Building Healthier Communities through Sticky Design
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1 Building Healthier Communities through Sticky Design Illinois Rural Public Health Institute Effingham, IL Mar Signs of the apocalypse...?
2 And a sign of hope!
3 Answers to some common questions: N. Attleboro MA Isn t health a result of personal decisions & habits? If we build it, will they come? (People are naturally lazy...) Shouldn t the free market dictate how we build our cities & towns? So, what is your prescription for healthy design (& how do we get there)? Fenton: Community Design & Policies for Routine Physical Activity Feb. 2012
4 Youthful recollections
5 Not just my idea Nov-2009 The Australian, 14-Oct-2009
6 Changes in Walking & Cycling to School, 1969 to 2001 Ham et.al., Jour. of Physical Activity & Health, 2008, 5, % of students age Car Bus W/B W/B = Walk/Bike
7 Trends in Childhood Obesity & Overweight CDC, National Center for Health Statistics. National Health Examination Surveys (NHANES) II (ages 6 11) and III (ages 12 17), and NHANES I, II and III, and
8 America s looming chronic disease apocalypse US Obesity Epidemic Ogden et. al. (JAMA 288, 14; Oct. 2002) % O b e s e (B M I> 3 0 )
9 Diabetes Prevention Program (DPP; New.Eng.J.Med., Feb. 7, 2002) Compared three treatments for nationwide cohort (3,000+) at risk for developing diabetes (elevated fasting glucose). 1. Control: Standard exercise and nutrition counseling; placebo. 2. Standard plus drug treatment: Metformin 3. Intensive lifestyle change: Nutritional training, 150 min./week physical activity.
10 Diabetes Risk Reduction (Diabetes Prevention Program; NEJM, Feb. 2002) % Reduction of Risk 100% 80% 60% 40% 20% 0% Risk Reduction Metformin Lifestyle Relative to Control Group (standard intervention)
11 My Rant: Change our thinking. It s not just an obesity epidemic. It s twin epidemics of physical inactivity and poor nutrition.* * Two of the three biggest drivers of skyrocketing healthcare costs.
12 The bad news in just three numbers: 30 Minutes of daily physical activity recommended (60 min. for youth). 20 % of American adults actually meet these recommendation (thru LTPA). 365,000 Estimated annual deaths in America due to physical inactivity & poor nutrition. (2 nd only to tobacco.)
13 Surgeon General s Report 1996 Physical Activity Guidelines minutes/week of moderate physical activity; more is better. Any activity is better than none. Can be broken up. 300 min/week for children. Reduced risk for CVD, diabetes, osteoporosis, obesity, dementia in old age, clinical depression, a growing list of cancers... Getting exercise, or just getting around Kankakee?
14 Leisure Time Physical Activity in the US (MMWR: 50(09), 166-9; 54(39), 991-4) 50 Inactive Sufficiently Active % of US Population
15 But in the end... It s a matter of personal choice, isn t it?
16 Exercise Participation Effect of Short Bouts, Home Treadmills (Jakicic et.al., J. Amer. Med. Assoc., 282, 16) 240 Exercise (min/wee ? LB SB SBT months
17 Exercise Participation Effect of Short Bouts, Home Treadmills (Jakicic et.al., J. Amer. Med. Assoc., 282, 16) Exercise (min/wee LB SB SBT months
18 Self-help vs. Commercial Weight Loss Programs (Heshka et.al., J. Amer. Med. Assoc., 289, 14; Apr. 2003) Weight Change, kg months Self-help Commercial
19 A realization: Simply telling people to exercise is not enough. We need to support increases in routine, daily physical activity for everyone.
20 A realization: Simply getting people on diets is not enough. We need to help provide healthy food that is affordable, accessible, & appealing for everyone.
21 Social Ecology Model Determinants of behavior change Sallis & Owen, Physical Activity and Behavioral Medicine. Individual - motivation, skills. Interpersonal - family, friends, colleagues, social norms. Institutional - school, work, health care & service providers. Community - networks, facilities. Public Policy - laws, ordinances, permitting practices & procedures. Champaign
22 Socio-ecological successes? Tobacco Education, kids, taxes, 2 nd hand smoke policies/bans. Seat belts, child safety restraints Media, training, laws, enforcement. Recycling Kids, facilities, fees. Water & sewer Education, ordinance & design requirements, inspection/enforcement procedures.
23 Thanks to Prof. Ross Brownson, Wash. Univ., St. Louis
24 vs.
25 Necessary and important, but not enough. > < We must build communities where people are intrinsically Belleville more active.
26 If we build it, will they come?
27 Yes! Four elements: Denton TX i. Destinations w/in walk, bike, & transit distance. ii. Sidewalks, trails, bike lanes, safe crossings. iii. Inviting, functional sites for bikes, peds, transit. iv. Safe & accessible for all ages, incomes, abilities.
28 In planner language: Mix of land uses; varied destinations. Network of bicycle, pedestrian, & transit facilities. Functional site designs & details. Universal safety & access.
29 i. Land use. Schools, services near housing. Schools ompact neighborhoods shared open space. Pinellas Trail Housing above retail below. Mixed use, multifamily. E.g. shopping, post office, library,...
30 In other words, create & sustain village centers. Keep where we live, work, shop, play, learn, pray... closer together! It s not a neighborhood if you don t have a corner store (Indianapolis)
31 Convenience of Destinations and Walking for Older Women King et.al., Am. J. Health Promo.,18(1) Sep Average Daily Steps or more Destinations in a 20 minute walk Steps/day Nearby destinations matter!
32 ii. Network encourages active travel with: Peoria Riverfront Trail Presence of sidewalks, pathways, bike lanes. Shorter blocks, cul-de-sac cutthroughs, more intersections. Access to trail, park, greenway; quality, reliable transit.
33 Transit riders are physically active. Besser, Dannenberg, Amer. J. Prev. Med., 29 (4), Nov Just during the daily walk to transit: Half of transit riders walk at least 19 mins. 29% get at least 30 mins. of activity. Minorities, poor (income <$15k/yr.), denser urban dwellers more likely to get 30+ mins./day. Appleton WI
34 Bicycle network options: On street Shared-use arrow Sharrow merican River Trail acramento, CA Bike lanes
35 iii. Site Market Po design: Which setting is more appealing for travel on foot and by bike? Kingsport, TN
36 Right here in Effingham...
37 Site design? Research & practice suggest: Kankakee Portland, OR Buildings near the sidewalk, not set back; parking on street or behind. Trees, benches, lighting, awnings, human scale. Details: bike parking, open space, plants, art, materials.
38 Possible incentives: Decrease, share parking (include bike racks). Build-to, not set-back lines. Mixed-use, multi-story; residential density bonus Expedite permits. Appleton WI Neenah WI You must support your elected & appointed officials if you expect them to act!
39 Median islands iv. Safety. Engineering can dramatically improve safety. Increasing pedestrian and bike trips decreases overall accident & fatality rates. Roundabout (Jacobsen P, Injury Prevention, 2003; 9: ) Curb extensions
40 E.g. Lane re-alignments Often called road diets, being seen more often. Urbana; before & after. Can reduce collisions & severity. Dramatically improves performance for pedestrians & cyclists.
41 Diagonal parking increases on-street capacity, but... Des Moines, IA Reverse angle: Fewer, less severe collisions. Safer for bikes & pedestrians. Slows traffic.
42 Reverse diagonal parking with bicycle facilities... Chattanooga, TN York, PA
43 But what about rural areas...? Suburbanization of America US population shift, (after Bowling Alone, R. Putnam, 2000) % of Total Population Suburb Urban Rural Suburbia is steadily consuming the landscape... year
44 2. Rural areas are where you can affect the shape of development before it s done! Rural housing near Millstadt? Or just more suburbia?
45 Tools for urban and rural settings.
46 Community design & nutrition? Community gardens (near schools, parks, senior housing); conserving farmlands; Community Supported Agriculture. Farmer s markets, green grocers. Olathe, KS Regulate fast food, drivethrough locations.
47 Community gardens & farm markets can help overcome food deserts, but they re not enough. East St. Louis Need neighborhood grocers as well (coops, CSA s, whatever it takes).
48 Five Elements of Healthy Community Design: Ped, bike, & transit network Mix of destinations Safety & access Healthy affordable food Site design
49 Shouldn t the free market dictate how we build our cities & towns?
50 Internalizing external costs: Environmental: Reduced traffic; air, water, & noise pollution. Social: Equitable transportation. More personal connections. Safety: Kids, elderly mobility. Crime deterrent. Education, schools: Student health, safety. Behavior & performance! Transportation costs & infrastructure. Community engagement; schools as neighborhood centers.
51 Economics. Walking the Walk: How Walkability Raises Housing Values in U.S. Cities (CEOs for Cities report)* walkscore = 12 walkscore = 52 Higher score = $4,000-$34,000 home value *
52 On Common Ground Nat l Assoc. of Realtors pub.; Summer The Next Generation of Home Buyers: Taste for urban living. Appetite for public transportation. Strong green streak. Plus, Americans are driving less overall!
53 What s happening? 1 st & 2 nd generation malls & big boxes are struggling. Employers seek vibrant, livable communities, where employee health, satisfaction, & retention are high! Winter Park, FL Rosemount Or more simply: Which generates more economic activity, a dying mall or thriving downtown?
54 So how to get there? (Can we really do this?) Walk audits Implementation Planning sessions
55 Some elements of success: A. Don t accept the cost argument take a systematic approach! B. Build a team for stealth, not bulk. C. Recruit, engage, co-opt your boards. D. Anticipate the NIMBY, BANANA, CAVE folks; build a political cover process. E. The key question for staff: Are you a process-server or a professional?
56 A. It s not just about the money, it s about the job! Routine accommodation Opportunistic improvements
57 Require not just traffic, but multi-modal transportation analysis for all development. Mitigation = transit, bike, & pedestrian facilities, possibly systemic rather than on site. Westerville, OH
58 Not just government. E.g. E. St. Louis, Westminster Presbyterian Church
59 B. Build a compact, focused, interdisciplinary leadership team targeting healthy design: Education, schools Planning & Zoning Engineering, DPW Parks, Recreation Public Health & Safety Historical preservation Social justice & equity Chamber of Commerce Developers, Lenders, Realtors Neighborhood Assoc., Church & Service Groups Environment, Conservation Policy information:
60 The org chart: ACS Employers YMCA AHA ADA Hospital Insurer Rec. Health Planning Transport DPW Parks Trails Electeds Neighborhoods Bike/Ped Advocates Developers Schools PTOs
61 The stealth chart: Transport Planning Elected Parks Trails Rec. Bike/Ped Advocate Enviro. Neighborhoods Employers Hospital Insurer DPW Environ. Chamber Health ADA Vision ACS Found. Schools AHA Econ. Devlpmt Developer PTOs Churches Service Orgs. Banks Chamber NAR NAHB
62 To be on the stealth leadership team people must: Fully embrace the vision of active, healthy community design. Be able to spend time on this as part of job responsibilities; not just volunteers. Have community influence and be able to reach critical partners.
63 C. Procedures & projects, not programs. Fenton, Community Design..., Childhood Obesity, 8(1); Feb Master planning, zoning, & subdivision ordinance for mixed use, open space, etc. Complete streets guidelines & routine practice. Transportation trail networks. Bicycle & transit infrastructure & incentives; Transportation Demand Management (TDM). Schools as centers of Community Health; systematic Safe Routes to School.
64 1. Enlightened zoning policies. Use Main Streets & compact neighborhoods as a guide. Density bonuses: corner stores, affordability, infrastructure improvements. Residential clusters in centers, near transit. Require multi-modal transportation analysis. Act NOW, during the lull! More of this less of this?
65
66 2. Build Complete Streets into ordinance: All users (pedestrians, cyclists, transit riders, & drivers) of all ages & abilities considered in every road project (new, repair, maintenance). Start w/ resolution (whereas... Be it resolved...) Incorporate during routine painting, paving, maintenance, utility work! Barnstable
67 State Street (to Main Street, Belleville) Possible conversion from four lanes to three?
68 3. Develop a comprehensive network of transportation trails. Connect to other elements of transport network (e.g. sidewalks, bike lanes, transit stops) Focus on destinations (e.g. schools, shopping, parks, senior housing). Build into the fabric of the community. UofA multi-use trail
69 4a. Institutionalize transit support & transportation demand management. Connect transit: rail, bus, dial-a-ride, school bus. Institutionalize: IDs as transit passes, tie to wellness programs! Start w/ colleges, city employees, hospitals... Less parking not more! Buses: costs, coverage, time, frequency(?)
70 4b. Create a bicycle-friendly community. Bike lanes, sharrows on wide streets. Bike parking at destinations: schools, library, farmers market. Bike corral, valet parking Maps, way-finding signs, route markers. Bike sharing; start small, then grow. Hubway, Boston
71 5. Schools as centers of community health. Five major areas: Physical education Recess policies Share use access School nutrition: meals, snacks, concessions, etc. Safe Routes to School E.g. PE & Recess Qualified PE teachers; focus on movement! Daily PE and/or recess No withholding as punishment.
72 Shared use policies for school facilities. Community access? Gyms, weight rooms. Playgrounds, fields. Community gardens. Classrooms (adult classes, community meetings).
73 Whole picture includes nutrition; target policy change: Menu update; may require training, equipment. Recess before lunch Vending machine policies. Healthy prizes & snacks. Fund-raising (e.g. sell fruit, service; not candy, popcorn). Concessions; start w/ healthy options at favorable prices. Community garden, as part of curriculum; eat, sell, donate.
74 E.g. Comprehensive Safe Routes to School. Premise: More students more safe physical activity, more of the time. Where it s safe enough, more walking & cycling. Where it s not, work to make it safer! Activity for all students. Benefits: Health & safety; academic performance; transportation efficiency.
75 5E plans as a priority for school administrators. Evaluate where kids come from, by what mode, & why. Engineer safer routes. Educate & encourage safer, healthy behavior (drivers & kids). Enforce proper speeds, procedures for all.
76 E.g. Remote pickup/drop-off areas. Program. Walking school busses, bicycle trains... Project. Construct remote drop-off in adjacent park. Policy: Relocate bus/car drop-off/pick-up to park; 5 min. car safety delay to let ped, bike, bus riders clear. Columbia, MO
77 D. Beat NIMBY-ism with an Outreach, Education, & Recruitment (OER) Program Actively recruit a large core of engaged citizens to support healthy policy & project efforts. Educate them on providing constructive, effective public testimony & discourse (letters to the editor, etc.). Inform them ( blasts, blogs, tweets, phone trees?) of key opportunities: plans, meetings, workshops,. Mansfield walk audit
78
79 * Build health equity into all strategies. E.g. Find those you hear from least: Multi-lingual materials, sessions at community partners (churches, schools, social & health services). Tackle gentrification. Housing partners, inclusionary zoning, mix & accessory dwellings. Integrate transit. Focus on quality & access for lower income residents. Nantucket
80 E. Process server or professional? It s not really about building sidewalks & painting bicycle lanes & crosswalks. It s about building the capacity and the policies to create these everywhere. It s never really about the money. It s about the long term vision and the political and community will to make it a reality. VISION LEADERSHIP
81 Why care about stickiness & active community design? The inactivity epidemic; our kids may pay! Quality of life; safety & comfort; social equity. ~4,000 pedestrian, ~40,000 motor vehicle, ~400,000 sedentary-related deaths/year. Greenhouse gasses, over an hour of average commute time/day, traffic congestion and costs. OPEC; drilling in ANWR; oil wars in Mid-east. More eyes on the street, less crime. Shopping locally, healthier housing values. Higher employee retention, higher productivity, lower health care costs.
82 Olshansky et.al., A Potential Decline in Life Expectancy... New Eng. J. of Med., March 17, 2005
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