Introduction
More and more, inter-disciplinary research associates the "built environment" (i.e., land use, transportation systems and community design) with health outcomes and well-being at the population level. For example, healthful neighborhood conditions require adequate and good quality housing; access to public transit, schools, and parks; safe routes for pedestrians and bicyclists; meaningful and productive employment; unpolluted air, soil, and water; and, cooperation, trust, and civic participation.
These built environment factors are generally determined outside the institutional realm of public health, in the purview of Planning, Transportation, Housing and Economic Development agencies. While there are few mandates to consider health in “built environment” planning and policy-making, public health agencies in diverse cities such as San Francisco, Riverside, Denver, and Minneapolis, are increasingly investing in strategies to influence the “built environment” to improve population health and reduce health inequities.
In San Francisco, the Department of Public Health has responded to the need for health and planning tools and guidelines by creating the Healthy Development Measurement Tool, a comprehensive evaluation metric to consider health needs in urban development plans and projects. The HDMT encompasses three core components:
- Community Health Indicator System - Over 100 indicators of social, environmental and economic conditions that can be used to evaluate baseline conditions in a neighborhood, planning area or city, and to monitor those conditions prospectively. Data are disaggregated by neighborhood and where possible are mapped spatially to highlight disparities.
- “Healthy Development” Checklist - A downloadable checklist of development targets (associated with each indicator) that can be used to assess whether urban plans and projects help achieve community health objectives.
- Menu of Policies and Design Strategies - A listing of potential actions that can be taken by project sponsors or policy-makers to achieve development targets in the checklist and advance community health objectives.
The fundamental value behind the HDMT is that all communities should have equal access to health resources. As such, HDMT objectives and indicators explicitly call out the need for development that serves existing and new residents and workers. Data are also disaggregated by neighborhood and are illustrated spatially in an effort to highlight disparities. SFDPH has primarily targeted use of the HDMT in communities experiencing health inequities as these communities are most likely to be impacted by new development. Where applied, the HDMT might thus help to achieve a higher quality social and physical environment that protects and promotes health.