EOA2016: Healthy Community Design, Dr. Richard Jackson

Richard J JacksonMD MPH FAAP

HonAIA [email protected]

UCLA Fielding School of Public Health

/

Designing and Building for Health, Well-Being

and Sustainability

mailto:[email protected]

The Edge of Amazing“Connecting Neighborhood to Nation to

Improve Community and Population Health”

Community Connections22nd Century Healthy Community

DesignHealth System Transformation

Summer 2016 Heat Map USA

Average Global TemperaturesSince 1880

The Built Environment is Social PolicyIN CONCRETE

Presenter

Presentation Notes

http://latimesblogs.latimes.com/lanow/2010/09/westside-subway-wont-relieve-much-traffic-according-to-draft-environmental-impact-report.html http://www.usatoday.com/travel/destinations/2006-02-08-la-subway_x.htm http://zev.lacounty.gov/news/transportation/westside-story-always-a-traffic-drama

Atlanta Journal-Constitution, March 10, 2006

We Used to Build Real Towns and Neighborhoods but Now…

Housing Policy Is Social Policy

Howard Frumkin MD DrPH

Two houses, adjoining back yards(From Streetsblog, 02/28/2013)

Pedestrian Fatality Rates for Collisions at Different Speeds

Zegeer et al 2002

For every age group from 3 through 34--crashes were the No. 1 cause of death

http://www.nhtsa.gov/



USA Today 10/20/2011

US Adult Obesity Rates 1990



http://stateofobesity.org/adult-obesity/


0

25

50

75

100

Relationship Between BMI and Risk of Type 2 Diabetes

Chan J et al. Diabetes Care 1994;17:961.Colditz G et al. Ann Intern Med 1995;122:481.

Age-

Adju

sted

Rel

ativ

e R

isk

Body Mass index (kg/m2)

Men

Women

<22 <23 23-

23.924-

24.925-

26.927-

28.929-

30.931-

32.933-

34.935+

1.02.91.0

4.31.0

5.01.5

8.12.2

15.8

4.4

27.6

40.3

54.0

93.2

6.7 11.6

21.3

42.1

Presenter

Presentation Notes

Relationship between BMI and risk of type 2 diabetes The risk of diabetes increases with increasing BMI values in men and women [1,2]. Moreover, the age-adjusted relative risk for diabetes begins to increase at BMI values that are considered normal for men (24 kg/m2) and women (22 kg/m2) based on mortality risk. The marked increase in the prevalence of obesity is an important contributor to the 25% increase in the prevalence of diabetes in the United States over the last 20 years [3]. Increases in abdominal fat mass, weight gain since young adulthood, and a sedentary lifestyle are additional obesity-related risk factors for diabetes [1,4,5]. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481-486. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-969. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998;21:518-524. Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1985;34:1055-1058. Helmrich SP, Ragland DR, Leung RW, Paffenbarger Jr RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147-152.

US Diabetes Rates 1995



David B Allen MDNew England Journal

of Medicine April 29, 2012

“…over 30 years…new-onset type 2 diabetes in adolescence has increased

from 3% to ~50% today”.

Diabetes Prevalence NHANES (using Hemoglobin A1c , FPG)

Sample of US PopulationAll Age Groups, Races, Income and Education

1988-1994 2000-2002 2011-20129.8% 10.8% 12.4%

For Prediabetes36.5%

10,000 steps

• 3234 people with Pre-Diabetes(IGT –Impaired Glucose Tolerance)

• Walked or exercised five times a week for 30 minutes for six months

• Lost 5% to 7% of their body weight • Reduced their risk of diabetes by 58%

“The Status of Baby Boomers’ Health in the United States: The Healthiest Generation?”

JAMA Internal Medicine

February 4, 2013

Overall Health Status USPersons Aged 46-64

NHANES 1988-1994 NHANES 2007-2010

Report “excellent” health32% 13%

Limitations to Life Functions9% 14%

Using Walking Assist (wheelchair, cane, etc)3% 7%

“Lifestyle Factors” USPersons Aged 46-64 (NHANES)

1988-1994 2007-2010

Smoking28% 21%

Obesity 29% 39%

“Lifestyle Factors” USPersons Aged 46-64 (NHANES)

1988-1994 2007-2010

No Regular Physical Activity17% 52%

Life Expectancy at Birth and Health Spending 2011

Buford Highway Atlanta, Georgia

Medline Keyword Search:“Built Environment” and “Health”

Sept1993 – Sept 200358 Articles

American Journal of Public Health

Built Environment and Health Issue

September, 2003

Data and Science

The Built Environment:

Designing Communities to

Promote Physical Activity in Children

Policy Statement American Academy of Pediatrics

June 2009

Medline Keyword Search:“Built Environment” and “Health”

Sept1993 – Sept 200358 Articles

Sept 2003 – May 2013665 Articles

American Journal of Public Health

Built Environment and Health Issue

September, 2003

Institute of Medicine Report

Accelerating Progress in Obesity Prevention

May 8, 2012

Educational Benefits of Walking and Biking to School

• Increases concentration

• Improves mood and ability to be alert

• Improves memory and learning

• Enhances creativity

Presenter

Presentation Notes

The California Department of Education has found a positive correlation between physically active children and higher test scores.

Charlotte, NC, Light Rail Opened November, 2007

http://en.wikipedia.org/wiki/File:LYNX_Car_104_at_TremontStation.jpg

http://en.wikipedia.org/wiki/File:LYNX_Car_104_at_TremontStation.jpg

http://en.wikipedia.org/wiki/File:LYNX(carson_station).jpg

http://en.wikipedia.org/wiki/File:LYNX(carson_station).jpg

After 2 Years…Light Rail Transit Users Had

• An average reduction of 1.18 BMI points – For a person who is 5’5” --equivalent to a

weight loss of 6.45 lbs.• An 81% reduced odds of becoming

obese over time.

Education

American Institute of Architects

Local Leaders—Healthier

Communities Through Design

2013

The High LineNYC

A 20 block walk in Manhattan

without a cross street–

and it was delightful even with a 2 year old.

NYC Active Design Guidelines

• Resilient Bldgs• Energy

Efficient Buildings

• Healthy Bldgs• Smart zoning

and locations

http://www.nyc.gov/html/ddc/html/design/active_design.shtml

Ten Principles

for Building Healthy Places

The Urban Land Institute 2013

Policy

Under current statute, the California general plan is presented as a collection of seven “elements,” or topic categories

• Required– Circulation– Housing– Conservation– Open Space– Noise– Safety – Air Quality

• “Optional”– Health – Equity – Community Development– Water– Resiliency – Others as communities request

or need. “Optional”

C

Every Chapter of the 2015 Draft California General Plan Has the Byline:

Designing Healthy, Equitable, Resilient and Economically

Vibrant Places

Caltrans Mission and VisionEffective 2014

Presenter

Presentation Notes

http://www.dot.ca.gov/hq/tpp/offices/ocp/docs/CSIAP2_rpt.pdf

CalTrans GoalsEffective 2014

“Relinquishment” of State Highway Jurisdiction in Downtown Urban Areas

Financing

Presenter

Presentation Notes

http://blogs.worldbank.org/climatechange/british-columbia-s-carbon-tax-shift-environmental-and-economic-success

British Columbia’s Carbon TaxRevenue Neutral by Law

• Implemented July 2008• Covers fuel use and carbon emissions. • 2008: $10 per tonne of carbon dioxide

– Increased by C$5 p/y. • In 2014 $30 per tonne ($0.26/gal)• "Revenue neutral" by law. • BC has cut $760 million income and other

taxes

Presenter

Presentation Notes

http://blogs.worldbank.org/climatechange/british-columbia-s-carbon-tax-shift-environmental-and-economic-success

Per capita consumption of Petroleum Products Subject to BC carbon Tax (% change)

2007-2012British Columbia down16.1%Rest of Canada up 3%

Happiness and Joy

CicLAvia Los Angeles April 2012

Indianapolis Cultural Trail

• 8 miles $69 million• First $15 million from Glick

family (start with philanthropy) • $2 million for Art• Links the city together• Revitalized Business• Helps to Recruit and Retain

Top Talent• And, yes, a GOP Mayor

Importance of Art and Beauty and Nature

Atlanta Beltline/Atlanta City Streetcar System PlanApproved by City Council Dec 8, 2015

A

• 50+ miles of street car lines

• 5 Cross town routes• 22 miles of Beltline

Corridor• “Atlanta is a city that brings

people together and connects them to opportunities,” said Councilmember Andre Dickens, ABI Board member and sponsor of the legislation.

http://beltline.org/2015/12/09/atlanta-beltline-receives-approval-for-the-first-long-range-public-transit-plan-for-the-city/

Westside Subway Extension

• “When built, the subway will provide a high-capacity, high-speed, dependable alternative for those traveling to LA’s “second downtown.” The area includes key job destinations such as Miracle Mile, Beverly Hills, Century City and Westwood including the UCLA campus. Over 300,000 people travel into the Westside every day for work from areas throughout the County.” http://www.metro.net/projects/westside/overview/

Alternative 5: Santa Monica Extension & West Hollywood Extension

Boyle Heights, Los Angeles. The Evolution into Mariachi Plaza

For Mariachi Plaza….”proposed eight-story medical office building and a six-level parking garage, plus a three-floor building with street-level retail would take out a small row of shops immediately north of the plaza…