Design For Health

UN Habitat Reports on Health

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.

Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings (2010), produced in collaboration with the World Health Organization, provides a good overview of the history and current situation in terms of cities and health. Topics cange across the natural and build environment, social and conomic issues, food secutiy, health services, and general urban governange http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3049
Diagram from Hidden Cities
Collection of Municipal Solid Waste , Key issues for Decision-makers in Developing Countries (2011) grapples with an important problem in public health. Written in a very accessible style it answers practical questions about how too extend solid waste collection to a wider population. http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3231
A Global Assessment on Women’t Safety (2008) focuses on tools for enhancing safety including public education, adviacey, participatory approaches, and changing public spaces. It’s part of a series of reports on this topic http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=2848

Resources: Health, Place, and Children

Children, because they are still growing and developing, often suffer from different or additional health risks compared with adults. There are many useful resources on this topic–I list a few below specifically tailored to health and places.

Feeding chickens. Photo: Heather Forsyth
Some additional resources are available at http://www.designforhealth.net/resources/children.html

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:

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.

Tools: The National Collaborative for Childhood Obesity Research Catalog of Surveillance Systems

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.

The database can be filtered by keywords related to the level (person to community to policy), scope (local, state, national), key health variables, age groups, ethnicity, research design, and cost to use.

Each system has an individual entry including information on distinctive characteristics, sampling, key variables, costs, whether information is linked to geographical databases or to other surveys, example publications using the data, and other resources.

This is an extremely useful database and can provide a quick point of entry for those interested in assessing what data are available.

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.

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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