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).
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.
The Oregon Transportation Research and Education Consortium is a national-level federally-funded University Transportation Center. One of their three research themes is healthy communities. To find out about their different projects go to the search page, at http://otrec.us/research/browse, type in “health” and click on “filter projects. Projects range from a focus on air quality to pedestrian infrastructure and homelessness.
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.
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:
- Active Living Research Tools and Measures: A compilation of community audit, park audit, survey, tracking, and related tools for measuring physical activity environments and behaviors.
- National Collaborative for Childhood Obesity Research:(NCCOR) Measures Registry: A database of measurement tools including many related to measuring physical activity behavior and the built environment; oriented toward research applications: http://tools.nccor.org/measures/
- Standardized Questionnaires of Walking and Bicycling Database: A database with approximately 100 tools focused on physical activity: http://appliedresearch.cancer.gov/tools/paq/
- Toole Design Group: 29 case studies of measuring walking and cycling: http://www.pedbikeinfo.org/pdf/casestudies/PBIC_Data_Collection_Case_Studies.pdf
|Pedestrians in suburban Paris. Photo: Ann Forsyth|
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.
- InformeDesign summarizes many articles, and has an easy search interface, which is very helpful: http://www.informedesign.org/Default.aspx. To find syntheses that evaluate the balance of evidence one needs to go to other sources.
- UCLA HIA-CLIC has some helpful summaries of research organized by sector (e.g transportation) and pathway (e.g air quality) http://www.hiaguide.org/sectors-and-causal-pathways. Not every issues has information—a number are forthcoming—but it’s generally a helpful site.
- Design for Health’s research summaries are now 3 or 4 years old: http://designforhealth.net/resources/researchsummaries.html. This is more of a problem in the area of physical activity and food—where there has been a lot of recent research—than in the other topics where there are fewer new studies. For those wanting to get updated research there are larger topical pages listing other resources: http://designforhealth.net/resources/generalhealthissues.html and a list of web sites by topic is available at .
UN Habitat produces and distributes a large number of reports, many related to health with numerous publications on water infrastructure, social inclusion, disaster management, housing issues, and climate change. Although you can buy printed reports that isn’t always necessary as many can be found for free.
|Diagram from Hidden Cities|
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.
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|
The National Collaborative for Childhood Obesity Research is a group spearheaded by the National Institute of Health, Centers for Disease Control, and Robert Wood Johnson Foundation. The Catalog of Surveillance Systems is a new product, also sponsored by the USDA. The catalog provides a searchable database of ongoing monitoring systems related to health. It includes both public systems such as the Census of Agriculture and National Vital Statistics System and private ones such as the Nielsen Homescan and InfoUSA.com. In all, 77 systems are represented.