Community Health through Sticky Design Health Resources in Action Mark Fenton

1. Community Health through Sticky Design Health Resources in Action Mark Fenton

2. Key points • Perspective. What we’ve been doing is not working. • The evidence. A design prescription for broad community health. • The coalition. Creating an interdisciplinary team. • A jump start. An approach to kicking-off a focused & effective initiative.

3. Youthful recollections Were you a free range child?

4. Not just my idea . . . 30-Nov-2009

5. Changes in Walking & Cycling to School (1969 to 2001) W/B = Walk/Bike

6. Trends in Childhood Obesity & Overweight Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Examination Surveys II (ages 6–11) and III (ages 12–17), and National Health and Nutrition Examination Surveys I, II and III, and 1999–2006. www.rwjf.org/files/publications/annual/2008/year-in-review/

7. What we’ve been doing has not been working.

8. Let’s change the conversation: US “Obesity Epidemic”Ogden et. al. (JAMA 288, 14; Oct. 2002)

9. The point:It’s notjust an obesity epidemic. It is twin epidemics of physical inactivity and poor nutrition.* *Two of the three biggest drivers of skyrocketing healthcare costs.

10. The bad news in just three numbers: Minutes of daily physical activity recommended by national guidelines. % of American adults actually meet these recommendation (thru LTPA). ,000 Estimated annual deaths in America due to physical inactivity & poor nutrition. (2nd only to tobacco.) 30 20 365

11. 2008 Physical Activity Guidelines, DHHS • 150 minutes/week of moderate physical activity; more is better. • Any activity is better than none. • Can be broken up. • 300 min/week for children. • Reduced risk for CVD, diabetes, osteoporosis, obesity, dementia in old age, clinical depression, a growing list of cancers . . .

12. Leisure Time Physical Activity in the US (MMWR: 50(09), 166-9; 54(39), 991-4)

13. Exercise Participation

14. Social Ecology Model • Individual - motivation, skills. • Interpersonal - family, friends, colleagues, social norms. • Institutional - school, work, health care & service providers. • Community - networks, facilities. • Public Policy - laws, ordinances, permitting practices & procedures.

15. Necessary and important, but not enough. < We must build communities where people are intrinsically more active.

16. Variety of uses within walk, bike, & transit distance. Connecting facilities: trails, sidewalks, bike lanes, transit. Destinations are functional & inviting for pedestrians, bicyclists, & transit users. Safe & accessible for all ages, incomes, abilities Denton TX YES! Four elements: Elizabethtown Franklin

17. Live, work, shop, play, learn, pray. 1. Land use. E.g. post office, grocery, schools Middle School Compact neighborhoods & shared open space. Housing above, retail below.

18. 2. Network of facilities: • Presence of sidewalks, bike lanes, pathways. • Shorter blocks, more intersections. • Access to trail, park, greenway, transit. South County Bike Path

19. Bicycle network options:

20. E.g. Devils Foot Rd., N. Kingstown “But no one walks here anyway. Why spend the money? • Sidewalk. • Buffer strip. • Bicycle lanes. • Median islands at key crossings (e.g. school bus stop). >

21. 3. Site Design Which setting is more inviting for travel on foot and/or by bicycle?

22. Buildings near the sidewalk, parking on street or behind. Access & comfort, trees, benches, lighting, awnings, human scale design. Details: bike parking, open space, plantings, materials. Site design

23. E.g. Tower Hill Road – More like Main Street? • Planting strip, buffer. • Fewer curb cuts. • Parking maximums. • Shared lots & entries. • Bicycle parking required. • Median islands!

24. Median islands Engineering can dramatically improve safety. Increasing pedestrian and bike trips decreases overall accident & fatality rates. 4. Safety. Roundabout (Neenah, WI) Curb extensions

25. Lane re-alignments • Often called road diets, being seen more often. • Can reduce collisions & severity. • Dramatically improves performance for pedestrians & cyclists.

26. Possible here? Tower Hill at Kingstown Rd.

27. E.g. Traffic calming, ped/bike accommodation • Curb extensions downtown. > • Mini-circles at 4-way stops, & as neighborhood calming. • High Street crossing paint; textured median & sign. Human ‘bump-out’ at Main St. trail crossing. Columbia & Main

28. 5. Community design & food systems? Community gardens (near schools, parks, senior housing); conserving farmlands; Community Supported Agriculture. Farmer’s markets, green grocers, healthy corner stores. Regulate fast food, drive-through locations.

29. Five Elements of Healthy Community Design Safety & access www.activelivingresearch.org

30. Projects & Policies, not just Programs • Master planning & zoningordinance updates for mixed use, open space conservation. • Completestreets guidelines & routine practice. • Transportation trailnetworks. • Bicycle & transit infrastructure & incentives; Transportation Demand Management (TDM). • SafeRoutestoSchool, schools as healthy community centers (shared use, PE, recess).

31. Food system policies • School policies: • Recess before lunch • Meals; Vending (sodas?) • Fund raising; concessions. • Snacks & prizes. • Overall access & exposure: • Protecting farmlands! • Trans-fats, portion policies • Sugar sweetened beverage tax; fruit/veggie subsidy. - Regulate fast food, drive-thru locations.

32. Building a Healthy Community Collaborative • Stealth leadership teams. • Short list of action items. • Action teams, not committees. • Identified staff support. • Infrequent partnership meetings focused on action, synergy. • Get a jump start on action.

33. 1. Build a leadership team targeting healthy design: • Education, schools • Planning & Zoning • Engineering, DPW • Parks, Recreation • Housing authority • Transit system • Public Health & Safety • Historical preservation • Social justice & equity • Chamber of Commerce • Developers, Lenders, Realtors • Neighborhood Assoc., Church & Service Groups • Environment, Conservation

34. The “org” chart: Bike/Ped Advocates YMCA Parks Rec. Planning AHA Trails Health ACS Developers ADA Transport Electeds Hospital Employers PTOs DPW Schools Insurer Neighbor- hoods

35. The “stealth” chart: Bike/Ped Advocate Trails Elected Rec. Transport Planning Parks Enviro. Vision DPW Econ. Devlpmt Neighbor- hoods NAR Environ. Banks Developer NAHB Chamber Chamber Schools Health Employers PTOs Insurer Hospital Churches Found. ADA Service Orgs. AHA ACS

36. To be on the leadership team people must: • Fully embrace the vision of active, healthy community design. • Be able to spend time on this as part of job responsibilities; not just volunteers. • Have community influence and be able to reach critical partners.

37. 2. Short list of action items; e.g. Rapid City, SD. Coldest Walk Audit in my experience (-14F). Countdown timers > No more waivers by City Council for sidewalks in subdivisions!

38. 3. Create action teams: Zoning ordinance update • Tight, focused action teams on specific topics. • No monthly meetings, just functionally targeted work. • Specific targets & timelines for progress; benchmarks! Transport Trail System Leadership Team Complete Streets Transit & TDM Healthy Schools Food Systems

39. 4. Staff the effort. • Facilitate meetings, maintain agendas. • Keeps focus on the action plans, checks progress, timeline. • Can act as main contact point for “partnership.” Univ. of Nebraska, Omaha E.g. Live Well Omaha helped hire an active transportation coordinator in planning department. Funded jointly by Alegent Health (private sector) and Metropolitan Planning Organization.

40. 5. Convene full partnership infrequently. • Teams report on concrete progress toward goals & timeline. • Request assistance, guidance for areas of shortfall. • Offer support to other action teams. • Seek confluence points. • Recruit new partners!!! Trail connecting school, sports fields, neighborhoods. Boone, NC

41. 6. Get a Jump Start on Action Consider an outside voice to help provoke action. • Help assess current conditions. • Engage interdisciplinary team, esp. leadership. • Focus interventions on concrete action items. • Provide on-going technical support. Walk audit, Bloomington, IL

42. E.g. typical phases of the jump start: • Assessment: From physical scouting to full policy review. • Engagement: Stakeholder workshop(s), surveys, key informant discussions. • Recommendations: E.g. leadership breakfast. • Reporting: Document steps. • Technical Assistance: On-going support on the details.

43. Three reasons I like walk audits: • Powerful educational tool, gets people actually experiencing the reality of the environment. • Can be critical inspiration for a community, helping them to explore what is possible. • Excellent for public input & development of a specific plan, especially first steps!

44. Engagement: Healthy Community Workshop • Any & all concerned citizens (parents, children, seniors). • Professionals: School administration, faculty, & staff; public works, police, fire, health, planners, engineers, historical, conservation. • Elected officials & staff. • Advocates: Environment, safety, social justice. • Businesses: Chamber of commerce, economic development. • Developers: Builders, land owners, realtors, lenders.

45. Typical workshop agenda • Envision. Wishes for this area 5, 10, 20 years from now. • Learn. Presentation of the tools and language. • Walk. See how it’s working here, and what’s possible. • Work. Group effort, all 3 Ps. • Plan. Commitments, next steps.

46. Require ideas from all of the Ps • Programs: Build awareness, support, skills, & encourage behavior change. • Projects: Alter & improve the built environment for walking, cycling, and active living in general. • Policies: Rewrite the rules so stickier environments & practices are the norm!

47. Recommendations & Reports • Target: Elected (city council, school board) & appointed (planning commission) officials; department heads; business leaders; and & all who can lead to change! • Focus: Concrete action items; policies & infrastructure over programs. Get sticky! • Less background, demographics, current conditions. • More concrete action items; w/ timelines, partners, & proposed resources.

48. Examples of TA providers • www.saferoutesinfo.org • www.saferoutespartnership.org • www.completestreets.org • www.activelivingresearch.org • www.pedbikeinfo.org • www.cdc.gov/transportation • www.hria.org • www.markfenton.com

49. Olshansky et.al., “A Potential Decline in Life Expectancy . . .” New Eng. J. of Med., March 17, 2005