Associate Professor, Department of City and Regional Planning, University of California, Berkeley
November 18, 2009
The following is a guest post from Jason Corburn, author of “Toward the Healthy City: People, Places, and the Politics of Urban Planning.” Corburn is an Investigator with the RWJF Investigator Awards program, and Associate Professor in the Department of City and Regional Planning at the University of California, Berkeley.
What makes a city healthy and how would we know when a city is healthy? This question has challenged planners, public health officials and urban residents from Mesopotamia to modern American cities. Too often, a healthy city is only thought of as the sum of its residents; if people have health care and are healthy, then the city must be healthy. Yet, this view often overlooks what makes people sick in the first place and contributes to uneven distributions of disease, premature death and disability across urban areas – namely the physical, social and economic conditions of cities. Today – not unlike hundreds of years ago - moving toward the healthy city means ensuring greater equity in urban policy and planning, so that all groups can live, learn, work and play under health supportive and promoting conditions.
While planning and public health emerged as professions with a similar goal, making urban life healthier, the professions are largely disconnected. My new book, Toward the Healthy City: People, Places, and the Politics of Urban Planning, explores the historic connections and disconnects between the fields and the lessons history can have for moving toward the healthy city today.
Today’s greatest urban health challenge is equity. As the Robert Wood Johnson Foundation Commission to Build a Healthier America has documented so well, where and how one lives can have a tremendous impact on health. Consider these two stark examples:
- In New York City, the predominantly poor, minority neighborhoods of the South Bronx, Harlem, and Central Brooklyn have rates of diabetes, asthma, mental illness, and HIV/AIDS that are nearly double that of the rest of the city.
- The Bayview-Hunters Point neighborhood in San Francisco, where Latinos and African-Americans are a majority, has the highest rates of adult and pediatric asthma, adult diabetes, and congestive heart failure in the entire city.
Moving toward greater urban equity will require city planners and public health professionals to work together. Yet, public health remains segmented by disease or behavioral modification programs, not focused on making places healthier. The everyday decisions by urban planners - from housing, transportation, food access, safety, education, and others – are rarely considered health policy decisions. Recent attention to the ‘built environment’ and health – largely focused on how the design of our streets and neighborhoods can influence physical activity and related illnesses – is much too narrow and ignores the fact that America’s urban poor, immigrants and people of color die earlier and suffer more, by almost every measure of disease, than all other groups in the United States.
In my new book, I focus on solutions and recommendations for how city planners, public health agencies and community groups can work together to make urban living environments more equitable and healthy. The book grounds history and theory with practical case studies from the pioneering efforts of government agencies and community coalitions in the San Francisco Bay Area. It should come as no surprise to some that the Bay Area is now leading the way in reconnecting planning and public health, often with an explicit health equity focus. There are many lessons to be learned for all cities, towns and regions across the US from the efforts in California.
In the first case study, I illustrate how a public health agency can redesign its work away from an exclusive focus on single diseases, risky behaviors and enforcing regulations to promote greater health equity in cities. When a collaborative research effort involving government and community residents in Bayview surveyed locals – who had been demanding environmental justice – the results revealed that crime, unemployment, access to healthy food and housing conditions were the community’s top “environmental” priorities. These findings, revealed by a partnership between local activists and the San Francisco Department of Public Health (SFDPH), led to new projects and programs aimed at addressing community concerns of food insecurity and a shift in the department’s focus to reflect the need to address the social determinants of health.
The confluence of community knowledge and epidemiologic insights helped the Environmental Health Section of the SFDPH redefine its mandate to engage with non-health specific policies and agencies, and to design new processes for evaluating the social determinants of health. A new program was created and staffed – the Program on Health Equity and Sustainability – with the explicit mission of addressing health equity in land use and urban policy. In less than a decade, this program and its commitment to health equity have contributed to new institutional practices and partnerships aimed at moving Toward the Healthy City.
Subsequent cases explore the use of Health Impact Assessment, which helps identify the health consequences of public policies, programs and projects. In downtown San Francisco, for example, housing activists and public health professionals entered into the labyrinth of land use planning and weighed-in on the controversial redevelopment proposal for the Trinity Plaza project. How did the agency and citizens decide to use health impact assessments? How was the community-based struggle for affordable housing impacted by the introduction of health arguments? What influence did the legally mandated environmental impact assessment process have on health analyses? How can cities develop indicator and tracking systems to monitor how well they and their policies are doing in moving toward the healthy city? These are questions that planning and public health agencies along with community organizations across the country are struggling to answer and Toward the Healthy City answers.
As recently as last month, the Robert Wood Johnson Foundation announced the Health Impact Project, a collaboration with The Pew Charitable Trusts, that encourages the use of health impact assessment to help decision-makers make better-informed choices to prevent harm and unexpected costs. My book highlights in detail that moving toward the healthy city will require not one, but a host of new practices like health impact assessments, and that a new politics of place, called healthy urban governance, is necessary for cities to be continually moving toward greater health and social justice.