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Design For Health

Plan Evaluations from the American Planning Association

The American Planning Association recently released a report, Healthy Planning, evaluating 22 comprehensive and sustainability plans in terms of health issues. Funded by the CDC this report looks at 22 plan documents. As the APA’s web site web site states: “The evaluation assessed the extent to which these plans addressed public health through six broad health-related planning topics:

  • Active Living
  • Emergency Preparedness
  • Environmental Exposures
  • Food and Nutrition
  • Health and Human Services
  • Social Cohesion and Mental Health”

Its an interesting report downloadable at http://www.planning.org/research/publichealth/pdf/evaluationreport.pdf. Anna Ricklin, the current manager of APA’s Planning and Community Health Research Center led the team creating the report. The plans were selected from a 2012 survey that had identified 890 plans using mentioning public health and 45 additional plans identified by the CDC. Plans were selected because they covered a wide range of health topics and also geographical diversity (urban, rural, county, city, etc). The report doesn’t present evaluations of individual plans but examines how many of the plans covered particular topics and issues. It does, however, identify lists of top plan e.g. for active living  top jurisdictions included Baltimore County, Washington, DC, and Fort Worth and for food and nutrition the top places where Alachua County (FL), the Oneida Nation, and Baltimore County.  A next phase of the project will look in greater depth at some specific case studies.

 

A number of my Cornell students worked on the report with APA (acknowledged on page 4).

American Planning Association’s Planning and Community Health Research Center

APA

APA’s Planning and Community Health Research Center

For those interested in how to connect health and urban planning, the APAs Planning and Community Health Research Center is a good place to start. Resources include links to a number of health-related interest groups, links to educational programs, and a useful listing of APA’s health-related publications. A companion resource is the Planning and University Research Registry (PURR) where researchers can list projects both in progress and completed. A number are related to health and planning.

WHO Healthy Cities

The WHO Healthy Cities Program has been around since the mid-1980s and but is not as well known in the United States as it perhaps should be. The program is focused on “health development through a process of political commitment, institutional change, capacity-building, partnership-based planning and innovative projects” (http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/urban-health/activities/healthy-cities). Healthy city activities typically focus on fostering collaborations and partnerships to promote health with a refreshing mix of interventions—policies, programs, and plans. Activities that won Healthy Cities Awards in recent years include schools that promote urban health, injury and violence prevention activities, best practices in public toilets, and healthy urban transportation (http://www.alliance-healthycities.com/htmls/awards/index_awards.html).


It’s hard to find exactly how many cities participate but the WHO European office claims that over 1,400 European cities take part in 30 national networks. As the network is global, presumably the overall numbers are much larger. An Alliance for Healthy Cities brings some of these cities together: http://www.alliance-healthycities.com/htmls/about/index_about.html 

The WHO European office has a useful healthy cities checklist that shows the wide range of topics of interest to the program from ecosystem health and public participation to diversity and economic vitality. You can read the whole list at http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/urban-health/activities/healthy-cities/who-european-healthy-cities-network/what-is-a-healthy-city/healthy-city-checklist

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.

Resources: Planning and Active Living

Active living, the idea that it’s good to build exercise into daily life, has been big news in planning for a while but I still get questions about how to incorporate active living into plans. A decade ago, when it was a fairly new idea, there was the hope that if we built places where people were more prone to do activities like travel walking, that they’d keep exercising as well, increase their total activity, and reduce weight. It turns out to be a bit more complicated than this as I noted in my blog on high density and overweight adolescents in China. Research is quite mixed in its findings—there’s a lot of variation in how people respond to environments. Programs, policies, prices, education, and attitudes all shape how people use environments. But as a bottom line it is useful to provide options for people to be active in different ways so that when they want to do so they can. 

So how can you help provide options? Several web sites provide case studies of communities have done this work.
Mexico City Cycle Day, 2011. Photo: Ann Forsyth
  • Active Living by Design has been around since 2001 and has a useful web site. The group has worked with a number of cities and countied and provides case studies linked to an onsite map: http://www.activelivingbydesign.org/communities.
  • The APA has a webinar with some practice examples: http://www.planning.org/nationalcenters/health/education/webinars/activecommunity.htm
  • Design for Health also highlights some alternative transportation plans including ones by Bloomongton and St. Louis Park. Some of the questions in the DFH Comprehensive Plan Review checklists also target active living—noted in a column: http://www.designforhealth.net/resources/checklists.html

Tools for Conducting an HIA on a Comprehensive Plan

I’ve recently had a number of queries about how to conduct a health impact assessment on an existing comprehensive plan. This is a great thing to do because it can help prioritize changes in an update. How to conduct an HIA is a big topic, but fortunately there are a lot of resources available with more coming online over the next year.

One place to start is the set of Comprehensive Planning Checklists on the Design for Health web site: http://designforhealth.net/resources/legacy/checklists/. They are based on evidence–though there is stronger evidence for the “essential for health” sections than the “good for health” ones. Each question has a column that explicitly states which area of research it is based on and these are described more fully in online research summaries (see next point). These checklist are also broken into standard categories for comprehensive or general plans in the United States. Two other resources, highlighted in an earlier blog, may be useful: the Australian Healthy Urban Development Checklist and British Delivering Healthier Communities in London.

Research Summaries that form the basis of the DFH checklists that are available for free: http://designforhealth.net/resources/researchsummaries/. The current versions reperesent work up to about 2007 or 2008 and in fast developing areas–such as food–we’ll be preparing updates in the next year. For extra information in the interim you might look at the “pathways” section of HIA-CLIC http://www.hiaguide.org/sectors-and-causal-pathways/pathways.
Model of Downtown Tianjin in the
Tianjin planning museum.
Photo: Ann Forsyth.

For advice about what to do after you have used the checklist and done your evaluation, the Design for Health web site has Information Sheets linked to the research summary topics that have examples and cases:
http://designforhealth.net/resources/planningissues/

In addition, a course on Planning for Healthy Places with Health Impact Assessments by the American Planning Association in association with the National Association of County and City Health Officials, is also a good place to start: http://professional.captus.com/Planning/hia/default.aspx. It is currently being updated by a team including Christine Green and Kimberly Hodgson at APA, Nisha Botchwey from the University of Virginia, and myself, with advice from Dee Merriam of the CDC. The update will substantially expand the resources section so there will be lots more information than this brief note can provide.


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 Pedestrian and Bicycling Survey (PABS)

I’ve recently been involved creating a new survey for measuring transportation behavior, particularly walking and cycling.  The Pedestrian and Bicycling Survey (PABS) is a mail out/mail back survey designed to be an inexpensive means for local governments to learn about nonmotorized transportation use in their communities.

An important component of the design of the PABS was creating a probabilistic sampling approach that would be relatively straightforward to administer and, if desired, could be carried out in house (within municipal agencies). While other sampling approaches—such as snowball sampling across the internet—can achieve a large number of responses, the probability of any person being asked to take the survey is not known making it a challenge to generalize from the sample to the wider population.

Pedestrians in suburban Hong Kong
Documentation includes a report outlining how the survey was developed and the results of reliability (repeatability) sampling. A manual provides step by step guidance about how to use the survey too. The survey is provided at the end of both documents and is available in English and Spanish. Materials are available for download at http://transweb.sjsu.edu/project/ 2907.html (scroll down to find the manual).
Future plans include creating a more modular version so users can mix and match sections to suit the questions they need answered. Updates will be available at http://www.designforhealth.net/health/PABS.html.

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.

How to Learn About the Basics of Healthy Community Planning

Linking health and planning requires learning about (at least) two areas. Public health folks are often confused about planning and planners have a lot to learn about health. There are a number of useful web sites and below I list just a few free guides that can lead you through the maze.

Healthy Urban Development Checklist
  • The Healthy Urban Development Checklist: A Guide for Health Services when Commenting on Development Policies, Plans and Proposals introduces public health folks to planning. Developed by the NSW Department of Health in Australia, it will be useful in many other locations. It takes a little while to load but once it’s on screen it provides a useful introduction to health issues and the planning system. It covers a typical range of issues including food, physical activity, housing, transport employment, community safety, open space, social infrastructure, social cohesion, environment, and specific development contexts such as infill.
  • Delivering Healthier Communities in London  was developed for the National Health Service London Healthy Development Unit in 2007. Also a bit slow to load, it is organized around key health issues–mental health, cardiovascular disease, respiratory disease, excessive heat and cold, and injuries. It links each of these the environmental factors.
  • The Design for Health web site comes from the other direction, aimed at informing planners about health. Its health impact assessment tools draw on research summaries and can feed into planning actions. Topics are rather similar to the Healthy Urban Development Checklist (above).
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