by Ellen Tohn, Tohn Environmental Strategies; Rupal Sanghvi, HealthxDesign; Cheryl Gladstone, Enterprise Community Partners; Matthew Trowbridge, MD, MPH, University of Virginia School of Medicine; Megan Sandel, MD, MPH, Children’s Health Watch, Boston University School of Medicine
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Health and wellness are largely driven by activities outside of the doctor’s office. Where we live, work and play all have a tremendous impact on our health. That’s why housing developers can play a pivotal role in improving health.
For over a decade, the housing community has embraced the creation of affordable, healthy buildings. We have linked housing finance to green building standards in 36 states. As a result, more than 38,000 families live-in homes with lower energy and water bills, better air quality and fewer asthma triggers.
To date, our focus on health has revolved around housing quality at the building-level. However, the housing development process represents an opportunity to address health outcomes at a population level. We can expand our application of the health lens, engage community in neighborhood improvements and leverage housing as an entry-point for improving health, including and extending beyond health services.
To support housing providers in their quest to link housing to health, the 2015 Enterprise Green Communities Criteria introduces two new, bold plans. It requires housing developers to: 1) understand community health conditions and position buildings to be responsive; and 2) create opportunities for active living through an emphasis on “active design” and “transit-oriented development.”
The first new component of the criteria requires housing providers to integrate public health data into the pre-development process. This helps demonstrate where need concentrates by geography, and thereby enables “smarter” development decisions that can address persistent health inequities. The criteria provides developers with a framework for engaging the health sector and building support for health-oriented projects. Advancing “outcomes-based design” can also establish metrics that demonstrate the impact of housing on population health. For example, the Denver Housing Authority used a health impact assessment to inform a recent redevelopment project. Data from a food pricing survey, combined with information from community residents, identified a need for healthy food retailers within safe walking distance. As a result, the housing authority’s master plan included a community garden, space for a farmers’ market and pedestrian improvements.
A second new component of the criteria focuses on obesity prevention by incentivizing active design and increasing physical activity in and around housing developments. A staggering one-third of American adults and children are obese and two-thirds are overweight. Living in buildings and neighborhoods that encourage walking and provide access to healthy foods can help address the obesity epidemic.
The community development field is poised to make powerful decisions that can stem the tide of chronic disease, often at no additional cost, simply through more informed decision-making. Several jurisdictions provide readily-available public health data that can help developers incorporate health into their project planning, and numerous resources exist to support the inclusion of active design. Additionally, we can identify health practitioners—staff from health departments and schools of public health—who are working to link health and community development. Finally, we can engage community residents to identify their priority health concerns and ensure accountability to these priorities.