Designing Healthier Environments to Conquer Disease Epidemics: Successes in NYC and Elsewhere. Karen K. Lee, MD, MHSc

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1 Designing Healthier Environments to Conquer Disease Epidemics: Successes in NYC and Elsewhere Karen K. Lee, MD, MHSc

2 Can Design Help Address Today s Health Epidemics? THE 19th CENTURY: Infectious Diseases THE 21st CENTURY: Chronic Diseases, many of which are Diseases of Energy 19th Century codes, planning and infrastructure as weapons in the battle against contagious disease These strategies were built into the city fabric, and they were effective The emerging design solutions for health parallel sustainable design solutions Effective designs will have to be an invisible, pervasive, and inevitable part of life

3 Decreases in deaths from infectious diseases 57.1% BEFORE the wide use of antibiotics! 45.8% AFTER the wide use of antibiotics! % % 9% 2011

Environmental changes in 19 th and early 20 th centuries 1842 New York s water system established an aqueduct brings fresh water from Westchester.

of Street-sweeping created, which eventually becomes the Department of Sanitation 1901 New York State Tenement House Act banned the construction of dark, airless tenement

4 Environmental changes in 19 th and early 20 th centuries 1842 New York s water system established an aqueduct brings fresh water from Westchester NYC creates Central Park, hailed as ventilation for the working man s lungs, continuing construction through the height of the Civil War 1881 Dept. of Street-sweeping created, which eventually becomes the Department of Sanitation 1901 New York State Tenement House Act banned the construction of dark, airless tenement buildings 1904 First section of Subway opens, allowing population to expand into Northern Manhattan and the Bronx 1916 Zoning Ordinance requires stepped building setbacks to allow light and air into the streets

5 The epidemics of today are: CHRONIC DISEASES (obesity, diabetes, heart disease & strokes, cancers) Top 5 Causes of Death in U.S.: 1. Tobacco, 2. Obesity, 3. High Blood Pressure, 4. High Blood Sugar, 5. Physical Inactivity Energy in: Food Energy out: Exercise

6 Today. over 70% of deaths each year are from chronic diseases.

7 Diabetes trends among U.S. adults No Data <4.5% % % % >9.0% Source: CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at

8 Obesity and Diabetes have increased rapidly. Our genetics have not changed in one generation, but our built environment has!

9 Translating Health Evidence into Non-Health Policies Affecting Health The Need for Partnerships Across Sectors Finding Synergies and Co-Benefits Complementary Roles of Partners Health: Presenting available research-based evidence and statistics on key health issues; help organize conferences for cross-sector discussions; help coordinate initiatives; health evaluation Design and Construction, Transportation and City Planning: Ideas of what s feasible in the current local context; identifying opportunities and mechanisms, including and especially synergistic efforts; Co-Leadership in efforts Other Agencies (Buildings, Housing, Parks, School Construction) Inputs and leadership on their issues also Researchers: evidence reviews and synthesis, evaluation research Using Evidence-Based and Best-Practice Strategies Using Annual Conferences to Highlight Successes and Next Steps Key Roles for Peer-to-Peer Partnerships and Mentoring among Cities

10 Inter-Sectoral Initiatives to Improve Health Synergies: Health Safety Environmental Sustainability Universal Accessibility Economic Benefits

11 Co-benefits of Active Design: Improve the Environment Fuel / Electricity Use Air Quality / Landfill Obesity/Diabetes/ Heart Disease Biking or walking rather than automotive transport Stairs rather than elevators and escalators Active recreation rather than television Safe tap water rather than bottled and canned beverages Fresh produce rather than unhealthy processed foods

12 Co-benefits: Reduce infrastructure costs More compact, walkable development patterns save money on avoided infrastructure costs Water & Sewer Laterals Required Water & Sewer Costs (billions) Road Lane Miles Required Road Land Miles Costs (billions) Sprawl Growth Scenario Compact Growth Scenario 45,866,594 $ ,044,179 $ ,245,294 $ ,855,874 $817.3 Savings 4,621,303 $12.6 (10.1%) 188,305 $109.7 (6.6%) Sprawl Costs: Economic Impacts of Unchecked Development, Robert W. Burchell, Anthony Downs, Barbara McCann and Sahan Mukherji, Island Press, 2005

13 Co-benefits: Save people money People in walkable, transit-rich neighborhoods spend only 9 percent of their monthly income on transportation costs; those in auto-dependent neighborhoods spend 25 percent. Source: Center for Transit-Oriented Development

14 Co-benefits: Create more jobs Building bicycle and pedestrian infrastructure creates more jobs per dollar invested, compared to road infrastructure only Source: Political Economy Research Institute: June 2011

15 Co-benefits: Create desirable places to live, work & play Sprawl Community : Preferred by 43% There are only single-family houses on large lots There are no sidewalks Places such as shopping, restaurants, a library, and a school are within a few miles of your home and you have to drive most places Smart Growth Community : Preferred by 56% There is a mix of single-family detached houses, townhouses, apartments, and condominiums on various sized lots Almost all of the streets have sidewalks Places such as shopping, restaurants, a library, and a school are within a few blocks of your home and you can either walk or drive There is enough parking when you drive to local stores, restaurants, and other places Public transportation, such as bus, subway, light rail, or commuter rail, is distant or unavailable Parking is limited when you decide to drive to local stores, restaurants, and other places Public transportation, such as bus, subway, light rail, or commuter rail, is nearby Source: National Association of Realtors National Poll, 2011 Q: In which community would you rather live?

16 Active Design Guidelines DDC, DOH, DOT, DCP Chapters: 1) Environmental Design and Health: Past and Present 2) Urban Design: Creating an Active City E.g. Land use mix, pedestrian and bike networks, transit, access to parks and playgrounds, healthy food and beverage access 3) Building Design: Creating Opportunities for Daily Physical Activity E.g. Stair placement / design / signage, active recreation amenities, bicycle parking, tap water facilities 4) Synergies with Sustainable and Universal Design

17 Initiatives in NYC IMPROVED CHILDREN S ENVIRONMENTS Passed Daycare Regulations for physical activity time (1h min.), healthier foods & beverages, limits to TV Improved school foods and beverages Salad bars, water jets, 1% milk Increased physical activity opportunities in schools Gymatoriums School PlayStreets Train teachers to add physical activity throughout the day

Initiatives in NYC IMPROVED FOOD AND BEVERAGE ENVIRONMENTS Passed laws banning trans fats, requiring calorie postings and limiting sugary drink sizes in restaurants Increased tap water drinking

18 Initiatives in NYC IMPROVED FOOD AND BEVERAGE ENVIRONMENTS Passed laws banning trans fats, requiring calorie postings and limiting sugary drink sizes in restaurants Increased tap water drinking facilities in buildings and public places Created tax and zoning incentives for supermarkets in food deserts Increased access to farmers markets Created Greencarts Adopted food standards for foods served at and by city agencies

19 Initiatives in NYC IMPROVED ENVIRONMENTS FOR PHYSICAL ACTIVITY Developed and implementing the Active Design Guidelines (ADGs) Distributed >15,000 copies internationally; Trained >3000 Integration into public sector design and construction projects, standards (schools, supportive housing), & RFPs Created incentives e.g. LEED Innovation Credit for PA Required bicycle parking in new buildings >30,000 Burn Calories, Not Electricity stair prompt signs to >1,000 NYC buildings, including city-owned and operated buildings

20 Building Strategies Stairs: signage and prompts Motivational Signage placed at points of decision Promoting stair use at work Stair Week

21 Building Design Strategies Stairs: aesthetics Stairs prominent and visible, and receive natural daylight Art in stairs to increase visual interest Stairs designed to invite users

22 Building Design Strategies Recreational programming Provide fun and affordable recreational opportunities

23 Initiatives in NYC IMPROVED ENVIRONMENTS FOR PHYSICAL ACTIVITY Improved urban realm for walking, cycling, transit (incl. BRT) Increased children s play spaces and co-located adult rec spaces Schoolyards to Playgrounds Summer Streets and Community PlayStreets (streets closed to cars, opened up for active recreation and transportation)

24 Impacts Increased: - Commuter cycling 289% - Bus and subway ridership 10% - Stair use where stair prompts are used in city worksites; >40% increase at 9 mos in 10-story low-income housing - Fruit and vegetable consumption - Job creation in high needs areas through new supermarket development Decreased: - Traffic fatalities 37% - Traffic volumes 1.5% - Car registrations 5% Started Reversing Childhood Obesity

Cheonggyecheon Area before Retrofitting http://www.

25 Cheonggyecheon Area before Retrofitting

Cheonggyecheon Area after Retrofitting http://www.

26 Cheonggyecheon Area after Retrofitting

Comprehensive Policy and Environmental Approaches for Addressing Obesity and Non-Communicable Diseases

Comprehensive Policy and Environmental Approaches for Addressing Obesity and Non-Communicable Diseases Karen K. Lee, MD, MHSc, FRCPC Adjunct Professor, Schools of Public Health, University of Alberta (World