Denver 9/27 Monica Buhlig

WE BUILD A BRIGHTER FUTURE

kp.org/communitybenefit

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Toward Healthy Communities & a Healthy Environment:

The Role of Public Health in TOD and Livability

Monica Buhlig, MPH

Sr. Community Health SpecialistKaiser Permanente Community Health Initiatives

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Our Mission: To provide high-quality, affordable health care services

to improve the health of our members and the communities we serve.

Nation’s largest not-for-profit health plan

National Statistics (2008):

8.6 million members

35 Medical Centers/Hospitals; 431 Medical Offices

14,600 Physicians; 167,300 Employees

$40.3 billion Operating Revenue; $1.18 billion Community

Benefit

Regions:

Northern California

Southern California

Northwest (Oregon/Washington)

Colorado

Georgia

Mid-Atlantic States (VA, MD, DC)

Ohio

Hawaii

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Factors Influencing Health Status

Source: McGinnis, J.M and Foege, W.H. (1993). “Actual Causes of Death in the United States,” Journal of the American Medical Association.

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The Challenge for the Health Sector

• Excellent medical care alone is insufficient

• Major drivers of the (obesity) epidemic and related chronic diseases are environmental

• Consensus: Comprehensive environmental and social change is required to turn down the epidemic – we will be part of the solution

Our Members Can’t be Healthy

if They Live and Work in Unhealthy Communities

Ecological Health

Economic HealthCivic Health

Individual and Population HealthNexus

Opportunities:

Transportation/

Land use

Food systems/

access

Access to goods/

services

Violence

Prevention

(Green) Jobs

Environment(al

justice)

Community

power

Social connection

A SHARED VISION: The Four Health/Wealth: Working

in the Nexus

See, for instance, Serageldin and Steer (1995), “Expanding the Measure of Wealth, “

World Bank monograph

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“A Good Solution Solves

Many Problems”

…And involves

many partners…..

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Unique Partnerships Common Strategies and

Multiple Benefits

Partnership for Sustainable Communities (HUD, EPA, DOT)

Livability Principles:

1. Provide more transportation choices (Economic and

Ecological)

2. Promote equitable, affordable housing (Economic Health)

3. Enhance economic competitiveness (Economic Health)

4. Support existing communities (Ecological and Civic Health)

5. Coordinate policies and leverage investment (Economic

Health)

6. Value communities and neighborhoods (Civic Health)

…Where is the fourth health?...

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Sustainable Communities Regional Planning Grant

Denver Region: Centers and Corridors (TOD)

Areas of Greatest Focus

• Livability principles

• Public engagement

• Inter-disciplinary engagement

• Goals and metrics

• Tools to make it happen

Health Impact Assessment-Like Tool

Equity Focus

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State

LiveWell

Colorado

Federal

Livability

Prin

Regional

SCRPG

Livability Principles:

Unique Partnerships Multiple Benefits

Local22

communities

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A Value-Added Partnership: Public Health

Contributions

PUBLIC HEALTH ASSETS

• Evaluation and Data (Health status and costs)

• Collaboration

• Community Engagement

• Focus on disparate populations

• Evidence-base => Utilize models identifying how to

address links between health and built environment

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Your Partners: Who is “Public Health”?

• Communities Putting Prevention to Work

• HCR Community Transformation Grants

• Local/State Public Health Departments

(Epidemiology/Obesity/Disparities)

• Health Foundations

• Health Plans

• Health Care Professionals

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Thank you for

your

contributions

to health!

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Relationship Between Built

Environment and Public Health

• Inactivity/Obesity

• Injuries/Fatalities

• Stress/Mental Health

• Air Quality

• Water Quality & Quantity

• Climate

• Food Supply

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Economic consequences of obesity

• Base on a study in managed care:

• BMI 30-34.9 = 25% increase in costs

• BMI 35 and above = 44% increase in costs

• Colorado’s annual obesity costs:

• $500 million (direct cost) + $470 million

• (lost productivity) = $970 million

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Healthy Community Design

• Improves individual & population health

• Improves environmental health

• Improves economic health

• Promotes sustainability

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Elements of Healthy Community

Design

• Transportation

• Land Use

• Public Spaces

Plans, Codes, Policies

Built and Natural

Environments

Public & Individual Behaviors

Health of People

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Transportation

Neighborhood traffic calming

Bicycle lanes and paths

Wide sidewalks

Street trees

Mode options

Built and Natural Environments

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Transportation

•Slows traffic & makes

neighborhood streets

safer for pedestrians

and cyclist

•Provides alternatives to

automobile travel

• Increases opportunities

for walking or cycling to

transit

• Reduces injuries

• Reduces risk for chronic

diseases

• Reduces obesity and

associated diseases

• Reduces asthma

Public & Individual Behaviors Health of People

• Decreases air

pollution, carbon

dioxide omissions

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Land Use

•Compact mixed-use development; Co-location of housing, jobs, services, & transportation

•Healthy food retail and restrictions on unhealthy food outlets

•Land-use patterns that encourage neighborhood interaction and a sense of community


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Land Use

• Decreases automobile use

• Increases walking and

bicycling

• Encourages healthy food

choices

• Can foster “eyes on the

street”

• Encourages social

interaction and community

connection

• Increases neighborhood

safety, reduces violence

• Reduces injuries


diseases and obesity

• Fosters positive mental

health & social capital

• Reduces asthma


• Decreases air

pollution, carbon

dioxide omissions

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Public Spaces

•Parks

•Trails

•Urban forests

•Community gardens and urban farms

•Paths

•Greenways

•Street trees


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Public Spaces

• Increases walking,

bicycling and other

physical activity and

recreation

• Invites community activities

• Encourages social

interaction and community

connection

• Encourages gardening and

other interactions with

nature


diseases and obesity

• Reduces stress and

isolation

• Fosters positive mental

health & social capital

• Reduces asthma


• Improves air quality

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Economic Impact

• Public transit investments yield 19% more jobs than highway construction

• More walking / biking supports local retailers

• Public transit projects concentrate and attract development

• Better transportation policies are key to connecting low income people with jobs…and food, healthcare, etc.

Sources: Littman, 2008; Center for Transit Excellence, 2008

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Ray LaHood U.S. Secretary of

Transportation

• DOT encourages states, local governments, community

organizations and public transportation agencies to:

“Consider walking and bicycling as equals with other

transportation modes: The primary goal of a

transportations systems is to safely and efficiently move

people and goods. Walking an bicycling are efficient

transportation modes for most short trips and. Where

convenient intermodals systems exist, these

nonmotorized trips can be linked with transit to

significantly increase trip distance.”

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Kaiser Permanente’s Involvement in

Healthy Community Design

• Safe Routes to School National Partnership

• International Walk to School Day

• Community Health Initiatives (CHI)- Healthy Eating

Active Living

• Thrive Campaign

• National Healthy Eating Active Living Convergence

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Why We Can’t Fail

•“The steady rise in life

expectancy during the

past two centuries may

soon come to an end”• -- N Engl J Med 2005;

352:1138-1145

Denver 9/27 Monica Buhlig

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