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California Environmental Health Tracking Program

California Department of Public Health

850 Marina Bay Pkwy
Building P, 3rd Floor
Richmond, CA 94804

(510) 620-3038



Winter 2013-2014


Planning: What's Health Got To Do With It?


Note: this article is adapted from "What's Health Got To Do With It?", Max Richardson, Galatea King, Kara Vuicich, and Jeremy Nelson, The Commissioner


Some of the largest public health challenges of today are related to how we plan and build our communities. These include high rates of obesity, heart disease, diabetes, and asthma, as well as the public health impacts of climate change. While these issues affect us all, they disproportionately affect disadvantaged communities. Making planning decisions with community health and health equity in mind will require environmental and public health data.


For these reasons, planning officials in many communities are redoubling their efforts to prioritize land use patterns that locate affordable housing close to jobs and services and create transportation systems where walking, biking, and public transit are safe and viable options.


Jeremy Nelson- a professional planner and Vice President with Vialta Group, and a member of CEHTP's advisory group- states that


Transportation and land use planning is a fundamental shaper of our daily lives and routines, and, for that reason, public health should be at the forefront of every planning decision we make in our communities. Having good public health data is critical to maintaining attention and accountability on these issues-as the old saying goes 'What gets measured gets managed.'



(Re)convergence of Planning and Public Health

The American planning profession is rooted in public health. Early planners dealing with the effects of industrialization and rapid urbanization in the late 19th and early 20th centuries were motivated by a desire to promote better health.


However, the planning and public health professions diverged during the postwar period. Urban planning began to focus on economic growth and large-scale transportation and infrastructure projects. Public health became increasingly concerned with controlling and eradicating infectious disease.


During this time, chronic and environmental illnesses were on the rise. Over several decades, it became apparent that these health issues are influenced by how our communities are designed, and many public health practitioners and planners initially found themselves unequipped to address the interrelated challenges of community design and health. Fortunately, the two professions have begun working together to better understand and address the impacts that our built environment has on health, and new tools are emerging to build and plan for healthy cities. Urban planning, like public health, is a data-driven field. Public health data and surveillance is a key component for bringing health into planning processes.


Below are some examples of how new data and tools are facilitating the re-emergence of "healthy planning," and how in some California communities, planners are putting public health at the forefront of their work.


Long-Range Planning for Healthy Communities

General (or Comprehensive) Plans are the "constitution" for community
development and required by California law. They act as blueprints for how a city will grow, and by design, pull together a broad range of stakeholders and community priorities. More communities in California have begun voluntarily incorporating health into their General Plans.


The Governor's Office of Planning and Research (OPR) is in the process of updating California's General Plan Guidelines. For the first time, OPR will provide guidance on land-use related health considerations.


Elizabeth Baca, MD, MPA and the Senior Health Advisor in OPR notes


It is an exciting time to be part of the team updating the guidelines. We have been doing broad outreach across the state. Although health is an optional consideration in general plans, we are seeing a growing interest to address health. In our outreach, it has become clear how important data is to help inform policy and plan for healthy places. Using data to examine the spatial relationship among health outcomes, social, environmental, and economic conditions is an important first step to improve health at a population level. 


Los Angeles, the second largest city in the U.S., has a dense downtown core, diverse neighborhoods and communities throughout the city, and expansive suburban valleys. In collaboration with a broad range of city departments, elected officials, and community stakeholders, the city is developing a Health and Wellness Chapter for its General Plan that will benefit its many diverse communities. Based upon an assessment of public health data and community needs, the Health and Wellness Chapter will outline a series of goals, policies, and programs to include health in the city's future development. More information is available here.


Evaluating Health Impacts of New Development

San Francisco has used Health Impact Assessments (HIAs) to evaluate potential health impacts of proposed development for over a decade. In 2003, a new development project with 1,400 new condominiums was proposed for a site with 360 existing rent-controlled apartments. The new development proposed including only 170 low-income units. At the request of community residents affected by the project, the San Francisco Department of Public Health conducted an HIA to review the project's potential health impacts. 


The HIA found that the project could have serious adverse effects on displacement and homelessness, thereby affecting residents' mental health, social networks, and overall well-being. Informed by public health data and working with the developer, a plan was crafted to replace the 360 rent-controlled units and provide a community meeting space and children's play area. More information is available here.


Planning for Climate Change and Public Health

Climate change will impact the very nature of environmental public health and is forcing cities to re-think how they develop for the future. California is leading the nation in setting policies to slow further climate change and help communities adapt to its impacts. The California Department of Public Health (CDPH), in collaboration with private, public, and non-profit partners, is working to integrate health into climate action planning at the state and local level. CDPH offers guidance and trainings for local health departments, planners, and other partners on various strategies to include health in climate change mitigation and adaption planning. More information is available here.


Using Environmental Health Data for Planning

Two key challenges for planners aiming to incorporate health into their work are evaluating health outcomes and accessing health and environmental data. Both the National Environmental Health Public Tracking Program and CEHTP can offer resources to planners. Some of the data and tools available through CEHTP that can help inform planning include:


  • Our traffic tool, which reports traffic volumes at specific locations throughout California
  • Local level data for asthma and birth outcomes
  • Indicators of climate change vulnerability at the community level


For more information on CEHTP and the data and tools available, please visit www.CEHTP.org.


CEHTP Contributes to New Research on Pesticides and Birth Defect 


In partnership with CEHTP, researchers from Stanford University examined the association between pesticides and hypospadias, a common male birth defect affecting approximately 600,000 to 900,000 males in the United States. Hypospadias is a significant public health issue which sometimes requires surgical correction and can cause impaired sexual function and emotional and social difficulties stemming from the condition.


The research team examined whether infants were at increased risk of hypospadias if their mothers lived in close proximity to where pesticides were used while pregnant. CEHTP staff contributed to the study by geocoding birth records and then using the CEHTP pesticide linkage tool to link birth records with pesticide use records. Analyzing these data for eight counties in the agricultural Central Valley, the study team found that fifteen pesticides were weakly associated with hypospadias. The study results were published in the Journal of Pediatrics on October 28, 2013. While more research is needed, these results extend the growing body of knowledge on this important public health issue.


For more information about the study, view the press release here.


Learn more about the Pesticide Linkage Tool and other CEHTP data services here.

The California Environmental HealthTracking Program is a collaboration of the California Department of Public Health and the Public Health Institute.  This newsletter is supported by Cooperative Agreement Number 5U38EH000953-02 from the Centers for Disease Control and Prevention (CDC).  Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.