The fields of urban planning and public health initially sprung from the same emergency—the proliferation of disease in dense industrial cities. Planners worked to solve the problems by widening streets, instituting building standards, and separating land uses. Public health workers solved the problems by surveilling disease outbreaks, treating the ill, and promoting healthy behaviors. From their common roots these two professions eventually diverged—to the detriment of both. There is only so far healthy behavior promotion can go if urban planners are not focused making healthy behavior easy. There is only so far that urban planning can get in creating functional cities without taking public health into account. Healthy people make a healthy city.

Source: Kaiser Family Foundation

The social determinants of health and their components can dramatically impact health outcomes.

The social determinants of health are the structural factors and conditions in which people live. They include many factors with direct linkages to planners and the planning realm such as housing, transportation, safety, parks, and walkability. These physical and structural factors are so important to human health outcomes that studies have shown that your zip code can determine your health more than your genetic code. In the Twin Cities, a three-mile difference in housing location could mean up to a 13-year difference in life span for residents. The Robert Wood Johnson Foundation created a visualization of this effect. The image shows the disparity in life span along the I-94 corridor. The disparity is because some of the social determinants of health can drastically vary from neighborhood to neighborhood.

Source: Robert Wood Johnson Foundation

Residents living three miles apart from each other can have a difference in life spans of 13 years.

Right now, cities in the Twin Cities metro area are going through the decennial process of writing comprehensive plans for their communities. These plans speak to topics like land use, housing, and economic development, all of which can influence the social determinants of health. Comprehensive plans are influential policy documents that allow communities to course-correct and set intentional future priorities. Acknowledging that comprehensive plans are ripe places to include healthy policy, Hennepin County began the Metro Healthy Comprehensive Plans Workgroup. The group came up with a checklist of items that would promote health in each chapter of a comprehensive plan. The checklist calls for implementation priorities such as an increased number of and safety for bike routes to increase biking rates, human-scaled street design, mixed-use commercial districts to create walkability, and community facilities with views of nature to lower stress levels and increase use of outdoor spaces. You can find that checklist here.

“Health in All Policies” is the Public Health Institute’s official approach to integrating health consideration into policymaking. The Public Health Institute (PHI) is a nonprofit working to research and promote equitable public health policy in response to rising healthcare costs and growing inequities nationwide. The PHI uses this approach to help correct for spatial health disparities. Importantly, they acknowledge that no policy choice is neutral and that every decision has an impact, intended or not. Some policy decisions can make healthy behaviors easier, perhaps by creating new protected bike lanes, making biking safer and more appealing, or allowing for the construction of a grocery store in a former food desert, making healthy food easier to access. The PHI calls for health to be considered in all decision-making processes, across sectors and policy areas.

 

Overall, population health will be increased when more decision-makers are aware of the effects of their choices. City planners decide what form the built environment takes. They make decisions every day that can affect health outcomes for the communities in which they work. Humans respond to the built environment as it dictates what transportation is feasible, what food is accessible, and what activities are most appealing. For example, planners can create code that allows for mixed-use commercial development in more parts of the city, increasing density and access to food and services within walking distance. They can also require that any street reconstruction include landscaped stormwater basins or bike lanes. They can create a sidewalk network that serves all parts of the city equally, and where every crosswalk is ADA compliant. They can also be mindful of creating affordable housing options in areas where residents can easily meet their needs without needing a car. Planners can lay the groundwork for this policy during the comprehensive planning process. Planning policy should work towards creating a built environment that allows people, no matter where they live or their socioeconomic situation, to achieve healthy lifestyles.