Healthy Urbanism

This past Tuesday I had the good fortune to attend the largest conference I’ve ever seen, the American Public Health Association annual conference (the program guide was as thick as a textbook). This conference doesn’t mess around. There is a constant stream of sessions all day with no break for lunch – you better come ready to learn. Thankfully I did, so I’ll share some of what I heard…

My primary focus of the day was health impact assessments (HIA), since that is what I’m undertaking at work. There were a couple of good sessions covering this topic, including the state of the field and some specific examples. I was surprised to learn that there have been about 80 completed HIAs across the country, with another 40 or so underway. I find these to be pretty impressive numbers, considering HIA is a relatively new phenomenon in the US. What was particularly encouraging is that the World Bank and IFC are now beginning to require HIA for some of their large development loans. Even more surprising, there are actually multinational corporations that have done HIAs on big projects.

At the end of the day, however, this is a drop in the bucket when compared with what’s possible. HIAs still face a lot of barriers to more widespread acceptance, including regulatory limits, political resistance, unwilling developers and just general skepticism. One suggestion I found particularly interesting was to write the HIA recommendations in regulatory language so that they could be easily transferred to enforceable code. Additionally, HIA’s emphasis on community engagement should be used to differentiate it from other forms of considering health in decision-making. One of the items I took from the various HIAs that were discussed was using community surveys and focus groups to help determine the project scope. This seems much more useful and effective (and fair) than leaving it to just a few people or a steering committee.

Perhaps most importantly, HIA helps to raise the profile of health considerations in community decision-making. This is done with the broader public through extensive community outreach and public input. Community members then often raise these concerns with policy makers, ideally creating buy in at both levels. Of course, efforts need to be made to create strong partnerships with elected officials, community leaders and other relevant organizations. This multi-pronged approach, along with specific and pragmatic recommendations, can make a HIA very useful for a community.

(See this post on RWJF’s blog for more on the HIA sessions)

Outside of health impact assessments, I did learn a few other things. Dr. Sean Lucan, a family physician in the Bronx, reported on a study he conducted that investigated the relationship between food environment perceptions and dietary patterns. He found that poor perceptions of one’s food environment were correlated to an unhealthy diet. This means that even if food access is actually there, but residents don’t perceive it, they are still more likely to eat unhealthy foods. What I took away was that we can’t just put some fresh food in a store and assume people will start buying it; there also needs to be an educational/promotional campaign to raise awareness of the importance and availability of healthy foods.

Another session looked at some intriguing work around schools and nutrition. The highlight for me here was a study that looked at fast around schools. It’s especially important with rising childhood obesity rates and strong evidence linking fast food access to higher body mass index (BMI). Conducted in California, this study noted how many fast food establishments were within 1,000 feet of schools, a half mile and how many were visible from school grounds. On top of that, they looked at the type and location of marketing, particularly that which targeted children. They even looked inside these places to see where and how they advertised nutrition information for their menu items (many places had it tucked in the back by the bathrooms rather than up front by the counter where you actually order your food). It’s pretty disturbing how many fast food outlets they found that were located so close to schools, and how many of them directly advertised to the kids. They also learned that McDonald’s specifically targets schools as profitable locations for their restaurants. I think this would be an interesting study to replicate locally, pairing it with a review of zoning regulations to see what policies could be targeted to reduce the fast food density around schools.

The theme that weaved itself throughout the conference was social justice. Every session I attended included presentations that addressed this issue, and it was exciting to hear about the amount of good work being done out there. Kudos to APHA for making this a central element of a conference that reaches such a wide range of people and fields that have the opportunity to make a difference.

Good news for the residents of Colorado as LiveWell Colorado has just published their Built Environment Policy Blueprint. This document promises to be an excellent resource on built environment policy recommendations to improve public health. In particular, the report looks at land use, active transportation and development. It’s focused on Colorado, but will certainly be useful to anyone else working in this arena. Also available from them is the Food Policy Blueprint, an equally impressive document that addresses policy solutions to improve healthy eating.

As I discovered this last week, LiveWell Colorado is just one of many organizations in Colorado that are working towards creating and improving healthy lifestyles. My organization, Tri-County Health Department, is working on a Communities Putting Prevention to Work grant from the CDC to address obesity in a variety of ways. Several government agencies at both the state and municipal level are working on an array of projects incorporating the built environment, physical activity and healthy eating. These include the City of Denver, Colorado’s Dept. of Transportation, Dept. of Local Affairs, Dept. of Public Health & Environment, a variety of LiveWell communities across the state and many more I’m sure I’m forgetting. There are also a variety of non-profits, such as Partnerships for Healthy Communities, the Regional Institute for Health & Environmental Leadership, Denver Urban Gardens and many, many more.

There are two elements of all this that I find particularly exciting. One is the community of professionals that has sprung up to work closely with each other across issues and institutions. There are a lot of engaged, passionate, and intelligent people grappling with these topics from a variety of backgrounds and organizations that are helping each other out. Second is the emphasis of many of these folks on the social justice component of this work and it’s importance to vulnerable communities and populations. Plenty of research has shown that minorities and lower income populations are disproportionately affected by health disparities and it is vital that we work to correct this imbalance. It is incredibly encouraging to see so many things happening right now, and I’m thankful that I’ll get an opportunity to contribute.