Confronting the challenges in reconnecting urban planning and public health

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.     

Urban planning and public health at CDC

Urban planning, also called city and regional planning, is a multidisciplinary field in which professionals work to improve the welfare of persons and communities by creating more convenient, equitable, healthful, efficient, and attractive places now and for the future. The centerpiece of urban planning activities is a "master plan," which can take many forms, including comprehensive plans, neighborhood plans, community action plans, regulatory and incentive strategies, economic development plans, and disaster preparedness plans. Traditionally, these plans include assessing and planning for community needs in some or all of the following areas: transportation, housing, commercial/office buildings, natural resource utilization, environmental protection, and health-care infrastructure. Urban planning and public health share common missions and perspectives. Both aim to improve human well-being, emphasize needs assessment and service delivery, manage complex social systems, focus at the population level, and rely on community-based participatory methods. Both fields focus on the needs of vulnerable populations. Throughout their development, both fields have broadened their perspectives. Initially, public health most often used a biomedical model (examining normal/abnormal functioning of the human organism), and urban planning often relied on a geographic model (analysis of human needs or interactions in a spatial context). However, both fields have expanded their tools and perspectives, in part because of the influence of the other. Urban planning and public health have been intertwined for most of their histories. In 1854, British physician John Snow used geographic mapping of an outbreak of cholera in London to identify a public water pump as the outbreak's source. Geographic analysis is a key planning tool shared by urban planning and public health. In the mid-1800s, planners such as Frederick Law Olmsted bridged the gap between the fields by advancing the concept that community design contributes to physical and mental health; serving as President Lincoln's U.S. Sanitary Commission Secretary; and designing hundreds of places, including New York's Central Park. By 1872, the disciplines were so aligned that two of the seven founders of the American Public Health Association were urban designers (an architect and a housing specialist). In 1926, the U.S. Supreme Court, in validating zoning and land-use law as a legal government authority in Village of Euclid v. Ambler Realty, cited the protection of public health as part of its justification. Other connections have included 1) pioneering urbanist Jane Jacobs, who during the 1960s, called for community design that offered safe and convenient options for walking, biking, and impromptu social interaction; and 2) the Healthy Cities movement, which began in Europe and the United States during the 1980s and now includes projects in approximately 1,000 cities that in various ways highlight the role of health as much more than the presence of medical care.     

Urban Planning and Health Equity

Although the fields of urban planning and public health share a common origin in the efforts of reformers to tame the ravages of early industrialization in the 19th century, the 2 disciplines parted ways in the early 20th century as planners increasingly focused on the built environment while public health professionals narrowed in on biomedical causes of disease and disability. Among the unfortunate results of this divergence was a tendency to discount the public health implications of planning decisions. Given increasingly complex urban environments and grave health disparities in cities worldwide, urban planners and public health professionals have once again become convinced of the need for inclusive approaches to improve population health and achieve health equity. To make substantive progress, intersectoral collaboration utilizing ecological and systems science perspectives will be crucial as the solutions lie well beyond the control of any single authority. Grounded in the social determinants of health, and with a renewed sense of interconnectedness, dedicated and talented people in government agencies and communities who recognize that our future depends on cultivating local change and evaluating the results can come to grips with the enormous challenge that lies ahead to create more equitable, sustainable, and healthier cities worldwide.     

Relationship between water supply,sanitation, public health,and environment: elements for the formulation of a sanitary infrastructure planning model

The understanding of sanitation infrastructure, public health, and environmental relations is a fundamental assumption for planning sanitation infrastructure in urban areas. This article thus suggests elements for developing a planning model for sanitation infrastructure. The authors performed a historical survey of environmental and public health issues related to the sector, an analysis of the conceptual frameworks involving public health and sanitation systems, and a systematization of the various effects that water supply and sanitation have on public health and the environment. Evaluation of these effects should guarantee the correct analysis of possible alternatives, deal with environmental and public health objectives (the main purpose of sanitation infrastructure), and provide the most reasonable indication of actions. The suggested systematization of the sanitation systems effects in each step of their implementation is an advance considering the association between the fundamental elements for formulating a planning model for sanitation infrastructure.     

Toward a Research and Action Agenda on Urban Planning/Design and Health Equity in Cities in Low and Middle-Income Countries

The importance of reestablishing the link between urban planning and public health has been recognized in recent decades; this paper focuses on the relationship between urban planning/design and health equity, especially in cities in low and middle-income countries (LMICs). The physical urban environment can be shaped through various planning and design processes including urban planning, urban design, landscape architecture, infrastructure design, architecture, and transport planning. The resultant urban environment has important impacts on the health of the people who live and work there. Urban planning and design processes can also affect health equity through shaping the extent to which the physical urban environments of different parts of cities facilitate the availability of adequate housing and basic infrastructure, equitable access to the other benefits of urban life, a safe living environment, a healthy natural environment, food security and healthy nutrition, and an urban environment conducive to outdoor physical activity. A new research and action agenda for the urban environment and health equity in LMICs should consist of four main components. We need to better understand intra-urban health inequities in LMICs; we need to better understand how changes in the built environment in LMICs affect health equity; we need to explore ways of successfully planning, designing, and implementing improved health/health equity; and we need to develop evidence-based recommendations for healthy urban planning/design in LMICs.     

Urban health: an urban planning perspective

Urban planning processes and practices, and their impacts on the health and well being of citizens, are numerous and take many forms. Creating living urban environments that are conducive to health and well being requires an integrated approach between urban planners and health professionals. This article focuses on the almost 100 years of experience of Canada's National Capital Commission (NCC) in developing urban plans (policy plans, master plans) for planning and building Canada's Capital. To address the continuous growing public interest in environmental concerns, the NCC developed in the 1990s an integrated approach using a strategic environmental assessment (SEA). This approach could be easily transferred to various urban-planning contexts worldwide. This paper aims to describe the NCC approach, in order to stimulate discussion on growing environmental health concerns and urban planning.     

The health of cities and their citizens (urban development and municipal public health). 2008 SESPAS Report

The policy of continued improvement in citizens' health, further to the definitions provided in the latest World Health Organization reports, entails a huge undertaking on the part of local administrations in issues that not only affect health management but also involve a change in other health-related policies, such as urban development and planning. Until now, urban development has been reluctant to incorporate the criteria defined by health strategies into its field of knowledge. However, there is a lack of research in public health, which could specify the clear effects of the environmental on citizens' health and enable criteria applicable to spatial planning to be defined. The present article reflects on certain experiences acquired in our environment of processes that bring together these two views of health, ranging from urban and environmental policies in indicator-based reports to a series of good practice. The integrated municipal action of San Fernando de Henares in the Healthy Cities project has also been significant.     

Health impact assessments are needed in decision making about environmental and land-use policy

The importance to public health of environmental decisions-including those about land use, transportation, power generation, agriculture, and environmental regulation-is increasingly well documented. Yet many decision makers in fields not traditionally focused on health continue to pay little if any attention to the important health effects of their work. This article examines the emerging practice of health impact assessment and offers real-world examples of its effective implementation, including studying the impact of nearby highways-a major source of air pollution-on proposed new housing for seniors. The article argues that officials at the federal, state, and local levels should consult health experts and consider using health impact assessments when their decisions on such issues as urban planning, land use, and environmental regulation have the potential to directly affect the conditions in which people live and work.     

Urbanization and health in China,thinking at the national,local and individual levels

Background

China has the biggest population in the world, and has been experiencing the largest migration in history, and its rapid urbanization has profound and lasting impacts on local and national public health. Under these conditions, a systems understanding on the correlation among urbanization, environmental change and public health and to devise solutions at national, local and individual levels are in urgent need.

Methods

In this paper, we provide a comprehensive review of recent studies which have examined the relationship between urbanization, urban environmental changes and human health in China. Based on the review, coupled with a systems understanding, we summarize the challenges and opportunities for promoting the health and wellbeing of the whole nation at national, local, and individual levels.

Results

Urbanization and urban expansion result in urban environmental changes, as well as residents’ lifestyle change, which can lead independently and synergistically to human health problems. China has undergone an epidemiological transition, shifting from infectious to chronic diseases in a much shorter time frame than many other countries. Environmental risk factors, particularly air and water pollution, are a major contributing source of morbidity and mortality in China. Furthermore, aging population, food support system, and disparity of public service between the migrant worker and local residents are important contributions to China’s urban health.

Conclusions

At the national level, the central government could improve current environmental policies, food safety laws, and make adjustments to the health care system and to demographic policy. At the local level, local government could incorporate healthy life considerations in urban planning procedures, make improvements to the local food supply, and enforce environmental monitoring and management. At the individual level, urban residents can be exposed to education regarding health behaviour choices while being encouraged to take responsibility for their health and to participate in environmental monitoring and management.

     

Radio station acceptance of AIDS-related advertising messages

Survey responses were received from the managers of 630 radio stations, who reported which type of AIDS-related commercials or public service announcements they are willing to accept for broadcast. The authors examine whether the public interest can outweigh fear of offending audience segments and discuss ways health education planners can increase acceptance of AIDS-related commercials. For planning a public health campaign, both the number and types of stations that will accept various public health messages are important if the messages are to reach high risk demographic groups.     

Revitalizing Communities Together

Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.     

Public Health, the APHA, and Urban Renewal

Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.THE PAST DECADE HAS SEEN a reemergence of efforts to connect public health and urban planning. Focusing on the health effects of the built environment, new research has shed light on the association between urban sprawl and obesity, the association between the physical form of neighborhoods and the physical activity levels of its inhabitants, and the role of housing in asthma. On the basis of this research, new programs are being developed, new building and design standards have been proposed, and there is new willingness to manipulate the built environment to promote and protect health. During this process, it will be important to remember the lessons of 20th-century program failures as public health seeks to intervene again in the built environment in this new century.     

Sorting out the connections between the built environment and health: A conceptual framework for navigating pathways and planning healthy cities

The overarching goal of this article is to make explicit the multiple pathways through which the built environment may potentially affect health and well-being. The loss of close collaboration between urban planning and pulic health professionals that characterized the post-World War II era has limited the design and implementation of effective intervention and policies that might translate into improved health for urban populatons. First, we present a conceptual model that developed out of previous research called Social Determinants of Health and Environmental Health Promotion. Second, we review empirical research from both the urban planning and public health literature regarding the health effects of housing and housing interventions. And third, we wrestle with key challenges in conducting sound scientific research on connections between the built environment and health, namely: (1) the necessity of dealing with the possible health consequences of myriad public and private sector activities; (2) the lack of valid and reliable indicators of the built environment to monitor the health effects of urban planning and policy decisions, especially with regard to land use mix; and (3) the growth of the “megalopolis” or “super urban region” that requires analysis of health effects across state lines and in circumscribed areas within multiple states. We contend that to plan for healthy cities, we need to reinvigorate the historic link between urban planning and public health, and thereby conduct informed science to better guide effective public policy.     

浙江省基本公共卫生服务均等化财政保障体制机制研究

浙江省基本公共卫生服务均等化存在的主要问题是：公共卫生资源配置和公共卫生机构服务能力存在城乡、地区差别,特殊人群享受公共卫生服务均等化程度较低,某些财政保障政策不合理。对此,需要通过制定规划、缩小投入差距、提高筹资层次、创新支付方式、增加薄弱环节投入、增强公共卫生机构服务能力、建立绩效评价体系等措施,提高浙江省基本公共卫生服务均等化水平。     

Environmental justice: building a unified vision of health and the environment

The assorted and multidimensional concerns that give rise to the issue of environmental justice have proved to be intellectually daunting and highly resistant to positive change. Low-income, people of color, and tribal communities confronting environmental stressors are beset by stressors in both the physical and social environments. For this reason, while the bifurcation of the public health and environmental fields taking place over the past several decades has yielded generally negative impacts in areas of public health, environment, and planning, the consequences for low-income and disadvantaged communities have been especially grievous. This commentary builds on the recent Institute of Medicine workshop titled "Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century." The workshop organizers posited that only by thinking about environmental health on multiple levels will it be possible to merge various strategies to protect both the environment and health. In this commentary we examine how such a new vision of uniting public health and the environment can contribute to attaining environmental justice for all populations.     

Examining urban brownfields through the public health "macroscope"

Efforts to cope with the legacy of our industrial cities--blight, poverty, environmental degradation, ailing communities--have galvanized action across the public and private sectors to move vacant industrial land, also referred to as brownfields, to productive use; to curb sprawling development outside urban areas; and to reinvigorate urban communities. Such efforts, however, may be proceeding without thorough investigations into the environmental health and safety risks associated with industrial brownfields properties and the needs of affected neighborhoods. We describe an approach to characterize vacant and underused industrial and commercial properties in Southeast Baltimore and the health and well being of communities living near these properties. The screening algorithm developed to score and rank properties in Southeast Baltimore (n= 182) showed that these sites are not benign. The historical data revealed a range of hazardous operations, including metal smelting, oil refining, warehousing, and transportation, as well as paints, plastics, and metals manufacturing. The data also identified hazardous substances linked to these properties, including heavy metals, solvents, polycyclic aromatic hydrocarbons, plasticizers, and insecticides, all of which are suspected or recognized toxicants and many of which are persistent in the environment. The health analysis revealed disparities across Southeast Baltimore communities, including excess deaths from respiratory illness (lung cancer, chronic obstructive pulmonary disease, influenza, and pneumonia), total cancers, and a "leading cause of death" index and a spatial and statistical relationship between environmentally degraded brownfields areas and at-risk communities. Brownfields redevelopment is a key component of our national efforts to address environmental justice and health disparities across urban communities and is critical to urban revitalization. Incorporating public health into brownfields-related cleanup and land-use decisions will increase the odds for successful neighborhood redevelopment and long-term public health benefits.     

Child injury in a changing world

Abstract

The importance of child injuries has now been recognised as a significant public health problem internationally. The World Health Organisation (WHO) and United Nations Children's Fund (UNICEF) have recently published the first world report on child injury prevention. As infectious diseases decline, the relative importance of injury has increased, but the pace of change of global processes means that absolute increases in injury may occur over the next 20–30 years. This paper examines child injury in a changing world by outlining the ways in which the forces of globalisation, urbanisation, motorisation and environmental change could have an impact on injury epidemiology and policy.

We consider how those in public health and those in the injury field should respond to the changing world of injury. Child injury prevention needs to be incorporated into planning for the rapidly changing urban environments of low-income countries and strategies devised for the large numbers of people displaced by environmental change.     

The voice of the public in public health policy and planning: the role of public judgment

Community involvement with public health planning and implementation are vital to improving community health. There are a variety of community health models that are available. We describe these four models from the perspective of how they involve the broader community. These models are evaluated from a different perspective about linking the community and politics and agencies, that involves naming issues, framing options, public deliberation and public acting. We suggest ways that these models can be further refined to connect citizens to the processes that we use for community health improvement.     

Artificial Turf Football Fields: Environmental and Mutagenicity Assessment

The public has recently raised concerns regarding potential human health and environmental risks associated with tire crumb constituents in the artificial turf of football fields. The aim of the present study was to develop an environmental analysis drawing a comparison between artificial turf football fields and urban areas relative to concentrations of particles (PM10 and PM2.5) and related polycyclic aromatic hydrocarbons (PAHs), aromatic hydrocarbons (BTXs), and mutagenicity of organic extracts from PM10 and PM2.5. No significant differences were found between PM10 concentrations at an urban site and on a turf football field, both during warm and in cold seasons, either with or without on-field activity. PM2.5 concentrations were significantly greater at the urban site in the cold season as was the ratio of PM2.5 to PM10. BTXs were significantly greater at urban sites than on turf football fields on both on warm and cold days. The ratio of toluene to benzene (T/B ratio) was always comparable with that of normal urban conditions. The concentration of PAHs on the monitored football fields was comparable with urban levels during the two different sampling periods, and the contribution of PAHs released from the granular material was negligible. PM10 organic extract mutagenicity for artificial turf football fields was greater, whereas PM2.5 organic extract mutagenicity was lower, compared with the urban site studied. However, both organic extract mutagenicity values were comparable with the organic extract mutagenicity reported in the literature for urban sites. On the basis of environmental monitoring, artificial turf football fields present no more exposure risks than the rest of the city.     

Beyond Urban Penalty and Urban Sprawl: Back to Living Conditions as the Focus of Urban Health

Researchers have long studied urban health, both to describe the consequences of urban living and to design interventions to promote the health of people living in cities. Two approaches to understanding the impact of cities on health have been dominant, namely, urban health penalty and urban sprawl. The urban penalty approach posits that cities concentrate poor people and expose them to unhealthy physical and social environments. Urban sprawl focuses on the adverse health and environmental effects of urban growth into outlying areas. We propose a model that integrates these approaches and emphasizes urban living conditions as the primary determinant of health. The aim of the model is to move beyond describing the health-related characteristics of various urban populations towards identifying opportunities for intervention. Such a shift in framework enables meaningful comparisons that can inform public health activities at the appropriate level and evaluate their effectiveness in improving the health of urban populations. The model is illustrated with two examples from current urban public health practice.