This post is by Jessica McKelvie Kemp, PhD, a vice president for the Center for Planning Excellence.
When most people think about health, they think about the doctor’s office and checkups — about the health care system. You might think about eating right and getting exercise. But what planners think about is the way the built environment and community design affects our health.
The truth is that the health care system plays a relatively small role in a person's overall health. Factors like economic status, where you live, the quality of your environment and your ability to access transportation, social interactions, fresh food and jobs actually contribute much more to how healthy you are. These factors are called the “social determinants of health.”
For example, do you have access to parks and outdoor recreation? Does your neighborhood have sidewalks and bike paths? Can you easily get to doctor's appointments, jobs, child care or social activities? Is your neighborhood safe? Is there a full-service grocery store that you can walk to? Is your neighborhood adjacent to an interstate highway or a chemical plant?
Community design also affects air and water quality, and land use and zoning have a huge impact on all of these issues. Here’s what you need to know about planning for healthy communities.
Where Planning and Health Intersect
Historically, urban planning and public health were connected — urban planning was born out of concerns about how housing conditions affected people's health and fostered the spread of disease. Over time planning and public health diverged, but it’s time to add the public health layer back into planning.
The biggest threats to public health facing us now are chronic conditions such as heart disease, cancer, obesity and dementia, many of which are related to lifestyle. But if someone doesn’t have transportation to a medical appointment, access to healthy foods or opportunities to exercise or enjoy green space, the threat to public health is also an urban planning issue.
For residents of East Baton Rouge Parish, the evidence overwhelmingly shows that the ways our communities are designed can negatively affect our health. For example, 17 percent of East Baton Rouge’s population lives in areas where there is unacceptably low access to grocery stores, according to the Healthy BR Community Health Needs Assessment. Also, 30 percent of the population drives alone to work and has a long commute, and the average lifespan of Scotlandville residents is more than five years shorter than residents of Carmel Acres — 65.4 years versus 71.2.
More comprehensive planning would help to address these issues. When a community or a parish creates a comprehensive plan, it needs to consider more than economic development and transportation and housing, because these decisions also affect public health.
How do we create a transportation strategy that's not just about reducing congestion and moving cars, but also about improving public health? Active transportation options such as walking, biking and public transit encourage daily physical activity and improve air quality, but they have to be accessible and safe in order to deliver these benefits. We can also ensure that housing is well-situated to encourage active transportation, social interaction and access to green space. Zoning for mixed-use spaces — especially those that include affordable housing — helps create healthy environments that make it easy to walk and bike more, access jobs and education, and develop social connections.
For those who can’t live within walking and biking distance of daily destinations, we can provide high-quality transit that allows residents to get to work, grocery stores, doctor’s appointments and child-care facilities without spending hours driving or waiting for buses. Let’s be thoughtful about where we locate affordable housing and how residents can enjoy a healthy environment.
Investing in Community Health
One benefit of planning for health is that strategies for improving public health through community design can deliver a range of valuable benefits. If you improve a park by adding sidewalks and crosswalks that connect it to the surrounding area, it encourages more physical activity, which improves health — but it also encourages more social interaction, leading to better mental and emotional well-being, and it increases property values and reduces crime. The trees and other vegetation along sidewalks can retain stormwater and reduce flooding while also improving water quality. The dollars spent on healthy community design pay off many times over by delivering a range of community benefits in addition to improving public health.
A recent project at Longfellow Park in Baton Rouge is a good example. The neighborhood walking club walked in the community center parking lot because they couldn't make it safely to the newly renovated park that was just across the street. By improving pedestrian connectivity to the park and adding crosswalks and lighting, the park is now attracting more users, providing health benefits to members of the community, improving social bonds and making the park safer and more accessible for all. Increased activity and foot traffic deters crime in the area. During heavy rainfall, the greenspace in the park can detain and filter stormwater runoff, reducing demand on our overburdened drainage system and improving water quality.
Engaging Health Care Professionals
Within the health care system, we can equip health care professionals — especially those serving vulnerable populations — with a better understanding of how community design affects patients’ health. Making more holistic recommendations and being aware of the resources available in the community is crucial. Researchers are learning that if communities can build physical activity into daily life, it creates a long-term impact on public health. Health care professionals can be powerful advocates for healthy community design that makes healthy lifestyle choices easier.
When discussing lifestyle changes with patients, rather than simply recommending weight loss or healthier eating, health care professionals can dig a little deeper with questions about access to the facilities required to do so. Providers can ask questions like "Can you join a social group at your community center? Can you walk your grandchild to the park after school?" Some health care professionals are exploring the idea of providing “five-minute walk” maps to patients to help them identify healthy destinations that are within walking distance of their homes. Connecting patients with these types of resources in their community encourages a more holistic approach to health that better addresses the role of the built environment in lifestyle choices.
Health is fundamental to every aspect of life. If our population is not healthy, we won’t be as productive at work or able to participate to our full potential in family and community life; our cultural institutions suffer. In Louisiana, where health outcomes are poor on a number of indicators, we need to take every opportunity to address public health issues. If we're not doing that through planning at all scales, then we’re missing important opportunities to improve quality of life for our residents.