Healthy Metropolis

WHO Healthy Cities

2011-12-18T14:19:00.000-08:00

The WHO Healthy Cities Program has been around since the mid-1980s and but is not as well known in the UnitedStates as it perhaps should be. The program is focused on“health development through a process of political commitment, institutionalchange, capacity-building, partnership-based planning and innovative projects”(http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/urban-health/activities/healthy-cities).Healthy city activities typically focus on fostering collaborations and partnerships to promotehealth with a refreshing mix of interventions—policies, programs, and plans. Activities that won Healthy Cities Awards in recent years include schools that promote urban health, injury and violence prevention activities, best practices in public toilets, and healthy urban transportation (http://www.alliance-healthycities.com/htmls/awards/index_awards.html).

It’s hard to find exactly how many citiesparticipate but the WHO European office claims that over 1,400 European citiestake part in 30 national networks. As the network is global, presumably the overallnumbers are much larger. An Alliance for Healthy Cities brings some of thesecities together: http://www.alliance-healthycities.com/htmls/about/index_about.html

The WHO European office has a useful healthy citieschecklist that shows the wide range of topics of interest to the program fromecosystem health and public participation to diversity and economic vitality.You can read the whole list at http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/urban-health/activities/healthy-cities/who-european-healthy-cities-network/what-is-a-healthy-city/healthy-city-checklist.

Design for Health on Flickr: Sets and Collections

2011-12-18T13:53:00.000-08:00

Cyclist: Photo by Ann Forsyth

The Design for Healthphotostream now has hundreds of photos organized into “sets” such as “pedestrians”or “markets” and collections such as “Landscape”. Hundreds more photos will beadded in the coming month. Check it out at http://www.flickr.com/photos/designforhealth/

Design for Health on Flickr

2011-12-07T13:45:00.001-08:00

Urban Agriculture in Beihai, China. Photo by Ann Forsyth. Soon to be available on Flickr.

Design for Health now has aFlickr photostream at http://www.flickr.com/photos/designforhealth/. It will eventually contain all the images nowavailable in the DFH web site under image resources: http://designforhealth.net/resources/imageresources.html. However, we will gradually add others from aroundthe world. Most images are by Ann Forsyth except where noted specifically (forexample some are from Kevin Krizek).

Research Summaries: Some Links

2011-11-17T09:25:00.001-08:00

For practitionersinterested in integrating health research into planning and design, the taskcan be daunting. There are many articles that touch on the topic of theconnection between people, health, and place but with varying levels ofrelevance, research quality, and cost (and many can be quite expensive to thosewho don’t have university library subscriptions). Into the gap have come anumber of organizations creating practice-oriented research summaries.

InformeDesignsummarizes many articles, and has an easy search interface, which is veryhelpful: http://www.informedesign.org/Default.aspx. To find syntheses that evaluate the balanceof evidence one needs to go to other sources.

UCLA HIA-CLIC has somehelpful summaries of research organized by sector (e.g transportation) andpathway (e.g air quality) http://www.hiaguide.org/sectors-and-causal-pathways. Not every issues has information—a number areforthcoming—but it’s generally a helpful site.

Design for Health’sresearch summaries are now 3 or 4 years old: http://designforhealth.net/resources/researchsummaries.html. This is more of a problem in the area ofphysical activity and food—where there has been a lot of recent research—thanin the other topics where there are fewer new studies. For those wanting to getupdated research there are larger topical pages listing other resources: http://designforhealth.net/resources/generalhealthissues.html and a list of web sites by topic is availableat http://designforhealth.net/resources/websites.html.

UN Habitat Reports on Health

2011-11-10T08:32:00.000-08:00

UN Habitat produces and distributes a large number of reports, many related to health with numerous publications on water infrastructure, social inclusion, disaster management, housing issues, and climate change. Although you can buy printed reports that isn’t always necessary as many can be found for free.

Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings (2010), produced in collaboration with the World Health Organization, provides a good overview of the history and current situation in terms of cities and health. Topics cange across the natural and build environment, social and conomic issues, food secutiy, health services, and general urban governange http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3049

Diagram from Hidden Cities

Collection of Municipal Solid Waste , Key issues for Decision-makers in Developing Countries (2011) grapples with an important problem in public health. Written in a very accessible style it answers practical questions about how too extend solid waste collection to a wider population. http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3231

A Global Assessment on Women’t Safety (2008) focuses on tools for enhancing safety including public education, adviacey, participatory approaches, and changing public spaces. It’s part of a series of reports on this topic http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=2848

Planning for Healthy Places with Health Impact Assessments

2011-11-08T17:34:00.000-08:00

A screenshot of the online slide show

A few years back the American Planning Association in association with the National Association of County and City Health Officials created the online course Planning for Healthy Places with Health Impact Assessments at http://professional.captus.com/Planning/hia/default.aspx. Don’t be put off by the initial survey that you have to fill in to get into the site—it’s short and you don’t need to be an APA member to access it! Sponsored by the Centers for Disease control and Prevention the initial course was developed by Rajiv Bhatia, Laura Biazzo, MPH, Division of Nutrition and Physical Activity of the Centers for Disease Control and Prevention, Brian Cole, Andrew Dannenberg, Carrie Fesperman, and Candace Rutt.

With Christine Green from APA and Nisha Bochwey from the University of Virginia I’ve worked to update the program (without changing the voiceover except for one short additional module!)—Christine is the maven of resources and Nisha did a stellar job on quizzes. There are a lot of new examples. The computer generated voice is a bit weird but the content is a good introduction to HIA—and thanks to the CDC it’s free.

What’s in a Name?

2011-09-15T08:18:00.000-07:00

Plan available directly from the
City of Bloomington

Recently, I was looking at the Pew Health Impact Project web site and noticed a featured HIA: the Xcel Energy Corridor: http://www.healthimpactproject.org/resources#reports

This is an excerpt from a plan featured on the Design for Health web site (one of the 19 Minnesota communities in Phase 1 of the project). On Design for Health site it is listed under the place name (Bloomington) and plan name (Alternative Transportation Plan) at http://www.designforhealth.net/cases/bloomington.html

Whatever the name it’s great to have these examples featured in multiple places.

Food Resources

2011-09-10T17:43:00.000-07:00

Food stall in Stockholm. Photo: Ann Forsyth

How people get access to healthy food is a concern to many. I’ve recently had some requests for information. Design for Health resources include an "issues sheet" with ideas for incorporating food into planning and a research summary. Links include a food security assessment, also featured on an earlier blog http://healthymetropolis.blogspot.com/2010/11/tools-food-security-assessments.html

The APA's national healthy communities center has a food interest group is also a terrific resource as are its numerous publications on this issue: http://www.planning.org/nationalcenters/health/food.htm

Visuals: What Does a Rapid HIA Look Like?

2011-08-17T12:05:00.000-07:00

This blog has dealt earlier with the logistics of doing an HIA but what does a workshop look like? One source is the Arden Hills Healthy City Planning Workshop Summary Report Appendices. This document contains images of each stage of the half-day workshop. Go to http://designforhealth.net/pdfs/cases/HIA_ArdenHills_Appendices_3June2010.pdf and look at pages 33-36. More information about the process is available at: http://designforhealth.net/cases/ardenhillsworkshop.html.

Images from Arden Hills workshop. Photos: Design for Health.

Tools: What is a Rapid HIA?

2011-07-31T13:33:00.000-07:00

On the face of it Rapid HIAs are quick, but that's not the whole story. A rapid HIA while faster than a full, environmental impact assessment-style HIA, still takes some time. It is also different to some other quick HIA types such as desktop screening or scoping exercises.

Students performing a practice health impact assessment
at the School of Planning and Architecture, Vijayawada

Fundamentally a rapid HIA is an interactive workshop—taking half a day or a day--that brings together stakeholders to identify and assess health impacts. However, additional time is needed to engage stakeholders in identifying key concerns and interest groups, to prepare background docuemtns for the workshop, have participants read those docuemtns, and write up the results. The good news is that a lot of the background information is similar to typical analyses that are standard in many planning and public health processes. Background information on health is available from several sources. Examples of completed HIAs are online.

Several toolkits are also available.

Design for Health has two versions. The most recent Rapid HIA toolkit was ublished in 2008 but will be updated over the coming year. It draws on a number of previous examples, including the famous Merseyside model. In 2010 DFH conducted a rapid HIA, termed a Healthy City Planning Workshop. This took a more flexible approach than the 2008 toolkit and also adapted worksheets from a number of recent HIAs. The reports from the workshop include basically all the information used to run and report on the HIA workshop--the actual information packet provided to participants in advance; the agenda of the meeting, copies of handouts, worksheets, and presentations from the workshops; a series of photos keyed to parts of the agenda; and the workshop’s summary report. This makes the report usable as a toolkit.

The Merseyside Guidelines for Health Impact Assessment (2001) published by the International Health IMPACT Assessment Consortium, is often cited as the most widely used HIA model in England.

Human Impact Partners, Oakland provides several relevant tools including a number of guides and worksheets: http://www.humanimpact.org/hips-hia-tools-and-resources. Be sure to scroll down the page because a lot of the more interesting material is at the bottom.

Resources: Health, Place, and Children

2011-07-25T11:17:00.000-07:00

Children, because they are still growing and developing, often suffer from different or additional health risks compared with adults. There are many useful resources on this topic--I list a few below specifically tailored to health and places.

Feeding chickens. Photo: Heather Forsyth

Children's Health Protection
Sponsored by the U.S. Environmental Protection Agency (EPA), this Web site has a terrific search feature for looking up publications related to where children live, learn, and play. Their Children’s Environmental Health section has additional resources:including a site on indicators called America’s Children and the Environment.
Guide to Community Preventive Services
This resource from the Centers for Disease Control and Prevention (CDC) provides a study titled “Community Interventions to Promote Healthy Social Environments: Early Childhood Development and Family Housing,” which gives recommendations from reviews of HUD Section 8 Housing Vouchers, Rental Vouchers and preschool programs based on early childhood development intervention success. There’s also a section on adolescent health, focused on broad health topics.
Effective Interventions to Tackle Inequalities in Children's Health
This London Health Commission report provides a summary of “what works” —or what appears to work—in relation to the aims and interventions proposed in the draft children and young people's strategy; examines other interventions with strong evidence of effectiveness in reducing inequalities in child health; and identifies where there are gaps in the evidence.

Some additional resources are available at http://www.designforhealth.net/resources/children.html

Resources: Planning and Active Living

2011-07-16T16:33:00.000-07:00

Active living, the idea that it’s good to build exercise into daily life, has been big news in planning for a while but I still get questions about how to incorporate active living into plans. A decade ago, when it was a fairly new idea, there was the hope that if we built places where people were more prone to do activities like travel walking, that they’d keep exercising as well, increase their total activity, and reduce weight. It turns out to be a bit more complicated than this as I noted in my blog on high density and overweight adolescents in China. Research is quite mixed in its findings—there’s a lot of variation in how people respond to environments. Programs, policies, prices, education, and attitudes all shape how people use environments. But as a bottom line it is useful to provide options for people to be active in different ways so that when they want to do so they can.

So how can you help provide options? Several web sites provide case studies of communities have done this work.

Mexico City Cycle Day, 2011

Active Living by Design has been around since 2001 and has a useful web site. The group has worked with a number of cities and countied and provides case studies linked to an onsite map: http://www.activelivingbydesign.org/communities.
The APA has a webinar with some practice examples: http://www.planning.org/nationalcenters/health/education/webinars/activecommunity.htm
Design for Health also highlights some alternative transportation plans including ones by Bloomongton and St. Louis Park. Some of the questions in the DFH Comprehensive Plan Review checklists also target active living—noted in a column: http://www.designforhealth.net/resources/checklists.html

Tools for Conducting an HIA on a Comprehensive Plan

2011-07-04T11:14:00.000-07:00

I’ve recently had a number of queries about how to conduct a health impact assessment on an existing comprehensive plan. This is a great thing to do because it can help prioritize changes in an update: http://healthymetropolis.blogspot.com/2010/12/when-in-planning-or-policy-process-does.html. How to conduct an HIA is a big topic, but fortunately there are a lot of resources available with more coming online over the next year.

One place to start is the set of Comprehensive Planning Checklists on the Design for Health web site: http://www.designforhealth.net/resources/checklists.html. They are based on evidence--though there is stronger evidence for the “essential for health” sections than the “good for health” ones. Each question has a column that explicitly states which area of research it is based on and these are described more fully in online research summaries (see next point). These checklist are also broken into standard categories for comprehensive or general plans in the United States. Two other resources, highlighted in an earlier blog, may be useful: the Australian Healthy Urban Development Checklist and British Delivering Healthier Communities in London.

Research Summaries that form the basis of the DFH checklists that are available for free: http://www.designforhealth.net/resources/researchsummaries.html. The current versions reperesent work up to about 2007 or 2008 and in fast developing areas--such as food--we’ll be preparing updates in the next year. For extra information in the interim you might look at the "pathways" section of HIA-CLIC http://www.hiaguide.org/sectors-and-causal-pathways/pathways.

Model of Downtown Tianjin in the
Tianjin planning museum.
Photo: Ann Forsyth.

For advice about what to do after you have used the checklist and done your evaluation, the Design for Health web site has Information Sheets linked to the research summary topics that have examples and cases:
http://www.designforhealth.net/
resources/planningissues.html

In addition, a course on Planning for Healthy
Places with Health Impact Assessments by the American Planning Association in association with the National Association of County and City Health Officials, is also a good place to start: http://professional.captus.com/Planning/hia/default.aspx. It is currently being updated by a team including Christine Green and Kimberly Hodgson at APA, Nisha Botchwey from the University of Virginia, and myself, with advice from Dee Merriam of the CDC. The update will substantially expand the resources section so there will be lots more information than this brief note can provide.

How Do People Connect Places and Health in Practice?

2011-05-23T12:00:00.000-07:00

I am often asked how to connect health and place, practically. There are two main ways of thinking about this--one relates to topics and another to methods.

In terms of topics there are several lists available. Most end out looking like the following list, adapted from Design for Health (http://www.designforhealth.net/resources/generalhealthissues.html). However other, quite similar, lists exist (http://www.hiaguide.org/sectors-and-causal-pathways/pathways). They mix health issues and environmental features mainly because different issues are thought about in those terms. They also play out differently for various groups including children, seniors, people with low incomes, and so on.

Self-build housing in Beihai, China

Accessibility to places, people, and services that can promote health
Air quality
Disasters--including climate change
Environment + housing quality related to pollutants
Food quality
Healthcare access
Mental health--often related to stress (e.g. plants can reduct stress)
Noise
Physical activity options
Safety—from accidents and crime
Social capital/connections--with complicated relations to place
Water quality

A range of methods help practitioners make these connections:

Policy and Program Collaborations: The UN Healthy Cities Program is an example, focusing on building awareness and collaboration among partners including governments and universities.
Health Impact Assessments: These are actually a range of tools, both participatory and technical, aiming to link local knowledge and health research/data maximize health benefits+ minimize health risks for all groups. They can be done on a range of policies, programs, and plans, not only ones affecting places.
Quality of Life Tools: This is a term for a range or preexisting tools and methods that focus on the connection of people and place, and connections between people. Examples include safety audits, food security assessments, and asset maps. Various social development tools such as anti-racism trainings with a place-based approach, also fit in this category.
Healthy Community Plans and Designs: Such proposals translate health research into practice at scales from the building to the region.

Tools: The National Collaborative for Childhood Obesity Research Measure Registry

2011-05-03T11:46:00.000-07:00

Recently I highlighted work of the National Collaborative for Childhood Obesity Research (NCCOR). a group spearheaded by the National Institute of Health, Centers for Disease Control, and Robert Wood Johnson Foundation. They have now released a new tool, or rather a registry of measures related to diet and physical activity: http://tools.nccor.org/measures/. I was part of the team on this project. My role was cataloging some of the physical activity measures, a mix of “questionnaires, instruments, diaries, logs, electronic devices, direct observations of people or environments, protocols, and analytic techniques.” Overall there are over 700 measures.

Example of Straight Line and Network
Buffers Created Using GI

The main search page at http://tools.nccor.org/measures/ allows users to search by domain (e.g. Individual dietary behavior, food environment…), measure type, age of people measured (though as this information seems to have been unevenly cataloged I found it not so useful for environmental measures), and context or type of place. Measures with reliability and validity information, as well as those used in studies of children and adolescents, were given priority. However, for the domain of physical activity environments this would have limited the measures too much so these are drawn from a wider range of sources.

Research: High Density and Overweight Adolescents

2011-03-22T02:42:00.000-07:00

I typically don’t report on scholarly studies in this blog but recently came across a nicely designed study that makes a larger point—that the links between health and place are complex. Fei Xu, JieQuan Li, YaQiong Liang, ZhiYong Wang, Xin Hong, Robert S Ware, Eva Leslie, Takemi Sugiyama, and Neville Owen have produced a report on the Nanjing High School Students’ Health Survey, published in the Journal of Epidemiology and Community Health in 2010 (64, 1017-1021, http://jech.bmj.com/content/64/11/1017). Titled: “Residential density and adolescent overweight in a rapidly urbanising region of mainland China” the study used data collected from 2,375 adolescents in 2004 to examine the relationship between (large-scale) district level densities and weight.

New high rise behind village
residences in suburban Shanghai, 2010

Densities are reported per square kilometer but in range from 5 persons per hectare to 307. The study divided the sample into high, medium, low density residents. Youth in the middle and higher density areas (that is over > 35 person per hectare) were roughly twice as likely to be overweight.

The relationship was reduced a bit but still significant after controlling for TV time, study time, recreation, age, gender, and parents education. Physical activity data came from self reports through a version of the International Physical Activity Questionnaire (IPAQ) that only asked about some kinds of activities. Given a lack of data on overall physical activity and food intake the authors speculate on a number of reasons for this difference e.g. youth in higher density and potentially higher income areas eating more, higher density areas having less recreational space, or (and here I am paraphrasing quite loosely) that higher density areas may just be too convenient with too much internet access so youth don’t have to expend much energy getting places. The high densities in China are also quite high compared with the US and Australia in particular, where much research has been done. They are also increasing rapidly—the authors report overall densities in Nanjing, presumably including some rural districts, increasing from 14 persons per hectare in 1997 to 23 in 2007.

The study is interesting because in many studies of adults, those in higher densities walk more for transportation (though they may not walk more overall) and some find they are thinner (though not all studies measure this or find it to be true, including my own). In this study of youth, with a large group and fairly good measures, those in higher densities are chubbier. While it is important not to make too much of one study, this is yet another example of the complexity of the relationship between health and place, and the importance of social factors.

Tools: The Pedestrian and Bicycling Survey (PABS)

2011-03-10T02:23:00.000-08:00

I’ve recently been involved creating a new survey for measuring transportation behavior, particularly walking and cycling. The Pedestrian and Bicycling Survey (PABS) is a mail out/mail back survey designed to be an inexpensive means for local governments to learn about nonmotorized transportation use in their communities.

An important component of the design of the PABS was creating a probabilistic sampling approach that would be relatively straightforward to administer and, if desired, could be carried out in house (within municipal agencies). While other sampling approaches—such as snowball sampling across the internet—can achieve a large number of responses, the probability of any person being asked to take the survey is not known making it a challenge to generalize from the sample to the wider population.

Pedestrians in suburban Hong Kong

Documentation includes a report outlining how the survey was developed and the results of reliability (repeatability) sampling. A manual provides step by step guidance about how to use the survey too. The survey is provided at the end of both documents and is available in English and Spanish. Materials are available for download at http://transweb.sjsu.edu/project/ 2907.html (scroll down to find the manual).

Future plans include creating a more modular version so users can mix and match sections to suit the questions they need answered. Updates will be available at http://www.designforhealth.net/health/PABS.html.

Tools: The National Collaborative for Childhood Obesity Research Catalog of Surveillance Systems

2011-03-09T04:39:00.000-08:00

The National Collaborative for Childhood Obesity Research is a group spearheaded by the National Institute of Health, Centers for Disease Control, and Robert Wood Johnson Foundation. The Catalog of Surveillance Systems is a new product, also sponsored by the USDA. The catalog provides a searchable database of ongoing monitoring systems related to health. It includes both public systems such as the Census of Agriculture and National Vital Statistics System and private ones such as the Nielsen Homescan and InfoUSA.com. In all, 77 systems are represented.

The database can be filtered by keywords related to the level (person to community to policy), scope (local, state, national), key health variables, age groups, ethnicity, research design, and cost to use.

Each system has an individual entry including information on distinctive characteristics, sampling, key variables, costs, whether information is linked to geographical databases or to other surveys, example publications using the data, and other resources.

This is an extremely useful database and can provide a quick point of entry for those interested in assessing what data are available.

Mapping Health Issues with GIS: Participatory Approaches

2011-01-18T12:38:00.000-08:00

Participatory GIS is a growing field. For those interested in integrating participatory GIS into healthy planning, several web sites provide helpful illustrations of the potential.

Public Participatory GIS based in a company called Vertices in New Brunswick, New Jersey, (http://www.ppgis.info/) provides illustrative maps on topics from bike crashes to a calculator for calories burned walking different routes. Not all maps are local, for example the public health maps rangr from alcohol sales places in New Orleans to food sales in Philadelphia.

Transparent Chennai (http://www.transparentchennai.com/), at the Institute for Financial Management and Research, uses GIS but with a focus on topics such as squatter settlements, environmental hazards, and other aspects of quality of life. What is particularly handy about this site is one can build a map from different kinds of information including environmental, political, infrastructural, and social issues: http://www.transparentchennai.com/buildamap/. This site really shows the potential for a fairly integrated yet still user driven experience that could be particularly helpful for those interested in working with communities on issues of health and place.

Part of a map from Transparent Chennai

Map Kibera (http://mapkibera.org/) started in 2009 by several NGOs in a large squatter settlement in Nairobi Kenya, reportedly was an inspiration for Transparent Chennai. The site has a lot of information apart from maps, showing how different kinds of information—spreadsheets, a blog, twitter, a wiki, and so on—can be linked.

For a more technical, expert-led approach to using GIS see the DFH Threhold Analysis HIA and research oriented NEAT-GIS and LEAN-GIS protocols. These can however be used in a participatory setting. The Arden Hills Rapid HIA used similar maps as background information, for example (see report appendices).

My thanks to Azhar Tyabji, at the Institute for Financial Management and Research, for leading me to his colleague Nithya V. Raman (and her team’s) work on Transparent Chennai.

How to Learn About the Basics of Healthy Community Planning

2011-01-03T13:52:00.000-08:00

Linking health and planning requires learning about (at least) two areas. Public health folks are often confused about planning and planners have a lot to learn about health. There are a number of useful web sites and below I list just a few free guides that can lead you through the maze.

Healthy Urban Development Checklist

The Healthy Urban Development Checklist: A Guide for Health Services when Commenting on Development Policies, Plans and Proposals introduces public health folks to planning. Developed by the NSW Department of Health in Australia, it will be useful in many other locations. It takes a little while to load but once it’s on screen it provides a useful introduction to health issues and the planning system. It covers a typical range of issues including food, physical activity, housing, transport employment, community safety, open space, social infrastructure, social cohesion, environment, and specific development contexts such as infill.

Delivering Healthier Communities in London was developed for the National Health Service London Healthy Development Unit in 2007. Also a bit slow to load, it is organized around key health issues--mental health, cardiovascular disease, respiratory disease, excessive heat and cold, and injuries. It links each of these the environmental factors.

The Design for Health web site comes from the other direction, aimed at informing planners about health. Its health impact assessment tools draw on research summaries and can feed into planning actions. Topics are rather similar to the Healthy Urban Development Checklist (above).

When in the Planning or Policy Process Does a Health Impact Assessment Fit?

2010-12-03T08:32:00.000-08:00

Many people are interested in when to do an HIA. The simple answer is, it depends. There are a lot of different formats that may be used alone or in combination.

Screening tools to see if an HIA is worth it
Scoping tools to investigate the topics and dimensions worth exploring more
Desktop or mini HIAs that can be done quickly in an office
Rapid assessments or appraisals that re more participatory, drawing on expert and local knowledge (see an earlier post for some examples)
Intermediate HIAs that are more comprehensive or multi-dimensional but not yet on a par with a full environmental impact assessment
Full HIAs—a lot of work
Integrated HIA that are plugged in to other processes

They may also be done prospectively—to figure out what may happen—or retrospectively to assess what did happen. This latter version is often looked down upon as not sufficiently proactive. However, it can be a great way to start a new planning process—looking at the current state of affairs to figure out what to do next. This can be a lot less threatening than assessing a draft plan or policy that people already invested in.

The attached diagram from a Design for Health training captures some of this variety.

Is There a Role for Evidence-Based Practice in Urban Planning and Policy?

2010-12-02T17:49:00.000-08:00

Integrating health into planning often uses the approach called evidence-based practice. An article on this topic by some of the folks from Design for Health, including me, is currently available for free: http://www.informaworld.com/smpp/content~db=all~content=a918403162~frm=titlelink. It was a finalist in the Association of European Schools of Planning Best Paper Prize: http://www.aesop-planning.com/Prize_BBP.html

Details about the paper are below.

Is There a Role for Evidence-Based Practice in Urban Planning and Policy?

Authors: Kevin Krizek; Ann Forysth; Carissa Schively Slotterback

Planning Theory and Practice, 2009, 10: 4, 459 — 478.

Abstract

Can the craft of planning take advantage of a growing body of planning-relevant research? Evidence-based practice proposes a better connection between research and professional work, but raises several concerns about the character of valid evidence, the strength and clarity of planning research, and inequalities in the available resources for integrating research into planning practice. Much of planning practice is a reflective craft where skills of mediation, negotiation, listening, and framing are prominent. As part of the planner's work employing these skills, however, there is a valuable role for research-generated evidence to inform decision making. Evidence-based practice needs careful implementation but it can enrich the field of planning by linking research to practice.

Technical Resource 3: People and Participation.net

2010-11-23T10:17:00.000-08:00

Workshop on housing options.
(Joanne Richardson in center,
Ann Forsyth photographer)

Expert-driven tools can be very helpful for assessing community health. However, in all but the smallest assessments, it’s important to combine such expert methods with more participatory approaches. Local people know their own communities and that local knowledge can be very helpful. They may also have fears that need to be investigated—some may be appropriate and some may not but in either case it is important to know about them.

Public health, urban planning, and related fields have different cultures of participation and this also varies by country, region, setting, and project type. However, one terrific resource for giving most people good ideas is the British web site People and Participation.net: http://www.peopleandparticipation.net/display/Involve/Home

A process planner that quizzes the user on everything from money and time available to political support and shoots out a set of participation options: http://www.peopleandparticipation.net/display/ProcessPlanner/Home. Using this planner is a way of getting out of the rut of doing the same old thing. It can also just give you a place to start that is relevant to your situation.
If you want to see all the methods they are also listed: http://www.peopleandparticipation.net/display/Methods/browse+methods
Their library is particularly good and with a keyword cloud and lists of recommended webs sites, practical guides, and web tools: http://www.peopleandparticipation.net/display/Participationlibrary/Home
Users can also upload case studies: http://www.peopleandparticipation.net/display/CaseStudies/Home

The Design for Health project has a short information sheet on how to use participatory methods to integrate health into the planning process: http://www.designforhealth.net/resources/participation.html. I have reviewed some other participation tools on my Planetizen blog at: http://www.planetizen.com/node/46672.

Tools: Food Security Assessments

2010-11-21T07:55:00.000-08:00

Oakland, California (Photo by Ann Forsyth)

The topic of food and planning is one of great interest—particularly promoting healthy food options. Of course what people eat is a complicated result of their personal preferences, financial resources, and social context. Food availability depends on climate, the time of year, whether people grow their own food, how much it costs, home food storage options, and the kinds of stores in the local area.

However, a number of tools can help larger communities plan for their food access. One such tool is the Food Security Assessment. In 2002, the USDA Economic Research Service published a well-known Community Food Security Toolkit: http://www.ers.usda.gov/Publications/EFAN02013/ with the entire toolkit at http://www.ers.usda.gov/publications/efan02013/efan02013.pdf. There are other toolkits around, with many good tools developed for use internationally in areas likely to suffer substantial food shortages, but this one by a U.S. government agency may be a good place for others to start.

The USDA web site provides helpful information about food security in the U.S.: http://www.ers.usda.gov/Briefing/FoodSecurity/. A 2007 USDA Food Security Assessment provides an example at the international level: http://www.ers.usda.gov/Publications/GFA19/. However, using the methods in the toolkit, local communities can do this as well.

The food security assessment and other food related tools are discussed in the DFH Food Issues Sheet at http://www.designforhealth.net/pdfs/Information_Sheet/BCBS_ISFood_090107.pdf based on research outlined in the Food Key Questions research summary http://www.designforhealth.net/pdfs/Key_Questions/BCBS_KQFood_082207.pdf.

Technical Resource 2: InformeDesign

2010-11-02T13:26:00.000-07:00

InformDesign (http://www.informedesign.org/) is an online database of research on people and environments. With substantial funding from the American Society of Interior Designers, and based in the University of Minnesota Department of Design, Housing, and Apparel, the database emphasizes research at the building and component level. However, there is enough other work to make it worth a visit, even for urban planning scale investigations.

The site is basically a database of research summaries in a standard format: introduction, design issue or topic, design criteria or implications, key concepts or central ideas, research methods, limitations identified by the authors of the piece, commentaries on limitations noticed by the InformeDesign reviewers as well as additional information, and a full citation.

The site offers several navigation and search options though not all are obvious. A simple search window is on the home page. There is also an advanced search engine that I found to be well designed though results are listed by URL only and one has to click on the link to the summary to get more information such as titles. Also on the home page are buttons titled “space,” “issues,” and “occupants” that link to lists of subtopics that are further subdivided on later pages. When a user clicks on a subtopic, or a sub-subtopic, articles are listed by name and author and have check boxes to add to a personalized list.

For those interested in more general information about the project, a main menu links to useful information about the site, its sponsors, and the database. An online tutorial on Research 101 provides a refresher on research vocabulary and concepts.

Free Articles on Health and Environments

2010-10-22T11:34:00.000-07:00

For those not at universities, finding research on the connections between health and places can be a bit tricky. However, a growing number of online resources are meeting these needs. The entry below lists just a few of these:

Several research funders provide free access to journals:

Active Living Research, funded by the Robert Wood Johnson Foundation, has sponsored quite a few special issues with free downloadable articles. Many of them are are listed at: http://www.activelivingresearch.org/resourcesearch/journalspecialissues.

Healthy Eating Research, another RWJF-funded group, also has free special issues: http://www.healthyeatingresearch.org/publications-mainmenu-111/special-journal-issues-mainmenu-118. In addition they have sponsored a number of proceedings and presentations: http://www.healthyeatingresearch.org/publications-mainmenu-111/proceedings-and-presentations-mainmenu-145.

Some government agencies who fund and use research have online databases, including free downloads:

Pub Med.gov is produced my ythe U.S. National Library of Medicine at the National Institutes of Health: http://www.ncbi.nlm.nih.gov/pubmed. With over 20 million citations, some linke to free downloads. I find their advanced search engine to be most helpful: http://www.ncbi.nlm.nih.gov/pubmed/advanced.

The U.S. Transportation Research Board's Transportation Research Information Service (TRIS) is a terrific database of transportation resources, some related to health and some of these available for free: http://tris.trb.org/.

The U. S. HUD USER research portal is similar, with a bias toward housing: http://www2.huduser.org/portal/bibliodb/pdrbibdb.html. This wasn’t working when I uploaded the link but I imagine it will be soon.

There are a number of free online journals. Many are newer.

A terrific resource for free journals is Highwire, a division of the Stanford University Libraries that aims to make research more accessible: http://highwire.stanford.edu/lists/freeart.dtl. For example back issues of Environment and Urbanization are free after 3 years: http://eau.sagepub.com/ and the American Journal of Public Health after 2 years: http://ajph.aphapublications.org/.

Examples of journals with where authors pay fees, include the International Journal of Environmental Research and Public Health (http://www.mdpi.com/journal/ijerph) and the International Journal of Health Geographics (http://www.ij-healthgeographics.com/). I have reviewed for the latter (for free) but have mixed feelings about this approach of charging to publish, although it is common in the sciences.

In planning the online journals with free submission and publication are in related areas such as transport and include the Journal of Transport and Land Use (https://www.jtlu.org/index.php/jtlu).

Other groups provide research summaries. Design for Health’s own research summaries provide accessible summaries of research on various health topics, as of 2007 and 2008: http://www.designforhealth.net/resources/researchsummaries.html. There are others that I will highlight in upcoming blogs.

Blogs about Health and Places

2010-09-25T10:00:00.000-07:00

As blogs have proliferated some have begun to deal with health and places. Below I list a sampling of the range of such sites, many dealing with health issues as part of a larger interest in topics such as urban development or housing. They are in alphabetical order.

City Parks Blog (http://cityparksblog.org/) is the blog of the Trust for Public Land’s Center for City Park Excellence and the City Parks Alliance. One of the interests of the center is in health: http://cityparksblog.org/2009/01/06/parks-mediate-our-urban-mental-health/

From State of the Planet blog

Healthy Cities (http://healthyurbanplanning.blogspot.com/) is the blog of Jason Corburn, a faculty member at Berkeley. It focuses on highlighting resources such as reports and statistics and has an international flavor.

Squatter City (http://squattercity.blogspot.com/) is maintained by Robert Neuwirth. Neuwirth is journalist and author of Shadow Cities, a 2006 book based on a total of two years of living in four different squatter settlements. My undergraduate students find it a compelling read. Neuwirth’s blog deals with a wide range of issues about urban settlements.

State of the Planet (http://blogs.ei.columbia.edu) is a compilation of blogs from the Earth Institute at Columbia University. It is by far the most elaborate in this list with fancy graphics, multiple contributors, and obviously represents a lot of staff time. It has a useful keyword search.

Urban Chickens (http://www.urbanchickens.net/) is an example of a blog about local food production. Entries deal with many of the practicalities of raising one’s own eggs. The proliferation of these kinds of blogs really help people who have a DIY approach. Keep an eye out for next year’s listing of urban chicken coop tours: http://www.urbanchickens.net/2010/03/urban-chicken-coop-tours-in-2010.html

Walk Score, the blog (http://blog.walkscore.com/) builds off the popularity of the walkscore tool. In the main web site an automated calculation based on destinations such as shops. As an expert on pedestrian planning I think this is oversimplified but the tool itself is fun and the blog is a mix of example results and tips about using the scoring (e.g. how to customize scores).

Other web resources about health and places are available at: http://www.designforhealth.net/resources/websites.html

Therapeutic Landscapes Network at http://www.healinglandscapes.org/

2010-09-15T08:39:00.000-07:00

Garden landscape
(Photo by Ann Forsyth)

Focusing on gardens and other landscapes, with a particular emphasis on gardens in healthcare settings, the web site of the Therapeutic Landscapes Network is a well-designed and maintained resource. I have found the following sections to be particularly helpful:

The evidence-based design section at http://www.healinglandscapes.org/ resources-ebd.html includes online searchable databases, books, and articles.

The gardens overview at http://www.healinglandscapes.org/gardens-overview.html links to ressources on various kinds of healing gardens including those in healthcare, community gardens, prison gardens, and memorial gardens.

A section on art and health http://www.healinglandscapes.org/related-art-health.html provides a succinct overview of important resources.

For further reading, the Design for Health web site deals with planting and mental health at: http://www.designforhealth.net/resources/mentalhealthissue.html

HIA-CLIC--UCLA Health Impact Assessment Clearinghouse Learning and Information Center

2010-08-30T12:32:00.000-07:00

This UCLA clearinghouse has been a terrific resource for some time but has recently updated its web site: http://www.HIAGuide.org.

Particularly useful are its:

List of HIA laws in the U.S.: http://www.hiaguide.org/legislation. It’s a short list which is interesting in itself.
Nice division between sectors and pathways. Pathways include things like access to parks or air quality, akin to the Design for Health topics: http://www.hiaguide.org/sectors-and-causal-pathways/pathways. Sectors include taxation, housing, and education: http://www.hiaguide.org/sectors-and-causal-pathways/sectors.
Inventory of HIA methods: http://www.hiaguide.org/methods-resources/methods

Still under construction is is useful already but promises to be an even richer resource.

How to Do a Rapid Health Impact Assessment: Useful Reports

2010-08-14T08:12:00.000-07:00

The Rapid Health Impact Assessment—the kind of HIA that takes the form of a structured workshop with substantial preparation and reporting—boasts a number of detailed manuals, such as the classic by Erica Ison: http://www.apho.org.uk/resource/item.aspx?RID=44890.

Arden Hills Healthy City Planning Workshop
(Photo by Ann Forsyth)

However, moving beyond such general guidance it can be hard to find out how others have conducted their HIAs. Some people provide extensive background reports but not much about what actually happened at the workshops. Others focus on the outcomes of the HIA and not the inputs and process. An increasing number of practitioners are, however, reporting on HIAs in straightforward ways that provide transferrable tools for others. This entry highlights several of these, all containing useful examples of worksheets, maps, and recommendation checklists or tables.

The London Olympics HIA, completed in 2004 is an example of a health impact assessment conducted on a major employment and housing development. Prepared by consultant for the London Health Commission and the London Development Agency, the HIA had two parts: a desktop assessment using many existing reports and a workshop with 21 key participants (including advocates, government representatives, academic and academics). The HIA looked at construction, operation, and post games time periods and the consultant produced a 155 page report, available online: http://www.apho.org.uk/resource/view.aspx?RID=61057. This comprehensive report contains substantial background information, results from exercises in the workshop including some interesting voting activities, and clear recommendations.

The Lowry Corridor HIA of 2007, while an internally conduced assessment rather than a true participatory HIA, is a terrific resource. Focusing on the redevelopment of a major road in Minneapolis, the report contains several well thought-out worksheets and a number of interesting maps: http://www.apho.org.uk/resource/item.aspx?RID=60512. It is a very accessible document.

Commerce City, Derby Redevelopment Area HIA is also not a traditional rapid HIA but it is included here for its imaginative use of participation and analysis tools. These range from computer mapping and proposals for street redesign to photos taken by residents and stills from a video produced by local high school students. Located in a lower income, majority Latino area of suburban Denver the HIA was conducted by the Tri-County Health Department who in turn employed short-term consultants on special topics. With a focus on physical activity and nutrition, recommendations from the 65- page report (http://www.tchd.org/pdfs/hia_final.pdf) fed into a master plan.

The Arden Hills Healthy City Planning Workshop of 2010 assessed options for reusing a military facility in a suburb of the Twin Cities. The state Department of Health sponsored this HIA collaborated with the City of Arden Hills, hiring a consultant to actually conduct it (Design for Health). This is one of the very few HIA reports that includes basically all the information used to run and report on the HIA workshop--the actual information packet provided to participants in advance; the agenda of the meeting, copies of handouts, worksheets, and presentations from the workshops; a series of photos keyed to parts of the agenda; and the workshop’s summary report. The summary report and appendices, along with a description of the workshop, are online: http://www.designforhealth.net/cases/ardenhillsworkshop.html.

More information about HIA in general can be found at http://www.designforhealth.net/resources/healthimpact.html.

Technical Resource 1: Gapminder www.gapminder.org

2010-08-04T15:51:00.000-07:00

With a focus on international development, health, and globalization, Gapminder shows what it is possible for Swedish statisticans to to do with flash animations and time on their hands on long cold nights. You can see founder, Hans Rosling, in action on video and then try it yourself with online and downloadable animations. His most famous video is at now a few years old but gives a good sense of how to use the tool. You might want to check out what he said at the U.S State Department in Washington DC last year and it is instructive to compare with a presentation for an Indian audience: http://www.gapminder.org/videos/hans-rosling-asias-rise-ted-india/.

While data are provided by country, one of the data sets is the percent urban population making it possible to see the relationships between urbanization and many health and environmental indicators. Several tools allow comparison of regions and states within countries for example, comparing countries with Chinese provinces and U.S. states: http://www.gapminder.org/labs/

Gapminder makes the important point that more wealth does not always lead to better health.

This blog owes something to an earlier Planetizen entry: http://www.planetizen.com/node/42744. For more on the various ways health intersects with place, see: http://www.designforhealth.net/resources/generalhealthissues.html

Finding Information about HIA: Design for Health Blog

2010-07-30T05:58:00.000-07:00

How health impact assessment can make a difference is an issue of some interest at present. For those wanting to explore HIA online, several major clearinghouses provide a wealth of information from legislative updates to workbooks.

Centers for Disease Control HIA Resources: http://www.cdc.gov/healthyplaces/hia.htm
This page is a useful index of major sources and an easy place to start.
Health Impact Assessment Clearing House Learning and Information Center—HIA-CLIC at UCLA: http://www.hiaguide.org/
This terrific site had a wonderful training section with lots of resources: http://www.hiaguide.org/training/training-guides. They also have a section tracking legislation in the U.S.
HIA Connect in Australia: http://www.hiaconnect.edu.au/index.htm
The HIA Practical Guide by HIA Connect, downloadable from this page, is a fairly short and very clear guide to HIA. HIA Connect also has an active eNews service: http://www.hiaconnect.edu.au/hia_e-news.htm.
HIA Gateway, UK: http://www.apho.org.uk/default.aspx?QN=P_HIA
One of the best listing of HIAs around the world with a good advanced search feature that allows you to search by keyword, date, and geography: http://www.apho.org.uk/resource/advanced.aspx.
Human Impact Partners, Oakland: http://www.humanimpact.org/
I particularly like their tools and resources section which includes a number of guides and worksheets: http://www.humanimpact.org/hips-hia-tools-and-resources. Be sure to scroll down the page.
RWJF/Pew Health Impact Project: http://www.healthimpactproject.org/hia?id=0007
This is a fairly new project and their web site is evolving. Their news section is a useful part of the site: http://www.healthimpactproject.org/new.
World Health Organization HIA: http://www.who.int/hia/en/
Determinants of health from http://www.rotherhampct.nhs.uk/hia/determin.gif.
Originally G. Dahgren (1995) European Health Policy Conference

Providing an international perspective this web site has a particularly strong section on HIA examples, classified by sector: http://www.who.int/hia/ examples/en/.

For more information about HIA go to the Design for Health web site at http://www.designforhealth.net/ resources/healthimpact.html.