Healthy Planning in California

In spite of the economic downturn, incorporating public health into the planning process is increasing in California. From Sacramento to San Diego, planners are slowly realizing that land use and other urban planning decisions are health policy decisions. Whether these actions, which include Health Elements in General Plans and using Health Impact Assessment to review development and other decisions, will focus only on relatively apolitical built environment issues (like walking and community gardens) or include more important political and social determinants of urban health equity -- such as poverty, residential segregation, tax policies, and building community power  - - is yet to be seen.  As I've noted in other blog entries and in my book, Toward the Healthy City, the impetus for this reconnection of planning and public health is coming from community-based organizations, with resources from foundations, not planning departments.  County health departments, especially those in San Francisco and Alameda, have been key leaders and will need to increase their efforts to bring along complacent planning agencies. An article in the The Sacramento Bee reviewed some of the efforts across the state, many of which are funded by The California Endowment's Healthy Communities Program:
http://www.sacbee.com/2010/11/14/3181550/urban-hip-and-healthycan-wellness.html

MDGs - Focus on equity, not just poverty

The summit on the Millennium Development Goals last week at the UN highlighted that the indicators are mixed bag of failure and success...even with 5 years to go.  Failure because they tend, among other things, to measure national progress which can mask within country inequalities and few countries in the global south have systems in place to report on the measures.  Yet, the mere existence of the MDGs provides a space for discourse about development and ways to make the world more equal...even if the measures alone, if reached, won't get us there.  A new blog on the Guardian's web site is one of the best I've seen on these issues. Madeleine Bunting, a contributor to the Guardian, has an especially interesting post on why equality, not just measures of development "progress," are not a major priority of the UN, but should be.   

Boston Health Commission: Where you live matters for health equity

Following the work of other local health departments, such as Alameda County in the San Francisco Bay Area, the Boston Public Health Commission has launched a program to address health disparities in the city's neighborhoods.  A fancy web site, http://whatsyourhealthcode.com/, emphasizes that PLACE MATTERS for health. Unfortunately, only $150,000 is dedicated to this campaign and most of the "Take Action" suggestions do not give the reader any clues about how local, state and federal policies are largely to blame for health inequities and that new policies are needed to reverse these inequities.  The Boston Public Health Commission's Center for Health Equity and Social Justice does have some more direct information and action items, including some excellent presentations on the relationships between structural racism and health.  Planners and others can build all the community gardens, parks, sidewalks and bike lanes they want, but until we start getting serious about reversing the connections between racism, place and health, those built-environment strategies alone are not going to move society toward more healthy and equitable cities.

Making Environmental Justice a priority...again

The Obama administration finally got around to convening the Interagency Working Group on Environmental Justice. This group, established in 1994, had not met for almost a decade.  A Federal Advisory Committee, this group was a very important forum for EJ activists and others to gain the attention of federal decision makers.  I remember attending one meeting of the IWGEJ where residents from Mossville, Louisiana, made their case about dioxins and other chemicals in the air and water and related health issues facing their community and the adjacent chemical plants.  The EPA and other federal agencies were forced to respond and are continuing to address EJ concerns in Mossville.   This forum was also supposed to hold EPA and all agencies accountable to their mandate to develop policies and strategies for incorporating EJ analysis into agency decision-making.  Hopefully this meeting will show some real leadership to follow-through on the EPA's own Inspector General report from 2006, that revealed few if any EPA senior managers were directing their staff to conduct EJ reviews of federal policies, programs or projects.  Implementing this step alone could have a significant and lasting positive impact on urban health inequities in communities across the country.

Sustainable development from Obama?

As I've noted in this blog before, the Obama Administration has a number of iniatives that are aiming to promote sustainable development.  The most visible program is called Sustainable Communities and is a partnership between 3 federal agencies: EPA, HUD and DOT - or environment, housing and transportation. The program is off to a commendable start: re-introducing regional planning into the lexicon of the federal government, re-connecting land use, housing and transportation decisions and, at seeming to place equity as a key priority.  They iniative is up against years of federal, state and local actions that have contributed to unsustainable and most importantly for environmental health, inequitable development.  Razing urban neighborhoods to build the interstate highway system, promoting white-flight to suburbs through mortgage insurance policies, concentrating poverty and racial residential segregation through federal housing programs, and siting multiple hazardous facilities, such as sewage treatment plants and power plants, in low-income, communities of color - - are just some examples of federal policies that this initiative must confront.  An article from The American Prospect, The Reverse Commute,  reviews this program and the myriad of challenges it faces - - particularly its tendency to over-rely on New Urbanist design principles to move the nation toward sustainable development.   Written by a planner and someone with experience of social justice issues in cities, this is one of the better articles on the program but fails to engage enough with the issues of bureaucratic fragmentation and issue segmentation, home-rule, and structural racism that continue to plague our planning institutions.  

 

Here is a recent press release detailing the federal funds behind this program and their attention to livability and human health.

HUDNo.10-131/U.S. Department of Housing and Urban Development (HUD

 

Planning, sexual violence & HIV/AIDS

A new report from Amensty International confirms what we have seen and heard in our own work in Nairobi's slums: a lack of planning contributes to sexual violence against women, including rape, and the spread of HIV/AIDS.  The Amnesty report, called Insecurity and indignity: Women's experiences in the slums of Nairobi, Kenya, documents the experiences of women living in four of Nairobi's slums, Kibera, Mathare, Mukuru Kwa Njenga and Korogocho. Of course, planning is not solely to blame, but lack of adequate toilets, places to bathe, lighting, housing, and other place-based issues make life insecure for many girls and women living in slums.  Violence against women also happens inside the home, at the workplace and is unacceptable anywhere, anytime.   Compounding the problem is that violence against women, from rape to domestic abuse, often goes unreported and unspoken about, adding to the trauma.  Police presence is rare in Nairobi's slums and in Mathare and Makuru, where we are working, social control is more often by youth gangs than any government authorities.  Another horrific outcome of violence against women is the spread of STDs, especially HIV/AIDS, and the burden this places on women, families and entire communities. 
For more media coverage of this important issue: Fears of rape in Kenya's slums 'trap women'

Sustainable Urban Development Act 2010

New legislation sponsored by John Kerry, called the Sustainable Urban Development Act of 2010 (S. 3229), directs the United States Agency for International Development (USAID) to focus on urban planning and governance issues because this is a priority of US foreign policy.

The legislation calls for USAID to address common issues in cities of the global south, including growing informal settlements, increasing levels of pollution, overburdened transport systems, and lack of affordable housing, land tenure, gender equality, and basic water and sanitary infrastructure. The legislation calls for updating the Making Cities Work Strategy, and focusing on supporting urban planning and governance strategies, with an emphasis on community participation in decision-making. establishing a senior adviser for urban sustainable development at the agency and launching a 'pilot urban strategies initiative' implemented in select cities in the global south.
Some more commentary on this important legislation from the Cities Alliance and IRIN news.

Read more about the Making Cities Work Strategy here.

Health care legislation, disparities & healthier places

Lost in the media coverage of March 2010's Health Care legislation (namely the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010) were some important provisions to address health inequities experienced by both populations and places. Here are some of the important sections I've found. Please send me yours.

SEC. 2303. COMMUNITY HEALTH CENTERS = $9 Billion allocation!
SEC. 3132. TASK FORCE ON COMMUNITY PREVENTIVE SERVICES = with a focus on health disparities.
SEC. 3151. COMMUNITY PREVENTION AND WELLNESS SERVICES GRANTS for
HEALTH EMPOWERMENT ZONES = community-based projects that address multiple causes of health disparities.
SEC. 399Z-1. SCHOOL-BASED HEALTH CLINICS = Communities with high percentages of children and adolescents who are uninsured, underinsured, or eligible for medical assistance under Federal or State health benefits programs.
SEC. 339. GREEN SCHOOLS = improving the physical quality of the school environment.

OK, not enough, and we should already have a government run health system for all, but these additions to the legislation should contribute to addressing health inequities.  Better sumthin' over nothin'.

Racism & wealth in the US

In 1903, W.E.B. DuBois said in The Souls of Black Folks: "To be a poor man is hard, but to be a poor race in a land of dollars is the very bottom of hardship."
One of the most important, but ignored in most US media, stories of the last week highlights this hardship in a striking way.  A study,  published by the Institute on Assets and Social Policy at Brandeis University (one of my alma maters) found that the wealth gap between blacks and whites quadrupled between 1984 to 2007; from $20,000 in 1984 to $95,000 in 2003! This gap persisted for African Americans and white families in the same income range. Wealth is defined by what you own minus what you owe, so this is a much more robust and important measure than income or poverty status. What we need to remember is that income quality doesn’t lead to racial wealth equality and this helps explain the persistence of racial and ethnic health inequities!


These data are disturbing for blacks and Latinos, and especially for single women of color:

One reason for this is racism in our policies - such as tax cuts for investment income (the tax rate on capital gains income is only 15%  while ordinary paycheck income is taxed at 35%) and inheritance taxes - both of which benefit the already (mostly white) and wealthy.  Persistent discrimination in housing, credit (think predatory/subprime lending, credit-card debt and pay day loans/check cashing stores), and labor-markets also perpetuate these wealth inequities.

The solutions? TARGETED PUBLIC POLICIES, with the federal government leading the way! Federal policies must close tax loopholes exploited by businesses and redistribute the wealth of the rich - whose wealth often relies on federal government built highways and tax codes.  New wealth building opportunities must be targeted to families and communities of color whose lives and health are made even more precarious by not having enough assets to stay healthy when an economic challenge arises.

Healthy Planning in Richmond, CA + Health in All Policies

One of the most ambitious healthy planning initiatives in the State of California recently received some attention from the New York Times. I am working on the City of Richmond, California's Health and Wellness Element - - a section of their General Plan Update that focuses on integrating population health into all city and county planning and policy decisions.  The NY Times article is entitled "Richmond's New Priority: Taking Health Seriously." I've reproduced the first page of the article and Health and Wellness Element here:

While the article mentions the aims of walkability and urban design, the focus is on health equity: improving the quality of life and health outcomes for the poorest and least well-off groups in Richmond.  The Health Element will act as the 'public health blueprint' for the City, Contra Costa County Health Services, and a host of other public, private and non-profit groups working in Richmond for the next 10 to 20 years.

While the General Plan and Health Element are yet to be adopted by the City Council, work has already begun on an implementation strategy - - a glaring omission of many comprehensive plans that tend to just sit on a shelf.  The California Endowment is actively supporting the implementation and a related 10-year Healthy Richmond project.  These are major changes in both the world of urban planning and health philanthropy, and represent one of the best examples to date of healthy urban planning in the United States.

This work could set the framework for the State of California's recent declaration and commitment to Health in all Policies, by the State's Strategic Growth Council.  Yet another example of California's commitment to formally link the work of urban planning, health, climate change and community development.

World Health Day 2010 - Connecting Urban Planning & health

The theme of The World Health Organization's (WHO) World Health Day this year is Urban Health, with a special focus on the role of urban planning for healthy cities. Check out the home page here: http://www.who.int/world-health-day/2010/en/

The report on from WHO on why urban health and planning matter can be found here:

http://www.who.int/entity/world-health-day/2010/media/whd2010background.pdf

HEALTH: Putting the Focus on Cities - IPS ipsnews.net

HEALTH: Putting the Focus on Cities - IPS ipsnews.net

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State of the World's Cities 2010: Slum Upgrading Can Work!

The UN-HABITAT State of the World's Cities Report released for the World Urban Forum suggests that slum upgrading can reduce poverty, improve living conditions and not just gentrify neighborhoods.  See the press coverage here and the full report here.

The report notes that the number of Brazilians living in slums was reduced by 10.4 million people from 1999-2009 and 227 Million people world-wide have moved out of slum conditions since the year 2000.  Unfortunately, Sub-Saharan Africa saw only a 5% reduction in slum dwellers over this period.  Here is one graphic from the report showing the reductions in slum populations in Africa:

Importantly, the State of the World's Cities report emphasizes that some of the most unequal cities in the world are in the United States, where the rich live next-door to some of America's poorest.   The causes are many, but racial residential segregation - its historic legacy and present-day continuation is, according to the UN report, the KEY driver of urban inequality in the US.  One powerful quote:

"Even where standards of living are high, the marginalization and spatial segregation of specific groups creates cities within a city: distinctly deprived areas that further reinforce unequal opportunities and the distance between abject poverty and affluence."

The implications is that slums are NOT inevitable and economic growth alone is insufficient.  We need to look to Brazil, Thailand and other countries that have made a national and neighborhood commitment to participatory and integrated healthy city planning - where improvements to infrastructure, housing, land rights, economic livelihoods, and governance are the focus.  National and local government, NGOs, academics, multi-laterals, bi-laterals, and others...help organize slum residents, build on their expertise and knowledge, and let us all get back to the hard collaborative work that must be done.

California data for tracking healthy places

An innovative non-profit out of Los Angeles http://www.healthycity.org/ is releasing the next iteration of their Healthy Cities database and mapping program.  These new data will enable users to analyze a wealth of information across California, not just LA County as the previous web portal allows.  This is a major opportunity for comparative analyses and development of healthy city indicators, something this State and all metropolitan areas desperately need.
While the new system launches March 3rd, I had a chance to preview it at beta.healthycity.org.
 I searched the Iron Triangle neighborhood in Richmond, CA, using zip code 94801. I selected environmental facilities and health clinics, then added asthma rates to produce this map:

I know the map is hard to read, but there are some nice features, such as the ability to redefine shading colors and breaks in quintiles.  One can add a range of demographic, housing, economic and health data. One major piece that I couldn't find was an an export function that would allow for more complex comparative analyses using statistical software.  Yet, one great feature is that everything is geocoded with Lat/Long coordinates, so hopefully eventually exporting into GIS, Google Earth or some other mapping program should be seamless.  This project is very similar to InfoShare, http://www.infoshare.org/, in New York City, which I have used for many years.  The interface with Healthy City is much more user friendly, but with any data and mapping portal, it will take you some time to get exactly what you are looking for. 

Green Urban Innovation? Lacks a racial & social justice lens

Prospect Magazine has just published "How Slums Can Save the Planet" http://www.prospectmagazine.co.uk/2010/01/how-slums-can-save-the-planet/.
What the article argues is that living in dense environments requires and inspires green innovations; from intense recycling to urban agriculture, like these folks in Nairobi growing food staples in sacks of soil
http://allafrica.com/stories/201002180809.html
Yet, this article fails miserably because it give scant attention to the reasons WHY folks are living in slums in the first place and why they must innovate - namely a lack of planning for urban migration, global trade that has exploited resources and ravaged local economies, non-existent poverty and food programs and inadequate land rights and legal protections, among other issues. In other words, romanticizing urban poverty and slum-life will NOT save the planet for the poor; only the rich will benefit. This type of analysis also runs the risk of accepting slums or informal settlements as necessary, rather than working to organize residents to demand better planning and treatment from governments and multilateral agencies. Unfortunately, another elite 'green' white guy living in Marin County telling the world how 'those slum dwellers' can help him.

Life & Death: Where you live matters

A wonderful series of articles recently published in the Contra Costa Times in December 2009 examined the place-based determinants of life and death in the East Bay area of California. Find the series here:
http://www.contracostatimes.com/life-expectancy/life-expectancy/ci_13919582

What was the conclusion of zip-code level health, death, environmental and demographic data? Not surprisingly to many of us...where you live matters for your degree of suffering and length of life.  Residents of poor East Oakland die, on average, 16 years before residents of wealthier neighborhoods in the Oakland Hills.  These findings are almost identical to the groundbreaking report, Life and Death from Unnatural Causes: Health and Social Inequality in Alameda County.

Importantly, these articles also document that community organizations, Contra Costa Health Services, the California Endowment and others are using a host of strategies to reverse these glaring and disturbing health inequities.  Unfortunately, the articles fail to explore the role of urban planning and community development in shaping life chances for urban residents.  More on this and the specific activities in Richmond, CA soon.