Transcript building bridges: integrating the work of public health and urban planning Rajiv Bhatia, MD, MPH San Francisco Department of Public Health January 27th, 2005

building bridges: integrating the
work of public health and urban
planning
Rajiv Bhatia, MD, MPH
San Francisco Department of Public Health
January 27th, 2005
What makes us healthy?
OECD
Average
Annual
Health
Spending
$2114
United States $5267
Life
Expectancy
(years)
77.2
76.8
The fundamental conditions and
resources for health are peace,
shelter, education, food, income, a
stable ecosystem, sustainable
resources, social justice and
equity.
1986 WHO Ottawa Charter for Health
Promotion
Poor ventilation, mold,
and rodents
Substandard construction and
deferred maintenance
crowding
hunger
Dangerous streets
Worsening traffic and
longer commutes
 Poor food quality
 No places for play
 Declining moderate
wage jobs and economic
diversity
Limited access to Jobs,
Health Care, and
Friends and families
Asthma Map
Rx: Healthy Planning
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Connect problems and issues
Value local knowledge and experience
Apply public health research
Develop inter-disciplinary partnerships
Build consensus / reduce conflict
Ensure accountability
Health Impact Assessment
Definition

Methods to account for the effects of
public policy decisions on human
health and well being
Health Impact Assessment
Multiple Approaches
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Integrating health analysis
into environmental review
under CEQA and NEPA
Promoting health analysis
through participatory
research and community
partnerships
Implementing health
assessments as a
collaborative and
consensus building process
Rincon Hill Area Plan
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Impact Analysis
No school planning
Limited open space
Housing not matched
to employment
Effects on residential
segregation
Rincon Hill Area Plan
Outcomes
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Increased below
market housing
Support for on-site
inclusionary housing
Support for reduction
in parking
Trinity Apartments Redevelopment
Impact Analysis
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Permanent Loss of
low rent units
Displacement of
residents
Disruption of an
established
community
Trinity Apartments Redevelopment
Outcomes
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EIR study of
displacement impacts
Replacement units for
current residents
Eastern Neighborhoods Community Health
Impact Assessment
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Visions a healthy city
Identifies health
objectives influenced by
planning
Predicts effects of three
neighborhood zoning
plans
Proposes monitoring of
the outcomes of
development
Eastern Neighborhoods Community Health
Impact Assessment
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Builds on international
HIA approaches
Uses a consensus
building / deliberative
model
Participants include 40
public and private
organizations
Occurs in parallel to
environmental impact
assessment
HIA within Partnerships
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Research on displacement
effects
Co-authoring a
community plan
Training on EIR process
Equity analysis of
transportation plans
Critique of Level of
Service analysis
Major Obstacles
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New role for public health—training needs,
funding, political legitimacy
Concerns about new processes, agendas,
analysis, and regulations on development
Competing development agendas
Limited trust in collaborative approaches
Overcoming Obstacles
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Framing land use as a public health issue
Using multiple approaches
Building common agenda with community
partners
Reaching out to developers and business
interests
Supporting planners and their work
Expected Outcomes
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Public understanding of health and land
use relationships
New roles for public health in planning
Broader community participation
Support for comprehensive planning
Impacts on development decisions
Impacts on decision-making practice
Lessons Learned
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Health, Sustainability, Smart Growth,
Social Equity have the same requirements
HIA: an invitation to a party
Need for democratic, responsive, and
accountable institutions
We are all in this together; methods need
to reduce polarization of interests
Health promotion works through
concrete and effective community
action in setting priorities, making
decisions, planning strategies and
implementing them to achieve better
health. At the heart of this process is
the empowerment of communities,
their ownership and control of their
own endeavors and destinies.
1986 WHO Ottawa Charter for Health
Promotion
“..medicine is a social science, and
politics is nothing but medicine on a
grand scale.”
--Virchow