D R A F T September 22, 2014

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This document presents a summary of topic areas for which connections to public health have already been firmly established, either in the scientific literature or through other HIAs. Because of this existing knowledge, the QAP HIA project team has chosen to perform a rapid, or desk-top, assessment summarizing existing evidence for each topic area and presenting recommendations for applying this evidence within the context of the 2015 QAP update. A comprehensive assessment of other selected topic areas will be presented in a separate document. Below, each of the following topics is summarized, starting with a brief rationale for its inclusion in this assessment. Some relevant state-level public health statistics are then offered, followed by a set of recommendations for DCA to consider as it updates the QAP. Finally, each section includes links to resources that may be helpful in considering or implementing the recommendations, as well as a primary point of contact from the HIA project team should DCA want additional information beyond what is presented here.

Statement on Housing Affordability...................................................................................... 2

Environmental Health and Safety .......................................................................................... 3

Proximity to highways and other sources of air pollution ........................................... 4

Smoke free housing...................................................................................................... 6

Flooring materials ......................................................................................................... 8

Green housing ............................................................................................................ 10

Trees and greenery .................................................................................................... 12

Injury hazards .............................................................................................................. 14

Active Design and Access ................................................................................................... 16

Pedestrian ingress/egress and circulation ................................................................. 17

Bicycle facilities........................................................................................................... 20

Mixed use developments ........................................................................................... 22

Parking ........................................................................................................................ 24

Transit Oriented Development .................................................................................. 26

Healthy Living..................................................................................................................... 28

Nutrition and cooking activities ................................................................................. 29

Fitness amenities and activities .................................................................................. 30

Health Impact Assessment .................................................................................................. 32

A note on data sources: The statistics on health outcomes and determinants presented below are from publicly available data

sources such as the Georgia Division of Public Health (GADPH), the US Centers for Disease Control and

Prevention (CDC), and from sources Health Rankings and CommunityCommons.org, that

compile data from a variety of primary sources for public use. Footnotes on data sources are included

throughout for reference.

D R A F T September 22, 2014

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Statement on Housing Affordability

Rationale: At all income levels housing that is affordable relative to household income is highly conducive to good health. Additionally, lack of housing (homelessness) and housing instability are associated with a wide range of poor health outcomes for adults and lifelong poor health for affected children. Programs and policies like the Low Income Housing Tax Credit (LIHTC) that aim to increase access to affordable housing can therefore be viewed in some respects as public health interventions. It is with this view that this HIA examines components of the Georgia Qualified Allocation Plan (QAP) for LIHTC. Programs that help to ensure the availability of safe and healthy affordable housing, for all income levels, will improve health. Federal, state, and local governments should continue to fund and oversee such programs with the goal of ensuring affordable housing for all families. Allocation strategies that can increase the supply of appropriately priced housing without compromising quality or safety will improve health. The removal of barriers to affordability (policies that increase access to education and living wage employment, reduce the cost of living, reduce the cost of housing, and increase housing supply) can all support healthful outcomes.

Georgia Health Statistics:

Taking all causes of death together, Georgians were roughly 13% more likely to die in 2010 than Americans as a whole.1

Roughly one in four children in Georgia lives below the poverty level.2 49% of renting households in Georgia pay more than 30% of their income for housing.3

Recommendation:

he State of Georgia and the government of the United States of America should continue to fund and implement effective, evidence based strategies to ensure that safe, healthy, sustainable, quality housing is available to all Americans at a price they can afford. That includes maintaining or potentially expanding the Low Income Housing Tax Credit and related programs.

Resources:

Various reports on Regulatory Barriers to Affordable Housing available from the US Department of Housing and Urban Development: http://www.huduser.org/portal/taxonomy/term/42

Unaffordable Housing: the Costs to Public Health, a 2004 report from the San Francisco Department of Public Health, Occupational and Environmental Health, Program on Health, Equity, and Sustainability: http://www.sfhealthequity.org/component/jdownloads/finish/6-housing/135-unaffordable-housing-the-costs-to-public-health/0?Itemid=62

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

1 US CDC National Vital Statistics Summary 2010: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf 2 As compiled by CommunityCommons.org from US Census Bureau, American Community Survey: 2008-12. 3 As reported by DCA in the State of Georgia Three Year Consolidated Plan: July 1, 2010 June 30, 2103:

http://www.dca.state.ga.us/communities/CommunityInitiatives/programs/downloads/State%20of%20GA%203yr%20Con%20Plan%202010-12%20%20051410-FINAL.pdf

D R A F T September 22, 2014

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Environmental Health and Safety The National Center for Healthy Housing reports that many homes contain environmental hazards that can adversely affect human health. Some of the hazards that Americans may encounter in their home or neighborhood environments include mold and pests, toxic materials, air pollution, and many more. As stated in the previous section, the LIHTC program has benefitted many families by providing them quality, affordable alternatives to substandard housing. However, there is evidence that some hidden hazards can even affect new, high-quality homes. This category of topics focuses on innovative ways the QAP could promote health by more completely addressing environmental health and safety issues.

General Resources:

The National Center for Health Housing: http://www.nchh.org/

Our Built and Natural Environments: A Technical Review of the Interactions Between Land Use, Transportation, and Environmental Quality (2nd Edition): http://www.epa.gov/smartgrowth/built.htm

Executive Order 12898, "Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations:" http://www.epa.gov/environmentaljustice/resources/policy/exec_order_12898.pdf

CDC National Center for Environmental Health - Environmental Hazards and Health Effects: http://www.cdc.gov/nceh/ehhe/

D R A F T September 22, 2014

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Proximity to highways and other sources of air pollution

Rationale: Studies have consistently found elevated rates of asthma and other health concerns (including infant mortality, low birth weight, and possibly autism) in populations that live or spend extended periods of time near high traffic areas. The most noticeable and consistent effects occur within 200 meters of roadways with Annual Average Daily Traffic (AADT) of more than 25,000 vehicles per day, a measure available from the Federal Highway Administration (FHWA). uses from locating within a defined distance from these types of high volume roadways. Railroads, intermodal facilities, ports, and some types of industry have also been found to have similar effects.

Georgia Health Statistics:

In 2013, Georgia was 45th out of 50 states for air quality, 34th for infant mortality, and 45th for low birthweight.4

In 2012, nearly one million adults in Georgia reported having asthma.5 In 2010, there were over 10,000 asthma-related hospitalizations among adults and

children in the state, costing more than $174 million.6

From 2006 to 2012, nearly one in ten babies (9.5%) was low weight at birth (less than 2500g).7

From 2006 to 2010, the infant mortality rate was 7.6 per 1,000.8

Recommendations:

In the Environmental Manual: Section II.A.4, site maps could also be required to identify roads within 200 meters (650 feet) from the edges of the proposed site which

are classified as Interstate, Expressway, or Principal Arterial. These classifications may be obtained from the county or local jurisdiction. They do not have to appear on the Map as the scale is different; they may be identified with an arrow pointing in the direction of the road with the road name and distance at its closest point.

In Environmental Manual: Section II.B, a new element could be added as such: o 17. Air Quality

Document Annual Average Daily Traffic (AADT) of the identified roads. AADT can be obtained from the local jurisdiction, http://trafficserver.transmetric.com/gdot-prod/gdot_report.html, or http://www.fhwa.dot.gov/policyinformation/hpms/shapefiles.cfm. AADT is not available for all segments of all roads. Use AADT from the nearest available segment unless there is reasonable expectation that this data does not reflect traffic volume near the property. If no counts are available, the assessment should assume that Interstates and Expressways exceed the limit. The environmental professional may use their judgment as to whether other roads constitute a high traffic volume. Projects should not be accepted that propose buildings within 200 meters (650 feet) or a

4 As reported by Americas Health Rankings: http://www.americashealthrankings.org/GA 5 As complied by CommunityCommons.org from US Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System: 2011-

12. 6 GA Department of Public Health: http://dph.georgia.gov/asthma-surveillance 7 As complied by CommunityCommons.org from Centers for Disease Control and Prevention, National Vital Statistics System: 2006-12 8 As complied by CommunityCommons.org from US Department of Health & Human Services, Health Resources and Services Administration, Area

Health Resource File: 2006-10.

D R A F T September 22, 2014

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road with an AADT that exceeds 25,000 motor vehicles per day. Parking and undeveloped areas of the property may fall within that buffer.

Resources:

Factors for Identifying and Assessing Disproportionate Environmental Health Impacts from US Environmental Protection Agency (EPA): http://www.epa.gov/ncer/events/calendar/2010/mar17/whitepaper.pdf

Highway Functional Classification: Concepts, Criteria and Procedures from the Federal Highway Administration (FHWA): http://www.fhwa.dot.gov/policyinformation/hpms/hfcccp.cfm

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Smoke free housing

Rationale: Tobacco use, particularly smoking, is proven to be the most prevalent underlying cause of death in the US. In addition to increasing risk of death, disability, and high costs for the smoker, habitual smoking also leads to negative health outcomes for other members of the household and community that are exposed to environmental tobacco smoke. Children who are exposed to tobacco smoke at home have higher rates of asthma attacks, cancer, and heart disease, and are more likely to start smoking. Prior research has shown that, in comparing health effects of smoking versus non-smoking families, children living in families with smokers have far greater prevalence of cancer and cardiovascular morbidity. Residents of multifamily properties can be exposed to tobacco smoke due to smoking that occurs in their own home, in common areas, or in other units with shared hallways or ventilation systems. Low income households and those using housing subsidies may have fewer options or more barriers to address tobacco smoke in their daily environment (such as moving). Many housing developments have successfully implemented smoking restrictions, such as prohibiting smoking indoors, in residential units, or where smoke could affect other units. This strategy has been shown to be highly successful in reducing tobacco exposure, especially for children. However, tobacco is physiologically addictive and because of this, many smokers are unable to quit smoking even after multiple attempts. Individual smokers (and their families) could face penalties or even homelessness if they are unable to quit smoking in order to live in a smoke-free development. Smoking policies must respect the needs of both non-smoking and smoking tenants. For instance, smoke free policies can be phased in, smoking may be allowed outside away from buildings and common areas, and smoke free properties can help residents quit with cessation information and services. The majority of current smokers report that they would like to quit, but need more time or more help. A tobacco addiction can also be quite expensive to maintain; residents who quit smoking may be able to achieve better financial stability.

Georgia Health Statistics:

Four in five residents in Georgia are non-smokers.9 From 2003 to 2007, roughly one in six deaths for persons over age 34 was attributable

to smoking.10

9,400 Georgia children take up habitual smoking every year.11

Smoking is estimated to contribute $3.18 billion in health care costs annually in the state of Georgia. $537 million of that is paid by the state Medicaid program.18

In Georgia, parents and guardians expose more than 423,000 children to tobacco smoke in the home each year.18

9 Reported by the US Centers for Disease Control and Prevention from data collected for the Behavior Risk Factor Surveillance System, 2011:

http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2012/states/georgia/index.htm 10 GA DPH, Georgia Tobacco-related Cancers Report, 2012: https://dph.georgia.gov/sites/dph.georgia.gov/files/Tobacco-

Related%20Cancer%20Report_111612.pdf 11 As reported by the Campaign for Tobacco Free Kids, Tobacco Free Georgia: http://www.tobaccofreekids.org/facts_issues/toll_us/georgia from

various data sources: http://www.tobaccofreekids.org/facts_issues/toll_us/sources/

D R A F T September 22, 2014

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Recommendations:

In Chapter 19 of the Core Plan on Monitoring and Compliance, the following

-family and mulit-family buildings, including inside of residential units. Properties should have an enforcement policy, however eviction should not be an enforcement method except for repeated, flagrant, and intentional

In the Core Plan Appendix I on Threshold Criteria, chapter IV Required Services, smoking cessation classes, groups, or services could be encouraged, or even required at smoke free properties.

Resources:

-Smoking Policy: http://www.albanyhousingauthority.com/portfolio-item/albany-housing-authority-no-smoking-policy/

National Center for Healthy Housing comments on smoke-free policies: http://www.nchh.org/Portals/0/Contents/Comments%20to%20HUD%20on%20smoke%20free%20housing.pdf

Model laws and policies: http://www.no-smoke.org/goingsmokefree.php?id=499

Smoking cessation resources: http://smokefree.gov/

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

D R A F T September 22, 2014

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Flooring materials

Rationale: Current specifications with in the QAP require carpet in bedrooms. However, research identifies carpeting as a potential trigger for asthma symptoms due to the high potential for accumulation of dust mites, mold, mildew, and other irritants. Low income households tend to have elevated asthma rates and are at greater risk for exacerbation of symptoms due to environmental conditions. Additionally, research suggests that exposure to unhealthy carpeting is more likely for low income individuals and residents of subsidized housing. Some issues specific to this population that lead to increased risk of exposure include limited resources for cleaning products and services, lower health literacy, fewer options for relocating, and sometimes mobility limitations that impact the ability perform routine cleaning. Asthma can have serious consequences for affected households. Children with uncontrolled asthma (which includes medication and environmental management) can miss as much as 1 out of every 10 days of school, while their family faces significant economic burdens due to medical costs and time lost from work.

Georgia Health Statistics:

From 2008-2012, over a quarter million Georgians visited the emergency room for asthma treatment, which is significantly higher than the rest of the country. About half of the visits were children under 18.12

In 2013, roughly two in three adults with asthma had learned how to treat their symptoms, but only one in six had taken a course on managing their disease.13

Recommendations:

Consider including the following language in the Architectural Standards, V. section H. Allow up to 15% of units to be built with smooth/hard surface flooring (such as wood, laminate, or ti

Households with one or more members diagnosed with asthma should be able to request a unit with hard-surfaced bedrooms, especially if symptoms are currently

dea could possibly be reflected in the Section 19 of the Core Plan on Monitoring and Compliance.

In the Core Plan Appendix I on Threshold Criteria, chapter IV Required Services , consider permitting asthma management classes or consultations as required services, including educating residents on carpet maintenance, allergen control, and creating an asthma action plan.

Comments: It may also be possible to designate some rehab funding to install hard surface flooring in existing units upon request or evidence of asthma diagnosis/treatment.

12 As reported in the GA DPH Online Analytical Statistical Information System (OASIS). 13 As reported by Americas Health Rankings: http://www.americashealthrankings.org/GA

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Resources:

Health Impact Assessment of Flooring in Public Housing by the San Francisco Department of Public Health: http://www.healthimpactproject.org/hia/us/flooring-in-public-housing

The Breathe-Easy Home: The Impact of Asthma-Friendly Home Construction on Clinical Outcomes and Trigger Exposure by Enterprise Community Partners. http://www.enterprisecommunity.com/resources/ResourceDetails?ID=67822.pdf

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Green housing

Rationale: Prior assessmethis type of development is highly supportive of good health. A 2014 study of residents of

s,

Leadership in Energy & Environmental Design (LEED) program) found that the self-reported health of adults improved significantly one year after moving into the housing. Cmental health also improved, and there were measurably fewer hazards such as mold and allergens. Additionally, energy and water costs were much lower green housing.

Georgia Health Statistics:

Georgia has over 5,000 LEED registered and certified homes but, as of 2013, only four LEED for Neighborhood Development projects.14

16% of Georgia adults report that they are in fair or poor health. In some counties, this number is as high as 36%.15 (County Health Rankings)

Recommendation:

Under the Core Plan Appendix I on Threshold Criteria, chapter IV Required Services, properties that receive points for Sustainable Development could include classes or information on using energy and water efficiency features as a required service. Southface may be able to provide the curriculum and other resources.

In the Core Plan Appendix II on Competitive Scoring Criteria, chapter VI. Sustainable Developments, maintain and update the scoring for Sustainable Development in accordance with industry best practices.

In the Core Plan, Section 19 on Monitoring and Compliance, consider a requirement for applicants to submit a short review of sustainable features or amenities that were implemented at one year after Placed in Service, as well as a summary of average utility costs by unit type and any notable maintenance findings.

Resources:

Green Housing = Improved Health: A Winning Combination, National Center for Healthy Housing: http://www.enterprisecommunity.com/resources/ResourceDetails?ID=67488.pdf

Saving Energy, Improving Health: Potential Impacts of Energy Efficiency Program Design on Noise and Air Pollution Exposure: http://www.sfhealthequity.org/component/jdownloads/summary/6-housing/257-saving-energy-improving-health-potential-impacts-of-energy-efficiency-program-design-on-noise-and-air-pollution-exposure?Itemid=62

14 Determined from the US Green Building Council Directory of Projects: http://www.usgbc.org/profile 15 As reported in the County Health Rankings from data collected for the US Centers for Disease Control and Prevention, Behavioral Risk Factor

Surveillance System: http://www.countyhealthrankings.org/app/georgia/2014/measure/outcomes/2/map

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Health and Housing Outcomes From Green Renovation of Low-Income Housing in Washington, DC Enterprise Community Partners, Inc & National Environmental Health Association: http://www.enterprisecommunity.com/resources/ResourceDetails?ID=0090954#

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

D R A F T September 22, 2014

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Trees and greenery

Rationale: Previous work has shown that incorporating trees and greenery into the design of developments is a versatile tool for promoting public health. By providing shade and natural surfaces, trees and greenery can reduce ambient heat, especially in urban areas, as well as UV exposure. They also absorb some types of air pollution, potentially contributing to reductions in respiratory diseases. A large body of research makes connections between the presence of greenery and positive measures of mental health. There is also evidence that trees and greenery can contribute to reducing violent crime, domestic violence, and traffic crash rates, counter to standard roadway design manuals from organizations like AASTHO, that frame trees primarily as obstructions to be removed from the roadside. Research also demonstrates that minority and low income households are more likely to suffer some of the negative effects of inadequate tree coverage, such as deaths from excessive heat, violent crime, and disorders such as asthma attacks and low birth weights associated with exposure to air pollution. Tree cover is significantly impacted by land development.

Georgia Health Statistics:

In 2010, asthma was three times as common among adults whose annual household income was less than $15,000 than among those making $75,000 or more per year.16

Motor vehicle crashes are the leading cause of death for people under age 34 in Georgia.17

Homicide is a top-ten cause of death from birth to age 44; suicide stays in the top ten from age 10 through 44.10

Georgia tree canopy declined with development over past decades but started to rebound after 2005 to nearly 20 million acres.18

Recommendations:

Include the following language in the Architectural Standards, section III.F on Landscaping:

o How to Conserve Natural Resources on Construction Sites as a resource specific to preserving large mature trees on site.

o Plant trees along streets, driveways, and walkways and around buildings using the Right Tree in th method.

Comments: The above language would also be relevant to the site plan requirement set out in Threshold Criteria, XVI.K. Also, LEED-ND and Earthcraft Communities both incorporate trees and vegetation, so this may relate to Sustainable Development points as well.

Resources:

How to Conserve Natural Resources on Construction Sites - Georgia Forestry Commission: http://www.gfc.state.ga.us/resources/publications/HowtoConserveNaturalResourcesonConstructionSites.pdf

16 GA Department of Public Health: http://dph.georgia.gov/asthma-surveillance 17 As reported in the GA DPH Online Analytical Statistical Information System (OASIS). 18 From the Natural Resources and Spatial Analysis Lab at the University of Georgia College of Agricultural and Environmental Sciences:

http://narsal.uga.edu/glut/data-stats/georgia-tree-canopy-trends

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The Right Tree for the Right Place Tree City USA Bulletin #4: http://www.na.fs.fed.us/spfo/pubs/uf/sotuf/chapter_3/appendix_a/appendixa.htm

i-Tree - a state-of-the-art, peer-reviewed software suite from the USDA Forest Service that provides urban forestry analysis and benefits assessment tools: https://www.itreetools.org/

Public Health Benefits of Urban Trees (from Canopy, an environmental nonprofit dedicated to planting and protecting trees): http://www.canopy.org/wp-content/uploads/Public%20Health%20Benefits%20of%20Trees%20%202-15-11.pdf

GA Urban Forest Council: http://www.gufc.org/

Urban Ecosystem Analysis Atlanta Metro Area: Calculating the Value of Nature: http://arboretum.agnesscott.edu/wp-content/blogs.dir/4/files/2012/05/American-Forests-Urban-Ecosystem-Analysis-Atlanta.pdf

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Injury hazards

Rationale:

among children ages 1 to 19 years, representing nearly 40 percent of all deaths in this age group. Each year, an estimated 8.7 million children and teens from birth to age 19 are treated in emergency departments for unintentional injuries and more than 9,000 die as a result of their injuries one every hour. Common causes of fatal and nonfatal unintentional childhood injuries include: drowning, falls, fires or burns, poisoning, suffocation, and transportation-

not strike randomly. Males are at higher risk than females. Infants are injured most often by suffocation. Toddlers most frequently drown. As children age, they become more vulnerable to traffic injuries. Motor vehicle injuries dominate among teens. Poverty, crowding, young maternal age, single parent households, and low maternal educational status all confer risk and make hazards, and the lower income populations served by LIHTC developments are especially vulnerable to this risk.

Georgia Health Statistics:

Unintentional injuries (excluding falls and car crashes) are the leading cause of emergency room (ER) visits for Georgians between the ages of 1 and 19.19

Falls are the second most common cause of ER visits for youth under age 14.19 Drowning and poisoning are also in the top ten reasons for ER visits by children.19

Recommendations:

Consider the following additions to the Architectural Standards, section V. on Building Interiors Design Standards, where appropriate:

o In family units, window treatments should have a way to secure dangling cords. o In units for older adults, provide extra lighting and accessible storage. o Ensure compliance with International Residential Code for One- and Two-Family

Dwellings 2012 Chapter 3 section R312.2 Window fall protection in upper stories of all units including one- and two-family buildings (http://publicecodes.cyberregs.com/icod/irc/2012/icod_irc_2012_3_sec012.htm ); or if DCA determines that window fall protection devices constitute a fire escape hazard, use windows that can be opened at the top.

Under Core Plan Appendix I, Threshold Criteria, section IV. on Required Services, allow safety classes to serve as Required Services, such as CPR, household safety, fire safety, or water safety, as well as senior fitness classes.

Comments: Another approach to reducing these hazards might be to offer a point in the Competitive Scoring Criteria for meeting the National Healthy Housing Standards, (http://www.nchh.org/Policy/NationalHealthyHousingStandard.aspx), having applications reviewed by a healthy housing specialist (http://www.nchh.org/Training/Healthy-Homes-Specialist-Credential.aspx), or taking the Pediatric Environmental Home Assessment training (http://www.nchh.org/Training/PEHACourse.aspx).

19 As reported in the GA DPH Online Analytical Statistical Information System (OASIS).

D R A F T September 22, 2014

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Resource:

National Action Plan for Child Injury Prevention: http://www.cdc.gov/safechild/NAP/summary.html

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

D R A F T September 22, 2014

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Active Design and Access Most Americans do not get enough physical activity. Physical activity, which is more than

reduced risk for obesity, heart disease, and some cancers, just to name a few. Instead, physical

activity can include walking or bicycling to work or school, gardening, taking the stairs, playing

active games, and many other daily activities. According to data collected by the CDC,20 only

one in five adults in Georgia get the recommended amount of weekly physical activity needed

to maintain good health. More than one in four adults did not get any leisure-time physical

activity at all. ildren, of which only one in four

meet recommended levels. Aspects of the built environment have been shown to impact

physical activity behaviors, which are a key determinant of health. Designing spaces that

and the following topic areas focus on this

concept.

In 2009, insufficient activity and inactivity were responsible for an estimated 3,031 deaths and $649 million in hospital charges.21

In 2010, almost two thirds of adults (64.8%) were overweight or obese (CDC).22

General Resources:

CDC Physical Activity Guidelines:

http://www.cdc.gov/physicalactivity/everyone/guidelines/

Urban Design Checklist: http://centerforactivedesign.org/dl/?id=85

Building Design Checklist: http://centerforactivedesign.org/dl/?id=84

Or download the complete Active Design Guidelines

http://centerforactivedesign.org/guidelines/ and the Active Design Supplement:

Affordable Designs for Affordable Housing

http://centerforactivedesign.org/affordablehousingcosts.

20 US Centers for Disease Control and Prevention 2014 State Indicator Report on Physical Activity:

http://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf 21 GA DPH 2010 Physical Activity Surveillance Report:

http://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/2010%20Physical%20Activity%20surveillance%20Report.pdf 22 US Centers for Disease Control and Prevention, 2012 Georgia State Nutrition, Physical Activity, and Obesity Profile:

http://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/georgia-state-profile.pdf

D R A F T September 22, 2014

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Pedestrian ingress/egress and circulation

Rationale: Walking is one of the easiest and most cost effective ways to be physically active, lose weight, and reduce stress. When valued as a mode of transportation, walking is a virtually no-cost option that can enable travel for people who may not be able to drive, including low income households and persons with disabilities or age-related ability limitations. The ability to choose walking over driving can also allow households to reduce their transportation expenses. A well-designed and maintained network of pedestrian paths, sidewalks, and crosswalks supports physical activity by allowing safe and convenient pedestrian access to nearby amenities. Project designs that enable residents to regularly choose walking for recreation or transportation purposes can lead to subsequent improvements in their health status and household financial stability. Depending on the proximity to community transportation options and other desirable neighborhood features, designs that support pedestrian circulation can also reduce traffic impacts and parking demand generated by a particular development.

Georgia Health Statistics:

Adults with a safe and convenient place to walk were more likely to engage in regular activity (42%) than those with no place to walk (27%).23

Around 2.5% of Georgia residents walk to work. In metro Atlanta, the figure is nearly 5%.24

In 2012, over 230,000 households in the state did not have a vehicle.24 Nationally, 8.2% of commuters in households making less than $10,000 walk to work,

more than any other income group. More than 5% of workers in households with income under $25,000 walk to work. 24

Recommendations:

Consider the following additional language under Section III.C. on Vehicle Circulation in the Architectural Standards Existing streets should not be abandoned; the surrounding street network should carry through the property. Site design should avoid fencing off the entire property; although single buildings, yards, or parking areas may be enclosed by fencing.

In the Architectural Standards section III.D. on Pedestrian Circulation, consider adding the following stipulations: o Pedestrian ingress and egress should be provided to all adjoining streets, including

along all vehicular entrances with crosswalks at street connections.

o

parking areas. o Safe pedestrian crossings should be provided at logical points such as intersections

or building entrances, including at vehicular entrances. Crossings should at least

23 GA DPH 2010 Physical Activity Surveillance Report:

http://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/2010%20Physical%20Activity%20surveillance%20Report.pdf 24 Data obtained from US Census, 2012 American Community Survey

D R A F T September 22, 2014

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have a painted crosswalk; this may be combined with features such as curb extensions or raised pavement to slow traffic.

o Distance between access points or crossings should not exceed 600 feet. Site

design should redevelopment.

o Pedestrian circulation may reference

http://www.walkable.org/assets/downloads/12STEPS.pdf Comments: Applicants should keep in mind that connectivity can be subject to existing zoning or subdivision ordinances, so they should look for zoning options that will enable them to incorporate a well-designed pedestrian circulation plan into their development.

Include the following in the Core Plan Appendix II, Competitive Scoring Criteria, section III. on Desirable Activities/Undesirable 1 point may be offered for property located in a jurisdiction or district that has adopted a local Complete Streets ordinance, Safe Routes To School policy/program, or similar mechanism for supporting safe pedestrian activity.

Under the Community Transportation Options presented in Core Plan Appendix II, Competitive Scoring Criteria, section IV., consider the following: o Points should only be offered if paved walkways connect to the transit stop

including marked crosswalks at crossings. o Flexible pool applicants may receive 3 points if they are ¼ mile from transit stop

but can demonstrate that there is a town center, commercial district, or retail center within that distance and directly connected by walkways or bikeways (on or off street) (or 2 points if they are ½ mile but connected to such destinations).

o Likewise, rural pool applicants may also be eligible for 1 point for being within ¼ mile of a retail center or town center and connected by walking and/or bicycle facilities.

In the Core Plan Appendix II, Competitive Scoring Criteria, section XV. On Leveraging of Public Resources, consider editing item C.4 to reference Complete Streets, Safe Routes to School infrastructure, Livable Centers Initiative award (or equivalent), traffic calming, and pedestrian crossings as targeted investment forms.

Comments: LEED-ND and Earthcraft Communities both incorporate pedestrian accommodations, so this may relate to Sustainable Development points as well.

Resources:

Georgia Department of Transportation Complete Streets Design Policy: http://nacto.org/wp-content/uploads/2014/01/GDOT-Design-Policy-Manual-Chap09.pdf

What are Complete Streets? | Smart Growth America. http://www.smartgrowthamerica.org/complete-streets/changing-policy/complete-streets-atlas

D R A F T September 22, 2014

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Do All Children Have Places to Be Active? Active Living Research. http://activelivingresearch.org/sites/default/files/Synthesis_Taylor-Lou_Disparities_Nov2011_0.pdf

Land Use Impacts on Transport: How Land Use Factors Affect Travel Behavior. http://www.vtpi.org/landtravel.pdf

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Bicycle facilities Rationale: Like walking, bicycling is an inexpensive form of transportation and physical activity. Many jurisdictions are just beginning to implement bicycle plans and facilities. Buildings and developments designed now should be adaptable to increased opportunities for bicycling. Like walking, increased bicycle ridership is associated with better health in many areas, most notably reductions in heart disease and obesity, and fewer traffic-related injuries. Where bicycle trips are substituted for driving trips, decreases in traffic-related emissions, traffic-related injuries or deaths, congestion-related delays, and household transportation costs are anticipated.

Georgia Health Statistics:

In 2010, nearly 30% of adults were obese.25

From 2007 to 2011, injuries (including vehicle crashes) were the third leading cause of premature death, behind only heart disease and cancer.26

Bicycling to work is most common in small rural towns, twice the rate of large central cities.27

Recommendations:

Consider the following additional language under Section III.B. on Parking in the Architectural Standards: o

o -family buildings without elevators, provide a secured room with a rack or rai

Consider the following additional language under Section III.C. on Vehicle Circulation in the Architectural Standards: o

carry through the property. Site design should avoid fencing off the entire property; although single buildings, yards, or parking areas may be enclosed by

o -use non-motorized access points to adjacent streets or properties on all sides of the pro

Under the Community Transportation Options presented in Core Plan Appendix II, Competitive Scoring Criteria, section IV., consider offering 1 point for connecting to adjacent bicycle facilities such as bike lanes, bicycle boulevards, or paths.

25 US Centers for Disease Control and Prevention, 2012 Georgia State Nutrition, Physical Activity, and Obesity Profile:

http://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/georgia-state-profile.pdf 26 As reported in GA DPH Georgia Annual Health Status Measures 2013:

http://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/DPH%20Health%20Status%20Measures.pdf 27 As noted in Active Transportation Beyond Urban Centers, a report from the Rails to Trails Conservancy:

http://www.railstotrails.org/resources/documents/ourWork/reports/BeyondUrbanCentersReport.pdf

D R A F T September 22, 2014

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In the Core Plan Appendix II, Competitive Scoring Criteria, section XV. On Leveraging of Public Resources, consider editing item C.4 to reference Complete Streets, Safe Routes to School infrastructure, Livable Centers Initiative award (or equivalent), traffic calming, and pedestrian crossings as targeted investment forms.

In the Core Plan Appendix I, Threshold Criteria, consider adding cycling courses as one of the services that may be offered.

Resources:

National Association of City Transportation Officials Urban Bikeway Design Guide: http://nacto.org/cities-for-cycling/design-guide/

League of American Bicyclists resource for bicycling classes: http://bikeleague.org/content/take-class

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

D R A F T September 22, 2014

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Mixed use developments Rationale: Long distances and travel times to commercial and other non-residential uses can present a barrier to lower income households that reduces access to goods and services. Proximity to a facility or business tends to increase use of that resource, particularly when it provides services or items of the type and price-range sought by the surrounding market. In addition to increasing access, proximity also promotes active travel (biking, walking, etc.) and the associated benefits from increased daily physical activity. Designs that incorporate proximity and access to healthful uses such as clinics, fitness centers, fresh food markets, quality child care, pharmacies, libraries, and so on, can lead to multiple positive impacts on community health. On the other hand, residential proximity to uses such as liquor stores and fast food establishments has been shown to associate with negative health outcomes and behaviors. There may also be positive effects on employment opportunities when residential units are located near commercial, office, or other uses. Mixed use development facilitates this proximity. Allowing a mix of uses on a parcel, especially when considering multifamily housing, can optimize land use on that parcel (or parcels). For example, developments can include productive services in locations that are less appropriate for residential units, such as at a noisy corner. Finally, a mixed use building or parcel design with well-managed businesses located at street level can act as a deterrent to crime by providing natural surveillance of nearby streets and common areas. However, the market is a major factor in determining the success of any given non-residential use, as is design. Such uses require patronage from the surrounding community and not just from residents of the property in which they are located, so integration into the larger community is important in attaining any health benefit offered by mixing uses.

Georgia Health Statistics:

Nearly 40% of Georgians spend more than 30 minutes commuting to work.28 In the past 5 years, 60% of all development in metropolitan Atlanta has been in the

29

t in other parts of the Atlanta region.29 Recommendations:

In the Market Study Manual, recommend that applicants evaluate the appropriateness of mixed use development in their market study, including details regarding the type and amount of mix.

In Exhibit A to Appendix I of the Core Plan on DCA Underwriting Policies, even if mixed use development is encouraged, restrictions on tax credit allocation can make it seem risky to incorporate non-residential facilities for lease. Therefore, it is suggested that DCA issue guidance regarding acceptable mixed-use operating mechanisms which might include lease-backs or cost-sharing, and exclude leased areas from receiving tax credits or being calculated in development or unit costs.

28 Data obtained from US Census, 2012 American Community Survey 29 As reported in a study of Walkable Urban Places in the Atlanta region supported by the Atlanta Regional Commission in 2013:

http://www.atlantaregional.com/land-use/walkups

D R A F T September 22, 2014

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In the Core Plan Appendix II, Competitive Scoring Criteria, section XV. On Leveraging of Public Resources, consider including the following under A.1 Qualifying Sources:

o New Market Tax Credits

o Private or foundation financing in (potentially with specifications for financial and

legal agreements)

Also consider offering one additional point if the proposal is in a location zoned for mixed-use development, even if the project itself is not mixed use.

Resources:

Mixed-use Development: Issues and Best Practices - A guide for community developers

interested in creating neighborhood based mixed-use development projects:

http://www.lisc.org/files/799_file_asset_upload_file335_7049.pdf.

Combining NMTC and LIHTC Novogradac:

http://www.novoco.com/events/conferences/lihtc/2013/san_francisco/manual/presenta

tions/combine_nmtc_lihtc.pdf

WEBINAR: Zoning for the Public's Health: Using Mixed-Use Zoning to Increase

Walkability and Reduce Crime: http://activelivingresearch.org/zoning-publics-health-

using-mixed-use-zoning-increase-walkability-and-reduce-crime

Land Use Law and Active Living: Opportunities for States to Assume a Leadership Role in Promoting and Incentivizing Local Options: http://digitalcommons.tourolaw.edu/scholarlyworks/473/

Zoning for Walkable Mixed‐use Neighborhoods: A Desktop Health Impact Assessment

(Douglas County (NE) Health Department):

http://www.douglascountyhealth.com/images/stories/Healthy%20Community/WMUN

%20HIA%2011%2029%2012.pdf

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Parking

Rationale: Parking regulations appear to have unintended consequences for land use, for transportation,

travel mode selection: large amounts of free parking lead to increased driving. More driving leads to increases in determinants of ill-health like sedentary behavior, traffic-related crashes, and air pollution. Prevalence of parking facilities and traffic creates a less attractive environment for walking or riding a bicycle, discouraging use of these modes and the associated physical activity benefits. The impervious surfaces of parking areas lead to undesirable environmental conditions through stormwater runoff and increased heat accumulation. An overabundance of parking can also create undesirable social conditions by acting as unmonitored, largely vacant space that can be conducive to criminal activity or simply waste space. Constructing parking facilities can cost anywhere from $5,000 per space in a surface lot to $30,000 per space in a parking garage. These costs reduce the amount of money available for residential units, other buildings, or amenities. At the neighborhood scale, parking availability is typically inversely associated with community desirability. That is, popular neighborhoods never have enough parking, and the resulting foot traffic or transit services often contribute to their success, while large areas of unused surface parking generally indicate a neighborhood that is not particularly vibrant or economically successful. The appropriate supply of parking varies widely with location. Properties located in a city or town, or near transit, will generally benefit from fewer parking spaces, while properties in rural areas may need more (and the impact of parking will be somewhat mitigated). Although it is understandable to consider parking as an amenity and to want to ensure that properties are similar to market-rate developments in terms of this amenity, this aspect of land use will generally be addressed by local ordinances and perhaps by a market analysis. Additional regulations in the QAP may cause residents to bear negative health impacts associated with oversupply of parking rather than allowing the supply to be context-driven

Georgia Health Statistics:

Impervious surface coverage doubled in Georgia from 1991 to 2008, covering nearly a million acres.30

About 6% of Georgia households own zero vehicles; 40% own 1 vehicle or fewer. 60% of zero vehicle households are low income.31

Recommendation:

Consider eliminating section III.B. on Parking in the Architectural Standards and relying solely on local requirements:

o As currently written, a TOD property that might be going into a site without parking requirements or with a parking maximum, and the developer would have to potentially build more parking or rule out the site due to the QAP minimum.

30 As reported by the University of Georgia Natural resources Spatial Analysis Lab: http://narsal.uga.edu/glut/data-stats/georgia-impervious-surface-

trends 31 Data obtained from US Census, 2012 American Community Survey

D R A F T September 22, 2014

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Resources:

Why and How to Reduce the Amount of Land Paved for Roads and Parking Facilities from the Victoria Transport Policy Institute: http://www.vtpi.org/EP_Pav.pdf

The High Cost of Free Parking from the University of California Transportation Center: http://www.uctc.net/papers/351.pdf

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

D R A F T September 22, 2014

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Transit Oriented Development

Rationale: Transit oriented development (TOD) is associated with opportunities for better health. It can increase walkability and the share of walking trips, the benefits of which are described above. It can also reduce the cost of living, increase access to retail services and employment opportunities, and increase transportation choices. Not all TOD has the same effect, however. The existing neighborhood may experience transformation as a result, including changes in property values and demographics. Also, the health-supportive changes may not occur if the necessary policies, such as zoning and infrastructure co-investments, are not in place. The QAP is likely to support good health through its ongoing strategies to foster TOD for LIHTC properties.

Georgia Health Statistics:

Georgians took 173 million trips on transit in 2002; 1.6 million were on rural transit systems.32

Georgia workers living in households below 1.5 times the federal poverty level are twice as likely to commute regularly by transit (4% versus 2% for the entire population).33

Recommendation:

In the Core Plan Appendix II, Competitive Scoring Criteria, section IV. On Community Transportation Options:

o Continue to award four points for option A. Use evaluation and stakeholder feedback to improve the specific criteria and documentation, if needed.

o Consider alternate documentation for transit stops in options B, C, and D should include a letter or MOU from the transit agency stating where a future route and/or stop will be located with a defined service date.

In the Core Plan Appendix II, Competitive Scoring Criteria, section XV. On Leveraging of Public Resources, consider highlighting fixed guideway transit stops/stations as a desirable under part C. Off Site Improvement, Amenity, and Facility Investment.

In the Core Plan Appendix II, Competitive Scoring Criteria, section XVI. Superior Project Concept and Design, subsection B, consider increasing the number of applications that can be awarded points for a Transit Oriented Development connection.

32 Jeon, Amekudzi, and Vanegas (2006). Transportation System Sustainability Issues in High-, Middle-, and Low-Income Economies: Case Studies

from Georgia (U.S.), South Korea, Colombia, and Ghana. Journal of Urban Planning and Development, Vol. 132 Issue 3, p172-186: http://people.ce.gatech.edu/~amekudzi/TranspoSustainIssues.pdf

33 Data obtained from US Census, 2012 American Community Survey

D R A F T September 22, 2014

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Resources:

A report on Community Development Financial Institutions and Transit-Oriented Development from the Federal Reserve Bank of San Francisco: http://www.frbsf.org/community-development/publications/special/cdfis-and-transit-oriented-development/

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Healthy Living Many of the changes described in the two previous sections are intended to create healthful

are most effective when paired with educational strategies to help people understand the health and financial impacts of the options that are available to them. Environmental change and behavioral change can create a self-reinforcing cycle that makes both types of changes sustainable. The following two topics focus on how these types of behavioral interventions could be addressed in the QAP.

In 2011, 18.9 % of Georgia adults reported that they perceive their health as fair or poor. However, that figure was 40.2% for people in households earning less than $15,000.

Resources:

The Georgia Healthy Communities Initiative: Building Healthy Communities Across Georgia. http://livehealthygeorgia.com/

ACHIEVE (Action Communities for Health, Innovation, and EnVironmental changE). http://www.achievecommunities.org/

Health Education & Communication Center of Atlanta. http://www.hecca.org/home.asp

D R A F T September 22, 2014

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Nutrition and cooking activities

Rationale: Along with improving access to healthy foods (addressed in the Mixed Use section above), increasing demand for healthy options is critical in promoting improvements in public health. Many Americans know that they should eat better, but they are not aware of exactly how to do so. Many lack familiarity with buying and preparing healthful foods in ways that taste good to them. Studies show that educational activities focused on nutrition, shopping, and cooking (including hands-on classes) are popular at all levels of income and can improve nutritional outcomes for the whole family. Community gardens are often considered as an innovative means for addressing this issue, but their efficacy in directly improving nutrition is indeterminate at this time; though research has demonstrated that community gardens do have many other public health benefits beyond any specific impact on nutrition. Better nutrition defined by eating more fruits and vegetables, consuming less added sugar, and increasing dietary fiber could significantly reduce the incidence and/or prevalence of diseases such as Type 2 diabetes, heart disease (including stoke), and some types of cancer. Healthier diets have also been shown to improve childhood development and learning.

Georgia Health Statistics:

Georgians consume an average of just 0.86 fruits per day and 0.79 vegetables, compared with CDC recommendations for 5 servings of fruits and vegetables daily.

34

Diabetes is the 8th most prevalent cause of death in Georgia.35 Colon cancer is the 13th most common cause of death in the state.35

Recommendations:

The Required Services listed in the Core Plan Appendix I, Threshold Criteria, section IV should include health-oriented events such as nutrition and cooking classes. Classes might involve a partnership with the local cooperative extension, food bank, or charity.

In the Core Plan Appendix I, Threshold Criteria, section XIV. Required Amenities, consider providing a functional kitchen in the community room, which would allow cooking classes to be held there. If the property has a garden, classes or events based around food growing could be included.

Comment: Applicants could specifically commit to offering a certain percentage of health-oriented events as part of a health-oriented scoring criteria.

Resources:

Nutrition for Everyone (CDC): http://www.cdc.gov/nutrition/everyone/index.html

Improving Home Food Preparation Practices among Families with Young Children: A Peer Mentoring Intervention (The Children's Hospital of Philadelphia, PolicyLab): http://policylab.chop.edu/project/improving-home-food-preparation-practices-among-families-young-children-peer-mentoring

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282

34 http://www.americashealthrankings.org/GA 35 As reported in the GA DPH Online Analytical Statistical Information System (OASIS).

D R A F T September 22, 2014

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Fitness amenities and activities

Rationale: The majority of Georgians do not get enough physical activity, defined by CDC as 150 minutes of moderate activity per week AND muscle-strengthening activities on two days each week for adults. In addition to the opportunities for active transportation mentioned above (in the Pedestrian, Bicycle, and Mixed Use sections), housing environments can also support recreational activity. On-site amenities and programs that encourage and educate residents about safe physical activity can have a significant benefit for many health outcomes, including obesity, diabetes, heart disease, and some cancers. Children who obtain the recommended amount of physical activity for their age group 60 minutes per day appear to perform better in school and enjoy better health status as adults.

Georgia Health Statistics:

Only one in five Georgia adults met both the CDC recommended amounts of weekly aerobic AND muscle-strengthening activity.36

Diabetes was the seventh leading cause of death in Georgia from 2007-2011.37 Poor diet and physical inactivity were the underlying cause of over 10,000 deaths in

Georgia in 2006, second only to tobacco use.37

Recommendation:

The Required Services listed in the Core Plan Appendix I, Threshold Criteria, section IV should include health-oriented offerings such as regular classes in popular aerobic styles, yoga or pilates, or guidance in strength training or personal fitness. There could also be additional activities appropriate to the type of property (that is, specific to older adults, children, or parents).

In the Core Plan Appendix I, Threshold Criteria, section XIV. Required Amenities, consider including the following:

o Dedicated walking paths

o Fitness equipment

o door fitness course

o A room that can be used for fitness classes

o Partnerships with a local YMCA, university sports education program, or similar organization could support this activity.

Comment: In combination with the Mixed Use recommendation (above) or Community Connections (separate report), some of these amenities could actually be a separate fitness

36 US Centers for Disease Control and Prevention 2014 State Indicator Report on Physical Activity:

http://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf 37 As reported in GA DPH Georgia Annual Health Status Measures 2013:

http://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/DPH%20Health%20Status%20Measures.pdf

D R A F T September 22, 2014

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center on or adjacent to the site and shared with the surrounding community (but at no charge to residents).

Resources:

2008 Physical Activity Guidelines for Americans (CDC):

http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html

HIA Project Team Contact: Jimmy Dills jdills@gsu.edu 404.413.0309

D R A F T September 22, 2014

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Health Impact Assessment Rationale: Health Impact Assessments (HIAs) are an effective, and cost-effective, health promotion strategy that can be integrated into planning and policymaking. Plans, projects, and policies that utilize HIA recommendations tend to implement evidence-based solutions that are attractive to government agencies, businesses, and communities and also create health-supporting physical and social environments. A number of government entities in Georgia have adopted HIA into their planning approach, including the Atlanta Regional Commission, the Albany Housing Authority, the City of Decatur, the City of Macon, and the Georgia Department of Public Health. For instance, any jurisdiction receiving their Locally Qualified Government review through the Atlanta Regional Commission can seek Excellence points

evaluate government plans or programs (such as comprehensive plans or transportation plans), large-scale developments (including DRIs), and other related projects that may impact

Recommendation:

In the Core Plan Appendix II, Competitive Scoring Criteria, section XVI. on Superior Project Concept and Design, HIA could be added to the criteria for B. Community Driven Housing, if any of the applications fall into a jurisdiction with documented adoption of HIA or using a housing plan that incorporated an HIA.

Comment: Alternately, a separate point could be offered for applicants that conduct an HIA of their proposal, or they could be referenced in Appendix II, Competitive Scoring Criteria, VIII. Community Revitalization Plans.

Resources:

PLAN 2040 Local Government Plan Implementation, 2012 Update:

http://documents.atlantaregional.com/plan2040/docs/lu_plan2040_local_government_i

mplementation_2012_12_update.pdf

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation

and the Pew Charitable Trusts designed to promote the use of health impact

assessments (HIAs) as a decision-making tool for policymakers:

http://www.pewtrusts.org/en/projects/health-impact-project

HIA Project Team Contact: Michelle Rushing - mmarcus2@gsu.edu 404.413.0282