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Guest Post: Toward the Healthy City

Jason Corburn, 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.


Comments on "Guest Post: Toward the Healthy City"

6 comments

  • Lynn Todman

    December 6, 2009

    Brava! Brava! I am an urban planner. I work at the Adler School of Professional Psychology in Chicago. And, I am often asked, why a school of psychology? The answer lies in the points that Corburn makes in his post. Essentially, mental health is not simply a function of personal behavior and individual pathology; it is also a function of the larger physical, social, economic and political environment in which one is situated. Thus, our goal at the Adler School is to prepare students to implement mental health interventions that go beyond behavior modification and to press for changes in the environment by addressing factors such as crime and violence, poor housing, spatial isolation, joblessness, failing educational and social service systems, and the innumerable other environmental factors that predispose some populations (e.g., low income ethnic minorities in urban areas) to higher rates of anxiety, stress, depression, and other forms of mental illness. To that end, we train our students to be socially responsible practitioners who intervene at the level of legislation and public policy, who challenge institutional behaviors, and who question the commonly-held attitudes and beliefs that undermine the mental health and well-being of the most disadvantaged and vulnerable communities. This requires that they work outside the traditional parameters of mental health, working, for instance, with urban planners, to manipulate and reform the social determinants of mental health.
    Moreover, consistent with the comments made by Corburn, central to our work at the Adler School are issues of justice and equity, which we advance through our Institutes for Social Change. Next June, one of the Institutes – the Institute on Social Exclusion – will host an international conference entitled, “The Social Determinants of Mental Health: From Awareness to Action” where presenters will discuss the myriad contextual factors that impact the mental health and well-being of marginalized communities as well as some of the existing and emerging policy and programmatic interventions informed by the social determinants framework. The keynote presenters will be Dr. David Satcher, one of the members of the WHO Commission on the Social Determinants of Health, and Dr. Sandro Galea of the University of Michigan, who has done seminal work linking social context and mental health.
    One of the conference outcomes will be the development of a Social Determinants of Mental Health Impact Assessment (SDMHIA) Tool. The SDMHIA is modeled, like the Health Impact Assessment (HIA) referenced in Corburn’s book, on the Environmental Impact Assessments that emerged out of the planning field more than four decades ago, thus illustrating the value of interdisciplinary thinking, and in particular, the value of linking of the urban planning and health professions.

  • Traci Lawrence

    December 3, 2009

    We frequently hear that poor health is related to poverty and limitied food choices. I must ask if the people making this statement have ever worked directly with the poor and homeless? Have they ever gone to the grocery store with them to make food purchases? Have they ever watched on a daily basis 8-10 hours per day, the unhealthy choices they make? The expensive junk food they buy with food stamps? I have been the Executive Director of a homeless shelter. We plan meals (According to USDA standards) with the residents of our shelter, then we take them shopping. Left on their own they will almost always, purchase high fat, sodium and sugar foods, that usualy require little to no preparation. These items are not only unhealthy but also very expensive. Each of you should stop and see how much you spend on food each month, then see how much food stamp recipiants receive each month. All of our staff did this for a month and no one spent as much on food as food stamp recipiants do. Another note....many of these same people are regulars at our food banks. It is time to start making people responsible for their choices and quit asking for more money. Throwing money at human problems seldom produces premanent results. Concerned persons should challange people to exercise and develop personal power and help them see they can take control of their health by taking control of their personal choices.

  • Cecilia Barbosa

    November 18, 2009

    I too was a student of Len Duhl in the early 80s at Berkeley where I did the joint degree program. It's great to see these disciplines coming together again and the leadership and innovations from Berkeley and the Bay Area. I look forward to reading this work.

  • Jessica Wolfe

    November 18, 2009

    Your book is a welcome addition to the traditionally silo-ed sectors of public health and urban planning. I would add, however, that the time is ripe to involve the private development sector as well in mending these sector "disconnects" if we are to enable truly healthy places. The current economic downturn is likely to provide unanticipated opportunities for retrofitting neighborhoods and communities where all types of health-oriented mixed use can transpire. Sometimes there are silver linings in dark clouds.

  • Kenneth Thompson

    November 18, 2009

    Its been a long time coming to get back to the link between urban planning and health.. interesting that the work of Len Duhl and others had to incubate in Europe for so long before it returned..
    One idea that I think might help in addressing health equity is the concept of social exclusion/inclusion- a European approach to understanding the many ways our society excludes people/populations- creating the circumstances for poor health, among other things. Its worth taking a look at the initiatives in the UK, for example, that have been going on for some time.
    I am very keen on finding ways to get regions with core cities to start talking with each other and sharing ideas about how to invest in and promote health equitably. Thanks for bringing these ideas back to the US
    Here in the rust-bet

  • Louise Lex

    November 18, 2009

    The healthy city is where public health started. It is exciting for me to see that we are at last recognizing that many of our diseases are a result of our inattention to the social determinants of health.

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