The Case for Healthy Community Design Patti Miller, MPP 2014 Governor’s Conference on Housing October 7, 2014

Presentation overview  NHPS vision and mission  How active living has been designed out  Negative impacts of development  The role of policy and environmental change  Strategies for and benefits of healthy community design

NHPS vision and mission  Vision –Optimal health and development for all children  Mission –NHPS is dedicated to working with others to help children lead healthier lives. Photo credit: Nemours

How active living has been designed out

Ancient walking city Photo credit: Noureddine Bougacha

Photo credit: Library of Congress, Geography and Map Division (

The auto city Photo credits: (left): Stock xchange.com; (right) New Castle County Parcel Search

Negative impacts of development

Prevalence of obesity among U.S. adults BRFSS, %–<20%20%–<25% 25%–<30% 30%–<35% ≥35% Source: Centers for Disease Control and Prevention

Prevalence of obesity among children

Health risks of overweight and obesity  Hypertension  Type 2 diabetes  Coronary heart disease  Stroke  Gallbladder disease  Osteoarthritis  Sleep apnea and respiratory problems  Some types of cancer  Psychosocial aspects Photo credit: Nemours Source: National Heart, Lung, and Blood Institute (1998). The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report

Current design contributes to obesity Photo credits: University of Delaware, Institute for Public Administration

Other consequences  Emissions and environmental pollution  Mental health –Crime / fear of crime –Social participation  Economic –Transportation costs –Infrastructure costs –Healthcare spending –Lost productivity Sources: Guite HF, Clark C, Ackrill G (2006); Evans, GW (2003); United Health Foundation, the American Public Health Association and Partnership for Prevention (2009); American Public Health Association (2010) Photo credit: morguefile.com

The role of policy and environmental change

CDC framework for preventing obesity Energy Intake Energy Expenditure Energy Balance Prevention of Overweight and Obesity Individual Factors Behavioral Settings Social Norms & Values  Home and Family  School  Community  Work Site  Healthcare  Genetics  Psychosocial  Other Personal Factors  Food & Beverage Industry  Agriculture  Education  Media  Government  Public Health Systems  Healthcare Industry  Business & Workers  Land Use & Transportation  Leisure & Recreation Food and Beverage Intake Physical Activity Sectors of Influence Source: Centers for Disease Control and Prevention (adapted from Institute of Medicine)

Impacts of various domains on early deaths in the U.S. Source: McGinnis JM, Williams-Russo P, Knickman JR (2002)

Determinants of health  Policymaking  Social (social factors and physical conditions of environment)  Health services  Individual behavior  Biology and genetics Source: Healthy People 2020 Photo credits: Nemours

Strategies for and benefits of healthy community design

Design promotes physical activity  Social environment  Land use economics  Transportation economics  Institutional and organizational policies  Promotion of active living Source: Brennan Ramirez LK et al (2006) Indicators of activity-friendly communities  Land-use environment  Facilities  Transportation environment  Aesthetics  Travel patterns

Design promotes social capital Residents of pedestrian-oriented, mixed-use vs. car- oriented neighborhoods:  Walk more  Feel more connected to their communities  More likely to know neighbors, trust others and participate in the political process Photo credit: University of Delaware, Institute for Public Administration Source: Leyden KM (2003)

Photo credits: (left) J. Mateyko; (right) A. Trabelsi Design decreases emissions

Contact information: Patti Miller, MPP