The Built Environment and Public Health:

A Tale of Two Communities

Susan Allan, MD, JD, MPH

Oregon State Public Health Director

July 14, 2005

Two communities – similar and different

• Arlington, Virginia• Oregon (especially Portland)

• Many similar activities, some key differences• Different motivations

– “Livability”– “Urban Village”– Attractiveness to business and their employees– “Health of the Environment”

• Health a “bit player,” but chance to affect the language used

• Public Health as “coach” or “cheerleader”

Public Health is…

“what we as a society do collectively to assure the conditions in which people can be healthy.”

1988 Institute of Medicine report “The Future of Public Health”

Why worry about the built environment?

• Toxic exposures– Community– Home– Air– Water

• Injuries• Obesity• Physical activity• Access to healthy foods• Safety and security• Social engagement – importance to health just

beginning to be understood• Etc……

Community Environmental Health Assessment (Arlington)

• Heard community concerns– Expected and unexpected

• Air quality

• Disease vectors (rodents)

• Pedestrian safety

Pedestrian Safety Project

• Partnership with Police Department

• Analyzed pedestrian accident data

• NTSA grant

• Puppet program for Hispanic children and their parents

Similarities

• Active and explicit land use planning• Public transportation• “green space” preservation• Bike paths• Public spaces• Public art• Special community events

Health NOT primary motivation, but often secondary message or

justification

***If you have been at the table and engaged, you may have important (although indirect) opportunities to shape how others think and talk.***

Transportation

• Public transportation

• Fareless Square

• Flexicar

• Bicycle commuter

Flexicar

Benefits from transportation plans

• Air quality

• Increased exercise– Walking– Bicycle commute

• Supports development of public spaces and social interactions

Recreation Centers and Senior Centers

Parks

Dog Parks

Attractive communities

• “Urban Village”– Small local shops– Neighborhoods

• Attractive public spaces– Informal community gatherings– Community fairs and events

Builds Community, Supports Healthy Activities

Farmer’s Market

Some other “built environment” activities with public health

implications• Lead in housing– Investigation of toxic kids– Housing remediation– Testing before sale

• Locating electrical substations• Microwave communication towers• Location of public leaf mulch piles• “Sludge” burning vs land application

Final challenge: Safety and Security

Formulation of reasons

• Livability

• Support economic development

• Create community

• Health – way to describe what is being done for other reasons

• Protecting health of environmental vs health of people

Why pay attention to “built environment”? - Arlington:

• “Urban Village”

• Livability

• Property values

• Attract employers

• Emphasis on communal values

• Health explicit subtext

Why pay attention to “built environment”? - Oregon (Portland)

• “Quality of life”– “Not California”– Open space– Property values

• Emphasis on individual choices

• Protection of Environment (“Green”)

Contrasts in motivation -Arlington

• Strong emphasis on community centers, senior centers– Social and physical activity

• Making the community attractive, appealing (and tidy)

• Bike paths and walking paths predominantly recreational

Contrasts in motivation -Arlington

• Homeless services carefully off the main streets, behind pretty facades

• Special transportation shuttle at lunch hours between prominent commercial centers

• Active promotion of growth around public transportation hubs (plan from early 1970s)

• Very explicit obesity reduction programs in schools and for County employees

• Low obesity rates

Contrasts in motivation –Portland/Oregon

• Little emphasis on community centers, senior centers– Drop-in centers for low income and for “self help” (free

lending of tools• Bike paths and walking paths both recreational

and commuting– Highest proportion of population commuting to work

by bicycle• Obesity rates:

– Adults: US average– Children: high

Contrasts in motivation – Portland/Oregon

• Portland - Homeless services casually on main thoroughfare, Sunday meals in prominent park

• Transportation free in “Fareless Square”, easy access for bicycles on trolleys, buses

• Oregon water not required to be fluoridated because of potential harm to the environment

Public Health Fantasies

• Ensure basic public health in education of all citizens– Better informed about how to manage their own health– Better informed about the costs/benefits of choices

• Better informed policy makers• Better informed voters

• Require “Public Health Impact Statement” for all major public and private actions

Excerpts from Arlington County Press Release 7-1-05

• A "smart growth" leader - …. the Environmental Protection Agency (EPA) gave its first national "smart growth" award to Arlington.

• Personal health - Data show that sprawl leads to poor health; people can take advantage of Arlington's smart growth to improve their personal health.

Thank you!