building bridges: integrating building bridges: integrating the work of public health and the work of public health and

urban planningurban planning

Rajiv Bhatia, MD, MPHRajiv Bhatia, MD, MPH

San Francisco Department of Public San Francisco Department of Public HealthHealth

January 27January 27thth, 2005, 2005

What makes us healthy?What makes us healthy?

Annual Annual Health Health SpendingSpending

Life Life Expectancy Expectancy (years)(years)

OECD OECD AverageAverage

$2114$2114 77.277.2

United United StatesStates

$5267$5267 76.876.8

The fundamental conditions The fundamental conditions and resources for health are and resources for health are

peace, shelter, education, peace, shelter, education, food, income, a stable food, income, a stable

ecosystem, sustainable ecosystem, sustainable resources, social justice and resources, social justice and

equity. equity.

1986 WHO Ottawa Charter for 1986 WHO Ottawa Charter for Health PromotionHealth Promotion

Poor ventilation, mold, and rodents

Substandard construction and deferred maintenance

crowding

hunger

Dangerous streets

Worsening traffic and longer commutes

Poor food quality

No places for play

Declining moderate wage jobs and economic diversity

Limited access to Jobs, Health Care, and Friends and families

Asthma MapAsthma Map

RRxx: Healthy Planning: Healthy Planning

Connect problems and issuesConnect problems and issues Value local knowledge and experienceValue local knowledge and experience Apply public health research Apply public health research Develop inter-disciplinary partnershipsDevelop inter-disciplinary partnerships Build consensus / reduce conflictBuild consensus / reduce conflict Ensure accountabilityEnsure accountability

Health Impact AssessmentHealth Impact Assessment

DefinitionDefinition

Methods to account for the Methods to account for the effects of public policy decisions effects of public policy decisions on human health and well beingon human health and well being

Health Impact AssessmentHealth Impact AssessmentMultiple ApproachesMultiple Approaches

Integrating health Integrating health analysis into analysis into environmental review environmental review under CEQA and NEPAunder CEQA and NEPA

Promoting health Promoting health analysis through analysis through participatory research participatory research and community and community partnershipspartnerships

Implementing health Implementing health assessments as a assessments as a collaborative and collaborative and consensus building consensus building processprocess

Rincon Hill Area PlanRincon Hill Area Plan

Impact AnalysisImpact Analysis No school planningNo school planning Limited open spaceLimited open space Housing not Housing not

matched to matched to employment employment

Effects on Effects on residential residential segregation segregation

Rincon Hill Area PlanRincon Hill Area Plan

OutcomesOutcomes

Increased below Increased below market housingmarket housing

Support for on-site Support for on-site inclusionary housing inclusionary housing

Support for Support for reduction in parkingreduction in parking

Trinity Apartments Trinity Apartments RedevelopmentRedevelopment

Impact AnalysisImpact Analysis

Permanent Loss of Permanent Loss of low rent unitslow rent units

Displacement of Displacement of residentsresidents

Disruption of an Disruption of an established established communitycommunity

Trinity Apartments Trinity Apartments RedevelopmentRedevelopment

OutcomesOutcomes

EIR study of EIR study of displacement displacement impactsimpacts

Replacement units Replacement units for current for current residentsresidents

Eastern Neighborhoods Community Eastern Neighborhoods Community Health Impact AssessmentHealth Impact Assessment

Visions a healthy cityVisions a healthy city Identifies health Identifies health

objectives influenced objectives influenced by planning by planning

Predicts effects of Predicts effects of three neighborhood three neighborhood zoning planszoning plans

Proposes monitoring Proposes monitoring of the outcomes of of the outcomes of developmentdevelopment

Eastern Neighborhoods Community Eastern Neighborhoods Community Health Impact AssessmentHealth Impact Assessment

Builds on international Builds on international HIA approachesHIA approaches

Uses a consensus Uses a consensus building / deliberative building / deliberative model model

Participants include 40 Participants include 40 public and private public and private organizationsorganizations

Occurs in parallel to Occurs in parallel to environmental impact environmental impact assessmentassessment

HIA within PartnershipsHIA within Partnerships

Research on Research on displacement effectsdisplacement effects

Co-authoring a Co-authoring a community plancommunity plan

Training on EIR Training on EIR processprocess

Equity analysis of Equity analysis of transportation planstransportation plans

Critique of Level of Critique of Level of Service analysisService analysis

Major ObstaclesMajor Obstacles

New role for public health—training New role for public health—training needs, funding, political legitimacyneeds, funding, political legitimacy

Concerns about new processes, Concerns about new processes, agendas, analysis, and regulations on agendas, analysis, and regulations on developmentdevelopment

Competing development agendasCompeting development agendas Limited trust in collaborative Limited trust in collaborative

approachesapproaches

Overcoming ObstaclesOvercoming Obstacles

Framing land use as a public health Framing land use as a public health issueissue

Using multiple approachesUsing multiple approaches Building common agenda with Building common agenda with

community partnerscommunity partners Reaching out to developers and Reaching out to developers and

business interestsbusiness interests Supporting planners and their workSupporting planners and their work

Expected Outcomes Expected Outcomes

Public understanding of health and Public understanding of health and land use relationshipsland use relationships

New roles for public health in planningNew roles for public health in planning Broader community participationBroader community participation Support for comprehensive planningSupport for comprehensive planning Impacts on development decisionsImpacts on development decisions Impacts on decision-making practiceImpacts on decision-making practice

Lessons LearnedLessons Learned

Health, Sustainability, Smart Growth, Health, Sustainability, Smart Growth, Social Equity have the same Social Equity have the same requirementsrequirements

HIA: an invitation to a partyHIA: an invitation to a party Need for democratic, responsive, and Need for democratic, responsive, and

accountable institutionsaccountable institutions We are all in this together; methods We are all in this together; methods

need to reduce polarization of interestsneed to reduce polarization of interests

Health promotion works through Health promotion works through concrete and effective community concrete and effective community action in setting priorities, making action in setting priorities, making decisions, planning strategies and decisions, planning strategies and

implementing them to achieve implementing them to achieve better health. At the heart of this better health. At the heart of this process is the empowerment of process is the empowerment of

communities, their ownership and communities, their ownership and control of their own endeavors control of their own endeavors

and destinies.and destinies.

1986 WHO Ottawa Charter for Health 1986 WHO Ottawa Charter for Health PromotionPromotion

““..medicine is a social science, ..medicine is a social science, and politics is nothing but and politics is nothing but

medicine on a grand scale.” medicine on a grand scale.” --Virchow--Virchow