KNikolai Healthandthebuiltenv ironment

Public Healthand the Built EnvironmentWhat’s the connection?: 

Public Health and the Built Environment What’s the connection?

Health Defined: 

Health Defined Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. World Health Organization

A Brief History…: 

A Brief History… Cholera and England’s Public Health Act (1848) Local and Central Boards of Health established Incorporated towns assumed responsibility for drainage, water supplies, removal of 'nuisances', paving, and more Financing was included But…London, Scotland and Ireland were excluded

A Brief History, continued…: 

A Brief History, continued… Tenement House Code in NYC (1901) Most far-reaching of all tenement reform bills Standards all but banned construction of tenements on 25 foot wide lots Required improved light, ventilation, and toilets Mandated improvements to pre-existing tenements

The Connection Today: Chronic disease and healthcare access: 

The Connection Today: Chronic disease and healthcare access Physical activity designed out of common activities Nutritious food less accessible and appealing Restaurant portion sizes “supersized” Air and water quality decrease as sprawl increases Chronic diseases increasing at alarming rates Access to healthcare decreasing as costs rise Need integrated planning

Obesity: 

Obesity 112,000 obesity-related deaths each year in U.S. Chronic conditions associated with obesity include: Type 2 Diabetes High Blood Pressure Heart Disease Breast and Colon Cancer Source: FAQs About Calculating Obesity-Related Risk, Centers for Disease Control and Prevention (CDC) 2005

Obesity Trends Among U.S. Adults 1991 – 2004: 

Obesity Trends Among U.S. Adults 1991 – 2004 Definitions: Obesity: having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher. Body Mass Index (BMI): a measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters. Source: Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) annual survey

Obesity Trends* Among U.S. AdultsBRFSS, 1991: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1991

Obesity Trends* Among U.S. AdultsBRFSS, 1992: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1992

Obesity Trends* Among U.S. AdultsBRFSS, 1993: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1993

Obesity Trends* Among U.S. AdultsBRFSS, 1994: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1994

Obesity Trends* Among U.S. AdultsBRFSS, 1995: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1995

Obesity Trends* Among U.S. AdultsBRFSS, 1996: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1996

Obesity Trends* Among U.S. AdultsBRFSS, 1997: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1997

Obesity Trends* Among U.S. AdultsBRFSS, 1998: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 1998

Obesity Trends* Among U.S. AdultsBRFSS, 1999: 

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2000: 

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2000

Obesity Trends* Among U.S. AdultsBRFSS, 2001: 

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, 2001

Obesity Trends* Among U.S. AdultsBRFSS, 2002: 

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

Obesity Trends* Among U.S. AdultsBRFSS, 2003: 

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, 2003

Obesity Trends* Among U.S. AdultsBRFSS, 2004: 

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, 2004

Slide22: 

1996 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2004 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% 2004

Diabetes: 

Diabetes Diabetics do not produce / properly use insulin to convert sugar and other foods into energy 7% of the US population has diabetes 15,000 Minnesotans diagnosed each year Sixth deadliest disease in Minnesota Type 2 diabetes accounts for 90% to 95% of cases Type 2 diabetes can be delayed or prevented through proper diet and exercise Type 2 diabetes is rising in children as obesity rates rise Source: Hennepin County Community Health Services Assessment: Diabetes

Slide24: 

Source: Mokdad et al., Diabetes Care 2000;23:1278-83. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1990

Slide25: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1991-92 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Slide26: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1993-94 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Slide27: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1995-96 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Slide28: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1997-98 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Slide29: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1999 Source: Mokdad et al., Diabetes Care 2001;24:412.

Slide30: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 2000 Source: Mokdad et al., J Am Med Assoc 2001;286:10.

Slide31: 

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 2001 Source: Mokdad et al., J Am Med Assoc 2001;286:10.

Slide32: 

Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10. Diabetes Trends* Among Adults in the U.S., BRFSS, 1990,1995 and 2001 (Includes Gestational Diabetes)

Thesis: Our land use planning (community design, built environment) affects our health.: 

Thesis: Our land use planning (community design, built environment) affects our health. Examples: Auto-focused design = less physical activity and lower air quality More impervious (impenetrable) surfaces = more water run-off and lower water quality Effects: More obesity, asthma, diabetes and other chronic diseases – and less availability of potable water

Fewer than 50% of Minnesota’s 6th and 12th graders get the recommended physical activity each week, and many eat poorly.Source: MN Student Survey, 2004: 

Fewer than 50% of Minnesota’s 6th and 12th graders get the recommended physical activity each week, and many eat poorly. Source: MN Student Survey, 2004

Only 27% of Minnesota’s adults get the recommended level of moderate physical activity each weekSource: SHAPE 2002 Geographic Data Book: 

Only 27% of Minnesota’s adults get the recommended level of moderate physical activity each week Source: SHAPE 2002 Geographic Data Book

Factors that May Influence Physical Activity Decisions and Health Status: 

Factors that May Influence Physical Activity Decisions and Health Status Building and site design Street and sidewalk design Air and water quality Land use mix Connectivity to parks / trails Density of development Perceptions Crime Safety Convenience

Building and Site Design: 

Building and Site Design

Street Design: 

Do street crossings balance the needs of vehicles and pedestrians? Thank goodness this woman is wearing running shoes! Street Design

Crosswalks: 

The Beatles crossing Abbey Road on “Zebra” striping! Crosswalks

Transit and Physical Activity Only 30 minutes of physical activity is recommended daily. Transit riders already average 20 minutes walking or biking to and from transit. : 

Transit and Physical Activity Only 30 minutes of physical activity is recommended daily. Transit riders already average 20 minutes walking or biking to and from transit.

Transit and Air Quality During the 1996 Olympics in Atlanta, downtown traffic was severely restricted: Peak daily ozone decreased 27.9%, and acute asthma attacks decreased 42% among Medicaid children. : 

Transit and Air Quality During the 1996 Olympics in Atlanta, downtown traffic was severely restricted: Peak daily ozone decreased 27.9%, and acute asthma attacks decreased 42% among Medicaid children.

Land Use, Sprawl, and Air QualityCan’t simply “get there from here” without connections: 

Land Use, Sprawl, and Air Quality Can’t simply “get there from here” without connections

Health Equity and Planning: 

Health Equity and Planning Safe, affordable homes Access to healthy food/groceries Physical activity Pedestrian injury and death Social capital/connections Mental health

Transportation of goods and Air Quality  The average piece of food is transported 1,600 miles.: 

Transportation of goods and Air Quality The average piece of food is transported 1,600 miles.

The Potential: 

The Potential 50% of all trips are under 3 miles 41% of all trips are under 2 miles 28% of all trips are under 1 mile Yet, 75% of trips less than 2 miles are made by car. National figures for urban areas. Source: 2001 National Household Travel Survey

New York Times, February 3 2007: 

New York Times, February 3 2007

Land Use and Water Quality: 

Land Use and Water Quality Sprawling development leads to stormwater runoff This “non-point source pollution” is the number 1 water quality problem in the US, and getting worse. Northland NEMO (Nonpoint Education for Municipal Officials)

Development patterns vs. Impervious Surfaces:: 

Development patterns vs. Impervious Surfaces: 10,000 houses on 10,000 acres produce 187 million ft3 /yr stormwater runoff Site: 20% impervious Watershed: 20% impervious 10,000 houses on 2,500 acres produce 62 million ft3 /yr stormwater runoff Site: 38% impervious Watershed: 9.5% impervious 10,000 houses on 1,250 acres produce 49.5 million ft3 /yr stormwater runoff Site: 65% impervious Watershed: 8.1% impervious The lower density scenario creates more run-off and consumes 2/3 more land that the higher density scenario. 1 unit/acre 4 units/acre 8 units/acre

An Alternate Approach:Conservation Design: 

An Alternate Approach: Conservation Design From Randall Arendt same number of housing units 10-50% less impervious surface up to 50% open space water resources protected

Slide50: 

What’s in this stuff?

Planning for Seniors: 

Planning for Seniors Characteristics Will be “Older Baby Boomers”– not like today’s seniors, and will be very active Greater income diversity: some very high income and about 20% very low income (US Savings rate is lowest since 1933 during the Great Depression) Want to “age in place” rather than move to a retirement community

Seniors and Accessory Dwelling Units (ADUs): 

Seniors and Accessory Dwelling Units (ADUs) An ADU is an additional, self-contained housing unit that is secondary to the main residence. These are sometimes referred to as “Granny cottages” since many are constructed to provide for family members. These can be an addition to a house, a stand alone cottage, or a basement or garage conversion.

Why construct ADUs?: 

Why construct ADUs? ADUs can allow seniors or disabled individuals to remain in their homes with their loved ones to check in on them and care for them.

Health Impact Assessments (HIAs): 

Health Impact Assessments (HIAs) A process by which a policy or project is assessed for its potential effects on the health of the impacted population. Impacts are identified and addressed, and positive impacts are optimized while negative impacts minimized. This is similar to an Environmental Impact Assessment, but focuses specifically on human health and equity.

HIA Steps: 

HIA Steps Screening: Determination of whether a specific policy/project is appropriate for HIA Scoping: Identification of key issues Assessment: Identification of relevant health determinants, their significance (high or low, positive or negative, etc.), and recommendations Communicating results: Involving community members Monitoring and Evaluation: Assessment of whether the HIA was successful.

Integration Tools: 

Integration Tools Broadened Comprehensive planning Long-term partnerships Creative and flexible policy development Flexible zoning and form based codes Corridor and site design Public space and public building construction – Capital Improvement Programs (CIP) Health Impact Assessments

Tying it all Together: 

Tying it all Together Work together in multidisciplinary groups Speak in terms people understand: Engineers: Congestion mgmt via bicycling & walking Public Health: Disease mgmt via exercise & healthy foods Demonstrate value – Return on Investment Get community Involvement Use creative funding Build on creative Strategies – e.g., Safe Routes to School (USDOT), Active Living by Design

Resources : 

Resources American Planning Association PAS Report Number 539/540, Integrating Planning and Health American Journal of Health Promotion, Vol. 21 (4S) March/April 2007 Journal of the American Planning Assn, Winter Issue 2006 American Journal of Public Health, September 2003 American Journal Of Health Promotion, Sept./Oct. 2003 European Union Health Impact Assessment Guide UCLA School of Public Health – Health Impact Assessment http://www.ph.ucla.edu/hs/health-impact/ http://www.nhc.govt.nz/PHAC/publications/GuideToHIA.pdf

Resources Continued:: 

Resources Continued: USDOT’s Safe Routes to School Program http://safety.fhwa.dot.gov/saferoutes/ World Health Org – Healthy Cities (1200 cities in 30+ countries) http://www.euro.who.int/healthy-cities Transit for Livable Communities http://www.tlcminnesota.org/ Blue Cross and Blue Shield of Minnesota http://www.preventionminnesota.com/community_funding.cfm Land Use and Health in California http://www.healthyplanning.org/toolkit_gpz.html NACCHO (Nat’l Assn of County and City Health Officials) Land Use Planning site http://www.naccho.org/topics/HPDP/Land_Use_Planning.cfm

Thank You! – Questions or Comments?Karen Nikolai, MCP, MPHCommunity Design LiaisonHennepin CountyMinneapolis, MN(612) 348-8089 office(952) 224-6630 cellkaren.nikolai@co.hennepin.mn.us: 

Thank You! – Questions or Comments? Karen Nikolai, MCP, MPH Community Design Liaison Hennepin County Minneapolis, MN (612) 348-8089 office (952) 224-6630 cell karen.nikolai@co.hennepin.mn.us