EOA2016: Healthy Community Design, Dr. Richard Jackson
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Transcript of EOA2016: Healthy Community Design, Dr. Richard Jackson
Richard J JacksonMD MPH FAAP
HonAIA [email protected]
UCLA Fielding School of Public Health
/
Designing and Building for Health, Well-Being
and Sustainability
The Edge of Amazing“Connecting Neighborhood to Nation to
Improve Community and Population Health”
Community Connections22nd Century Healthy Community
DesignHealth System Transformation
Summer 2016 Heat Map USA
Average Global TemperaturesSince 1880
The Built Environment is Social PolicyIN CONCRETE
Atlanta Journal-Constitution, March 10, 2006
We Used to Build Real Towns and Neighborhoods but Now…
Housing Policy Is Social Policy
Howard Frumkin MD DrPH
Two houses, adjoining back yards(From Streetsblog, 02/28/2013)
Pedestrian Fatality Rates for Collisions at Different Speeds
Zegeer et al 2002
For every age group from 3 through 34--crashes were the No. 1 cause of death
USA Today 10/20/2011
US Adult Obesity Rates 1990
US Adult Obesity Rates 1995
US Adult Obesity Rates 2000
http://stateofobesity.org/adult-obesity/
US Adult Obesity Rates 2016
0
25
50
75
100
Relationship Between BMI and Risk of Type 2 Diabetes
Chan J et al. Diabetes Care 1994;17:961.Colditz G et al. Ann Intern Med 1995;122:481.
Age-
Adju
sted
Rel
ativ
e R
isk
Body Mass index (kg/m2)
Men
Women
<22 <23 23-
23.924-
24.925-
26.927-
28.929-
30.931-
32.933-
34.935+
1.02.91.0
4.31.0
5.01.5
8.12.2
15.8
4.4
27.6
40.3
54.0
93.2
6.7 11.6
21.3
42.1
US Diabetes Rates 1995
US Diabetes Rates 2003
US Diabetes Rates 2016
David B Allen MDNew England Journal
of Medicine April 29, 2012
“…over 30 years…new-onset type 2 diabetes in adolescence has increased
from 3% to ~50% today”.
Diabetes Prevalence NHANES (using Hemoglobin A1c , FPG)
Sample of US PopulationAll Age Groups, Races, Income and Education
1988-1994 2000-2002 2011-20129.8% 10.8% 12.4%
For Prediabetes36.5%
10,000 steps
• 3234 people with Pre-Diabetes(IGT –Impaired Glucose Tolerance)
• Walked or exercised five times a week for 30 minutes for six months
• Lost 5% to 7% of their body weight • Reduced their risk of diabetes by 58%
“The Status of Baby Boomers’ Health in the United States: The Healthiest Generation?”
JAMA Internal Medicine
February 4, 2013
Overall Health Status USPersons Aged 46-64
NHANES 1988-1994 NHANES 2007-2010
Report “excellent” health32% 13%
Limitations to Life Functions9% 14%
Using Walking Assist (wheelchair, cane, etc)3% 7%
“Lifestyle Factors” USPersons Aged 46-64 (NHANES)
1988-1994 2007-2010
Smoking28% 21%
Obesity 29% 39%
“Lifestyle Factors” USPersons Aged 46-64 (NHANES)
1988-1994 2007-2010
No Regular Physical Activity17% 52%
Life Expectancy at Birth and Health Spending 2011
Buford Highway Atlanta, Georgia
Medline Keyword Search:“Built Environment” and “Health”
Sept1993 – Sept 200358 Articles
American Journal of Public Health
Built Environment and Health Issue
September, 2003
Data and Science
The Built Environment:
Designing Communities to
Promote Physical Activity in Children
Policy Statement American Academy of Pediatrics
June 2009
Medline Keyword Search:“Built Environment” and “Health”
Sept1993 – Sept 200358 Articles
Sept 2003 – May 2013665 Articles
American Journal of Public Health
Built Environment and Health Issue
September, 2003
Institute of Medicine Report
Accelerating Progress in Obesity Prevention
May 8, 2012
Educational Benefits of Walking and Biking to School
• Increases concentration
• Improves mood and ability to be alert
• Improves memory and learning
• Enhances creativity
Charlotte, NC, Light Rail Opened November, 2007
After 2 Years…Light Rail Transit Users Had
• An average reduction of 1.18 BMI points – For a person who is 5’5” --equivalent to a
weight loss of 6.45 lbs.• An 81% reduced odds of becoming
obese over time.
Education
American Institute of Architects
Local Leaders—Healthier
Communities Through Design
2013
The High LineNYC
A 20 block walk in Manhattan
without a cross street–
and it was delightful even with a 2 year old.
NYC Active Design Guidelines
• Resilient Bldgs• Energy
Efficient Buildings
• Healthy Bldgs• Smart zoning
and locations
http://www.nyc.gov/html/ddc/html/design/active_design.shtml
Ten Principles
for Building Healthy Places
The Urban Land Institute 2013
Policy
Under current statute, the California general plan is presented as a collection of seven “elements,” or topic categories
• Required– Circulation– Housing– Conservation– Open Space– Noise– Safety – Air Quality
• “Optional”– Health – Equity – Community Development– Water– Resiliency – Others as communities request
or need. “Optional”
C
Every Chapter of the 2015 Draft California General Plan Has the Byline:
Designing Healthy, Equitable, Resilient and Economically
Vibrant Places
Caltrans Mission and VisionEffective 2014
CalTrans GoalsEffective 2014
“Relinquishment” of State Highway Jurisdiction in Downtown Urban Areas
Financing
British Columbia’s Carbon TaxRevenue Neutral by Law
• Implemented July 2008• Covers fuel use and carbon emissions. • 2008: $10 per tonne of carbon dioxide
– Increased by C$5 p/y. • In 2014 $30 per tonne ($0.26/gal)• "Revenue neutral" by law. • BC has cut $760 million income and other
taxes
Per capita consumption of Petroleum Products Subject to BC carbon Tax (% change)
2007-2012British Columbia down16.1%Rest of Canada up 3%
Happiness and Joy
CicLAvia Los Angeles April 2012
Indianapolis Cultural Trail
• 8 miles $69 million• First $15 million from Glick
family (start with philanthropy) • $2 million for Art• Links the city together• Revitalized Business• Helps to Recruit and Retain
Top Talent• And, yes, a GOP Mayor
Importance of Art and Beauty and Nature
Atlanta Beltline/Atlanta City Streetcar System PlanApproved by City Council Dec 8, 2015
A
• 50+ miles of street car lines
• 5 Cross town routes• 22 miles of Beltline
Corridor• “Atlanta is a city that brings
people together and connects them to opportunities,” said Councilmember Andre Dickens, ABI Board member and sponsor of the legislation.
http://beltline.org/2015/12/09/atlanta-beltline-receives-approval-for-the-first-long-range-public-transit-plan-for-the-city/
Westside Subway Extension
• “When built, the subway will provide a high-capacity, high-speed, dependable alternative for those traveling to LA’s “second downtown.” The area includes key job destinations such as Miracle Mile, Beverly Hills, Century City and Westwood including the UCLA campus. Over 300,000 people travel into the Westside every day for work from areas throughout the County.” http://www.metro.net/projects/westside/overview/
Alternative 5: Santa Monica Extension & West Hollywood Extension
Boyle Heights, Los Angeles. The Evolution into Mariachi Plaza
For Mariachi Plaza….”proposed eight-story medical office building and a six-level parking garage, plus a three-floor building with street-level retail would take out a small row of shops immediately north of the plaza…