Built to heal

The I-5 bridge spans between Oregon and Washington.

With a steeper poverty rate, lower life expectancy, and higher rates of cancer, heart disease, diabetes and asthma than the rest of the county that surrounds it, West Oakland probably isn’t the first place that comes to mind when thinking about healthy places to live.
But the area is one of several locations in the San Francisco Bay Area where community groups, city officials and project developers are pioneering the use of Health Impact Assessment as a way to calculate the health effects of land-use decisions, with the goal of promoting health and mitigating negative impacts.

More a combination of processes and methods than a simple tool, Health Impact Assessment (HIA) measures potential health effects that a project or policy—such as a housing development or traffic ordinance—might have on a population. Ideally, such assessments, which can vary widely in scope from quick to extensive, are performed before a project is built or a policy is implemented, allowing decision makers to incorporate recommendations that would minimize negative health effects.

“They’re catalytic in getting involvement of health professionals in land-use policies,” says Rajiv Bhatia, director of occupational and environmental health for San Francisco Department of Public Health, which has led the way on HIA in the United States. Its Healthy Development Measurement Tool is the nation’s first evaluation metric for the health impacts of building projects.

Focusing on a range of health outcomes including physical activity, obesity, air quality and safety, HIAs cover some of same ground as mandated Environmental Impact Assessments. But very few environmental assessments contain comprehensive health analyses, Bhatia says. HIAs go further into linking heath impacts to land use, building and policy decisions.

Besides the obvious quality-of-life issues, combating health problems could save government, business and individuals billions of dollars each year. Heart disease costs the United States $475 billion annually, according to the Centers for Disease Control. A 2009 report from the California Center for Public Health Advocacy found that physical inactivity and obesity costs the state $41 billion per year in healthcare costs and loss of productivity. The same report found that decreasing weight and boosting physical activity by 5 percent over five years could save about $12 billion, and that improving community environments is a way to start.

Connecting health and the built environment during the design and planning process is becoming more common, says Erin Christensen, an urban designer at Seattle-based Mithun architecture firm. As an indicator, the Congress for New Urbanism in 2010 is teaming with the Centers for Disease Control to focus its annual conference on creating healthy places to live. For its part, Mithun works with a public health consultant on some projects to incorporate health concerns into its designs, Christensen says. One current project, a master plan for the South Lincoln Redevelopment, a mixed-income, mixed-use community in downtown Denver, is being designed to maximize walkability through street and sidewalk planning. The client, the Denver Housing Authority, looked to the Healthy Development Measurement Tool as a way to create a project that would be “holistically sustainable,” with features such as a community garden and an initiative to bring fruits and vegetables into the neighborhood through exiting markets, new stores or farmers’ markets, and access to community amenities.