Health + Community Design

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  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • Marin, Co SR2S evaluation: 64% increase in number of kids walking to school with safety & traffic calming improvements & encouragement. CA SR2S evaluation: 15% of kids walked to school more often after physical improvements (vs. 4% when no improvements).
  • Health Element or “Healthy Commumities” Component or integrated into existing Elements?
  • Health + Community Design

    1. 1. Health and Community Design
    2. 2. Overweight is Epidemic Rates in Adults <ul><ul><ul><li>2/3rds of American adults are overweight </li></ul></ul></ul><ul><ul><ul><li>In 1991 rates were 45% (almost 50% increase in 15 yrs) </li></ul></ul></ul>                                                                            (
    3. 3. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%
    4. 4. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%
    5. 5. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    6. 6. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20
    7. 7. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20
    8. 8. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002
    9. 9. Obesity Trends* Among U.S. Adults BRFSS, 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
    10. 10. OBESITY Risk Factors for the Chronic Disease <ul><li>Cardiovascular </li></ul><ul><li>Stroke </li></ul><ul><li>Endocrine </li></ul><ul><li>Orthopedic </li></ul><ul><li>Pulmonary </li></ul><ul><li>Hepatic </li></ul><ul><li>Psychosocial </li></ul>
    11. 11. Leading Causes of Obesity <ul><li>Poor Nutrition: Taking in too many calories </li></ul><ul><li>Inactivity: Burning off too few calories </li></ul>
    12. 12. Poor Nutrition <ul><li>Fast Food </li></ul><ul><ul><ul><li>Five-fold increase since 1970 </li></ul></ul></ul><ul><ul><ul><li>1/3 of US kids eat daily </li></ul></ul></ul><ul><li>Super-size me </li></ul><ul><ul><ul><li>Portion sizes </li></ul></ul></ul><ul><li>Sugars and Refined Flours </li></ul><ul><ul><ul><li>Soda consumption has doubled in 20 years </li></ul></ul></ul><ul><li>Processed Foods </li></ul><ul><ul><ul><li>Higher in calories, fat and salt </li></ul></ul></ul><ul><li>Irregular Meal Patterns </li></ul>
    13. 13. Physical Inactivity <ul><ul><li>25% of adults are sedentary </li></ul></ul><ul><ul><li>60% of adults not active enough </li></ul></ul><ul><ul><li>78% of kids don’t meet physical activity requirements. </li></ul></ul><ul><ul><li>Electronic Media & Kids </li></ul></ul><ul><ul><ul><li>5 ½ hrs/day </li></ul></ul></ul><ul><ul><ul><li>2 hrs more if computer/TV in room </li></ul></ul></ul>
    14. 14. Percentage of Trips in Urban Areas Made by Walking and Bicycling: North America and Europe 1995
    15. 15. The disappearing walk to school <ul><li>Only 10% of these trips are made by walking and bicycling </li></ul><ul><li>1 in 4 trips made by 5-15 year olds are for the journey to and from school </li></ul><ul><li>Of school trips one mile or less, about 28% are walk-based and less than 1% are bike-based </li></ul>
    16. 16. 20% to 30% of morning peak traffic is parents driving kids to school
    17. 17. Increasing Vehicle Travel
    18. 18. Explaining the Epidemic <ul><li>Not genetic or biological changes </li></ul><ul><li>Lifestyle and environmental changes </li></ul>
    19. 23. Improving Health through Community Design
    20. 24. Traffic Calming
    21. 25. Street Lighting
    22. 26. Improving Street Crossings
    23. 27. Compact/ Mixed Use Development
    24. 28. Attractive Street Design
    25. 29. Street Design & Connectivity
    26. 30. Transit-Oriented Development
    27. 31. Community Design/ Health Links <ul><li>San Diego study: 70 minutes more physical activity/week among residents in walkable neighborhood; 35% vs. 60% overweight </li></ul><ul><li>6 lb weight difference in sprawling vs. compact counties </li></ul><ul><li>King County study: 5% increase in neighborhood’s “walkability index” correlated with 32% increase in active transportation; 0.23 point reduction in BMI </li></ul>
    28. 32. <ul><li>Expanding our Roles and Vision </li></ul><ul><li>Urban planners, Transportation Engineers and Architects: </li></ul><ul><ul><li>Have a critical role in public health </li></ul></ul><ul><ul><li>************** </li></ul></ul><ul><ul><li>Public Health needs to appreciate the built environment influences public health as much as vaccines or water quality . </li></ul></ul>
    29. 33. The Public Health Impacts of the Built Environment <ul><li>Physical activity </li></ul><ul><li>Obesity </li></ul><ul><li>Chronic disease </li></ul><ul><li>Access to healthy foods </li></ul><ul><li>Pedestrian injuries/death </li></ul><ul><li>Crime & violence </li></ul><ul><li>Senior independence & mobility </li></ul><ul><li>Water quality & quantity </li></ul><ul><li>Mental health </li></ul><ul><li>Health disparities </li></ul><ul><li>Asthma & respiratory disease </li></ul>
    30. 34. Acute Asthma Events Among Children and Youth During the 1996 Summer Olympic Games Data Source Type of Asthma Event Mean No. of Events Per Day % Change Baseline Period* Olympic Period+ GA Medical Claims Emergency care and hospitalizations 4.23 2.47 -41.6 HMO Emergency care, urgent care and hospitalizations 1.36 0.76 -44.1 Emergency Departments Emergency care and hospitalizations 4.77 4.24 -11.1 GA Hospital Discharges Hospitalizations 2.04 1.65 -19.1
    31. 35. Best Practices
    32. 36. King County, Washington <ul><li>King County pursues aggressive “ smart growth: strategies: </li></ul><ul><li>Land Use- combating sprawl and building healthier communities. </li></ul><ul><li>Public transportation- getting more people onto leaner, greener busses. </li></ul><ul><li>Environmental management- turning waste into energy </li></ul><ul><li>Clean energy future- stimulating climate-friendly fuel and technology markets for a prosperous, sustainable economy. </li></ul>Ron Sims, King County Executive
    33. 37. <ul><li>Health & Transportation departments collaborated </li></ul><ul><li>Commissioned study on health/transportation links </li></ul><ul><li>The first Comprehensive Plan with physical activity/health as a goal and policies in the Urban Form and Transportation Elements </li></ul>Health as a General Plan Goal in King County, WA Seattle, Washington
    34. 38. Los Angeles County <ul><li>LAC Public Health and Regional Planning Directors have agreed to have their staff work collaboratively on General Plan </li></ul><ul><li>Policies supporting healthy, livable communities have been incorporated into the Draft Preliminary General Plan </li></ul><ul><li>Review/revise zoning ordinances to ensure they are in support of new general plan </li></ul><ul><li>Public Health input into proposed new developments at Regional Planning’s subdivision committee meetings and EIR reviews </li></ul>
    35. 39. What Can Cities Do? <ul><li>Include health objectives in general plans </li></ul><ul><li>Add a health element to the general plan </li></ul><ul><li>Get Public Health input projects and updates </li></ul><ul><li>Update zoning codes to allow compact, mixed use </li></ul><ul><li>Update street design standards </li></ul><ul><li>Dedicate/Increase funds for active transportation </li></ul>
    36. 40. Integrate Health into General Plan <ul><li>Health as explicit goal </li></ul><ul><li>Provide comprehensive definition of health </li></ul><ul><li>Link health and policies that support walkable, livable communities and smart growth </li></ul>
    37. 41. Models in California <ul><li>Chula Vista </li></ul><ul><li>Richmond </li></ul><ul><li>Chino </li></ul>
    38. 42. Integrate Health into Specific Plans <ul><li>Master Plan </li></ul><ul><li>Redevelopment Plans </li></ul><ul><li>Downtown Plans </li></ul>
    39. 43. California Assembly Bill 437 Authorizes the county health officer to provide assistance to cities and counties with local land use planning and transportation planning processes as they relate to public health.

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