building bridges: integrating the work of public health and urban planning Rajiv Bhatia, MD, MPH San Francisco Department of Public Health January 27 th, 2005

What makes us healthy?

Annual Health Spending Life Expectancy (years) OECD Average $ United States $

The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity WHO Ottawa Charter for Health Promotion

Poor ventilation, mold, and rodents

Substandard construction and deferred maintenance

crowding hunger

Dangerous streets

Worsening traffic and longer commutes

Poor food quality

No places for play

Declining moderate wage jobs and economic diversity

Limited access to Jobs, Health Care, and Friends and families

Asthma Map

R x : Healthy Planning Connect problems and issues Connect problems and issues Value local knowledge and experience Value local knowledge and experience Apply public health research Apply public health research Develop inter-disciplinary partnerships Develop inter-disciplinary partnerships Build consensus / reduce conflict Build consensus / reduce conflict Ensure accountability Ensure accountability

Health Impact Assessment Definition Methods to account for the effects of public policy decisions on human health and well being Methods to account for the effects of public policy decisions on human health and well being

Health Impact Assessment Multiple Approaches Integrating health analysis into environmental review under CEQA and NEPA Integrating health analysis into environmental review under CEQA and NEPA Promoting health analysis through participatory research and community partnerships Promoting health analysis through participatory research and community partnerships Implementing health assessments as a collaborative and consensus building process Implementing health assessments as a collaborative and consensus building process

Rincon Hill Area Plan Impact Analysis No school planning No school planning Limited open space Limited open space Housing not matched to employment Housing not matched to employment Effects on residential segregation Effects on residential segregation

Rincon Hill Area Plan Outcomes Increased below market housing Increased below market housing Support for on-site inclusionary housing Support for on-site inclusionary housing Support for reduction in parking Support for reduction in parking

Trinity Apartments Redevelopment Impact Analysis Permanent Loss of low rent units Permanent Loss of low rent units Displacement of residents Displacement of residents Disruption of an established community Disruption of an established community

Trinity Apartments Redevelopment Outcomes EIR study of displacement impacts EIR study of displacement impacts Replacement units for current residents Replacement units for current residents

Eastern Neighborhoods Community Health Impact Assessment Visions a healthy city Visions a healthy city Identifies health objectives influenced by planning Identifies health objectives influenced by planning Predicts effects of three neighborhood zoning plans Predicts effects of three neighborhood zoning plans Proposes monitoring of the outcomes of development Proposes monitoring of the outcomes of development

Eastern Neighborhoods Community Health Impact Assessment Builds on international HIA approaches Builds on international HIA approaches Uses a consensus building / deliberative model Uses a consensus building / deliberative model Participants include 40 public and private organizations Participants include 40 public and private organizations Occurs in parallel to environmental impact assessment Occurs in parallel to environmental impact assessment

HIA within Partnerships Research on displacement effects Research on displacement effects Co-authoring a community plan Co-authoring a community plan Training on EIR process Training on EIR process Equity analysis of transportation plans Equity analysis of transportation plans Critique of Level of Service analysis Critique of Level of Service analysis

Major Obstacles New role for public healthtraining needs, funding, political legitimacy New role for public healthtraining needs, funding, political legitimacy Concerns about new processes, agendas, analysis, and regulations on development Concerns about new processes, agendas, analysis, and regulations on development Competing development agendas Competing development agendas Limited trust in collaborative approaches Limited trust in collaborative approaches

Overcoming Obstacles Framing land use as a public health issue Framing land use as a public health issue Using multiple approaches Using multiple approaches Building common agenda with community partners Building common agenda with community partners Reaching out to developers and business interests Reaching out to developers and business interests Supporting planners and their work Supporting planners and their work

Expected Outcomes Public understanding of health and land use relationships Public understanding of health and land use relationships New roles for public health in planning New roles for public health in planning Broader community participation Broader community participation Support for comprehensive planning Support for comprehensive planning Impacts on development decisions Impacts on development decisions Impacts on decision-making practice Impacts on decision-making practice

Lessons Learned Health, Sustainability, Smart Growth, Social Equity have the same requirements Health, Sustainability, Smart Growth, Social Equity have the same requirements HIA: an invitation to a party HIA: an invitation to a party Need for democratic, responsive, and accountable institutions Need for democratic, responsive, and accountable institutions We are all in this together; methods need to reduce polarization of interests We are all in this together; methods need to reduce polarization of interests

Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities, their ownership and control of their own endeavors and destinies WHO Ottawa Charter for Health Promotion

..medicine is a social science, and politics is nothing but medicine on a grand scale. --Virchow