concern as houses become more air tight.

This is a useful set of summary reports.

Noise Mapping England

Noise Mapping England is a terrific online resource providing highly localized noise mapping for a number of English cities. Noise sources include raid, rail, industry, and air and users can create separate maps for day and night.

For more information about health and noise see the noise section of the Design for Health web site.

Noise map of part of Manchester. For the legend navigate to the site.

Colorado Active Transportation Mile Markers

People trying to plan to increase active transportation face problems with data. It isn’t clear how much active transportation is occurring so it is difficult to tell if it is increasing or decreasing. Recently I was involved with Kevin Krizek and Charlier Associates in creating a set of recommendations for measuring walking and cycling in Colorado. The report recommends eight indicators or “A

The report and a link to a webinar on the project are available at LiveWell Colorado(scroll to the bottom). You can reach the report directly at Recommendations for Measuring Active Transportation.

Illustration from the webinar

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

How Do People Connect Places and Health in Practice?

I am often asked how to connect health and place, practically. There are two main ways of thinking about this–one relates to topics and another to methods.

In terms of topics there are several lists available. Most end out looking like the following list, adapted from Design for Health (http://www.designforhealth.net/resources/generalhealthissues.html). However other, quite similar, lists exist (http://www.hiaguide.org/sectors-and-causal-pathways/pathways). They mix health issues and environmental features mainly because different issues are thought about in those terms. They also play out differently for various groups including children, seniors, people with low incomes, and so on.
Self-build housing in Beihai, China
  • Accessibility to places, people, and services that can promote health
  • Air quality
  • Disasters–including climate change
  • Environment + housing quality related to pollutants
  • Food quality
  • Healthcare access
  • Mental health–often related to stress (e.g. plants can reduct stress)
  • Noise
  • Physical activity options
  • Safety—from accidents and crime
  • Social capital/connections–with complicated relations to place
  • Water quality

A range of methods help practitioners make these connections:

  1. Policy and Program Collaborations: The UN Healthy Cities Program is an example, focusing on building awareness and collaboration among partners including governments and universities.
  2. Health Impact Assessments: These are actually a range of tools, both participatory and technical, aiming to link local knowledge and health research/data maximize health benefits+ minimize health risks for all groups. They can be done on a range of policies, programs, and plans, not only ones affecting places.
  3. Quality of Life Tools: This is a term for a range or preexisting tools and methods that focus on the connection of people and place, and connections between people. Examples include safety audits, food security assessments, and asset maps. Various social development tools such as anti-racism trainings with a place-based approach, also fit in this category.
  4. Healthy Community Plans and Designs: Such proposals translate health research into practice at scales from the building to the region.

Tools: The National Collaborative for Childhood Obesity Research Measure Registry

Recently I highlighted work of the National Collaborative for Childhood Obesity Research (NCCOR). a group spearheaded by the National Institute of Health, Centers for Disease Control, and Robert Wood Johnson Foundation. They have now released a new tool, or rather a registry of measures related to diet and physical activity: http://tools.nccor.org/measures/. I was part of the team on this project. My role was cataloging some of the physical activity measures, a mix of “questionnaires, instruments, diaries, logs, electronic devices, direct observations of people or environments, protocols, and analytic techniques.” Overall there are over 700 measures.

Example of Straight Line and Network
Buffers Created Using GI

The main search page at http://tools.nccor.org/measures/ allows users to search by domain (e.g. Individual dietary behavior, food environment…), measure type, age of people measured (though as this information seems to have been unevenly cataloged I found it not so useful for environmental measures), and context or type of place. Measures with reliability and validity information, as well as those used in studies of children and adolescents, were given priority. However, for the domain of physical activity environments this would have limited the measures too much so these are drawn from a wider range of sources.

Technical Resource 3: People and Participation.net (now Participation Compass)


Workshop on housing options.
(Joanne Richardson in center,
Ann Forsyth photographer)
Expert-driven tools can be very helpful for assessing community health. However, in all but the smallest assessments, it’s important to combine such expert methods with more participatory approaches. Local people know their own communities and that local knowledge can be very helpful. They may also have fears that need to be investigated—some may be appropriate and some may not but in either case it is important to know about them.
Public health, urban planning, and related fields have different cultures of participation and this also varies by country, region, setting, and project type. However, one terrific resource for giving most people good ideas is the British web site People and Participation.net (now Participation Compass): http://participationcompass.org/
Register for free to gain access to the site and some really terrific tools including:

  1. A process planner that quizzes the user on everything from money and time available to political support and shoots out a set of participation options–click on methods then planning. Using this planner is a way of getting out of the rut of doing the same old thing. It can also just give you a place to start that is relevant to your situation.
  2. If you want to see all the methods they are also listed alphabetically.
  3. Their library is particularly good and with a keyword cloud and lists of recommended webs sites, practical guides, and web tools:http://participationcompass.org/article/index/qa
  4. Users can also upload case studies: http://participationcompass.org/article/index/study

The Design for Health project has a short information sheet on how to use participatory methods to integrate health into the planning process: http://www.designforhealth.net/resources/participation.html. I have reviewed some other participation tools on my Planetizen blog at: http://www.planetizen.com/node/46672.

Tools: Food Security Assessments


Oakland, California (Photo by Ann Forsyth)
The topic of food and planning is one of great interest—particularly promoting healthy food options. Of course what people eat is a complicated result of their personal preferences, financial resources, and social context. Food availability depends on climate, the time of year, whether people grow their own food, how much it costs, home food storage options, and the kinds of stores in the local area.
However, a number of tools can help larger communities plan for their food access.
  • One such tool is the Food Security Assessment. In 2002, the USDA Economic Research Service published a well-known Community Food Security Toolkit: http://www.ers.usda.gov/Publications/EFAN02013/ with the entire toolkit at http://www.ers.usda.gov/publications/efan02013/efan02013.pdf. There are other toolkits around, with many good tools developed for use internationally in areas likely to suffer substantial food shortages, but this one by aU.S. government agency may be a good place for others to start.
  • The USDA web site provides helpful information about food security in the U.S.: http://www.ers.usda.gov/Briefing/FoodSecurity/. A 2007 USDA Food Security Assessment provides an example at the international level: http://www.ers.usda.gov/Publications/GFA19/. However, using the methods in the toolkit, local communities can do this as well.
The food security assessment and other food related tools are discussed in the DFH Food Issues Sheet at http://designforhealth.net/wp-content/uploads/2012/12/Information_Sheet/BCBS_ISFood_090107.pdf based on research outlined in the Food Key Questions research summary http://designforhealth.net/wp-content/uploads/2012/12/Key_Questions/BCBS_KQFood_082207.pdf.

HIA-CLIC–UCLA Health Impact Assessment Clearinghouse Learning and Information Center

>This UCLA clearinghouse has been a terrific resource for some time but has recently updated its web site: http://www.HIAGuide.org.

Particularly useful are its:
Still under construction is is useful already but promises to be an even richer resource.

How to Do a Rapid Health Impact Assessment: Useful Reports

The Rapid Health Impact Assessment—the kind of HIA that takes the form of a structured workshop with substantial preparation and reporting—boasts a number of detailed manuals, such as the classic by Erica Ison: http://www.apho.org.uk/resource/item.aspx?RID=44890.

Arden Hills Healthy City Planning Workshop
Photo: Ann Forsyth
However, moving beyond such general guidance it can be hard to find out how others have conducted their HIAs. Some people provide extensive background reports but not much about what actually happened at the workshops. Others focus on the outcomes of the HIA and not the inputs and process. An increasing number of practitioners are, however, reporting on HIAs in straightforward ways that provide transferrable tools for others. This entry highlights several of these, all containing useful examples of worksheets, maps, and recommendation checklists or tables.
  • The London Olympics HIA, completed in 2004 is an example of a health impact assessment conducted on a major employment and housing development. Prepared by consultant for the London Health Commission and the London Development Agency, the HIA had two parts: a desktop assessment using many existing reports and a workshop with 21 key participants (including advocates, government representatives, academic and academics). The HIA looked at construction, operation, and post games time periods and the consultant produced a 155 page report, available online: http://www.apho.org.uk/resource/view.aspx?RID=61057. This comprehensive report contains substantial background information, results from exercises in the workshop including some interesting voting activities, and clear recommendations.
  • The Lowry Corridor HIA of 2007, while an internally conduced assessment rather than a true participatory HIA, is a terrific resource. Focusing on the redevelopment of a major road in Minneapolis, the report contains several well thought-out worksheets and a number of interesting maps: http://www.apho.org.uk/resource/item.aspx?RID=60512. It is a very accessible document.
  • Commerce City, Derby Redevelopment Area HIA is also not a traditional rapid HIA but it is included here for its imaginative use of participation and analysis tools. These range from computer mapping and proposals for street redesign to photos taken by residents and stills from a video produced by local high school students. Located in a lower income, majority Latino area of suburban Denver the HIA was conducted by the Tri-County Health Department who in turn employed short-term consultants on special topics. With a focus on physical activity and nutrition, recommendations from the 65- page report (http://www.tchd.org/pdfs/hia_final.pdf) fed into a master plan.
  • The Arden Hills Healthy City Planning Workshop of 2010 assessed options for reusing a military facility in a suburb of the Twin Cities. The state Department of Health sponsored this HIA collaborated with the City of Arden Hills, hiring a consultant to actually conduct it (Design for Health). This is one of the very few HIA reports that includes basically all the information used to run and report on the HIA workshop–the actual information packet provided to participants in advance; the agenda of the meeting, copies of handouts, worksheets, and presentations from the workshops; a series of photos keyed to parts of the agenda; and the workshop’s summary report. The summary report and appendices, along with a description of the workshop, are online: http://designforhealth.net/cases/arden-hills-2010-workshop/.
  • More information about HIA in general can be found at http://designforhealth.net/hia/.
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