1. Frumkin, 2e Part Three: Environmental Health on the Regional Scale
Chapter 14: Healthy Communities

2. Health and the Built Environment
Buildings, streets, parks, plazas, and transportation systems all constitute the built environment, which affects health through a variety of means.

3. Components of Community Design
Land use refers to decisions about what functions— homes, factories, schools, stores, parks, and so on—are placed where.
Transportation refers to systems for moving people and goods from place to place. Travel demand is one determinant of transportation needs.
Community design addresses landscape architecture, the design and management of such settings as streetscapes and public spaces; land conservation, efforts to preserve land in its natural state; parks and recreation; and historic preservation.

4. Cities
In the nineteenth century, a growing understanding of the spread of infectious diseases led public health professionals to intervene in urban planning, public infrastructure, and housing quality.

5. The American Dream
Suburbanization was caused in part by the American dream of having a family, house, yard, car, and a white picket fence.
With a booming birthrate, home loan guarantee programs for veterans, the rise of the personal automobile, and the construction of the interstate highway system the creation of communities built upon this ideal was made possible.
Suburbanization caused the decline of land use mix, the admixing of residential, commercial, recreational, and educational uses.
Land was separated into distinct zones with separate purposes.

6. Modern Community Design
Key features of modern community design include:
Separation of land uses through zoning.
Low density development.
Dispersion of activity centers.
Automobile-oriented transportation systems.

7. Policies that Regulate Land Use
Building codes prescribe the bulk, scale, massing, and style of structures.
Zoning codes prescribe certain locations as appropriate for specific uses, such as residential, commercial, industrial, recreational, or open space uses, and regulate such parameters as density, lot coverage, and building setbacks.
Subdivision regulations operate on a larger scale than zoning, governing the layout and form of entire communities.

8. Community Design and Physical Activity and Obesity
There is growing evidence that land use and transportation practices of the last century have had major impacts on individuals’ physical activity levels.
Sedentary lifestyles have become the norm in the United States.
Sedentary lifestyles and low physical fitness are associated with increased risk for various conditions and diseases (cardiovascular disease, stroke, etc), whereas high physical fitness works to help prevent them.
Modern community design has spread out areas of visitation and decreased population density, causing decreased use of walking and biking.
Parks help increase physical activity

9. Air Quality and Community Design
Pollution from cars and trucks is most marked near transportation corridors with high traffic density, leading to pollution hot spots, or small areas with particularly high air pollution levels.
Exposure to air pollutants is associated with lung cancer and cardiovascular disease.
In cities the evolution of larger roads and escalating levels of traffic, secondary to regional land use patterns, explains why the roadways themselves seem to represent the source of air pollutants.
Though technology has helped to reduce air pollution, the increase in vehicle miles traveled has somewhat offset these gains.
The negative effects of air pollution underscore the need for alternative modes of dependable and safe transportation as a goal for community design and transportation planning .

10. Injury Risk and Community Design
Community design has considerable influence on the risk of injuries, especially those related to transportation.
The burden of fatal and nonfatal injuries from motor vehicle crashes is enormous.
The sprawling communities that characterize American cities encourage automobile use and higher speed roadways, putting people at greater risk for accidents.

11. Community Design, con’t
Roundabouts, one-way streets, and speed bumps to alter driver behavior and reduce crash likelihood and severity.
Pedestrians and cyclists are at risk of being hit by motor vehicles, though pedestrian-friendly street designs that include crosswalks and sidewalks reduce injury risk (complete streets provide space and safety for all forms of travel).
Walking and bicycling are known as active transportation because they entail physical exertion; for this reason, promoting these forms of travel is a public health goal.

12. Healthy Food and Community Design
Healthy eating is a central strategy in reducing obesity and chronic diseases.
Low-income and predominately minority communities often have limited access to grocery and retail stores that sell high- quality fruits and vegetables, and they have a disproportionate number of unhealthful fast-food outlets.
Examples of strategies to improve the food environment include providing incentives for grocery store and supermarket development, restricting fast-food retail store density, and encouraging community-supported agricultural programs, farmers markets, street carts with fruit and vegetables, and community gardens.

13. Noise and Community Design
Noise exposure contributes to hearing loss, increased blood pressure, heart disease, changes in hormonal levels, and circulatory problems.
There are several ways to reduce community exposure to transportation noise: reduce the amount of noise produced per vehicle; reduce the number or speed, or both, of vehicles driving past communities; construct sound barriers around large highways and other major noise sources; and route new or expanded highways through less densely populated areas.
Aircraft noise in surrounding communities can similarly be reduced by changes in runway use or flight path location, compatible land use zoning, and sound insulation of buildings.

14. Social Capital and Community Design
Community design may affect social capital in several ways.
Long commute times may reduce social capital, while the presence of cafés, coffee shops, bookstores, bars, hair salons, and other hangouts at the heart of a community increase it.

15. Mental Health and Community Design
Community design affects mental health in many ways:
High noise levels increase the likelihood of mental illnesses, like anxiety.
Sprawling communities may contribute to isolation, and depression.
Long commutes and aggressive driving lead to stress.
Parks and green space can be relaxing and contribute positively to mental health.

16. Design for Healthy Communities
Mix land uses, create walkable neighborhoods, provide a variety of transportation options, preserve open space, farm space, and natural beauty, create a range of housing opportunities, foster distinct, attractive living communities, encourage community stakeholder collaboration, direct development towards existing communities, take advantage of compact building design, and make developmental decisions, predictable fair, and cost effective.

17. Design for Healthy Communities
Healthy communities focus on universal design to ensure access to community facilities regardless of ability.
Smart growth coincides with many different developmental movements, including new urbanism, traditional neighborhood development, transit-oriented development, and brownfield redevelopment.
Solutions that reduce congestion are collectively known as transportation demand management, and also aid in the development of healthy communities.
Health impact assessments can be used to plan ahead when designing communities. They are used by public health professionals and others to examine the health consequences of a proposed project or policy prospectively and then yield recommendations that promote the positive health impacts and mitigate the adverse health consequences of the proposal.

18. Sustainable Development and Human Growth
Sustainability is defined as meeting the needs of the present without compromising the ability of future generations to meet their own needs.
Sustainability programs focus on community-planning and land use actions that support long-term environmental, social, and economic vitality in communities.
The Healthy Cities program was the first widespread, community-level application of an ecological health promotion model that highlights the links between people’s behavior and their environment.