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Bridging The Gap

Nov 03, 2014




Bridging the Gap Between Smart Growth and Public Health

  • 1. Bridging the Gap Between Public Health and Urban Planning Florida Department of Health Division of Environmental Health Daniel Parker, MSP Division Operations and Management Consultant

2. Protocol for Assessing Community Excellence In Environmental Health (PACE EH) 3. Florida PACE EH ProjectCommunity Feedback

  • No sidewalks
  • No bike paths
  • No street lights/Insufficient lighting
  • Not safe
  • Dilapidated housing/Uncared for property
  • Forgotten by leaders
  • Drinking water/ well contamination
  • Cut off from other neighborhoods.
  • No fire hydrants
  • Heavy Traffic
  • Hazardous waste
  • Sanitary nuisances
  • Solid waste issues
  • Sewage/septic issues
  • Frequent flooding
  • Water Quality
  • Drowning
  • Crime
  • Noise
  • Air contamination/ pollution
  • Leash ordinance

4. What do you want your City or County to look likein 10 or 20 years? 5.

  • 1926, Village of Euclid vs. Ambler Realty Co.
  • Public health protection a basic responsibility of local government
  • Zoning to separate homes from industry and pollution.
  • Given a legal mandate to restrict or control land use decisions in a community

Public Health and Planning 6. Definition of Environmental Health

  • In its broadest sense, environmental health comprises those aspects of human health, disease, and injury that are determined or influenced by factors in the environment. This includes not only the study of the direct pathological effects of various chemical, physical, and biological agents,but also the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture.

-- CDC Healthy People 2010 7. Built Environment

  • The built environment encompasses all of the buildings, spaces, and products created, or at least significantly modified, by people.
      • Health Canada,Health and Environment, 1997.
  • Land Use (industrial or residential)
  • Buildings (housing, schools, workplaces)
  • Public Resources (parks, museums)
  • Zoning Regulations
  • Transportation Systems

8. How might the built environment influence human health?

  • Access to medical and other health care
  • Quality of and access to schools
  • Healthy food outlets
  • Economic opportunities
  • Ease of social interaction and resulting social capital
  • Air and water quality
  • Opportunities for physical activity

9. The Burden of Physical Inactivity Rich Bell, Project Officer, Active Living by Design*, UNC School of Public Health *A National Program of The Robert Wood Johnson Foundation Email:[email_address] 10. Emergence of a Sedentary Society Rich Bell, Project Officer, Active Living by Design*, UNC School of Public Health *A National Program of The Robert Wood Johnson Foundation Email:[email_address] 11. According to the Center for Disease Controls' Healthy People 2010 Report, the definition of Environmental Health may include housing, urban development, land-use, and transportation. Submit Clear A) True B) False 12. Rand Corp Data 13. Prevalence of Overweight and ObesityAmong US Adults, Age 20-74 Years* ObeseBMI30.0 Percent BMI = body mass index. *Age-adjusted by the direct method to the year 2000 U.S. Bureau of the Census estimates using the age groups 20-34, 35-44, 45-54, 55-64, and 65-74 years. NHANES II 1976-80 (n=11207) NHANES III 1988-94 (n=14468) NHANES1999 (n=1446) NHANES III 1999-2000 (n=4115) Projected 2008 Overweight or obese BMI> 25.0 OverweightBMI 25.0-29.9 14. Quotes It is the occupation of a child toimmerse herself in her environment". Lowly, unpurposeful and mundane as they appear, sidewalk contacts are the small change from which a citys wealth of public life may grow.Jane Jacobs,The Death & Life of Great American Cities There is much more to walking than walking.Jan Gehl,New City Spaces 15. 16. 17. 18. The Big Picture 19. Unkempt properties, pollution cited in west Ocala survey By SUSAN LATHAM CARR, STAFF WRITER, Star Banner Residents of west Ocala complain that unkempt lots lower the value of their property. ERICA BROUGH/STAR-BANNER 20. Indian River County PACE EH Project 21. What is PACE EH? Submit Clear A) The Packers and Cubs Exchange B) Principles of Community Eating C) Protocols for Assessing Community Excellence in Environmental Health 22. Smart Growth Principles

  • Mix land uses
  • Take advantage of compact building design
  • Create a range of housing opportunities and choices
  • Create walkable neighborhoods
  • Foster distinctive, attractive communities with a strong sense of place
  • Make development decisions predictable, fair, and cost effective

23. Smart Growth Principles (Contd)

  • Preserve open space, farmland, natural beauty, and critical environmental areas
  • Provide a variety of transportation choices
  • Strengthen and direct development towards existing communities
  • Encourage community and stakeholder collaboration


  • 38% of study participants who live in the most walkable neighborhoods met government-recommended activity levels.
  • Only 18% of the residents in the least walkable neighborhoods met US Surgeon General recommendation of 30 minutes of moderate activity every day.
  • All study participants wore accelerometers
  • 3 walkability factors: mix of shops, homes, and schools, residential density, and number of connecting streets.
  • - American Journal of Preventive Medicine, February 2005

Create Walkable Neighborhoods 25. Provide a Variety ofTransportation Choices

  • Students 4 times more likely to walk to schools built before 1983 than those built more recently (South Carolina study).
  • Even children within 1.5 miles of schools are bused due to safety concerns.
  • Loss of neighborhood anchor.
  • State education policies.

26. Travel and Reduced Physical Activity

  • US average= 73 mins/day of driving
  • One-fourth of all trips made are one mile or less, but three-fourths of these short trips are made by car
  • Children between the ages of 5-15 walk/bike 40% less in 1995 than in 1977
  • For school trips one mile or less, only 31% are made by walking; within 2 miles, only 2% are made by biking.
  • In the US, 6% of trips are by walking/biking. In contrast, Italy is 54%; Sweden, 49%.
  • Allen Dearry, Ph.D. National Institute of Environmental Health Sciences NIH, DHHS October 2, 2003

Walk and Bike Trips Automobile Trips 27.

  • American Journal of Public Health, October 2004
  • Streets not well connected
  • Areas far from each other (schools, malls)
  • Walking and bike riding difficult or dangerous

Forward Thinking Professionals

  • American Journal of Public Health, September 2003
  • Studies show association between deteriorated physical environment and higher rates of crime.Safety influences activity.
  • Transportation Research Board/Institute of Medicine, January 2005
    • Does the Built Environment Influence Physical Activity?
  • Universities should develop interdisciplinary education programs to train professionals in conducting the recommended research and prepare practitioners with appropriate skills at the intersection of physical activity, public health, transportation, and urban planning.

28. Fear of Walking

  • City and county planning and zoning often ignore pedestrian traffic
  • Few incentives exist to design communities to be walkable, to enhance biking and moving
  • Crime and safety concerns are critical issues


  • Examines the interface of urban planning, architecture, transportation, community design and public health.
  • Loss of social capital.
  • Asthma rates among children doubled between 1976-1995 (CDC) (And 3X higher among blacks).
  • Obesity doubled between 1976-1994 (CDC).
  • Antidepressant prescriptions tripled during the 1990s.
  • 14% of gross domestic product goes to medical expenditures (2001).
  • Land use and community design may be critical contributing factors for health disparities.
      • Urban Sprawl and Public Health, by Frumkin, Frank, and Jackson, 2004

Public Health Connectionto Land Use 30.

  • Trust for Americas Health (2005)
  • Florida ranked 38 thin the U.S. in highest rate of adult obesity at 20.7%.
  • 64.5% of adult Americans overweight or obese.
  • .Decisions about where we build new houses and highways or schools and sidewalks can mean the difference between giving people more or less opportunity to participate in physical activity. Parris Glendening, former Governor of Maryland, president of Smart Growth Leadership Institute.
  • Need smarter design, including evaluation of health impacts of new building efforts, updating existing development, and encouraging design that promotes and integrates space, sidewalks, public transportationin new development.

An Ounce of Prevention 31. An Ounce of Prevention

  • Consider Hurricane Katrina
  • Cost to reinforce the walls vs. Cost to rebuild New Orleans
  • Cost to promote smart growth vs. cost of obesity (Obesity cost estimate is $100 billion)29 Colditz, GA. Economic costs of obesity and inactivity. Medicine and Science in Sports and Exercise, 1999; S664-5.

32. Pick the Smart Growth Principlesin this List Submit Clear A) Mix Land Use B) Put assets in New Communities C) Create New Roads for Faster Access to Destinations D) Provide a Variety of Transportation Choices E) Encourage Community & Stakeholder Collaboration 33. Fear and the Built Environment

  • One study examined environmental variables, such as the presence or absence of sidewalks, heavy traffic, hills, street lights, unattended dogs, enjoyable scenery, frequent observations of others exercising, and high levels of crime.
  • Positive environmental determinants of physical activity included enjoyable scenery (presence associated with more activity), whereas the greatest perceived barrier was the lack of a safe place to exercise.
  • Research indicates that two of the main reasons given for not exercising are lack of structures or facilities (such as sidewalks and parks) and fears about safety.
  • Overall, higher levels of perceived neighborhood safety are associated with higher levels of physical activity.
  • King AC, et al.Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women; Health Psych 2000:19(4):354-64.CDC.
  • Neighborhood safety and the prevalence of physical inactivity-selected sates, 1996. Mor Mortal Wkly Rep 1999:48(7):143-6.
  • Pate RR, et al. Physical Activity and Public Health: A recommendation from the CDC and the American College of Sports Medicine. JAMA 1995;273(5):402-7.


  • KB Homes Market Research
    • Research of Tampa home buyers
    • Asked what they valued most in their home and community.
    • More space and a greater sense of security.
    • 88% want home security system.
    • 93% want homes with more streetlights.
    • 96% insists on deadbolt locks or security doors.
    • Safety always ranks second,even in communities where there is virtually no crime.
      • As reported by Rick Lyman in NYTimes, August 15, 2005. Living Large by Design, in the Middle of Nowhere.

Fear and Public Health 35.

  • New York Academy of Medicine, 2004
    • 60% of citizens surveyed said they would not go to a public vaccination site in a smallpox outbreak.
    • 40% would not shelter in place for as long as told in a dirty bomb explosion.
    • Only 20% believe disaster planners know concerns and needs.
    • Only 50% confident they would receive help.
    • Only 30% believe public can have a lot of influence on disaster plans.
    • -- Lasker RD. Redefining Readiness: Terrorism Planning Through the Eyes of the Public.New York, NY: The New York Academy of Medicine,

Fear, Public Health, and the Built Environment 36.

  • USA Today, December 2004.
  • The freedom and adventure of walking to school has been replaced with overscheduled and oversupervised kids.As Royce Yeater of the National Trust for Historic Preservation puts it, consumers demand free-range chickens for their table but wont let their kids out of the house. USA Today, 1/25/2005, Trek to school not like it used to be, by Martha Moore

Fear and Urban Planning 37. 38. 39. Website: 40.

  • New York Times Editorial, October 6, 2005
  • Our sense of happiness is created by many things that are not easily measured in purely economic terms, including a sense of community and purpose, the amount and content of our leisure and even our sense of the environmental and ecological stability of the world around us A clearer understanding of what makes humans happy-not merely more eager consumers or more productive workers-might help begin to reshape those assumptions in a way that has a measurable and meliorating outcome on the lives we lead and the world we live in.

Life, liberty, and 41. Website: 42. The Greatest Threat to Public Health and Urban Planning is.

  • Copyright 1996 byThe American Prospect, Inc.Preferred Citation:Robert D. Putnam, "The Strange Disappearance of Civic America,"The American Prospectvol. 7 no. 24, December 1, 1996 .

43. Paradigm Shift for Public Health and Environmental Health Community Design Matters Transportation Matters Social Capital Matters Public Health 44. What does happiness have to do with public health? Submit Clear 45. Specific Activities in Florida

  • Renewed Interest in Health Impact Assessments
  • MOA between different state Departments on Smart Growth concepts
  • Meet with health promotion staff within health department (safe ways to schools, injury, data)
  • Broader definition of EH
  • History of Planning/Health
  • Frame land use as a public health issue


  • We need a community by community assessment approach to complement programmatic services.
  • We need to train ourselves for broad, cross-cutting thinking.
  • Must address the Fear Factor.
  • Need real public health outcome data from community assessments.

Bridging the Gap BetweenPublic Health and Urban Planning 47. Bridging the Gap BetweenPublic Health and Urban Planning

  • Public health take a role on local planning / zoning boards, planning commissions, metropolitan planning organizations, etc.
  • Planners give public health a review niche (HIA).
  • Let the Communities Speak.
  • Support more research into mental health to overall well-being, and its connection to the built environment.
  • Research into changes in the built environment and the effect on public health.
  • Planners, remember your roots in public health protection!

48. What will be your legacy? 49. Florida PACE EH Pilot Project

  • 2005 Vision Award Winner, Association of State and Territorial Health Officials
  • 2005 Jim Parker Award Winner for Public Health Leadership, National Association of City County Health Officials

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