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How planning can bolster community health

Panelists Dr. Lynn Todman, Kim Gilhuly, and Dr. Rajiv Bhatia answer questions from the audience during the "Improving Health Through Planning" roundtable.

View the panelists' presentations (combined into one 2.1MB PDF).

In planning, we tend to make major “if, then” assumptions:

“The presence of a grocery store in a neighborhood that previously lacked one will cause residents to make healthier food choices.”
“New public transit options mean people will walk more.”
“Mixing the incomes of residents in a housing development will result in meaningful interaction across wide demographics.”

Sound familiar?

At a Dec. 7 MPC roundtable, “Improving Health Through Planning,” national experts tackled these assumptions, while challenging the audience to rigorously assess the health impacts of projects, plans and proposals by first considering health early on in the process based on sound research, but also through the use of a relatively new evaluative planning tool, Health Impact Assessments (HIAs), designed to evaluate proposed projects, policies, and programs as they are put forth.

Dr. Rajiv Bhatia, director of occupational and environmental health in the San Francisco Dept. of Health, and assistant clinical professor of medicine at the University of California-San Francisco, kicked off the discussion by offering a definition of “health” that goes far beyond a person’s blood pressure. He argued that health encompasses economic, physical, and ecological well-being – indeed, said Bhatia, health equals freedom, because if we’re not healthy, we can’t do the kinds of things we want to do.

Dr. Bhatia told the story of a group of community organizations in San Francisco that began to demand more accountability from housing developers, in effect by pushing for a much broader definition of “sustainability.” A popular buzz word in development, “sustainable” typically refers to the “green” amenities peppering a development, such as low-flow toilets and solar-sensitive lighting fixtures. Bhatia said this understanding is “sustainable with a small ‘s’”; true sustainability – with a large S – is the long-term maintenance of well-being.  Residents and community organizations involved with the redevelopment of Trinity Plaza in San Francisco leveraged this broader definition of Sustainable to argue against a proposal that would have replaced 360 rent-controlled units with 1,400 market rate condos. They had the data to back them up, thanks to Bhatia and his team, which conducted an HIA that definitively showed the negative health impacts of the proposal, including increased stress, the breakdown of social networks, budget strain, and overcrowding. Ultimately, the City of San Francisco worked with the developer to redesign the project to keep the rent-controlled units within the larger redevelopment.  He used a similar example of how his department determined that 55 percent of fatal pedestrian injuries were attributed to just seven percent of city streets, leading to more targeted and proactive solutions based on the unique aspects of those more dangerous corridors. His experience with HIA’s demonstrate both important benefits and detriments to health, facilitating effective solutions. It is hard to argue, Bhatia concluded, with informed decision-making.

Kim Gilhuly of Human Impact Partners got more technical, outlining the six steps to conducting an HIA: screening, scoping, assessment, recommendations, reporting and mentoring and evaluation (which, she pointed out, should be familiar to anyone who has conducted an Environmental Impact Analysis, as HIAs were based on EIAs.) Gihuly also stressed one tangential, but important and positive impact of HIAs: regardless of the outcome of the analysis, the process strengthens the relationships of those who participate and empowers the community with new information.

Chicago local Dr. Lynn Todman is the executive director of the Institute on Social Exclusion at the Adler School of Professional Psychology, where she focuses on the ways in which social, political, economic and cultural structures systematically marginalize urban populations. Todman and her colleagues have pioneered Mental Health Impact Assessment (MHIAa) in communities such as Englewood in Chicago, where she is studying the mental health implications of proposed federal rules changes that would not allow employers to use criminal records of non-convictions , i.e. arrest records, in employment decisions. While this assessment is still in the process, Todman emphasized that “we shouldn't have to add an ‘M’ to HIA.” Rather, all HIAs should assess the mental health impacts of interventions because mental well-being is a critical component of overall health.

“Improving Health Through Planning” was generously sponsored by Blue Cross Blue Shield of Illinois and was followed by a dynamic training to deepen participants’ understanding of whether and how HIAs should be employed in a given situation.

For more information on HIAs and an extensive database of cases across the U.S., check out the Health Impact Project as well as the information at the World Health Organization and Centers for Disease Control.

Other resources (recommended by panelists):

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