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Good News…With Strings

Community Design & the Built Environment: A Significant Contributor to Community Chronic Disease Risks and Burdens Chris Kochtitzky, MSP Associate Director for Program Development Division of Emergency and Environmental Health Services Centers for Disease Control & Prevention.

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Good News…With Strings

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  1. Community Design & the Built Environment: A Significant Contributor to Community Chronic Disease Risks and BurdensChris Kochtitzky, MSPAssociate Director for Program DevelopmentDivision of Emergency and Environmental Health Services Centers for Disease Control & Prevention

  2. Good News…With Strings • We’re living longer • More people are surviving conditions (birth defects, chronic diseases) or circumstances (spinal cord injuries) previously fatal • These trends are likely to continue and even increase over the next 30-50 years • In order for these people to live healthy, high quality lives environmental supports are needed

  3. Community Design and Health Related to land use Related to automobile dependency Related to social processes • Obesity, physical activity, CVD • Water quantity and quality • Air pollution and asthma • Climate change contribution • Car crashes • Pedestrian injuries • Mental health impact • Social capital • Environmental justice

  4. Chronic Disease Burden & Community Design • Physical Inactivity & Negative Nutritional Choices • Obesity • Diabetes • Cardio-vascular Diseases • Motor Vehicle Air Pollution • Asthma • Cardio-vascular Diseases

  5. Definitions of Health • “Environmental health includes …the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture.” • World Health Organization

  6. Public Health Roles of Various Entities • The Future of the Public’s Health in the 21st Century, National Academies of Science, 2003: • “Many agencies have important but sometimes less obvious roles in public health…the latter may include… zoning boards, housing authorities, parks and recreation agencies”

  7. Source: Federal Interagency Forum on Aging. Older Americans 2004: Key Indicators of Well-Being.

  8. Percentage of Older Adults Who Engaged in Regular Leisure-Time Physical Activity,U.S., 2000--2003

  9. Other Vulnerable Populations • In 2005, compared with adults w/o a disability, a significantly smaller % of adults with a disability met national recommendations for physical activity • 37.7% versus 49.4%, and • A greater proportion were physically inactive • 25.6% versus 12.8%

  10. Far More Children Ride in a Car or School Bus to School than Walk or Bicycle (trips 1 mile or less) Calculations from the1995 Nationwide Personal Transportation Survey. US Department of Transportation, Federal Highway Administration, unpublished data, 2000.

  11. Children Walking to School • Parental reported barriers to walking/biking to school: 55% distance, 40% traffic danger Source: MMWR 2002;51(32):701-704

  12. Why? • We’ve designed regular physical activity out of our communities and our lives • We’ve replaced it with motor vehicle dependence that creates both increased injury risks and chronic disease outcomes such as CVD and asthma • We’ve designed social interaction and social connectedness out of our communities and our lives • The result is increases in stress and violence and related decreases in healthy activity and nutrition

  13. Woman, 82, gets ticket for slow crossing LOS ANGELES (AP) — An 82-year-old woman received a $114 ticket for taking too long to cross a street. Mayvis Coyle said she began shuffling with her cane across Foothill Boulevard in the San Fernando Valley when the light was green, but was unable to make it to the other side before it turned red. She said the motorcycle officer who ticketed her on Feb. 15 told her she was obstructing traffic. "I think it's completely outrageous," said Coyle…. "He treated me like a 6-year-old, like I don't know what I'm doing." Los Angeles police Sgt. Mike Zaboski of the Valley Traffic Division said police are cracking down on people who improperly cross streets because pedestrian accidents are above normal. "I'd rather not have angry pedestrians," Zaboski said. "But I'd rather have them be alive.“ Others, however, supported Coyle's contention that the light in question doesn't give people enough time to cross the busy, five-lane boulevard. On Friday, the light changed too quickly even for high school students to make it across without running. It went from green to red in 20 seconds. Monday, April 10, 2006

  14. Environmental Barriers for Persons with a Disability • In one study of individuals with a disability: • 78% reported building & community design made their lives difficult • 8.1% reported daily difficulties; • 22.1% reported difficulties at least weekly; • Another study found that in one community: • 60% of people with a disability did not have sidewalks between their homes & the bus stop. • 71% of these households lacked curb cuts in their area

  15. Promoting Physical Activity: Environmental & Policy Approaches – Community Guide Rec’s Task Force Recommendations & Findings • Community-scale urban design and land use policies -Recommended • Creation of or enhanced access to places for physical activity combined with informational outreach activities -Recommended • Street scale urban design/land use policies -Recommended

  16. Tools, Models, and Best Practices

  17. Health Impact Assessment • A tool to increase partnerships and communication between public health professionals and planners and other decision-makers

  18. Health Impact AssessmentDefinition • Collection of procedures and tools by which projects, policies, and programs can be evaluated based on their potential effects on the health of a population, and the distribution of those effects within the population Gothenburg consensus statement, 1999

  19. A Vision of Health Impact Assessment • Planners and others will request information on potential health consequences of projects and policies as part of their decision-making process • Health officials will have a tool to facilitate their involvement in planning and land use decisions • HIAs will lead to a better informed decisions

  20. Steps in Conducting an HIA • Screening • Identify projects/policies for which HIA useful • Scoping • Identify which health impacts to include • Risk assessment • Identify how many and which people may be affected • Assess how they may be affected • Recommendations • Identify changes to promote health or mitigate harm • Reporting of results to decision-makers • Evaluation of impact of HIA on decision process

  21. Community Involvement in Conducting an HIA • Increases community buy-in to project • Helps identify social issues as well as health issues • Routinely used in EIA process • Commonly used in HIAs in Europe • May add to time and resources needed to conduct HIA

  22. Completed HIAs in the United States 1999–2008 (N = 39) WA 3 MN 4 OR 1 MA 2 PA 1 OH 1 NJ 1 CO 1 CA 16 MD 1 GA 3 FL 1 AK 4

  23. Healthy Places Research Group • Atlanta-based collaborative effort of Emory University School of Public Health, Georgia Tech College of Architecture, Georgia State, CDC • Monthly forum for practitioners, researchers, students, and others interested in health and built environment issues • http://www.cqgrd.gatech.edu/hprg/

  24. Building Bridges • Public health professionals: Take a planner to lunch • Planners: Take a public health professional to lunch • Meet quarterly to discuss synergies

  25. Sources of Models and Best Practices • CDC’s Healthy Places Website (www.cdc.gov/healthyplaces) • NACCHO’s Community Design/Land Use Planning Program (www.naccho.org) • American Planning Association’s Planning & Community Health Research Center (www.planning.org/nationalcenters/health) • Prevention Institute (http://www.preventioninstitute.org) • Strategic Alliance for Healthy Food & Activity Environments Model Local Policies Database (http://eatbettermovemore.org) • Human Impact Partners (www.humanimpactparners.org)

  26. Sources of Models and Best Practices • Public Health Law and Policy Project Model Plans, Laws, and Regulation Database (http://www.phlpnet.org) • Safe Routes to School National Partnership (SRTSNP) (http://www.saferoutespartnership.org) • Joint Use (http://www.jointuse.org) • AARP Public Policy Institute Livable Communities Program (http://www.aarp.org/research/ppi/liv-com) • University of Illinois at Chicago Center on Health Promotion for Persons with Disabilities (http://www.uic-chp.org/index.html) • National Center on Physical Activity and Disability (NCPAD) • Universal Design & Built Environment Instruments • Health Empowerment Zone

  27. CDC’s Healthy Places WebsiteWWW.CDC.GOV/HEALTHYPLACES

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