Intersections Health and the Built Environment

8/11/2019 Intersections Health and the Built Environment

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Health and the Built Environment


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Health and the Built Environment


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ii Intersections: Health and the Built Environment

About the Urban Land InstituteThe Urban Land Institute is a nonprot research and educationorganization whose mission is to provide leadership in the respon-sible use of land and in creating and sustaining thriving communitiesworldwide.

The Institute maintains a membership representing a broad spec-trum of interests and sponsors a wide variety of educational pro-grams and forums to encourage an open exchange of ideas andsharing of experience. ULI initiates research that anticipates emerg-ing land use trends and issues, provides advisory services, andpublishes a wide variety of materials to disseminate information onland use development.

Established in 1936, the Institute today has nearly 30,000 membersand associates from some 92 countries, representing the entirespectrum of the land use and development disciplines. Professionalsrepresented include developers, builders, property owners, inves-tors, architects, public ofcials, planners, real estate brokers, ap-praisers, attorneys, engineers, nanciers, academics, students, andlibrarians.

ULI relies heavily on the experience of its members. It is throughmember involvement and information resources that ULI has beenable to set standards of excellence in development practice. TheInstitute is recognized internationally as one of Americas most re-spected and widely quoted sources of objective information on urbanplanning, growth, and development.

2013 by the Urban Land InstitutePrinted in the United States of America. All rights reserved.

Recommended bibliographical listing:Urban Land Institute. Intersections: Health and the Built Environment . Washington, D.C.: Urban LandInstitute, 2013.

ISBN: 978-0-87420-282-3


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Intersections: Health and the Built Environment

About the Building Healthy Places InitiativeAround the world, communities face pressing health challenges re-lated to the built environment. For many years, ULI and its membershave been active players in discussions and projects that make thelink between human health and development; we know that health isa core component of thriving communities.

In January 2013, ULIs Board of Directors approved a focus on healthycommunities as a two-year cross-disciplinary theme for the organization.

Through the Building Healthy Places Initiative, ULI is leveraging thepower of its global networks to shape projects and places in waysthat improve the health of people and communities . The organiza-tion is focusing on four main areas of impact:

Awareness. Raise awareness of the connections between healthand the built environment in the real estate community, workingto ensure that health is a mainstream consideration.

Tools. Develop or share toolsincluding best practices, criteria,and other materialsthat dene and advance approaches tohealthy buildings, projects, and communities.

Value. Build understanding of the market and nonmarket factors

at play in building healthy places, and the value proposition ofbuilding and operating in health-promoting ways. Commitments. Gain commitments from members and others,

including local governments, to work, build, and operate in morehealth-promoting ways.

Learn more and connect: http://www.uli.org/health.

Share your story via Twitter: #ulihealth.

About This ReportIntersections: Health and the Built Environment explores the relation-ship between how healthy we are and the way our buildings andcommunities function. We can build our way to better health, it pro-poses, by changing our approach to cities, communities, and places.As real estate leaders and stewards of the built environment, we cando more to improve lives and foster healthy outcomes. And along theway, we can create places of enduring value.


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iv Intersections: Health and the Built Environment

ULI Senior Executives

Patrick PhillipsChief Executive Ofcer

Cheryl CumminsExecutive Ofcer

Michael TerseckChief Financial Ofcer/Chief Administrative

Ofcer

Joe MontgomeryChief Executive, Europe

David HowardExecutive Vice President, Development and

ULI Foundation

Kathleen CareyExecutive Vice President/Chief Content

Ofcer

Lela AgnewExecutive Vice President, Communications

Marilee UtterExecutive Vice President, District Councils

Principal Author

Kathleen McCormickFountainhead Communications LLCBoulder, Colorado

Contributing Authors

Rachel MacCleery

Senior Vice President, ContentSara HammerschmidtAssociate, Content

ULI Project Staff

Rachel MacCleerySenior Vice President, Content

Sara HammerschmidtAssociate, Content

Basil HallbergSenior Research Associate

Ed McMahonSenior Resident Fellow, Environment

Maureen McAveySenior Resident Fellow, Retail

Sarah Jo PetersonSenior Policy Director

James MulliganManaging Editor

Joanne PlattPublications Professionals LLCManuscript Editor

Betsy VanBuskirkCreative Director

Deanna PinedaMuse Advertising DesignGraphic Designer

Craig ChapmanSenior DirectorPublishing Operations


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Cover LetterDear Reader,

The built environment is part of the health problem. But it is also part of the solution.

That is the main message of Intersections: Health and the Built Environment , an important newreport from ULI. As the world grapples with a host of health problemsincluding the growingtoll of chronic disease, air and water pollution, and surging health care costswe, the de-

velopers, builders, designers, and nanciers of the built environment, are being looked to forsolutions.

We know a lot about how to craft cities, communities, and projects that help foster healthieroutcomes for people. Opportunities for active transportation, accessible and attractive stair-cases, proximity to nature and transitall have been shown to improve health. And by re-sponding to market demands, healthy places also help generate economic value. We knowthat health is a core component of thriving communities.

But there is still a lot we can learn. And when it comes to public health, there are many un-tapped opportunities to do more. That is why ULI has launched the Building Healthy PlacesInitiative, which will leverage the power of ULIs global networks to shape projects and placesin ways that improve the health of people and communities.

Over the course of the initiative, public health topics will be threaded through ULIs conven-ings, publications, research, partnerships, and conversations. We will be sharing stories aboutinnovative projects and approaches, learning from each other and from experts in the eld,and seeking to advance understanding of what works when it comes to health.

We can build our way to better health. ULI members are in the business of improving theplaces in which we live our lives. Through a better understanding of the complex health chal-lenges we face, and through putting our knowledge into practice in the decisions we make asstewards of the built environment, we can promote healthone project, and one community,at a time.

Lynn ThurberUrban Land Institute Chairman

Patrick PhillipsUrban Land Institute Chief Executive Ofcer


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vi Contents

Contents

Chapter 1: We Can Build Our Way to Better Health. . . . . . . . . . . . . . . . . . . . . . . . 2ULI Leadership for Healthy Places . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5U.S. Health Trends: Troubling Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Health and Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8The Healthy Place Opportunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter 2: Moving in the Wrong Direction? Global Healt . . . . . . 12The Rise of Chronic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Trends Inuencing Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16A Path Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 3: Better Health through Community Design . . . . . . . . . . . . . . . . . . . 24Smart Growth: Building toward Health and Saving Money . . . . . . . . . . . . . . . . . . . . . . . . . . 26

The Power of Parks and Trails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Aging in Place: It Never Gets Old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Schools (Too Far) Out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Chapter 4: Active Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Transportation That Gets Us Moving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Complete Streets: A Safe Bet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Shared Cars and Car-Free Zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Slimming Down Parking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Chapter 5: Healthy Buildings, Healthy People. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Location Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Greener, Healthier Buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Designing for Active Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Reworking Workplaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Healthy Learning Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Health Care Facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55


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Chapter 6: Access to Healthy Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Crossing the Food Desert: Grocer y Stores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Urban Agriculture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Chapter 7: Clear Air, Clean Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64Air Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Water for Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Green Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Adding It All Up: Elements of Healthy Development. . . . . . . . . . . . . . . . . . . . . 74


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viii Contents

Information BoxesProjects That Work for Health

Via Verde, South Bronx, New York . . . . . . . . . . . . . . .9Hear tlands, Cornwall, England . . . . . . . . . . . . . . . . . 17Mueller, Austin, Texas . . . . . . . . . . . . . . . . . . . . . . . . 25Mariposa, Denver, Colorado . . . . . . . . . . . . . . . . . . . 28The Uptown, Oakland, California . . . . . . . . . . . . . . . 38HGST Campus, San Jose, California. . . . . . . . . . . . . 44The Bullitt Center, Seattle, Washington . . . . . . . . . 49Googleplex, Mountain View, California . . . . . . . . . . 54Alder Hey Childrens Health Park,Liverpool, England . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Union Market, Washington, D.C. . . . . . . . . . . . . . . . . 60Willowsford, Loudoun County, Virginia. . . . . . . . . . . 61Silver City Townhomes, Milwaukee, Wisconsin . . . 73Public Utilities Commission Headquarters,San Francisco, California. . . . . . . . . . . . . . . . . . . . . . 73

Innovations in HealthU.S. Cities Invest in Infrastructure for Health . . . . . . 4Colorado Health Foundation andColorado Communities . . . . . . . . . . . . . . . . . . . . . . . . 7Upwardly Mobile Medelln, Colombia. . . . . . . . . . . . 13Augustenborg EcoDistrict, Malm, Sweden . . . . . . 23ULIs Ten Principles for Building Healthy Places . . 27Being Intentional about Health Outcomes . . . . . . . . 29Blue Zones Project, Albert Lea, Minnesota. . . . . . . 29International Development Banks:$175 Billion for Active Transportation . . . . . . . . . . . 35Active Design Guidelines for Communities . . . . . . . 37

Protected Two-Way Bike Lanes in Chicago, Illinois 39Biking in Copenhagen, Portland, and Hangzhou. . . 40Global Programs for Sustainable and HealthyBuildings and Communities. . . . . . . . . . . . . . . . . . . . 48Active Design Guidelines for Buildings. . . . . . . . . . . 52Urban Farming, Detroit, Michigan . . . . . . . . . . . . . . 57

Fresh Food Retailer Initiative,New Orleans, Louisiana . . . . . . . . . . . . . . . . . . . . . . . 59Healthy Food Chain, Boulder, Colorado . . . . . . . . . . 60Urban Gardens, Cape Town, South Africa . . . . . . . . 63Clearing the Air in Mexico City, Mexico. . . . . . . . . . .68Community Sanitation Blocks, Mumbai, India. . . . . 69Watershed Management Group and TucsonsGreen Streets Policy. . . . . . . . . . . . . . . . . . . . . . . . . . 71

Insights from the Experts

Jonathan Rose, President, Jonathan RoseCompanies LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Dr. Richard Jackson, Chair, Departmentof Environmental Health Sciences, University ofCalifornia, Los Angeles . . . . . . . . . . . . . . . . . . . . . . . 33Bert Gregory, Chairman and CEO, Mithun . . . . . . . . 51Simon Ng, Head of Transport and SustainabilityResearch, Civic Exchange, Hong Kong. . . . . . . . . . . 67


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AcronymsAPTA American Public Transportation AssociationBREEAM Building Research Establishment Environmental Assessment MethodBRT bus rapid transitCSA community-supported agricultureCSO combined sewer overowEPA Environmental Protection AgencyGDP gross domestic product

HDMT Healthy Development Measurement ToolHIA Health Impact AssessmentLEED Leadership in Energy and Environmental DesignLEED-ND Leadership in Energy and Environmental Design for Neighborhood DevelopmentMDB multilateral development bankSTAR Sustainability Tools for Assessing and RatingVMT vehicle miles traveledVOC volatile organic compound


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2 Chapter 1: We Can Build Our Way to Better Health

We Can Build Our Way to Better Health1 C H A P T E R

Children play soccer on a eld adjacent to the ViaVerde housing complex in the South Bronx, New York.(Jonathan Rose Companies)


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In the 21st century, as the world meets the demands of population growth,increasing urban development, and climate change, we face new challengesin public health. Public health is no longer solely the business of health profes-sionals: public ofcials, urban planners, transportation decision makers, archi-tects, landscape architects, builders, and real estate developers all have a roleto play in addressing public health challenges.

What Is a Healthy Place?ULI believes that healthy places are designed,built, and programmed to support the physi-cal, mental, and social well-being of thepeople who live, work, learn, and visit there.

Healthy places

offer healthy and affordable housing op-tions, and a variety of safe, comfortable,and convenient transportation choices;

provide access to healthy foods, the naturalenvironment, and other amenities thatallow people to reach their full potential;

are designed thoughtfully, with an eye tomaking the healthy choice the easy choice,and they are built using health-promotingmaterials; and

address unique community issues withinnovative and sustainable solutions.

Many of todays health challenges are

driven by chronic or lifestyle diseases,including cardiovascular and respiratorydiseases, type 2 diabetes, and cancer. Thesediseases now cause nearly two-thirds ofdeaths worldwide each year. By 2030, chronicdiseases will cause 52 million global deathsper year, nearly ve times the number ofdeaths from communicable diseases.

Epidemic rates of chronic disease havebecome a drag on the economies and futuresof families, communities, nations, and wholeregions. The growing cost of health care is a

global megatrend that is making us rethink

land use and transportation patterns. Healthis becoming a competitive advantage or dis-advantage for cities.

With this shift, market opportunities areemerging to change the way we design andbuild so that we support healthy living andvibrant economies. Like demographics, op-portunities to be healthy are inuencing whatpeople want in their homes, workplaces,schools, public spaces, and communities.People care about their health. So what doesthat add up to for real estate?

Benches on the Calligraphy Greenway in Taichung,Taiwan, provide respite for visitors. (AECOM)

Health is a state of complete physical,mental, and social well-being and notmerely the absence of disease or inrmity.World Health Organization


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Health presents a market opportunity forforward-thinking developers and real estateleaders, and the market presents an oppor-tunity to help shape communities in health-promoting ways.

Research points to how buildings, roads,and neighborhood design affect human health.When devising strategies for the built environ-ment to improve health, we can also draw

from decades of work on smart growthmanysmart-growth approaches for the design, con-struction, management, and programming ofcommunities also work for health.

ULI Leadership forHealthy PlacesFor many years, ULI and its members havebeen active players in discussions and projectsthat make the link between human health and

development; we know that health is a corecomponent of thriving communities. Throughthe Building Healthy Places Initiative, ULI isleveraging the power of its global networks toshape projects and places in ways that im-prove the health of people and communities.

Professionals involved in land use have apowerful role to play in creating healthy places.ULI members can lead in building healthierenvironments in the following ways:

Through their organizations, by followingprinciples of planning, design, and construc-tion that incorporate healthy and sustainablepractices, and by setting an example withhealthy work environments and policies that

encourage tness and healthy eating; As a fundamental consideration in de-

velopment projects, by incorporatingelements that enhance health and the en-vironment, such as selecting developmentsites with public transit access; buildingin compact ways, including amenitiesthat promote healthy lifestyles; and usinghealthy building materials; and

Through their inuence on policy, by work-ing with local and national governments, re-gional transportation agencies, foundations

and community groups, and business, healthcare, education, and civic leaders to createland use, zoning, and building frameworksthat are conducive to healthy lives.

The good news is that the real estateindustry is getting on board. A summer 2013

ULI Members Agree That Health and the Built Environment Are LinkedResponses to ULI member survey conducted in July 2013

Strongly disagree

Disagree

Agree

Strongly agree

Human health and thebuilt environment areinextricably linked.

The real estate industry hasan important role to play in effortsto promote health and wellness.

The degree to which a project or placesupports health and wellness can affectits market success and/or economic value.

1%8%

56%36%

1%4%

49%47%

1%4%35%

60%

Source: Urban Land Institute.


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survey of ULI members found that the major-ity understand linkages between health andthe built environment; 96 percent stronglyagreed that the real estate industry has animportant role to play.

U.S. Health Trends:Troubling DirectionsThe bad news is that major health trends inthe U.S. are heading in the wrong direction,despite recent encouraging signs, includingmodest improvements in childrens weight andactivity levels. In the United States, a huge andgrowing portion of wealth and economic activ-

BY THE NUMBERS

Percentage of U.S. healthexpenditures attributed totreating chronic disease

Annual cost of the U.S. obesity epidemic

Annual U.S. health care costs related toobesity that could be saved if one in tenadults started a walking program

Projected percentageof U.S. GDP that will

be spent on healthcare by 2020, up from 7.2% in 1970

$147 billion

$5.6 billion19.2 %

75%

Sources: U.S. Centers for Disease Control and Prevention;U.S. Centers for Medicare & Medicaid Services; Alliance forBiking and Walking.

The High Costs of Poor Health in tUnited States

U.S. Obesity Rates Increased Dramatically between 1990and 2010Obesity trends among U.S. adults

No data


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Health Care Expenditures Are Claiming a Larger and Larger Share of U.S. GDPU.S. national health expenditures as a percentage of gross domestic product, by decade

0%

5%

10%

15%

20%

2020(PROJECTED)

201020001990198019701960

5%

7%

13%

18%

14%

9%

19%

Source: U.S. Centers for Medicare & Medicaid Services, Ofce of the Actuary.Note: The projection for 2020 includes impacts of the Affordable Care Act.

INNOVATIONS IN HE ALTH

Colorado Health Foundation andColorado CommunitiesColorado is a magnet for millennials and others drawn by the naturalenvironment and active lifestyle, which in turn produce economicbenets for the state: bicycling, for example, pumps over $1 billioninto state coffers.

In 2009, however, Colorado spent $1.6 billion treating conditionsrelated to obesity. Reecting rising obesity rates across the nation,some 21 percent of Colorados adults and 14 percent of its childrenare obese.

The Colorado Health Foundation, supported by a $2.2 billionendowment, is trying to reverse this trend to make Colorado thehealthiest state in the nation. The foundation supports projects suchas Mariposa, a healthy affordable-housing community in Denver.

To reinforce the connection between a healthy built environmentand economic development, the foundation partnered with ULI toconduct Advisory Services panels in three Colorado communities, therst step in an extended engagement process between the foundationand the communities aimed at increasing physical activity and foster-ing healthy outcomes among residents.

The Advisory Ser vices panels in Colorado recommended strategiesto foster act ive living in three communities.

ity is directed toward treating disease. Theseexpenses have the potential to squeeze outspending on more productive endeavors.

Here are some disturbing U.S. statistics: Health care expendituresa projected $3

trillion in 2014will consume 19 percentof the nations gross domestic product by2020, according to federal projections.

Three-quarters of U.S. health care spend-

ing goes toward treating chronic diseases. Health care will require an investment

of over $9,000 per person in 2014, morethan any other country. The lives of U.S.residents, however, are nearly ve yearsshorter than what would be expected withsuch a high level of expenditure.

The U.S. adult obesity rate, now affectingone in three adults, could reach 43 percentby 2018, generating $344 billion annually inhealth care costs related to type 2 diabe-tes, hypertension, and related diseases.

Can we turn the tide on these troublinghealth trends? It will be a daunting task. Butthe success of the U.S. campaign againsttobacco over the past four decadessmokinghas declined in use from 37 percent of adultsto 19 percentinspires those working to bendthe arc of U.S. health trends.


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To work, efforts must be comprehen-sive and must focus not just on health caredelivery but on all the forces shaping health,including the built environment.

Health and IncomeHousehold income levels, educational attain-ment, and race are important factors in the

health picture. Although the built environ-ment is not the whole story here, it is part ofthe story. Higher incomes can translate intobetter access to nutritious food, safe neigh-borhoods, recreational opportunities, andother elements of healthy lifestyles.

Life expectancy, infant mortality, childand adult health, and other indicators areall affected by income, education, and racialbackground. Efforts to ensure that all peoplelive in health-promoting communities, withaccess to healthy food, safe streets, high-quality parks, and stable and healthy housing,as well as pursuit of other strategies dis-cussed in this report, can help address andalleviate these disparities.

Health Outcomes Vary across Income Levels and by Racial and Ethnic GPercentage of U.S. adults in poor or fair health (age-adjusted)

Family income (percentage of federal poverty level) Racial or ethnic group

30.9%

21.2%

14.0%

10.1%

20.8%

19.2%

11.4%

6.6%

WHITE,NON-HISPANIC

HISPANICBLACK,NON-HISPANIC

0%

8%

16%

24%

32%

> 400300399200299100199


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PROJECTS THAT WORK FOR HEA LTH

Via Verde, South Bronx, New York Jonathan Rose Companies LLC, a New Yorkbased multidisciplinaryplanning and development rm, is noted for holistic projects that em-body aspects of healthy living. A recent project, Via Verde/The GreenWay, won the New Housing New York Legacy Competition and ULIsJack Kemp Workforce Housing Models of Excellence Award.

The $98 million Via Verde, codeveloped with Phipps Houses anddesigned by the partnership of Dattner Architects and Grimshaw,features 294,000 square feet of mixed-use construction on 1.5 acresclose to transit. Completed in 2012, the project has 222 mixed-income rental and co-op residential units, 7,500 square feet of retailand community facility space, and 40,000 square feet of green roofsand open space.

At its heart is a garden that serves as the organizing element andspiritual identity for the community. The green roofs and open space,located on connected low-rise townhomes, a mid-rise duplex build-ing, and a 20-story tower, are used to harvest rainwater and growfruits and vegetables. The LEED Gold project features other healthyliving amenities, such as open-air courtyards, a health education and

wellness center, a community medical clinic, a tness center, andbicycle storage.

Rooftop vegetable gardens can be found at the Via Verde housing complex inthe South Bronx, New York. (Jonathan Rose Companies)

The Built Environment and Physical Activity

BY THE NUMBERS

Percentage of theU.S. workforce that isoverweight or obese

Increased likelihood thatpeople who live near trailsmeet physical activityguidelines

Increased likelihood thatpeople who live in neigh-borhoods with sidewalksget at least 30 minutes ofexercise per day

67%

50%47%

Sources: Public Health Institute; Active Living Research.

The courtyard at the Station Center housing complex inUnion City, California, includes community gardens anda play area. (Bruce Damonte)


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INSIGHTS FROM THE EXPERTS

Jonathan Rose, President, Jonathan RoseCompanies LLC

Jonathan F.P. Rose, president ofJonathan Rose Companies LLC, hasbuilt a reputation for thinking outsidethe box to develop holistic projects thatembody principles of diversity, environ-mental responsibility, livelihood, andinterdependence.

Q: What are the key elements of a healthycommunity?

A: A healthy community begins withhousing, which is the platform for physi-cal, cognitive, and social health. But wealso need to recognize that a communityis more than a buildingit includes itscontext. Communities of opportunityinclude both the physical and social

infrastructure for well-being, including mul-tiple transportation options; safe, affordable,healthy, and green housing; affordable healthyfood; access to health care, jobs, education andtraining, and social and physical connections;and culture. Enterprise Community Partners

has advanced these principles forlow-income communities, but theyreally apply to all communitiesurban, subur-ban, ruraland at all economic levels.

Q: What specically can ULI members do to improve the health of the built environment?

A: They can start by building healthier, greener,more diverse communities in the right loca-tions: connected places served by existing in-frastructure and community resources. Humanhealth is dependent on a healthy natural envi-ronment, and so its essential that we reducethe environmental impact of development. If wedont, the outcome is the extraordinary pollutionevident in cities such as Guangzhou and Beijing.The internal environment of our buildings mustalso be healthy, with clean fresh air, daylight,healthy building materials, and reduced energyconsumption. Taken together, making build-ings and citywide environments healthier willimprove well-being.

Q: What should ULI members consider aboutreturn on investment for healthy communities?

A: In our experience, green, walkable, mixed-income, mixed-use communities like HighlandsGarden Village in Denver are increasingly whatthe market is looking for. Projects that fail toaddress these market drivers are more likelyto underperform. Were seeing emerging newstandards of best practice for green and healthyprojects. In our experience, healthier communi-ties have lower turnover and higher occupancy.Many of these strategies do not cost more, but just take more time to think through, usingintegrated design and planning. They may costmore on the infrastructure side, but that isbalanced by cost savings in social services andhealth care.

In our experience, green, walk-able, mixed-income, mixed-usecommunities like HighlandsGarden Village in Denver areincreasingly what the market islooking for.Jonathan Rose


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The Healthy PlaceOpportunityThinking about the relationship betweenhealth and the built environment is not new.In the 19th and 20th centuries, architectsand planners in London, New York, and Paris joined with public health professionals and

social reformers to reduce infectious dis-eases by designing buildings, streets, parks,neighborhoods, and clean water systems toimprove health.

Now, the built environment is once againan important part of the solution to todayspublic health crisis. ULI members are helpingcreate active, green, and sustainable environ-ments that are healthy for people and thatadd value to real estate.

As the ULI member survey shows, manyULI members understand that the design

and programming of a neighborhood orbuilding affect both its health and its value .Demographic trends, including the preferen-ces of millennials, baby boomers, and othergroups, are driving real estate practice.

Projects and communities that can re-spond to growing market demands for trans-portation that supports active lifestyles, forhousing types that allow people to age inplace, and for a mix of uses and other ele-ments that promote health will see their valueendure over time.

Meeting the demand for healthy living willrequire new development features, as wellas investment in strategies that have provenreturns, like parks. What are the emergingopportunities to meet the needs and desiresof the marketplace and improve health at thesame time? Savvy developers, planners, andcommunities will be paying attention.

The new Amazon headquarters in Seattle includesrain gardens, a green roof, and an exterior green wall.(Benjamin Benschneider)


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12 Chapter 2: Moving in the Wrong Direction? Global Health Trends

2 C H A P T E R

Moving in the Wrong DirGlobal Health Trends

Raised wooden boardwalks through wetland pondsin Nanhu Eco-City Central Park in Tangshan, China,increase interactions with plants and wildlife. (BeijingTsinghua Tongheng Urban Planning & Design Institute)


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Human health is affected by many factors, such as the foods we eat, the airwe breathe, the water we drink, and whether we can walk or bike to work orschool. Health is also inuenced by such factors as human choice and behavior,as well as genetics, access to health care, transportation, housing, education,income, and whether the environment is safe and promotes health.

Half the worlds population now lives incities. And although urbanization is gener-

ally associated with increasing prosperityand good health, rapid migration from ruralareas and enormous population growth areputting more pressure on infrastructurefor food, water, housing, health care, openspace, and other elements that contribute tohealthy environments.


Upwardly Mobile Medelln, ColombiaIn 2012, Medelln was recognized for having one of the best trans-portation systems in the world by the Institute for Transportation andDevelopment Policy, a global consortium for sustainable transporta-tion. The city has come a long way in the 20 years since it was brandedthe murder capital of the world.

A major driver of Medellns transformation has been an innovativetransportation system that provides access to jobs, educational op-portunities, and civic and recreational spaces for residents living in thecitys poor hillside favelas , or slums.

The centerpiece is Metro de

Medelln, a network of clean efcienttrain cars that serves over 500,000passengers daily. Financed by apublic/private partnership, the tran-sit network includes cable cars anda 1,263-foot outdoor escalator thatcarry favela residents up and downthe steep hillsides, saving hoursof travel time to reach jobs, healthcare, schools, and services.

The metros transit hubs havespurred new investment in infra-structure, services, and ameni-

ties, such as hospitals and policestations, many integrated into themetro infrastructure. The transitsystem benets from new connec-tions with new public green spacesand pedestrian routes, a publicbike-share program linked to uni-versities, and a r ideshare/carpoolprogram involving more than 170institutions.

Medelln, Colombias cable car system, opened in 2010,has revolutionized access and mobility for the cityspoorest residents. (Jess Zimbabwe)


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Health impacts from the design of thebuilt environment are a global concern. Manyhealth challenges are directly related totransportation choices, land use patterns,infrastructure, and accessibility. And manyopportunities exist to shift our approaches todesigning and developing buildings, neighbor-hoods, and infrastructure to reverse chronicdisease trends and improve public health.

The Rise of ChronicDiseaseCertain chronic diseases that used to affectonly wealthier populations in the developedworld are spreading to countries undergo-ing rapid urban development and the lifestyle

BY THE NUMBERS

Average percentageof GDP spent onhealth by EuropeanUnion countries

Percentage of Chinas

GDP spent on healthcosts attributed to airand water pollution

Number of livesthat by 2030will be claimed

each year by chronic disease globally

Estimated national income India willforgo between 2005 and 2010 becauseof premature deaths caused by heartdisease, stroke, and diabetes

4.3%

52 million

$240 billion9%

Sources: World Bank; Organization for Economic Cooperationand Development and European Commission; World HealthOrganization.

The High Costs of Poor Health

Grass and wooden decking at the Marco Polo Terraces, a new public open space at the HafenCity development inHamburg, Germany, invites visitors to stop and rest. (Thomas Hampel/Elbe & Flut)


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changes that go with it. Chronic diseasesnow outpace infectious diseases in everyglobal region except Africa, where rates arealso rising. These diseases are responsiblefor two-thirds of deaths worldwide. By 2030,chronic disease rates will increase by nearly50 percent, claiming the lives of 52 millionpeople. Ischemic heart disease, caused inpart by high cholesterol and diabetes, is the

number one cause of death worldwide.Global populations are also aging as aresult of public health efforts to curb in-fectious diseases. Urban populations facegrowing environmental threats and changinglifestyle patterns, such as physical inactivityand unhealthy habits related to food, alcohol,and tobacco.

The High Impact of Chronic Disease

BY THE NUMBERS

Increase in theprevalence of obesityin Europe sincethe 1980s

Share of deaths worldwidecaused by chronic diseases

Share of U.S. adults whoare obesethe highestrate of obesity in the world

Projected number of people with diabetesworldwide by 2030; 8 0% are projected tobe living in developing countries

2in3

366 million300%

1in3Sources: World Health Organization; Global Health PolicyCenter at the Center for Strategic and International Studies;U.S. Centers for Disease Control and Prevention.

The Wilmington Waterfront Park near the Port of Los Angeles, California, provides a venue for soccer games. Howto reconcile the impacts of ports with health is a global challenge. (Sasaki Associates)


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Today, for example, obesity affects onein ten adults globally and one in three adultsin the United States. High obesity rates arelinked to chronic and often lethal conditions,

including coronary heart disease, type 2 dia-betes, and certain cancers. Obesity is causedby lifestyle factors, such as the consumptionof unhealthy or excessive amounts of foodand a lack of activity.

Global obesity rates have doubled since1980. In the United States, obesity rates havealso increased dramatically: in 1990, no statehad an obesity rate greater than 15 percent,but by 2010, 12 states had obesity ratesgreater than 30 percent, and none had ratesof less than 20 percent.

Trends InuencingHealthMany trends and factors are inuencinghealth globally.

Population Growth/Urbanization. Globalpopulation is expected to increase from7 billion today to over 9 billion in 2050. In

emerging countries such as China and India,rapidly growing populations are increas-ing pressures on the natural resources thatsupply energy, food, and water. By 2050, over

70 percent of the worlds population willlive in cities, according to the World HealthOrganization.

Aging. Over one-quarter of the populationin the 34 member nations of the Organizationfor Economic Cooperation and Developmentwill be over 65 years old in 2050, comparedwith 15 percent today. Japan has increasedaverage life expectancy to 84 years, andnearly one-quarter of its population is alreadyover 65. Countries including Germany, Italy,and Greece are not far behind. In the United

States, the 65-plus population is expected todouble to nearly 72 million by 2030.

Environment. Global greenhouse gasemissions are projected to increase by 50percent between 2005 and 2025, mostly fromenergy-related carbon dioxide emissions.Urban air pollution will likely become the topenvironmental cause of death worldwide by2050; by then, natural-land biodiversity isexpected to decrease by 10 percent.

The World Is Becoming Increasingly UrbanUrbanization rates

P e r c e n

t a g e o

f u r

b a n p o p u

l a t i o n

0%

20%

40%

60%

80%

100%

AFRICA

203020001950

ASIA

203020001950

LATIN AMERICAAND THE CARIBBEAN

203020001950

MORE DEVELOPEDREGIONS

203020001950

WORLD

203020001950

15%

33%

55%

17%

37%

53%

41%

75%

83%

55%

76%

84%

30%

47%

60%

Source: United Nations.


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PROJECTS TH AT WORK FOR HEALTH

Heartlands, Cornwall, EnglandHeartlands is a 35 million ($55 million) redeveloped mixed-use residential arts community located in the village of Pool inCornwall. Focused on healthy living through redevelopment,investment, and sustainable design, the 18.5-acre site includesnew artist studios, apartments, a community hall, conference

facilities, a caf/restaurant/bar, and retail shops.In 2007, the local council won a lottery to develop a low-carbon

urban community around a defunct historic mine. An integrateddesign team led by U.K.-based Buro Happold Ltd engineers withStride Treglown architects restored the granite mine buildingsand turned them into a visitor attraction about the history ofCornish tin mining. Completed in 2011, the award-winning projecthas become a catalyst for economic development, producing over75 local jobs and attracting more than 240,000 visitors within therst year.

The community now enjoys active public spacesa villagegreen, market squares, childrens play areas, and eventsarenasas well as footpaths and bike trails that lead through

gardens and green spaces to the countryside.

Climate Change. Climate changetriggered sea level rise and extreme weatherevents are leading to new patterns of migra-tion and growth and could have a signicantimpact on economic development, food pro-duction, air quality, water supply and quality,sanitation systems, and housing. Buildingswill need greater resiliency in the face of ris-ing temperatures, wind and water forces, and

power failures.Lifestyle. Diet and exercise are twomajor determinants of health. Improvingdiets through access to affordable healthyfood and feeding a growing population willrequire expansion of agricultural production,which will increase competition for land.Inactivity, a major factor in obesity, stemsfrom excessive time spent in cars and infront of computers, televisions, and digitalmedia. In Europe, for example, where esti-mates show that physical inactivity causes

1 million deaths annually, only a third of theadult and youth populations are active 30minutes per day.

Heartlands has trans-formed a neglectedsection of Cornwall,England, into a touristdestination, with exspace for artists andmixed-income residen-ces. (David Clapp)


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D e a

t h s p

e r

1 0 0

, 0 0 0 p e o p

l e

0

4080

120

160

200

240

TuberculosisDiabetesRoadinjury

Diarrhealdiseases

HIV/AIDSLungcancer

Lowerrespiratoryinfections

Chronicobstructivepulmonarydisease(COPD)

StrokeIschemicheart

disease

102.085.3

42.1 40.822.2 21.3 21.0 17.419.3 18.6

GlobalLife expectancy Per capita spending

on healthPercentage of GDP

spent on health

70 $952 10.1%

KEY:

0

40

80

120

160

200

240


Diarrhealdiseases

HIV/AIDSLungcancer


COPDStrokeIschemicheart

disease

69.5

33.2 21.5 19.27.3 4.3 4.1

17.73.0

47.7

Mexico77 | $620 | 6.2%

0

40

80

120

160

200

240

TuDiabetesRoadinjury

Diarrhealdiseases

HIV/AIDSLungcancer



disease

121.0

74.4

24.2 31.7 47.4

1.5 4.2 8.8 19.6

France82 | $4,952 | 11.6%

0

40

80

120

160

200

240


Diarrhealdiseases

HIV/AIDSLungcancer



disease

169.2

57.4 39.225.3

58.0

2.0 1.6 0.58.9 26.6

Canada81 | $5,630 | 11.2%

0

40

80

120

160

200

240


Diarrhealdiseases

HIV/AIDSLungcancer



disease

178.7

96.4

53.0 65.5 59.6

0.5 4.3 6.011.0

United Kingdom81 | $3,609 | 9.3%

Noncommunicable, Chronic Diseases Are Leading Causes of Death GloballyData on the Top Ten Global Causes of Death and Other Health Statistics for Selected Countries and Regi

0

40

80120

160

200

240

183.7

56.2 50.427.9

53.3

3.9 3.1 14.4 0.4

28.1


Diarrhealdiseases

HIV/AIDSLungcancer



disease

United States79 | $8,608 | 17.9%

0

40

80120

160

200

240


Diarrhealdiseases

HIV/AIDSLungcancer



disease

140.6

96.4

41.928.4

43.1

2.4 1.5 8.925.1

Spain82 | $3,027 | 9.4%


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Key Global Health Statistics

Obesity

Percentage of adults who are obese(body mass index>30kg/m

2) Age standardized, 2008

_30

Data not available or not applicable

Source: World Health Organi zation, 2011.

Diabetes

Percentage of adults with diabetes Age standardized, 2012

1.78.8

8.915.9

16.023.1

23.230.2

30.337.3


Source: International Diabetes Federation, IDF Diabetes Atlas , 5th edition (Brussels , Belgium: International Diabetes Federation, 2011).


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Deaths from Road Injury

Road traffic deaths per 100,000 people2010

>_10

10.12020.130

30.140

40.170


Source: World Health Organization, 2013.

Drinking Water

Percentage of population with accessto improved drinking water sources2011

90


Source: World Health Organization, 2011.


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Water/Sanitary Waste. Global freshwa-ter demand is projected to increase by 55percent between 2000 and 2050 as consump-tion by manufacturing industries, thermalpower plants, and domestic use increases.Competing demands will put water use byfarmers at risk. More than 240 million peopleglobally will lack access to clean water by2050, with 1.4 billion people needing basic

sanitary waste systems.Road Accidents. Road trafc injuries werethe eighth leading cause of death in 2010 andare projected to become the fth leadingcause of death by 2030, with low- and middle-income countries bearing a greater burden.Though these countries account for approxi-mately half of the worlds vehicles, they makeup over 90 percent of road fatalities.

Flooding in Hoboken, New Jersey, in the aftermath of Hurricane Sandy affectedwater supplies and other infrastruc ture.

Road injuries are the eighth leading cause of death globally. Investments in transportation should improve safetyfor drivers, pedestrians, and other users of road and transit networks.


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Augustenborg EcoDistrict, Malm, SwedenThe Augustenborg EcoDistrict is an urban community of 3,000 resi-dents that was redeveloped in the late 1990s with green infrastruc-ture, transportation options, and energy-saving measures. Together,these investments have enhanced both the environmental sustainabil-ity and health of residents.

Investments in Augustenborg included open space, increasedwaste recycling, and improved stormwater retention. New trans-portation optionsincluding pedestrian and bike infrastructure, twoelectric trains, and a carpool system with electric vehicles and carsfueled by ethanol and biogasadded opportunities for active mobilityand reduced energy use.

The project has helped boost local pride and civic engagementand launch new local businesses, generating jobs. EcoDistricts likeAugustenborg show how communities can make intentional decisionsto redevelop in healthier, more sustainable ways.

A Path ForwardThe built environment is part of the problem,but it can also be part of the solution.

To meet current health challenges, coun-tries will need the following:

Careful land planning and urban design; Infrastructure investments and expan-

sions that provide safe, healthy, sustain-

able places for people; Greener buildings to provide healthier

interiors and reduce the use of naturalresources, such as energy and water;

Safer streets and highways, and publictransportation systems with infrastruc-ture for walking, biking, and other activetransportation modes;

Healthier diets supported by local agricul-ture and better food supplyand distribution systems;and

Cleaner energy sources tocombat increasing air pollu-tion, and adequate suppliesof clean water, especially inemerging countries.

The open stormwater managementsystem in the Augustenborg districtof Malm, Sweden, helps alleviate thecitys ooding. (Scandinavian Green RoofInstitute)


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3 C H A P T E R

Better Health throughCommunity Design

The High Line park on Manhattans west side, whichopened in 2009, was built on a historic freight rail lineelevated above the streets. (Iwan Baan)


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Designing a healthy communitywith new development, redevelopment, orincremental inllbegins with an understanding of how community designcontributes to health.

The Robert Wood Johnson Foundationnotes that physical features, social relation-ships, and available services and opportuni-ties within neighborhoods inuence healthin important ways, including by shaping

choices and behaviors. Community wellnessand safety are inuenced by neighborhoodfactors, such as access to transportation, thecondition of buildings, the presence and qual-ity of sidewalks and places to play or exercise,and the density of convenience stores, liquorstores, and fast-food restaurants relative togrocery stores that sell fresh foods.

Comprehensive community planningpresents an opportunity for planners, de-velopers, and residents to address healththrough zoning ordinances, design guidelines,and capital improvements. Healthy com-munity changes to comprehensive plans canbe addressed through amendments, revisedcodes or ordinances, overlay health plans,and stand-alone health-promoting policies.

Healthy places are communities thatare developed, designed, and built to promote good health.U.S. Centers for Disease Control and Prevention

PROJECTS TH AT WORK FOR HEALTH

Mueller, Austin, TexasElements such as sidewalks, parks, open space, bike routes, andalleys, along with diverse uses and destinations, support morephysical and social activity, according to preliminary results from astudy of the health impacts of walkable communities. The study wasconducted at Mueller, a community with a plan that received Silvercertication under the U.S. Green Building Councils Leadership inEnergy and Environmental Design for Neighborhood Development(LEED-ND) program.

With an estimated 13,000 residents and 13,000 employees atcompletion, Mueller is being redeveloped by Catellus DevelopmentCorporation in a joint project with the city of Austin on the site of the

former Robert Mueller Municipal Airport.The Texas A&M University study sponsored by

the American Institute of Architects asked resi-dents to compare their activity levels at Muellerwith their previous activity levels. Nearly three outof four residents reported more physical activity,including an average of 48 additional minutes perweek of walking and 90 minutes fewer per weekof traveling in a car. Residents walked more onneighborhood sidewalks, in parks and on trails,and along greenways than they did in their previ-ous neighborhood.

The Mueller development in Austin, Texas, includesa variety of trails, parks, pools, and sports courts toencourage residents to be physically active. (ThomasMcConnell Photography)


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choices near jobs, services, and schools tosupport local economies and to protect theenvironment. A vibrant local economy, a bal-ance between jobs and housing that reducesthe need for long commutes, and diversity inhousing sizes, types, and costs, including ad-equate affordable housing, are all importantto healthy and sustainable communities.

Smart growth development costs one-

third less for upfront infrastructure, such asroads, sewers, and water lines. It saves anaverage of 10 percent on ongoing delivery ofpolice, re, and ambulance services and gen-erates ten times more tax revenue per acrethan conventional suburban development,according to a Smart Growth America surveyof 17 studies of development scenarios.

Compact + Mixed Use + TransitCompact, mixed-use, walkable develop-ment, a high degree of street connectivity,

microscale urban design features, and linksto transit are key factors of a walkable com-munity, according to the U.S. EnvironmentalProtection Agency (EPA). The cumulative

INNOVATIONS IN HEALTH

ULIs Ten Principles for Building Healthy PlaceIn August 2013, a group of interdisciplinary experts convened by ULIdeveloped a set of principles for building healthy communities. Theseprinciples draw on insights gleaned during three Advisory Servicespanels conducted in Colorado in spring 2013, and are elaborated onin a separate ULI report, Ten Principles for Building Healthy Places .

1. Put people rst. 2. Recognize the economic value. 3. Empower champions for health. 4. Energize shared spaces. 5. Make healthy choices easy.

6. Ensure equitable access. 7. Mix it up. 8. Embrace unique character. 9. Promote access to healthy food. 10. Make it active.

The Avenue, a mixed-use development nearGeorge WashingtonUniversity inWashington, D.C., con-tains ofce, residential,and retail space, includ-ing a grocery store, abank, and restaurants.(Kevin Weber)


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28 Chapter 3: Better Health through Community Design

PROJECTS THAT WORK FOR HEA LTH

Mariposa, Denver, ColoradoThe design for Mariposa, winner of the U.S. Environmental Protection

Agencys National Smart Growth Achievement Award and a projectof the Denver Housing Authority, is a holistic plan for redevelopingpublic housing that uses a health lens to achieve benets for thecommunity.

Begun in 2009, the project includes 900 homes270 public hous-ing units within a mix of income levels and housing typeson 15acres next to a new light-rail station in Denvers La Alma/LincolnPark neighborhood. Partners in the transit-oriented developmentproject include the city of Denver and the Regional TransportationDistrict.

The former South Lincoln Homes, built in 1953, typied the ap-proach of concentrating the poor in social and economic isolation.The lack of education and jobs left the neighborhood stagnating with

few options for upward economic mobility. The statistics on resi-dents health were alarming: 55 percent were overweight or obese,while more than 38 percent indicated a health condition that keptthem from working.

The redevelopment plan by the housing authority and a team ledby architecture rm Mithun focused on improving the physical healthof residents and the nancial health of the community. Residentsidentied their main health issues: the need to increase residentsphysical activity; to improve pedestrian, bike, and trafc safety andaccess to health care; to reduce crime and the fear of crime; and toimprove social cohesion.

The Mariposa team also customized San Franciscos HealthyDevelopment Measurement Tool to assess the health conditions

of residents and identify opportuni-ties for improvement. It developed theMariposa Healthy Living Initiative, aimedat integrating health into every aspect ofthe projects design, construction, andimplementation.

Mariposa shows signs of early suc-cess. The Tapiz Apartments is a 100-unitLEED Platinum building with a communitycenter that offers job training, health andwellness programs, social activities, andart classes. A state-of-the-art kitchen andcaf house a culinary academy that pre-

pares youth for jobs in the food industry.Residents can grow their own fresh foodsin community gardens managed by DenverUrban Gardens.

Four newer buildings with 93 apart-ments built to LEED Gold standardsfeature green elements like rooftop solarpanels. The $22 million construction cre-ated 300 jobs and generated $47 millionfor the local economy.

Mariposa, a project of the Denver Housing Authority,includes 900 homes, adjacent transit access, a commu-nity center, and community gardens. (Rachel MacCleery)


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effect of smaller-scale inll development anddevelopment near transit stations can be acatalyst for other land use changes that ben-et public health and the environment.

Neighborhoods with destinations that peoplecan walk or bike to have been shown to supporta healthy lifestyle. A grid pattern, for example,maximizes opportunities for walking. Even mun-dane routines like walking to the grocery store

provide opportunities for exercise and chanceencounters with friends and neighbors.Walk scores used to market real estate in

3,000 cities in the United States, Canada, andAustralia are attracting millennials and babyboomers to urban neighborhoods. Walk Scoreis an online, geographic information systembased tool that assesses neighborhood walk-ability. Ranging from zero to 100, walk scoresof 70 or higher indicate neighborhoods wherepeople can live without a car.

Houses with above-average walkabil-

ity command a premium of about $4,000to $34,000 more than houses with averagewalkability in typical metropolitan areas, ac-cording to CEOs for Cities.

The Power of Parksand TrailsDesign for active living aims to get peoplemoving to improve health and well-being.Regular physical exercise helps controlweight and reduces the risks of cardiovascu-lar diseases, type 2 diabetes, and some can-cers. It also strengthens bones and muscles,boosts immunity and balance, and increasesthe chances of living longer. Exercise hasbeen shown to relieve stress, anxiety, andmild depression.

Research shows that living near parksand recreation facilities leads to higher levelsof physical activity. A study from the Journal


Being Intentional about Health OutcomesTools such as the Health Impact Assessment (HIA) and the Healthy

Development Measurement Tool (HDMT) are used to quantify andqualify the public health impacts of proposed policies, plans, ordevelopment projects.

Health Impact Assessments help communities assess thepotential effects of a proposed policy, plan, program, or project oncommunity health, including the distribution of benets and costswithin the community. HIAs recommend strategies for monitoringand managing health and bring public health issues to decision mak-ers outside of the public health eld, such as in transportation andland use. HIAs can be voluntary or regulatory processes that focuson health outcomes.

The Healthy Development Measurement Tool is an evalua-tion instrument used to assess and address health needs in urban

development plans and projects with the goal of achieving a higher-quality social and physical environment that advances good health.Created by the San Francisco Department of Public Health, theHDMT has six core objectives: environmental stewardship, sustain-able and safe transportation, social cohesion, public infrastructure,adequate and healthy housing, and a healthy economy.


Blue Zones Project, Albert Lea, MinnesotaAlbert Lea, a statistically average U.S. city of 18,000 located 90 milessouth of Minneapolis, underwent an extraordinary transforma-tion in 2009 through the Blue Zones Vitality Project, based on DanBuettners book The Blue Zones , which is about ve areas aroundthe world where people live up to 12 years longer than the averageAmerican.

Albert Lea residents adopted lifestyle and environmental chang-es, such as adding workplace wellness policies, revising restaurantmenus and vending machine offerings, and establishing communitygardens, walking clubs, walking school buses, and hiking trails.Residents well-being improved in four areas: they ate healthier, be-came more active, connected with one another, and found a greatersense of purpose.

The research showed that the average life expectancy for AlbertLeas residents increased over three years, and participants lost acollective 12,000 pounds. Employers experienced an average 21 per-cent drop in absenteeism, and city employees showed a 40 percentdecrease in health care costs.


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The Gansevoort Woodland section of the High Line inManhattan is one of several distinct neighborhoodsthat make up the elevated park. (Iwan Baan)

A parklet in San Franciscos North Beach neighbor-hood, designed by Rebar, provides a gathering placeand seating for the adjacent pizzeria. (Sren Jensen/RebarGroup Inc.)

of Applied Physiology found that communitiesdesigned for exercise can prevent 90 per-

cent of type 2 diabetes, as well as 50 percentof heart disease, stroke, and site-speciccancers.

Communities designed for active livingfeature public places such as greenways,multiuse trails, playgrounds, pools, athleticelds, and other recreation facilities thatencourage physical exercise.

Programming these public spaces withactivities such as family fun runs, healthyliving festivals, and free yoga classes cansupport a culture of healthy active living.

Civic and cultural places for people togathersuch as plazas, libraries, and the-atersare important for social and mentalhealth, for a sense of community belonging,and as a focus for urban development.

Dozens of studies show that parks spureconomic development by attracting home-buyers and boosting residential propertyvalues.

BY THE NUMBERS

Amount of private investment anddevelopment spurred by New YorkCitys High Line project

Estimated sales price premiumfor homes located near parks

Percentage of U.S.millennials (ages 1834)who cite proximity to

parks as an important community characteristic

Increase in value forproperties within ave-minute walk of the

High Line from 2003 (before construction) to 2011

$2,262

103%$4 billion

68%Sources: Active Living Research; New York Times /City of NewYork City; New York City Economic Development Corp oration;Urban Land Institute.

The Value of Proximity to Parks


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Manhattans High Line, the 20-block-longpark constructed on a former elevated freightrail line, has become a worldwide sensation,bringing over 3.7 million visitors to the city in2011. A study by the New York City EconomicDevelopment Corporation showed thatproperty values near the park increased 103percent between 2003 and 2011.

Parkletssmall temporary parks con-structed by extending platforms from side-walks into driving lanes or parking zones andadding seating, landscaping, art, and bikeparkingare creating livelier streets.

San Francisco, which started the rst for-mal parklets in 2010, now has 38 developedand maintained by community organizations,local businesses, and residents. These out-door living rooms also draw patrons to retailshops and cafs.

The award-winning Milwaukee Riverwalkreinvigorated a moribund two-mile river cor-

ridor in the heart of Milwaukees businessdistrict with new plazas, parks, walkways,and public art. As of 2002, the $12 millionRiverwalk had attracted over $700 million inprivate investment in new restaurants, cafs,shops, ofces, and boating facilities along thecleaned-up river and had drawn 3,500 newdowntown residents to riverfront condomini-ums redeveloped from warehouses.

Aging in Place:It Never Gets OldAging in place is a concept of providinginfrastructure, services, and opportunitiesthat allow people to live independently in theirhomes as they age.

The majority of people over 50 want tostay in their own homes as long as possible,according to a survey by AARP (formerly theAmerican Association of Retired Persons).

Communities that are walkable andconnected with safe level sidewalks, well-marked crosswalks, and adequate lighting

will serve people as they age, especially whenthey have limited mobility and can no longerdrive. Elements such as accessible hous-ing, frequent transit service, nearby grocerystores and health care facilities, and gather-ing places support healthy and active life-styles for seniors.

Most Older Americans Do Not Want to MovePercentage of Americans who want to remain in theircurrent home for as long as possible, by age group

84%

0%

20%

40%

60%

80%

100%

75AND OLDER

65745064ALL 50AND OLDER

78%

91% 95%

Source: AARP.

The Milwaukee Riverwaproject increased publicaccess to the waterand spurred residentialredevelopment of nearbywarehouses. (KenKayAssociates)


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In some communities, volunteer networksprovide services that allow seniors to remainin their homes.

For seniors who want to downsize or areliving on limited incomes, supportive hous-

ing options include senior group homes andcooperatives and accessory dwelling units,or apartments attached to homes or locatedabove garages.

Schools (Too Far) OutSuburban building codes in many U.S. commu-nities have led to large K12 school campuseslocated miles from residential neighborhoods.Such schools create challenges to studentsability to walk and bike to school and requirethat they be driven or bused.

The lack of sidewalks, crosswalks, and

bike lanes in many communities prevent safewalking or biking to school. Amenities likebike lanes and trails connecting to schools,bike racks, and programs that reward kidsfor walking, biking, or busing to school everyday have also been successful in getting kidsmoving.

Many schools in the United States havebegun Safe Routes to School programs tocreate safe and easy ways for children towalk or bike to school. In 2012, the state ofCalifornia authorized the use of Safe Routesto School funding for programs in rural com-munities, including safer access to schoolbus stops.

There Are Many Ways to Increase the Amount of Activity Children Get Each DayMinutes of physical activity gained per day per child from various improvements and activities

23

0

5

10

15

20

25

M i n u

t e s o

f m o

d e r a

t e t o v i g o r o u s p

h y s

i c a

l

a c t

i v i t y g a

i n e

d p e r

d a y

Parks(access)

Modifiedrecess

Modifiedplaygrounds

Standardizedphysical

educationcurriculums

After-schoolactivity

programs

Parks(renovated)

Walk/biketo school

Classroomactivitybreaks

Mandatoryphysical

education

16

12

10

6 65

1

19

Source: Active Living Research.

Playgrounds at schoolsprovide opportunities forplay and recreation dur-ing and after the schoolday. (Rachel MacCleery)


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INSIGHTS FROM THE EXPERTS

Dr. Richard Jackson, Chair, Departmentof Environmental Health Sciences,University of California, Los AngelesRichard Jackson, MD, MPH, FAAP, is a pediatri-cian and chair of the University of California, LosAngeles Department of Environmental HealthSciences. In 2013, he was a fellow at HuntersCollege. Dr. Jackson was formerly director ofthe National Center for Environmental Health ofthe Centers for Disease Control and Preventionand hosted the 2012 public television seriesDesigning Healthy Communities .Q: What are the greatest health threats containedin our built environment? A: Chronic diseases. A generation ago, 50percent of American men were getting dailyexercise, and now its only 17 percent. Walkingto the store or the train is just as good as being

on a treadmill in a tness club. If youre in an at-tractive safe place, thats conducive to walking.Frederick Law Olmsted saw parks and trails asa necessity for health; he called parks the lungsof the city. Now we have science that supportsthatair quality is better and cooler in parks.Q: What concerns you most about the health ofchildren in our car-centered society?A: The average 11-year-old is 11 pounds heavierthan a generation ago. Only one in eight kidsnow walks or bikes to school. Kids are increas-ingly car dependent, especially growing up in thesuburbs, and many arent developing autonomyand independence. Every child in Americashould be able to walk or bike to school. Weneed to build good sidewalks and bikeways withadults on them to help kids feel safe and provideeyes on the street. The more people are outengaged in the world, the safer well all be.Q: What are some of the key built-environmentelements you recommend to make communitieshealthier?

A: Neighborhoods that put peoplerst, rather than cars. Put infra-structure in place that supports walking,biking, and car sharing. We cant x theworld by xing the built environment, butits important that our environment notplace impediments to our well-being. The

built environment can help us be healthier.Q: Youve said we need to make beautiful

places that attract people to walk around andinteract socially.

A: Numerous studies show that childrenwho have increased physical activity canbetter manage diseases like attentiondecit disorder and depression. I wantarchitects, designers, developers, and plannersto understand that health is a lot more than theabsence of diseaseits well-being. Look atwhere people live long in the world, and you see80-year-olds out walking and working. Well-being is partly diet, but its also physical activity.Q: Do you have other advice for designing anddeveloping healthy places?

A: We have a window of opportunity, where wecan make changes that are good for the planet,our children, and our grandchildren, as well asour economy. We need more evidence of newdevelopment and how it affects peoples health,to attract people to those places. Many ULImembers are doing browneld or greenelddevelopment as a return on investment. Id liketo see a return on investment in social, cultural,

and human health terms. So many of our invest-ments are built on short-term return, but wehave to look at the long-term effects.

Put infrastructure in place that supports walking, biking, and car sharing.. . . The built environment can help usbe healthier. Dr. Richard Jackson


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36 Chapter 4: Active Transportation

Transportation ThatGets Us MovingA growing body of research shows that a safe,accessible, affordable, and well-built trans-portation network with a range of alternativescan enhance community health and well-being. Residents of mixed-use livable com-munities with transit options weigh less, are

more physically active, and experience lesschronic disease.Investments in the built environment that

promote active living, such as public transit,sidewalks, bike lanes, multiuse trails, andother alternative transportation infrastruc-ture, have been shown to reduce health carecosts and enhance local economies.

Universal design approaches encourageaccessible transportation use for seniors and

since 2004, while public transit rides haveincreased every year, reaching 10.5 billionin 2012, according to the American PublicTransportation Association (APTA).

In developing countries like China andIndia, however, car sales and VMT are in thefast lane. To continue to reduce VMT in devel-oped countries and reverse it in developingcountries, communities need to provide moreactive and public transportation options.

Public and private investments in trans-portation infrastructure and operationsamount to over $57 billion annually in theUnited States, according to APTA, with mostof it dedicated to building highways andimproving road infrastructure. As demandincreases for public and active transporta-tion options, funding priorities worldwide arebeginning to shift to support healthier options,such as walking, biking, and public transit.

More than 80 percent ofU.S. workers commutein vehicles, thoughpublic transit r idershiphas been increasing

year by year.


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Obesity Rates Are Lower in Countries Where Lots of PeopleBike and Walk to Work Levels of bicycling and walking to work versus measured obesity levels forselected countries

Share of commuterswho bike or walk to work

Percentage of adultswho are obese

0%

5%

10%

15%

20%

25%

U.K.(2008)*

IRELAND(2006)

CANADA(2006)

AUSTRALIA(2006)

U.S.(2009)

20%

25%

30%

35%

Sources: Built Environment jour nal; t he Org aniza tion fo r Econo mic Coo pera tion an d Devel opment .*U.K. data are for all trips, not just work trips.

Investments that promote biking includeseparated or well-marked bike lanes andmultiuse trails that link to transit; bike rackslocated at transit stops, schools, and otherpublic places; bike maintenance facilities;and buses and other transit modes that cancarry bikes.

The Santa Monica, California, Bike Center,designed by Brooks+Scarpa and built in two

locations, offers showers, lockers, bike stor-age, rentals, tours, retail, and a repair shopas part of municipal garage improvements.The Bike Center has increased downtown bik-ing by residents and visitors and has providedover $100,000 in city revenue within two yearsof its opening.

As part of the global bike revolution, bikesharesnetworks of public or commercialbicycles available for short tripsare prolif-erating in more than 500 cities in 49 countries,says the Earth Policy Institute. Started in


Protected Two-Way Bike Lanes in Chicago, IllinDowntown Chicagos Dearborn Avenue in the Central Loop districtwas recongured in December 2012 to provide a two-way bike laneprotected by a parking lane and bollards. A study of the bike lanesrst six months proved that they provided a safer environment forcyclists and pedestrians, with reduced vehicle speeds and conicts

with drivers.From 2006 to 2011, there were 1,140 reported crashes on the

1.15-mile section of Dearborn, with pedestrians and bicyclistsinvolved in more than half of the accidents that included injuries.Since the project wascompleted, no reports ofcrashes between cyclistsand vehicles or cyclistsand pedestrians havebeen reported. Bike trafchas increased with the$450,000 project, whichremoved a vehicle lane.

(John Greeneld)


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Global Bike Sharing Has Increased Dramatically since 2007Number of bicycles in bike-sharing programs by region

N u m

b e r o

f s h a r e

d b i c y c

l e s

0

100,000

200,000

300,000

400,000

500,000

600,000North America

Middle East

Latin America

Europe

Asia Pacific

2012201120102009200820072006200520042003200220012000

Source: Earth Policy Institute.


Biking in Copenhagen, Portland, and HangzhouBiking is increasing in popularity as people recognize its multiple

benets. Cities across the globe are successfully implementing bikeamenities and infrastructure to meet increasing demand.Copenhagen Bike Superhighways. Copenhagen is recognized as

one of the premier bike cities in the world. Good conditions for bikingare part of the citys ofcial health policy. In 2012, bikes were used for36 percent of trips in the city. The city has increased bikings modeshare and decreased travel time by improving connections betweenpublic transit and biking facilities, and by building bike superhigh-ways, contiguous standardized bike routes from other jurisdictionsinto the capital across distances of up to 14 miles.

Portland Bike Infrastructure. Portland, Oregon,boasts North Americas best bike infrastructure system,with an investment in over 300 miles of bike lanes, bike

boulevards, and off-street paths, which has launched anexplosion in bike use. Between 1990 and 2008, bicycle useexpanded 400 percent, whereas transit use increased 18percent and driving declined 4 percent. The networks $60million replacement value is equivalent to the construc-tion costs of one mile of urban freeway.

Hangzhou Bike Share. Hangzhous bike-share systemis one of the largest in the world, with nearly 70,000 bikes.The city of 6.8 million incorporated a bike-share programinto the public transportation system to increase transitridership and solve the last mile issue between transitstations and riders destinations. Started in 2008 with 61stations and 2,800 bikes, the program has helped increase

bike ridership to 38 percent of trips. Daily usage now aver-ages 240,000 trips. Hangzhou public ofcials expect thebike-share system to expand to 175,000 bikes by 2020.

Nrrebrogade in Copenhagen, Denmark, known asthe busiest bike street in the Western world, has beenpermanently closed to cars. (John Greeneld)


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Amsterdam nearly 50 years ago, bike-shareprograms enhance mobility, alleviate trafccongestion, reduce air pollution, support localbusinesses, and attract more young people.

Transit Really Is Good for YouThe steady growth of public transit in theUnited States indicates that people want tolive and work in places where transit is an

option. Studies show that people who are ac-tive tend to choose transit-accessible urbanneighborhoods.

Transit users tend to be healthier andweigh less. A study of transit riders inCharlotte, North Carolina, found they were81 percent less likely to be obese than thosewho drove to work from the same neighbor-hoods, according to the American Journalof Preventative Medicine . The study of Lynx

light-rail riders showed they lost weight andbody mass consistent with adding 1.2 miles ofwalking to their daily routine.

Transit investments are also economic de-velopment engines. In the Denver metropoli-tan region, where the $7.4 billion FasTrackspublic transit program is under construction,every public dollar invested generates $4 inlocal economic development over 20 years

and creates over 6,200 jobs per year, accord-ing to the Regional Transportation District.In the United States, all varieties of

public transportation modesheavy rail,light rail, buses, trolleys, streetcars, fer-ryboats, and vanpoolsshow increasedridership, according to APTA. What mattersto riders are convenient high-quality transitoptions with frequent service, rather thanparticular modes.

Light-rail systems in theUnited States, includingstreetcars and trol-leys, saw a 4.5 percentincrease in ridershipin 2012.


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Within two years, 22 U.S. cities mayhave new streetcar systems, reports CleanTechnica. The Tucson Modern Streetcar, a3.9-mile line, will carry 3,600 riders daily on aroute connecting downtown to the University

of Arizona.Bus rapid transit (BRT) combines theefciency and user-friendliness of light railwith the economy and exibility of on-roadvehicles. Today, 63 BRT systems operateon six continents, and as many as 93 moreare planned worldwide. Using high-speedbuses that travel in dedicated lanes, BRT

typically features efcient passenger board-ing, adaptable routes, comfortable stations,and technology that updates travelers on buslocations and timing.

Lively streets and dense mixed uses locat-

ed next to key transit stops encourage peopleto walk or bike to transit, and so do strategiessuch as placing building entrances near pub-lic transit stops along well-connected streets.Shelters and benches at transit stops alsopromote use, along with signage and mapsthat show routes, distances, and schedules.

The bus rapid transit corridor system in Guangzhou, China, which opened in early 2010, is integrated with the citysbicycle and subway infrastructure. (Karl Fjellstrom/ITDP)


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Complete Streets Provide Safe Accommodations for AllDiagram of complete street example

SIDEWALK SIDEWALKFURNISHINGZONE

TRAVEL ZONE PARKINGPARKING PEDESTRIAN ZONEPEDESTRIAN ZONE

FURNISHINGZONE

PARKING ANDLOADING

PARKING ANDLOADING

BIKE LANE BIKE LANETRAVEL LANE

34'15' 15'

TRAVEL LANE8' 8'7' 7'8' 8'6' 6'11' 11'

Source: SERA Architects.

Complete Streets:A Safe BetTrafc calming creates safer environmentsfor pedestrians and cyclists, as well as driv-ers. Cities are increasingly using CompleteStreets trafc-calming concepts, such asroundabouts and speed bumps, and nar-rowing trafc lanes through densely settled

areas to slow and manage trafc.In 2013, 500 U.S. communities have ad-

opted Complete Streets policies designed tomake streets safer and more accessible forall users. Complete Streets vary by commu-nity, but they often include sidewalks, bikelanes or wide paved shoulders, special buslanes, accessible transit stops, frequent andsafe crossing opportunities, and accessiblepedestrian and cyclist signals.

Shared Cars andCar-Free ZonesCar-share programs are lling the gap forbike- and transit-using urbanites who dontwant to own a car, or need one only for briefspecic trips. Fewer cars on the road supportthe pursuit of shared economies and environ-mental protection by reducing private vehicle

congestion and emissions.Car-share programs have existed in

Europe for decades and are catching on inthe United States and elsewhere. Car2Gos400,000 members worldwide are cruising inSmart cars in 23 cities.

Vauban, a neighborhood in Freiburg,Germany, was built for sustainability andfeatures completely car-free streets, witha tram connecting to the town center. As of


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Returns from Active Transportation

BY

Documents

Intersections Health and the Built Environment