This document discusses efforts to improve community health through community design and partnerships between planners and public health professionals. It describes the Plan4Health program funded by the CDC that aims to address chronic disease determinants through increased opportunities for physical activity and access to nutritious food. It provides an example from Connecticut where the Eastern Highlands Health District coalition is developing a toolkit for local planning and zoning commissions to influence policies and the built environment to promote health and wellbeing. Key informants highlighted challenges for commissions like regulations and a lack of training, and noted the reactionary nature of resident engagement. The toolkit aims to provide research, examples, and resources to help commissions consider health impacts of decisions.

1. Healthy by Design
Improving Community Health through Community Design

2. Improving Community Health through Community Design

3. Planning for Healthy Communities: Building
Equity Through Partnerships and
Collaboration
 Funding source: American Planning Association, with
funding from the Centers for Disease Control and
Prevention
 Project goal: Institutionalize and improve the capacity of
planners and public health professionals to address
chronic disease determinants.
 Focus areas:
 Inactivity: Increased opportunities for physical activity
 Unhealthy diet: Access to nutritious food

4. Grant program details
 Funds support existing and emerging coalitions anchored
by members of American Planning Association (APA)
chapters and American Public Health Association (APHA)
affiliates, with strong participation from other sectors.
 APA works with awardees on cross-disciplinary initiatives
to improve nutrition and physical activity, including:
 Resources, training, TA for implementation
 Robust communications and outreach
 Relationship-building among coalition members, community
groups, and many other stakeholders
 Fostering sustainability beyond project period

5. Plan4Health National Outcomes
 Short-term:
 messaging on the importance of policy, systems, and
environmental (PSE) improvements
 stakeholder awareness of how planning decisions are made and
where to address health issues in the planning process
 community capacity to implement PSE improvements
 Long-term:
 Full integration of planning and public health work, leading to
reduced chronic disease among Americans.

6. The Connecticut Experience
Partnering with local Planning and Zoning Commissioners to make small
rural communities healthier

7. At-a-glance
 WHO:
 EHHD CHART coalition in partnership with
Connecticut Chapter of American Planning
Association (CCAPA) and the Connecticut Public
Health Association (CPHA)
 CHART coalition, led by the Eastern Highlands Health
District (EHHD), has representation from a number
of partners and sectors including:
 Local planners
 Regional planning
 Parks and recreation
 Visiting nurses
 Healthcare
 Early childhood collaboratives
 School dining services
 School nurses
 Social services

8. At-a-glance
 WHAT:
 The development and dissemination of a
toolkit for local town planning and zoning
commissions and other influential local
governing and advisory bodies to impact
policies and the environment in ways that
positively affect the health and wellbeing
all town residents.
 Additionally, as part of the dissemination
efforts, the project will engage local
consumer and resident groups to
promote a greater level of ownership of
their local built and social environment,
and of their power to advocate and
influence local planning decisions.

9. At-a-glance
 WHY:
 There is currently no single source where
all PSE information relevant to small rural
communities is available in a format that
is readily useable by lay community
members.
 Anecdotal evidence suggests that “Some
Planning and Zoning Commission members
feel that their primary role is regulatory
and underestimate the value of their
planning function.”
 The built environment has been shown to
have a direct correlation with how
healthy communities can be…

10. At-a-glance
 HOW:
 PHASE I: DEVELOPMENT
 Convene coalition and orient on new project
 Host and/or attend conferences, meetings, and webinars to gather information and
become informed on the challenges and opportunities for PZCs in Connecticut
 Conduct key informant interviews (local PZC commission members and others) to
refine content and context of toolkit information for the greatest impact in rural
communities
 Continue meeting with coalition and utilize expertise of state chapters of the APA and
the APHA to develop components of the toolkit and specific items to include.
 Develop toolkit. Incorporate tools and resources that have been proven to be
effective including the APA Healthy Community Design Checklist, the Community
Healthy Living Index, and the Rural Active Living Assessment (RALA) Tools.
 Develop marketing and advocacy plan in collaboration with CPHA
 Compile toolkit; distribute in a beta testing mode; refine and adapt as needed.

11. Reoccurring Themes from Key
Informant Interviews

12. Perceived Responsibilities and Duties
• To make and enforce regulations
• To oversee the long-term
development of the town, in line
with the Plan of Conservation and
Development (POCD)
• To shepherd the balance between
facilitating economic growth and
the desire to maintain a rural
small town character (to protect
and promote the safety and
welfare of residents)

13. Motivation to serve and continue
serving
 SENSE OF RESPONSIBILITY
 Giving back to the community
 Compelled to add his/her technical expertise to a group of lay volunteers
 Hoping to make the process easier for residents
 Providing positive public service experience to residents
 …no one else will run for office!
 PERSONAL INTEREST AND ENJOYMENT
 To understand how P&Z decisions are made
 Having a say in how the town develops
 Political aspirations
 Love for strategic planning
 High levels of respect for colleagues and enjoying working with each other

14.  “I stay on the board because this is an
amazing board. It it's got engineers,
architects, landscape architects, lawyers,
people that have lived in their lifeline
residences. It's got good staff. It's diversified
– well, not that diversified in our age
anymore, but we all want to get to the same
result, but not all of us have the same path.
But most of us – all of us here are willing to
listen. We always learn from each other. […]
it makes doing what we have to do easier
because of our understanding of what has to
get done, and our understanding of how the
town works. It's an incredible board and so
that's why I stay.”

15. Challenges
 Regulations are written in “legalese” and are hard to
understand
 Not familiar with Roberts Rules of Order and other
important aspects of running public meetings and voting
rules that could have legal repercussions (i.e. when to
abstain)
 Can lose sight of the long-term direction, when dealing with
lots of day-to-day small fires
 Time commitment as a volunteer
 Turf issues
 Town Council
 State government
 Federal government
 Lack of funding

16. “It’s a very technical area and I certainly
don’t, by any means, understand it. The
important thing is that when we were going
through developing our regs we had a civil
engineer as the Chair of Planning and Zoning
and of course we have a Town Planner who
weighed in on it. […] So, not that I
understand it, but at least I’ve got the gist of
it, and I don’t think it’s my job to understand
it. It’s my job to say that’s a great idea and I
support it.”

17. “75 to 90 percent of the time is spent dealing
with the individual events. You know,
enforcement actions, and we get involved
because we’re made aware of these kinds of
things. I think that a commission – it would
be nice if the Commission was more focused
on actual planning-related activities. But you
have the Town Planner. That’s sort of her job
to deal with those kinds of things.”

18. Valuable training/orientation for
new PZC members
• “What every Planning and Zoning Commissioner
should know” handbook
• How to conduct a public meeting
• Legal training
• Training on how to read a set of plans
• Language about “plants, land forms, water,
measurement”
• Various trainings from State Dept of Environmental
Protection, UCONN Department of Agriculture,
Connecticut Bar Association
• Town staff and fellow commissioners

19.  “So this board is fortunate 'cause we have that
expertise. Other boards could use a whole lot of
legal training. They could use training on reading
a set of plans for crying out loud. They look at a
set of plans and they don't even know what
they're looking at. It looks like a bunch of lines
on a piece of paper to them.”

20. Town Support
 Having a dedicated staff person is essential
 Communication and availability are key
 Town staff needs to know the ins and outs of
regulations in such a technical field
 most PZC members do not and don’t want to be bogged
down with the legal details and technical intricacies
 Often helpful to have the town engineer present at
meetings
 Notice of training opportunities often come
through the town planner’s office and are often
either free or paid for by the town

21.  “In our town, we are lucky to have a Planner, but
she wears about ten different hats so her time is
pretty consumed. I don’t think all towns have a
Planner. I don’t think they have a dedicated staff
person so I imagine their world is a lot different
than ours. It probably makes them feel a lot more
lost than we feel.”

22.  “We have a Town Planner who is very willing to
share information and that’s very important. She
has educated us over the years. […] She’s done it
through sending us various articles off the listserv.
She has made us aware of various classes that
people can go to if they choose to. She has books
in her office if people are interested. She has also
printed off stuff that has been in our packets to
read. She’s been very informative over the
years.”

23. Resident Engagement with PZC

24. Resident engagement with PZC
 Reactionary, rather than proactive in nature
 Issue-driven
 about one’s own property,
 that of a neighboring property, or
 a sweeping change that would affect the entire
town
 Mostly non-existent
 Lack of interest
 Lack of knowledge
 Strapped for time

25.  “it’s amazing to me how apathetic the community can
be but at other times, especially if it’s in their
backyard, they all of a sudden turn out.”
 “We’re not seeing the 30 and 40 year-olds. They’re so
wrapped up in both of them having full-time jobs. […]
We’re not seeing the double earning family. They don’t
have the time and I begrudge them that they don’t have
the time. We’re not seeing them participate in
volunteer activities throughout town. We’re not seeing
them participate in running for office. We’re not seeing
them in church. We’re not seeing them in a lot of
places and that’s because they’re working Monday
through Friday. Saturday is grocery shop, clean the
house and Sunday is a day of rest. So, it’s a shame. I
think they still will coach their kids but they won’t go
beyond that. They won’t go beyond that.”

26.  “Interviewee:Very few people show up.
 Interviewer: And when they show up it’s because it’s
regarding their property.
 Interviewee: In their backyard and it’s some concern.
Exactly.
 Interviewer: Right, okay.
 Interviewee: Or we’re discussing how many chickens
you can have on an acre of land. That got a big turnout.

27. Role of PZC in influencing community
health

28. Greatest perceived health issues tied to
PZC responsibilities
 Water quality
 Sound pollution
 Sewage system and septic
 Traffic amount and safety
 (Trails)
 (Open space)

29. Active living = Parks & Recreations
domain
Healthy Food and Food
Security = PZC domain

30. “You don’t think about
putting together public
health and planning and
zoning.”
– 10-year member of a local
Planning and Zoning
Commission.

31. Helpful tools and resources for PZC to be
able to increase opportunities for active
living

32.  The “business case” for healthy design
 How to fund these initiatives
 How to deal with our unique topography
 (Lighter, Quicker, Cheaper, and…Healthier approaches to Place
Making)

33.  “A lot of us are active, so a lot of us
think about these things but the primary
motivator for development activity is
development. So, that sort of puts
interconnections and trails and healthy
food options – all that stuff goes kind of
on the backburner. So, anything you
guys can do to help us especially get up
to speed quickly or put the thought into
our mind early, it will trickle into all the
rest of the work that’s done throughout
the year.”

34. Important topics to include in toolkit
n =15 %
Research supporting the connection between
population health outcomes and the built
environment 9 60%
The unique challenges and opportunities experienced
by rural communities and potential solutions 11 73%
Overview of relevant planning/public health topics
(i.e. “health in all policies”, complete streets,
livability, playability, place making, walkability,
bikeability, trail connectivity, health equity, equitable
access to opportunities for active living and healthy
eating, etc.) 13 87%
The economic development/business case for healthy
community design 12 80%
Potential local partners 8 53%
Funding sources for relevant projects and initiatives
11 73%

35. Important elements to include in toolkit
n =15 %
Real examples from similar communities 10 67%
Sample policies and templates from similar communities 12 80%
Examples of rural health and planning assessment tools
(i.e. walkability audit, rural active living assessment tools,
etc.) 11 73%
Glossary of key public health terms and concepts 7 47%
Glossary of key planning and zoning terms and concepts 9 60%
Pictures/photos illustrating some of the key planning
concepts and terms 9 60%
Multimedia features such as hyperlinks, video clips,
podcasts 6 40%
List of additional resources for further exploration of
topics 5 33%
Other: Roberts Rules of Order/General PZC Introduction 2 13%

36.  “I would suggest that if you do come up with a
handbook for commissioners that it not be too
technical but it give the overview of what
responsibilities there are, how to be a participant
in a public hearing. I think that’s important but
also other considerations of your town, like you
want to get into food security and health issues
and that kind of thing. […] But if you make it a
100-page tome, nobody is going to read it. “

37. Miscellaneous Notes
 Most PZC members were very welcoming of the toolkit idea
and offered to help with reviewing the draft and providing
feedback
 Many expressed interest in a toolkit that goes beyond
“health” and provides a general overview of what it means
to be a PZC member , how to run a public meeting (i.e.
Robert’s Rules of Order), basic concepts and regulations,
etc.
 There is an overwhelming sense for the need to involve the
public in new and engaging ways, so that decisions are made
more proactively and are owned by local residents
throughout the development process.

38. Currently
 Contracted with planning consultant to finish developing the toolkit,
in collaboration with coalition members and project team. Expected
to be completed this fall.
Next Steps
PHASE II: DISSEMINATION
• Publish finalized toolkit (print and electronic)
• Host conference/seminars to launch toolkit and expose audience to
policy, systems, and environmental (PSE) best practices and resources
• Promote content of toolkit in local communities
• Hold workshops and presentations on advocacy for local resident
groups and coalition partner members, to promote citizen
engagement when it comes to influencing PSE changes at the local
PZC level
• Promote CHART’s efforts to eliminate health disparities through
community design through public media outreach

39. Inner Core Community Health
Improvement Initiative
Increasing Access to Healthy Foods
Metropolitan Area Planning Council
Lola Omolodun

40. Overview…
•MAPC and Our Public Health Division
•Inner Core Community Health
Improvement Initiative
•Discussion and Questions

41. What is MAPC?
Regional planning agency for Greater
Boston
 Promote smart growth and regional
collaboration
 Support planning efforts throughout the
region
 Efforts are guided by Metrofuture, our
stategic plan

42. Between now and 2030, we will:

43. HEALTH starts—long before illness—in our
homes, schools, and jobs.
Public Health at a Planning Agency?

44. What determines health?
Healthcare Genetics Social, Environmental, Behavioral Factors
20% 60%20%
Based on: Slide from The American Healthcare Paradox, Lauren Taylor; Original Source:
McGinnis et al, 2002

45. ZIP CODE IS MORE IMPORTANT THAN YOUR
GENETIC CODE
Source: Robert Wood Johnson Foundation,
Commission to Build a Healthier America

46. Public Health Division
Our Goal
 Integrate Public Health into Planning
Our Approach
 Health in All Policies Framework
Our Primary Focus Areas
 Healthy Community Design
Health Impact Assessments
 Healthy Food Access

47. Inner Core Community Health
Improvement Initiative
Plan4Health Grant
• American Planning
Association and American Public
Health Association Partnership
•Strengthen linkages between
Public and Planning
•Emphasize policy, systems and
environmental changes

48. Inner Core Community Health
Improvement Initiative
Strategy 1: Improve distribution systems to help
convenience stores purchase healthier foods
Strategy 2: Partner with grocery stores to make
changes within their environment to promote
healthier options
Goal: Increase access to affordable, healthy foods

49. Inner Core Community Health
Improvement Initiative
Target Area: “Inner Core” 20 miles within Boston

50. Inner Core Community Health Improvement
Initiative
Inner Core Profile:

51. Inner Core Community Health Improvement
Initiative
Inner Core Profile:

52. Inner Core Community Health Improvement
Initiative
Coalition Partners:

53. Inner Core Community Health
Improvement Initiative: Corner Stores
•Expand existing healthy corner store
initiative
• Major barrier to expansion
Distribution and Procurement
• How can we improve distribution networks?

54. Inner Core Community Health Improvement
Initiative: Corner Stores
Three Phases:
Phase 1 Phase 2 Phase 3
Identifying and
feasibility testing of
potential models
Understanding
existing distribution
systems
Implementation and
evaluation
Sustainability
Communication

55. Inner Core Community Health
Improvement Initiative: Corner Stores
Challenges
Making the Case
Incentives
Engaging Store Owners
Reducing Risk

56. Inner Core Community Health Improvement Initiative:
Grocery Stores
• Natural partners for promoting healthy foods
• Focus attracting stores
• Focus on in-store interventions
• How do we change store environment?

57. Inner Core Community Health Improvement Initiative:
Grocery Stores
Process:
Identifying and
Assessing Existing
Models
Engagement and
Outreach to Grocery
Stores
Developing
Recommended
Strategies
Implementation and
Evaluation
Communication
Strategy
Sustainability

58. Inner Core Community Health Improvement Initiative:
Grocery Stores
Challenges:
Low Priority
Resistance to Change
Making the Case
Sustainability

59. Inner Core Community Health
Improvement Initiative:
Lessons Learned…
 Identify and Engage Critical
Partners Early
Think Outside the “Public Health Box”

60. Thank You!
Metropolitan Area Planning Council
Lola Omolodun
lomolodun@mapc.org
617-933-0728

61. Discussion and Questions