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

2. 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

3. 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

4. How active living has been designed out

5. Ancient walking city Photo credit: Noureddine Bougacha

6. Photo credit: Library of Congress, Geography and Map Division (http://www.loc.gov/item/76696209/)

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

8. Negative impacts of development

9. Prevalence of obesity among U.S. adults BRFSS, 2012 15%–<20%20%–<25% 25%–<30% 30%–<35% ≥35% Source: Centers for Disease Control and Prevention

10. Prevalence of obesity among children

11. 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

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

13. 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

14. The role of policy and environmental change

15. 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)

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

17. 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

18. Strategies for and benefits of healthy community design

19. 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

20. 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)

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

22. Contact information: Patti Miller, MPP Patricia.P.Miller@nemours.org 302-298-7716