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How can (and is) Galveston rebuilding to create healthy neighborhoods? Lexi Nolen Director of the Center to Eliminate Health Disparities University of Texas Medical Branch
Workshop Objectives • Take a closer look at what determines health within a community • Identify some of the key challenges in Galveston to creating healthy neighborhoods • Learn some of the ways Galveston is trying to address these challenges
What is Health? The World Health Organization: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. http://www.who.int/about/definition/en/print.html (1948)
Actually… Social determinants of health, 50% Biology, 15% Physical environment, 10% Source: Canadian Institute for Advanced Research Health care systems, 25%
What are Social Determinants of Health? Social, economic and physical environmental conditions that affect people’s health
often the message that we get is…if we just: • exercise more • eat better • get regular check-ups • were a different race or gender • were not just plain unlucky we would be healthy!
Taking stock… • 70% destroyed or badly damaged • Pre-storm poverty and poor health and social indicators • Post-Ike changed demographic, availability of services and resources, infrastructure, social networks, data UTMB closed and almost destroyed …and an opportunity
Galveston Health in All Policies Project UTMB with SECURE Gulf Coast Center (7 institutions) Began in October 2009 Aim: to increase evidence informed policy making and planning related to social determinants of health within a context of post-disaster recovery planning
Hypothesis Post-disaster planning environments afford opportunities for accelerating local planning to address social determinants of health and health disparities through intersectoral actions and a “Health in All Policies” approach.
Why use a Health in All Policies approach after a disaster? Synchronized planning cycles; Renewed interest in improving local conditions, often above pre-disaster conditions; and Increased focus on and resources to support the interventions needed to create healthier neighborhoods.
…and If you start with a healthy community, the population will be more psychologically, physically, and economically resilient to future disasters
3 pillars of action assembling the evidence base on local challenges in relation to social determinants of health; raising awareness of these issues in the community; and partnering with decisionmakers and planners to incorporate evidence based recommendations into planning processes
A few of our challengesin Galveston Concentrated poverty and segregation Land use Food desert Transportation Recreation and outdoor physical activity
Issues in process • Early childhood development • Youth development programs (summer, after school, at risk) • Education • Community/police relations • Restorative Justice • Port development • Casino gambling
Partners Government • Galveston Housing Authority • City of Galveston • Comp Planning Cmte • Recovery Cmte • Revitalization Cmte • Dept of Planning • Parks and Rec Dept • Disaster Planning Dept • Transport Dept Community Groups • Social Services • Child Care • Local Donors • Disaster Planning (VOAD) • Coordinating Groups (United Way) • Low-income housing (older adults, general) Education • GISD • UTMB, Texas A&M • Galveston College
Concentrated Poverty and Segregation fewer institutional assets (schools, libraries, public transit) higher risk for transmission of infectious diseases, such as tuberculosis, as well as mortality risk for some groups increased exposure to land uses such as power plants, solid and hazardous waste sites, and bus yards reducing income-related residential segregation improves household safety, reduces exposure to crime, and decreases neighborhood social disorder
Actions Public Housing Redevelopment Plans • Mixed income housing units at Magnolia and Cedar Terrace • Scattered site infill housing • Strong human capital plan • Job training • Emphasis on child, youth, and adult education
Land Use Zoning and Mixed Use Neighborhoods increases physical activity, access to healthy food and nutritional intake; increases social cohesion, community surveillance and perceived safety; and lowers crime reduced obesity, improved physical fitness, increased mental health, reduced injuries and violence, reduced stress Industrial areas near residential areas increased exposure to air particulates, toxins, noise pollution and light pollution increased asthma and respiratory illness, developmental delays, neurological damage, sleep disruption leading to reduced mental function, mental health, and physical health
Actions City Comprehensive Plan Review of zoning policies to support mixed use neighborhood development Buffers between industrial and other areas Requirements for Health Impact Assessments for industrial expansion Public Housing Rebuilding Application of the Neighborhood Completeness Indicators Tool Protection of new neighborhoods from industrial health impacts
Food Deserts Access to healthy food: Having a full service grocery store (fresh produce, lean meats, low-fat dairy) within a half-mile increases good nutrition and reduces overweight (also affordability and support programs) Proximity to unhealthy food outlets (e.g. fast food, convenience stores, etc) tends to worsen nutrition, especially where access to healthy food is restricted
Transportation each additional hour spent in the car is associated with a 6% increase in the likelihood of being obese an effective transportation system is important for low income residents (proximity to bus stops, cost, routes, bus ridership rules, and safety) for normal trips, only 10% of Americans will walk one-half mile to a stop prohibitive transportation costs can interfere with employment prospects, economic self-sufficiency, and access to needed goods and services including health care and food
Actions Public Housing Rebuilding Plans Galveston Economic Development Partnership Recruit add’l full service grocery stores at strategic locations Incentivize corner markets Improve public transportation routes to existing stores
Physical activity Recreation areas and activities • green space improves perceived health, physical activity, and social cohesion and reduces crime, stress and depression, and sick days • community centers support social cohesion, childhood development, and physical activity while reducing violence and crime, heart disease, dementia, and other chronic conditions Hike and bike trails • health benefits of physical activity (reduced premature mortality, heart disease, hypertension, colon cancer, diabetes mellitus, etc) • reduced risk of injury to pedestrians and bikers
Tree Canopy Natural cooling and shading, noise reduction, encourages recreation, produces oxygen, serves as traffic buffers, creates positive ambience, and provides environmental protection Health impacts: reduced risk of skin cancer, stress reduction and positive mental health, improved respiratory health, increased physical activity, improved traffic safety.
Actions Master Park Developer Input into Master Parks Plan Public Housing Rebuilding Input into Master Plan Draft Comprehensive Plan HIA and community focus group feedback Evidence base suggesting need for new senior and youth rec centers