1

Please return to

your seats

Herkimer County

2

Design the world’s

best playground

Tatum’s Garden: Salinas, California

3

PLEASE RETURN YOUR PAPER 2-PAGE EVENT

SURVEY BEFORE YOU LEAVE FOR THE DAY.

MILDRED WARNERProfessor, Department Of City and Regional Planning,

Cornell University

A Multigenerational Approach to Planning for Health

Mildred E. Warner

Department of City and Regional Planning, Cornell University

www.mildredwarner.org/planning | mew15@cornell.edu

March 5, 2020

HAAAP Convening

Albany, NY

Research and Extension Funding provided by the USDA National Institute for Food and Agriculture

6

Need a Multi-generational Planning Approach

Core Principles (Vision)

7

Age-Friendly Cities

Child-Friendly Cities

Many Common Elements

Basic ServicesSafe WaterSafe StreetsOpportunity to PlayCivic ParticipationFamily SupportProtection from Exploitation

Housing TransportationServices (Health)Outdoor SpacesCommunicationCivic and Social ParticipationRespect

Warner, M.E (2017), “ Multigenerational Planning: Theory and Practice,” iQuaderni di Urbanistica Tre, No. 14 (Sept-Dec 2017). http://www.urbanisticatre.uniroma3.it/dipsu/wp-content/uploads/2018/01/u3_quaderni_14_warner.pdf

Am. Planning Assoc.Aging Policy Guide, 2014

(Inclusive Design)

• Housing – variety of types, accessory flats, eliminate family definitions

• Land Use – promote connectivity, allow mixed use

• Transportation – from commuting to mobility

• Economic Well Being –inclusive of all ages, support care work

• Community Assets – services, formal and informal supports

• Participation – across age, class, race, gender

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New Urbanist Bias in Planning for Aging

• Majority of elders in suburban and rural areas

• Built environment difficult to change in the short termo Especially if community lacks development pressure

• How can we support aging in place and respect the current location choices of seniors?

• Can a multi-generational approach help?

• Will this help build political will for investment?

9

10

A Theory for This Work

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$0

$5,000

$10,000

$15,000

$20,000

$25,000

0 10 20 30 40 50 60 70 80 90

Federal expenditures

State and local expenditures

Multigenerational Approaches May Address High Costs of Serving Children and Seniors

May promote fiscal efficiency (41%)

Government Spending by Age (2004)

Based on estimates by Edwards, Ryan D. 2010. Forecasting Government Revenue and Expenditure in the U.S. Using Data on Age-Specific Utilization, Working Paper no. WP10-01.

A Framework for Multigenerational PlanningThe link between design and services

Age

Fu

ncti

on

al ca

pa

cit

y

Early Life Adult Life Older Age

Full Capacity in an Enabling Environment

Inclusive Design

Service Provision Multi-

Generational Planning

Source: Warner, M.E., Homsy, G. H and Morken L. M. (2017). Planning for Aging in Place: Stimulating a Market and Government Response, Journal of Planning Education and Research, 37(1): 29-42.

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Children & Millennials Gen X Baby Boomers Seniors

Other or Mixed RaceAsian

Latino

African-American or Black

Non-Hispanic White

U.S. Population by Age and Race/Ethnicity

New Social Compact – Serving Children and Elders

Easier to raise funds if facilities are for all ages (51%)

PolicyLink. 2011. “The Changing Face of America: Demographic Change and the New Policy Agenda.” Presentation by Manuel Pastor at PolicyLink Equity Summit, 2011.

Age

Where are we now?

o Results of Planning Across Generations Survey

2013 with the International City/County

Management Association and Cornell University

o Surveyed attitudes, actions, zoning and planning

o 1478 city managers responded

o Data tables that follow show % responding

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Are we including the needs of children and seniors in our plans?

15

Planning Across Generation Survey, 2013 (1,478 city managers)

EmergencyPlan

ComprehensivePlan

Economic Development Plan

Do You Have? 91% 77% 57%

Does Your Plan Specifically Address?

Seniors 66% 53% 31%

Children/Youth 60% 53% 31%

Built Environment Not Optimal

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0% 20% 40% 60% 80%

Neighborhood Schools

Sidewalk system connecting

Park/play ground within 1/2-mile…

Access to fresh food markets

Public gathering spaces

Retail, services, and housing mix

Complete Streets

Bikelane

Percent of community with more than a half of community covered

MetroCore(N=209)Suburban(N=720)

Rural(N=466)

ICMA Planning Across Generation Survey, 2013 (1,478 city managers responding)

17

Regulations to promote connectivity, mixed use, density –suburbs and rural areas lag behind

ICMA Planning Across Generation Survey, 2013 (1,478 city managers responding)0% 20% 40% 60% 80%

Allow accessory dwelling units

Allow mixed-use

Allow child care business inresidential units by right

Require complete streets

Allow child care centers

Pedestrian-friendly design guidelines

Street connections between adjacentdevelopments

Promote parks or recreation facilitiesin all neighborhoods

Mandate sidewalk system

Metropolitan(n=194)

Suburban(n=675)

Rural(n=360)

Service Delivery Also Lags in Suburbs and Rural Areas

18

0% 50% 100%

Metro Core (N=224)

Suburban (N=751)

Rural (N=487)

Families with childrencan find range ofservices they needwithin my community

Seniors can find therange of services theyneed within mycommunity

ICMA Planning Across Generation Survey, 2013 (1,478 city managers responding)

What Leads to Change?

• Engagement of elders and families with children• Community Leadership – elected officials,

developers, planning and zoning board• Planning – comprehensive planning and zoning

and building codes

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Services for Children and Elders

Leadership

Engagement Elders

Children

Comp Plan

Aging,Children

Better Built Environment

Broader Housing Choices

Zoning

Planning Across Generation Survey, 2013 (1,478 city managers)

Cross Agency Partnerships Needed

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0% 50% 100%

Libraries

Parks and recreation department

School district

Police department

Area agency on aging

Public health department

Hospital or health care providers

Fire department

Housing agency

Economic development agency

Planning department

Community colleges

Child care resource and referral agency

Transportation or highway department

Metro Core(N=217)

Suburban(N=672)

Rural(N=418)

✓

✓

✓

✓

Are any of the following engaged in cross-agency partnerships to serve children or seniors?

Planning Across Generations Survey, 2013, 1478 city managers responding

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Shared Services may be one solution

Public School/Municipal CollaborationMetro Core

(N=218)Suburban(N=738)

Rural(N=464)

Schools and local government share facilities

78% 59% 48%

Which of the following services are offered in your community's public schools?

Metro Core(N=174)

Suburban(N=498)

Rural(N=284)

Child care services 64% 53% 38%

Adult education services

57% 51% 50%

Recreation programs for all ages

53% 52% 43%

Nutrition programs/meals for seniors34% 34% 42%

Health care services for all ages

21% 13% 19%

ICMA Planning Across Generation Survey, 2013 (1,478 city managers responding)

22

Community group/ Non-profit

Municipality

Youth recreation 42% 52%

Childcare/ Even Start /Pre-school

64% 7%

Communitytransportation

31% 41%

Adult education 4% 2%

Adult recreation 48% 40%

Adult healthcare/Socialservices

50% 50%

Community feeding 57% 43%

School-Community Shared Services in NYCornell, Shared Services Survey, 2013

Sharing highest in rural and small city districts.

Formal agreements facilitate sharing

70% of school districts share community services in NYS!

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Barriers to Joint Programming for Different Ages

0% 20% 40% 60% 80%

Lack of funding

Segregated funding streams

Liability

Lack of information

Lack of common data systems

Turf issues

Preference for age-segregated services

Concerns about safety

Regulations to protect children

Regulations to protect frail elders

Elected official opposition

Department head or staff opposition

ICMA Planning Across Generation Survey, 2013 (1,478 city managers responding)

24

Community’s Role

Warner, Mildred E. and Xue Zhang, 2019. “Planning Communities for All Ages,” Journal of Planning Education and Research, forthcoming. doi.org/10.1177/0739456X1982805

What factors drive rural-urban health disparities?

Which of the WHO/AARP domains matter most, and does this differ for rural communities?

Community Health:• Healthy behaviors (smoking prevalence, obesity prevalence, access to

exercise opportunities), • Access to health care (health care professional shortage areas), and • Quality of health care (preventable hospitalization rate, patient

satisfaction).

Linking Engagement, Physical Design and Public Health

AARP Livability indicators

Data: https://livabilityindex.aarp.org/

Age-Friendly Cities

Housing TransportationHealthNeighborhoodEnvironmentOpportunityEngagement

AARP Livability indicators

Data: https://livabilityindex.aarp.org/

Health

Engagement

Environment

HousingNeighborhoo

d

Opportunity

Transportation

Urbancore

Suburb

Ruralcore

Remoterural

AARP Livability indicators 2018

AARP Livability Indicators, 2018:Rural Counties Lag in Community Health

Data

AARP Livability Indicators American Community Survey 2017 All counties in the US

Data: https://livabilityindex.aarp.org/

Demographic structure Socio-economic condition Percent of non-Hispanic Black

Percent of non-Hispanic Other

Percent of Hispanic

Percent of population under 18

Percent of population over 65

Percent of population have a degree at

least bachelor

Percent of households have retirement

income

Per capita income

Poverty rate in White population

Gini

Median age of housing

Population, Population density, Population growth

Metropolitan area Non metropolitan area

Urban core county Suburb

Rural core county Remote rural

AARP Livability indicators 2018

Environment

Neighborhood

Housing

Transportation

Engagement

Opportunity

Urban core

Suburb

Rural core

Remote rural

Regression Model Results:

What factors lead to higher community health?

• Neighborhood matters most for urban core.• Neighborhood, transportation and engagement matter most for suburbs.• Neighborhood, engagement and opportunity matter most for rural.

Healthprevention, access and

quality

Opportunityinclusion and possibilities

Housingaffordability and access

Neighborhoodaccess to life,

work, and play

Transportationsafe and

convenient options

Environmentclean air and

water

Engagementcivic and

social involvement

AARP Livability IndicatorsSeven Domains of Age Friendly

Data: https://livabilityindex.aarp.org/

Conclusion

Neighborhood quality is essential to health for all counties.

Rural areas lag on built environment, so engagement and opportunity matter more

Built

environmentServices

Engagement

and

opportunity

Community Health

Zhang, Xue, Mildred E. Warner and Elaine Wethington, 2020. Can age friendly

planning promote equity in community health across the rural-urban divide?

Journal of International Journal of Environmental Research and Public Health,

17(4): 1275-91. https://doi.org/10.3390/ijerph17041275

33

Need a Comprehensive Multigenerational Approach

Contact: www.mildredwarner.org/planning

| mew15@cornell.edu

Funding provided by the USDA National Institute for Food and Agriculture

Articles

• Planning Across Generations

• Health Services for Aging

• Women and Planning

• Not Your Mother’s Suburb

Issue Briefs:

• Joint Use with Schools

• Health Impacts

• Rural Differences

• Gender Concerns

• Informal Networks

• Family Friendly Planning

• And more!

34

BreakPlease return in 10 minutes

Tompkins County

BILL ARMBRUSTERSenior Advisor, AARP Livable Communities

RANDY HOAKAssociate State Director, AARP New York

LINDSAY GOLDMANDirector, Healthy Aging, The New York Academy of Medicine

Option A: Livable Communities (back of room)

Option B: Visualizing Data for Impact (front of room)

Visualizing Data for Impact

Lindsay Goldman, LMSWHAAAP Convening | March 5, 2020

VISION

Everyone has the

opportunity to live a

healthy life

MISSION

Drive progress towards

improved health through

attaining health equity

3

7

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• Evolution of mapping the social determinants of health

• A New York City interactive mapping pilot

• Discussion:

How can we use data to advance health across all

policies?

AGENDA

MAPPING SOCIAL FACTORS IN 1865

4

0

stable

tenements

churches,

schools,

businesses

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MAPPING SOCIAL FACTORS IN 2009

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MAPPING SOCIAL FACTORS IN 2020

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Generously supported by

Developed in partnership with

Population & Neighborhood Characteristics

+

Location-Specific Overlays

=

Actionable Information

44

GOALS

• Build and strengthen connections

• Engage partners

• Maintain accountability

• Advance equity

• Improve service delivery

• Plan for the future

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DATA

46

GEOGRAPHY

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USE CASE: IMPROVE WALKABILITY

“We use the bus stops for

sitting because there are

no local rest places or

parks suitable for the

elderly.”

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USE CASE: FALLS PREVENTION

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USE CASE: GRANTMAKING

50

USE CASE: SNAP OUTREACH

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USE CASE: 2020 CENSUS OUTREACH

80% of people 65+

don’t speak English

30% of people 65+

have a disability and

live below federal

poverty

Chinatow

n

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USE CASE: PLANNING TO MEET FUTURE NEED

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USE CASE: PLANNING TO MEET FUTURE NEED

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• Would you find a tool like this useful?

• Are there specific goals that an interactive map might help you to achieve?

• What stories do you need data to help tell?

• Who is your target audience?

• What census data are you interested in?

• What local data are available?

• Who has access to the data?

• At what geographic level would you want to display information? At what

geographic level is the data available?

• Can you host the map on your server?

• How would you maintain the map?

• What are alternative strategies to present data?

FOR DISCUSSION:

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DEPT. OF HEALTH: COMMUNITY HEALTH PROFILES

East Harlem: North of 96th St. Upper East Side: South of 96th St.

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DEPT. OF HEALTH: HEALTHY AGING REPORT

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ELDER INDEX

LINDSAY GOLDMAN, LMSW

GOLDMAN@NYAM.ORG

@AGEFRIENDLYNYC

IMAGENYCMAP.ORG

59

PLEASE RETURN YOUR PAPER 2-PAGE EVENT

SURVEY BEFORE YOU LEAVE FOR THE DAY.

GROUP DISCUSSION UNTIL 3:40 PM

• How can the HAAAP Centers for Excellence be helpful to counties that are new

to this work? What are your needs for advice, tools, best practices?

• For the newer counties, what has your approach been like so far?

Where have you found

early success?

REPORT BACK

What is something new

you heard today that

will inform your work

or that you want to

investigate further?

Table 1

Erie CFE

Monroe

Ontario

Schenectady

Table 2

Tompkins CFE

Onondaga

Oswego

Broome

Table 3

OneidaCFE

Herkimer

Saratoga

Schoharie

Table 4

RocklandCFE

Orange

Ulster

Thank you

Erie County