Urban Planning As Preventive Medicine Shaunna K. Burbidge, PhD burbidge@metroanalytics.com State coverage Initiative Conference August 6, 2010

What is Health? Health is “the state of complete physical, mental, and social being and not merely the absence of disease or infirmity”. - The World Health Organization The Medical Model What impacts our health? How do we tackle health problems? Medical interventions or lifestyle changes The Social Model Health is an outcome of the affects of all the factors in our lives; including the built environment

Urban Planning and Health? 19th Century Health Initiatives Water supply Housing reform Sanitation Public Safety Three ways that our physical environment impacts health: Land-Use Auto Dependency Social Processes

Urban Sprawl Post WWII Boom Escape the City The beginning of the “commute”

Zoning Euclid vs. Ambler Realty Regulated land-uses Intended to improve public health

Why is Auto-Centric a Bad Thing? Automobiles account for 86.5% of U.S. trips, while Walking and bicycling combined account for only 10.3% (BTS 2001) 25% of all trips in the United States are less than one mile in distance, but nearly 75% of these trips are made by automobile (Killingsworth and Schmid 2001)

Air Quality Clean Air Act 6 Criteria Pollutants Non-Attainment Regions

Water Quality Hydrologic Cycle Impervious Surfaces Watersheds and Groundwater

Obesity and Inactivity From 1980 to 2003 the United States experienced a 40% increase in the number of residents who are “overweight” (CDC 2004) Currently 65-73 percent of the U.S. population is categorized as overweight or obese (CDC 2004) Currently 70% of U.S. adults do not obtain the recommended amount of physical activity, and approximately 25% of individuals report being completely inactive when not at work (DHHS 1996)

Physically Active Transportation Each hour spent driving increases your risk of obesity by 6% (Pucher and Renne, 2006) Integrating additional walking and biking into daily routines may prove to be a better public health strategy than traditional structured and organized programs (Handy 2004, Litman 2003, Saelensminde 2002) The Utah Department of Health found that an increase in walking and biking in the community would have a positive effect on mental health, lifestyle risk, environmental quality, chronic conditions, and overall health status (UDOH 2005)

Pedestrian Safety The built environment and walking versus the built environment and driving “There are no inherently good or bad design patterns, only good or bad in terms of outcomes” –Reid Ewing Barriers to Active Travel

Mental Health Depression Anxiety Social Isolation

An Inventory of Utah Ordinances Inventory of Utah cities with a population > 5,000 Community level ACE indicators were used to measure the existence of ordinances related to 6 domains: Sidewalks Bicycle Lanes Shared-Use Paths Greenways Recreational Facilities Trails Additional information was collected to further categorize “healthy opportunities” within the community (i.e. farmer’s markets, wellness programs, etc.)

“Healthiest” Planned Cities Six cities statewide had policies in place for all 6 ACE domains Cedar City (4,875) Draper (120,235) Farmington (18,811) North Logan City (7,545) Provo (116,217) St. George (67,614) **Population based on GOPB’s forecasts for 2009

Health Promotion Laggards The four cities performing the worst on the ACE inventory Highland (13,889) Holladay (14,643) Roy City (35,100) South Ogden City (15,328)

The Good News The majority of cities surveyed fell somewhere in the middle The average number of ACE domains addressed through regulations was 3 (out of a possible 6) Many cities are working very hard to incorporate public health aspects into their planning

Regression Analysis Municipal population was not significantly correlated to the presence of ACE ordinances in a given municipality The number of ACE ordinances was significantly correlated to a higher rate of healthy BMIs in a given municipality

Examples of Innovative Approaches Policy promoting community gardens (Taylorsville, UT) Require parks or open space with every new development (LaVerkin, UT) Promote alternative transportation modes by “requiring the construction of pedestrian connections between adjoining developments” (Saratoga Springs, UT) Separate recreation master plan that identifies existing programs and facilities as well as future needs (North Salt Lake, UT)

Examples of Policy Barriers Policy allowing developers to avoid installing sidewalks if they are “only for health or recreational purposes” (Fruit Heights, UT) “Despite attention given to bicycles as an alternative means of transportation… we have determined it best not to encourage [on street] bikeways” (Centerville, UT) Policy prohibits that playing on sidewalks and sledding in parks (Brigham City, UT)

How Can Health Officials Promote Healthy Planning? Get to know local planning officials American Planning Association Urban Land Institute Find out what is already in place Make suggestions based on regional/national best practices Don’t give up!!!

Final Thought If a 70 year old women walking down the street on a hot day collapsed of heat stroke, “the doctor in the emergency room would write ‘death by heatstroke’. He wouldn’t write ‘lack of trees, poor urban planning, or lack of public transportation.” -Dr. Richard Jackson