1. The Built Environment and Public Health: A Tale of Two Communities Susan Allan, MD, JD, MPH Oregon State Public Health Director July 14, 2005

2. Two communities – similar and different Arlington, Virginia Oregon (especially Portland) Many similar activities, some key differences Different motivations –Livability –Urban Village –Attractiveness to business and their employees –Health of the Environment Health a bit player, but chance to affect the language used Public Health as coach or cheerleader

3. Public Health is… what we as a society do collectively to assure the conditions in which people can be healthy. 1988 Institute of Medicine report The Future of Public Health

4. Why worry about the built environment? Toxic exposures –Community –Home –Air –Water Injuries Obesity Physical activity Access to healthy foods Safety and security Social engagement – importance to health just beginning to be understood Etc……

5. Community Environmental Health Assessment (Arlington) Heard community concerns –Expected and unexpected Air quality Disease vectors (rodents) Pedestrian safety

6. Pedestrian Safety Project Partnership with Police Department Analyzed pedestrian accident data NTSA grant Puppet program for Hispanic children and their parents

7. Similarities Active and explicit land use planning Public transportation green space preservation Bike paths Public spaces Public art Special community events

8. Health NOT primary motivation, but often secondary message or justification ***If you have been at the table and engaged, you may have important (although indirect) opportunities to shape how others think and talk.***

9. Transportation Public transportation Fareless Square Flexicar Bicycle commuter

10. Flexicar

12. Benefits from transportation plans Air quality Increased exercise –Walking –Bicycle commute Supports development of public spaces and social interactions

13. Recreation Centers and Senior Centers

14. Parks

15. Dog Parks

16. Attractive communities Urban Village –Small local shops –Neighborhoods Attractive public spaces –Informal community gatherings –Community fairs and events

17. Builds Community, Supports Healthy Activities

18. Farmers Market

19. Some other built environment activities with public health implications Lead in housing –Investigation of toxic kids –Housing remediation –Testing before sale Locating electrical substations Microwave communication towers Location of public leaf mulch piles Sludge burning vs land application

20. Final challenge: Safety and Security

21. Formulation of reasons Livability Support economic development Create community Health – way to describe what is being done for other reasons Protecting health of environmental vs health of people

22. Why pay attention to built environment? - Arlington: Urban Village Livability Property values Attract employers Emphasis on communal values Health explicit subtext

23. Why pay attention to built environment? - Oregon (Portland) Quality of life –Not California –Open space –Property values Emphasis on individual choices Protection of Environment (Green)

24. Contrasts in motivation -Arlington Strong emphasis on community centers, senior centers –Social and physical activity Making the community attractive, appealing (and tidy) Bike paths and walking paths predominantly recreational

25. Contrasts in motivation -Arlington Homeless services carefully off the main streets, behind pretty facades Special transportation shuttle at lunch hours between prominent commercial centers Active promotion of growth around public transportation hubs (plan from early 1970s) Very explicit obesity reduction programs in schools and for County employees Low obesity rates

26. Contrasts in motivation – Portland/Oregon Little emphasis on community centers, senior centers –Drop-in centers for low income and for self help (free lending of tools Bike paths and walking paths both recreational and commuting –Highest proportion of population commuting to work by bicycle Obesity rates: –Adults: US average –Children: high

27. Contrasts in motivation – Portland/Oregon Portland - Homeless services casually on main thoroughfare, Sunday meals in prominent park Transportation free in Fareless Square, easy access for bicycles on trolleys, buses Oregon water not required to be fluoridated because of potential harm to the environment

28. Public Health Fantasies Ensure basic public health in education of all citizens –Better informed about how to manage their own health –Better informed about the costs/benefits of choices Better informed policy makers Better informed voters Require Public Health Impact Statement for all major public and private actions

29. Excerpts from Arlington County Press Release 7-1-05 A "smart growth" leader - …. the Environmental Protection Agency (EPA) gave its first national "smart growth" award to Arlington. Personal health - Data show that sprawl leads to poor health; people can take advantage of Arlington's smart growth to improve their personal health.

30. Thank you!