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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).

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.

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.

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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.

Abstract
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.
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