Post on 27-Mar-2015
transcript
building bridges: integrating building bridges: integrating the work of public health and the work of public health and
urban planningurban planning
Rajiv Bhatia, MD, MPHRajiv Bhatia, MD, MPH
San Francisco Department of Public San Francisco Department of Public HealthHealth
January 27January 27thth, 2005, 2005
What makes us healthy?What makes us healthy?
Annual Annual Health Health SpendingSpending
Life Life Expectancy Expectancy (years)(years)
OECD OECD AverageAverage
$2114$2114 77.277.2
United United StatesStates
$5267$5267 76.876.8
The fundamental conditions The fundamental conditions and resources for health are and resources for health are
peace, shelter, education, peace, shelter, education, food, income, a stable food, income, a stable
ecosystem, sustainable ecosystem, sustainable resources, social justice and resources, social justice and
equity. equity.
1986 WHO Ottawa Charter for 1986 WHO Ottawa Charter for Health PromotionHealth Promotion
Poor ventilation, mold, and rodents
Substandard construction and deferred maintenance
crowding
hunger
Dangerous streets
Worsening traffic and longer commutes
Poor food quality
No places for play
Declining moderate wage jobs and economic diversity
Limited access to Jobs, Health Care, and Friends and families
Asthma MapAsthma Map
RRxx: Healthy Planning: Healthy Planning
Connect problems and issuesConnect problems and issues Value local knowledge and experienceValue local knowledge and experience Apply public health research Apply public health research Develop inter-disciplinary partnershipsDevelop inter-disciplinary partnerships Build consensus / reduce conflictBuild consensus / reduce conflict Ensure accountabilityEnsure accountability
Health Impact AssessmentHealth Impact Assessment
DefinitionDefinition
Methods to account for the Methods to account for the effects of public policy decisions effects of public policy decisions on human health and well beingon human health and well being
Health Impact AssessmentHealth Impact AssessmentMultiple ApproachesMultiple Approaches
Integrating health Integrating health analysis into analysis into environmental review environmental review under CEQA and NEPAunder CEQA and NEPA
Promoting health Promoting health analysis through analysis through participatory research participatory research and community and community partnershipspartnerships
Implementing health Implementing health assessments as a assessments as a collaborative and collaborative and consensus building consensus building processprocess
Rincon Hill Area PlanRincon Hill Area Plan
Impact AnalysisImpact Analysis No school planningNo school planning Limited open spaceLimited open space Housing not Housing not
matched to matched to employment employment
Effects on Effects on residential residential segregation segregation
Rincon Hill Area PlanRincon Hill Area Plan
OutcomesOutcomes
Increased below Increased below market housingmarket housing
Support for on-site Support for on-site inclusionary housing inclusionary housing
Support for Support for reduction in parkingreduction in parking
Trinity Apartments Trinity Apartments RedevelopmentRedevelopment
Impact AnalysisImpact Analysis
Permanent Loss of Permanent Loss of low rent unitslow rent units
Displacement of Displacement of residentsresidents
Disruption of an Disruption of an established established communitycommunity
Trinity Apartments Trinity Apartments RedevelopmentRedevelopment
OutcomesOutcomes
EIR study of EIR study of displacement displacement impactsimpacts
Replacement units Replacement units for current for current residentsresidents
Eastern Neighborhoods Community Eastern Neighborhoods Community Health Impact AssessmentHealth Impact Assessment
Visions a healthy cityVisions a healthy city Identifies health Identifies health
objectives influenced objectives influenced by planning by planning
Predicts effects of Predicts effects of three neighborhood three neighborhood zoning planszoning plans
Proposes monitoring Proposes monitoring of the outcomes of of the outcomes of developmentdevelopment
Eastern Neighborhoods Community Eastern Neighborhoods Community Health Impact AssessmentHealth Impact Assessment
Builds on international Builds on international HIA approachesHIA approaches
Uses a consensus Uses a consensus building / deliberative building / deliberative model model
Participants include 40 Participants include 40 public and private public and private organizationsorganizations
Occurs in parallel to Occurs in parallel to environmental impact environmental impact assessmentassessment
HIA within PartnershipsHIA within Partnerships
Research on Research on displacement effectsdisplacement effects
Co-authoring a Co-authoring a community plancommunity plan
Training on EIR Training on EIR processprocess
Equity analysis of Equity analysis of transportation planstransportation plans
Critique of Level of Critique of Level of Service analysisService analysis
Major ObstaclesMajor Obstacles
New role for public health—training New role for public health—training needs, funding, political legitimacyneeds, funding, political legitimacy
Concerns about new processes, Concerns about new processes, agendas, analysis, and regulations on agendas, analysis, and regulations on developmentdevelopment
Competing development agendasCompeting development agendas Limited trust in collaborative Limited trust in collaborative
approachesapproaches
Overcoming ObstaclesOvercoming Obstacles
Framing land use as a public health Framing land use as a public health issueissue
Using multiple approachesUsing multiple approaches Building common agenda with Building common agenda with
community partnerscommunity partners Reaching out to developers and Reaching out to developers and
business interestsbusiness interests Supporting planners and their workSupporting planners and their work
Expected Outcomes Expected Outcomes
Public understanding of health and Public understanding of health and land use relationshipsland use relationships
New roles for public health in planningNew roles for public health in planning Broader community participationBroader community participation Support for comprehensive planningSupport for comprehensive planning Impacts on development decisionsImpacts on development decisions Impacts on decision-making practiceImpacts on decision-making practice
Lessons LearnedLessons Learned
Health, Sustainability, Smart Growth, Health, Sustainability, Smart Growth, Social Equity have the same Social Equity have the same requirementsrequirements
HIA: an invitation to a partyHIA: an invitation to a party Need for democratic, responsive, and Need for democratic, responsive, and
accountable institutionsaccountable institutions We are all in this together; methods We are all in this together; methods
need to reduce polarization of interestsneed to reduce polarization of interests
Health promotion works through Health promotion works through concrete and effective community concrete and effective community action in setting priorities, making action in setting priorities, making decisions, planning strategies and decisions, planning strategies and
implementing them to achieve implementing them to achieve better health. At the heart of this better health. At the heart of this process is the empowerment of process is the empowerment of
communities, their ownership and communities, their ownership and control of their own endeavors control of their own endeavors
and destinies.and destinies.
1986 WHO Ottawa Charter for Health 1986 WHO Ottawa Charter for Health PromotionPromotion
““..medicine is a social science, ..medicine is a social science, and politics is nothing but and politics is nothing but
medicine on a grand scale.” medicine on a grand scale.” --Virchow--Virchow