Designing for Healthy Communities
Guest blog written by by Stuart J. Levin, MD, Wake Internal Medicine Consultants
Stuart J. Levin, M.D.
As a primary care physician in Raleigh over the past 20 years, I have witnessed the marked rise in obesity in my own practice with its associated chronic disease impacts including diabetes and cardiovascular disease. While our interventions in the office setting can be helpful in health maintenance, social determinants of health play the largest role in prevention of unhealthy lifestyles. One of the barriers to adequate physical activity has been the lack of attention to healthy community design.
A Shift in Urban Planning
For many years, Raleigh epitomized street-scale urban design and land-use policies, which created barriers to physical activity through an imbalance of preferred transportation modes. Raleigh’s land use increased more than tenfold between 1950 and 2000, at a rate three times faster than the gain in population. While Raleigh has a nationally renowned greenway system primarily designed for recreational use, pedestrians, bicyclists and those travelling by public transportation have rarely been considered in development of the city’s major corridors.
Fortunately, the pendulum has begun to swing in the opposite direction both locally and nationally. The economic downturn of the late 2000s forced a reassessment of existing resources as urban planners again begin to recognize the need to coordinate land use, transportation and infrastructure. At the same time, a growing body of evidence has developed documenting the role of the built environment in health problems associated with physical inactivity. Additionally, the CDC has begun to promote Health Impact Assessments (HIAs) as a means of incorporating the potential effects of proposed projects on the health of a population in conjunction with the goals of Healthy People 2020.
Blue Ridge Rd. Corridor
Six years ago, I became involved in starting a long-term planning group for the Blue Ridge Road Corridor (where my office is located and near my home). In 2012, area stakeholders in conjunction with the City of Raleigh funded a design group to produce a master plan for the area. The master plan incorporates multimodal transportation options including sidewalks, bicycle facilities and public transit.
As part of the ongoing planning process for the Corridor, one of North Carolina’s first comprehensive HIAs has recently been released to assess quantitative health benefits of implementing the 2012 Blue Ridge Road District Study. The results of the HIA are notable for prediction of a significant decrease in premature death and chronic disease as a result of increased multimodal connections within the district. Based on use of WHO’s Health Economic Assessment Tool model, the reduction in morbidity and mortality is estimated to generate a $308.3 million financial benefit.
Incorporating multi-modal improvements to land use planning will not in itself resolve the obesity epidemic, and is only one component of a multi-pronged approach. As the Blue Ridge Corridor HIA noted, no effects could be estimated for the 41% of residents who reported no current walking.
Nonetheless, the time has clearly come for city planners, policymakers and the business leadership to collaborate with public health experts in building healthy communities. This is not just good for health, but is good economic sense and will result in a healthier and more productive workforce.
Stuart J. Levin, MD, chairs the Blue Ridge Corridor Stakeholders Advisory Group in West Raleigh. Having initially moved to Raleigh in 1979, he has practiced internal medicine and pulmonary medicine at Wake Internal Medicine Consultants for the past 20 years and is a clinical professor of medicine at UNC.