Public Health & The Built Environment
Highlights and analyses of remarks made by 2015 Smart Growth Summit speakers Dr. Elizabeth Baca and Ron Sims about ways in which our health is impacted by the design of our built environment.
Public Health & The Built Environment
Jessica McKelvie Kemp – August 4, 2016
In Louisiana, we are fat – and getting fatter. We are sick – and getting sicker. From a public health perspective, the view is pretty bleak. The good news? We’re learning more about how best planning practices and our built environment can encourage daily behaviors that improve our health – such as walking more, playing more, biking, taking the stairs, socializing in community spaces and choosing healthy foods.
Concerned that children as young as two were showing up in her office with high cholesterol, physician and public health expert Elizabeth Baca found that prescribing more play time and physical activity wasn’t going to work for many patients whose parents replied that “there are no playgrounds,” “our neighborhood isn’t safe” or “there was a shooting.” The built environment needed to be improved to enable the activities that children and adults need to be healthy.
Environmental Context Matters
As Dr. Baca explained in her Smart Growth Summit talk, we are only just beginning to understand the multitude of ways in which contemporary health concerns are affected by community design and develop the policies needed to improve health outcomes. In communities such as Jacksonville, Florida and states such as California where Baca does much of her work, early successes have been realized by collecting baseline data on population health, active living infrastructure, and health costs, and using that data to develop and track policies that support improved public health outcomes. Policies that require public health goals to be incorporated into transportation, sustainability, and comprehensive plans and the formation of multi-agency councils that bring multiple planning efforts together to align strategies are working to improve health, especially in low-income communities where health disparities are greatest.
During his Summit presentation, Former King County (Seattle) Executive Ron Sims shared his experience transforming vulnerable Seattle neighborhoods via an approach focused on public health and the built environment. He commissioned a study to better understand this relationship and found that, among other things, a lack of green space and sidewalks and sprawling development were among the top factors negatively impacting residents’ health.
Sims’ experience echoes Dr. Baca’s as he speaks to the importance of the built environment – sidewalks, safe crossings, green space, well-lit streets and busy storefronts – in facilitating these activities: “You don’t walk if you don’t feel safe. You don’t walk if you’re not encouraged to do so.”
Providing infrastructure and amenities that encourage residents to choose active modes of transportation not only improves health and well-being – it also improves economic outcomes. As a growing number of health economists point out, “poor health outcomes cost taxpayers money” – between 15-20% of states’ GDP, according to Baca. Ranked in 2014 as the 4th most obese state in the nation, Louisiana is no doubt paying a high price. In 2015, Baton Rouge gained the unfortunate distinction of being the most obese of the 100 largest U.S. metros with a rate of 35.9%. Robert Wood Johnson’s 2016 County Health Rankings show that it is Louisiana’s rural parishes that are suffering the most from deleterious environmental factors and negative health outcomes. Disparities abound: statewide, 34% of Louisiana adults are obese, but some parishes have adult obesity rates as high as 43%. And while in some parishes 97% of the population has adequate access to locations for physical activity, in other parishes, that number is zero. These disparities fall along racial lines, as well – 43.2% of blacks in Louisiana suffer from obesity compared to 30.5% of whites.
Louisiana’s Office of Public Health states that “the primary way to promote health through community design is to make sure there is access to many types of transportation, healthy food, safe housing and public spaces that promote health.” OPH has been actively seeking ways to foster partnerships with transportation and community planning organizations. A national movement is also underway to ensure that our streets are designed to be “complete” and promote more active living. Complete Streets infrastructure such as sidewalks, pedestrian crossings, bike lanes and trails provide multiple health benefits by creating options for increased physical activity, improving safety and reducing the number of injuries and fatalities experienced by pedestrians and bicyclists. Furthermore, increasing access to transit and active transportation modes can help connect residents to medical services, healthy foods, social activities and other resources for wellness.
Better Health by Design
Complete Streets policies have been adopted in New Orleans, Baton Rouge, St. Bernard Parish and Lafayette. These policies require that all users – pedestrians, bicyclists, transit riders and those using wheelchairs or assistive devices, along with automobile drivers – be considered and accommodated where appropriate in the design of roadways. Louisiana DOTD has also adopted a Complete Streets policy and retooled their engineering standards to design roadways under their jurisdiction for all users. An important next step will be to ensure that public health outcomes figure into the criteria by which we define the success of these policies and identify priority projects, thus maximizing the return of community benefit from our investment in transportation infrastructure.
There are other important intersections of health and the built environment that deserve our attention, as well. We know that places with well-lit streets and steady pedestrian traffic experience less crime and are safer. We know that neighborhoods and districts equipped with inviting green spaces, parks, and community gathering areas encourage human interaction and improve social cohesion. And we know that access to quality transit improves access to health services and healthy food. Improving these components of underserved communities can produce a marked reduction in the health outcome disparities that negatively affect many low-income, rural and minority communities.
Planning to Do Better
In his timely and moving New York Times op-ed titled, “The City Where I Live and Alton Sterling Died,” Chris Tyson – public figure and LSU Law Center professor – details the many ways in which the geographic divide between north and south Baton Rouge has manifest in ugly divisions and tragic disparities among residents of the city. Tyson rightly observes that the dearth of “safe and stable neighborhoods,” “lack of access to reliable public transportation, quality health care, youth mentors and nutritious foods” are not organic disparities, but rather “the result of specific policy choices,” and thus “the toll that all of it eventually takes on neighborhood, families and individuals” is something we can address through better policies and planning.
We cannot cultivate strong leaders and develop a thriving economy if a significant portion of our population is dealing with the multi-faceted burdens of poor health. And while the causes of poor health outcomes are also complex and multi-faceted, planning has a fundamental role to play in promoting good health. Recognizing and tracking the health impacts associated with community design, transportation systems, parks and green spaces, and other public facilities and addressing them in the plans and policies that guide their development is another important step towards ensuring that Louisiana residents can thrive in healthy communities.