Planners4Health Session One: Assessing the Healthy Communities Landscape

Planners4Health Session One: Assessing the Healthy Communities Landscape



hi everyone good afternoon and welcome to our first session for the planners for Health Project assessing the healthy communities landscapes it's so great to have you with us there's a lot of you here in the room nearly 200 of you are watching and listening and I'm happy to welcome you my name is Anna Rick Lynn I'm the manager of a piays Planning and Community Health Center and I'm here with my team Elizabeth heartache and the Liza Norcross and we are going to have a great webinar today launching the project which just started last week I'm going to share some brief remarks before introducing our panelists and diving into the content and then we'll have some question and answer at the end so a couple of quick housekeeping notes you can raise a hand if you have questions or concerns throughout the webinar and you can always chat us as well in the chat box we'll be if you have any issues with audio or whatnot and questions as well we'll be looking to questions in the chat box and hopefully at the end you can we're going to transition into a conversation with participants so as we move through the webinar please collect your questions and thoughts and discussion points to share and at that point you also have the option to enter your audio pin so you can actually speak that's what we're going to aim to do is have a little bit of voice interaction at the end of this lesson so and I'll do a quick reminder about that at the end so a little bit of context about the overall plan for health project and planners for health we are operating the project through the planning Community Health Center it's a great resource for lots of information about planning and public health our website is there at the bottom so I encourage you to look at that and share it we've been working on planning and public health issues at ata for quite a while the planning community health center was founded in 2008 along with two other centers of research and learning at APA but we've been working on this for about since 2000 so it's really exciting to be able to advance with projects with advance our efforts around planning and public health with plan for help and now with planners for help we really think it's a smart investment planning is the overarching umbrella for all of the fields and all of the ways that we live our lives and we see planning as a convening profession for all of the topics that are very important to people in public health is at the core of that and improving public health is one of those in our code of ethics for planning and is one of the reasons that having was founded which I'll get to in a moment so we think this is a wonderful way to broaden the work and engage more people in your work some of you may know these two characters further Clau Olmstead and Jane Addams we're living and working at the end of the 19th and early 20th centuries for the Fall instead is a famous landscape architect but he was also a little known fact he was also the country's first Surgeon General during the Civil War and Jane Addams of course is a social reformer urban planner who embodied the social advocacy roots of the planning profession through her work with the Hull House in Chicago she was a tireless advocate for the needs of women children immigrants support and public health and together with concepts of landscape architecture where the vertical Olmsted's aim was to have people being able to get out in nature and enjoy fresh air and get away from overcrowding and the same kind of goals that Jane Addams aspired to with health and equity we consider these folks to be the founders of planning in public health in our country to some extent and looking to them as the core of bringing together these two fields which then diverged somewhat in the 20th century and so now in the 21st century we're bringing them back together and looking back to these health and equity aims as were looking to advance the plan for health and planners for health projects now some of you have worked on plan for health and we welcome you back as people involved in planners for health plans our health over the past couple of years was a pas first major investment in the planning and public health connection with place-based capacity building work we have 35 coalition's made up of planning and public health professionals supporting work across the country and then our second cohort of plan for health our coalition's are wrapping up now our first cohort wrapped up last spring so with the 28 chapters that are now involved in planners for help we want to advance even more and build the capacity at the chapter level to incorporate health into planning work our projects can benefit from some of plan for helps lessons learned and we have a few of our key takeaways that we're thinking about as we've been shaping the planners for health project one is a story of empowerment with public health professionals realizing that they could have a say and health cities are created for entering making a connection between health and safety things like sidewalk width as a factor in reducing obesity and there's an opportunity to strengthen and increase community engagement for both profession and the movement the overall movement of bringing these fields back together we know that planners bring a unique understanding to the broader healthy communities movement and can help demonstrate return on investment and engage a range of stakeholders like I said that planners are the conveners as we look to build our case for investing in healthy communities we've also seen potential impact the power of policy systems and environment changes those upstream interventions to improve population health and the broad reach of professional organizations and Association so we see APA and our partner the American Public Health Association is really important because of our national reach through our chapters and our affiliates so we'll be talking about those lessons learned throughout each of our webinars that we'll be offering through planners for health and and look to build upon those and look to have you share even more of your lessons learned as we progressed so now I'd like to turn it over before we dive into our place-based example as exactly what I just talked about I'd like to turn it over to our two colleagues from the prevention Institute which is a nonprofit organization building a movement to transform communities that support health equity and safety by bolstering the conditions and factors with foster resilience and well-being we've worked with Rachel Bennett and Franz Rivera to design the players child's curriculum and we're excited to have them present us with us today Rachel works collaboratively with partners on research policy advocacy and technical assistance related to healthy equitable community development and health and all policies she has a dual master's in planning and public health from the University of California in Los Angeles and an undergraduate Grip undergraduate degree in psychology from the University of California Davis she's committed to promoting social justice to the framework of public health and Sandra Vera is Vera is a graduate of the University of San Francisco with a master's in public administration and policy with an undergraduate degree in political science from California State University and she works to promote safety and healthy communities the project focused on improving the built environment increasing our club opportunities for physical activity in play which I love that part of it and increasing capacity across communities in the area of primary prevention so with that I will turn it over to Rachel and stand off and passing you the tools to do so oh thank you so much Anna and Elizabeth and Eliza and your entire team at at APA we're very excited to be part of this webinar and others along the way what you just shared and the history that you gave us an overview of is incredibly valuable unimportant to us as individual and as an organization prevention Institute or the past two decades has been exploring and addressing the factors that shape people's health in the first place and everything that you really speaks to us it's what we learned it's what we've heard it's what we've experienced as important opportunities to support communities and to support people in being healthier so you know efforts from from many health agencies to improve health have focused on changing individual behavior through education and awareness but our focus like those of many of our partners and many of those on this webinar in this call is focused on influencing the broader environments and systems that shape people's behavior and choices to be healthy so we're excited to bring this thread in in this conversation and in others what we've come to understand from data both quantitative and qualitative is that our environment those places and spaces where people live work and play as many of you already have heard and really are lined with shapes or health often much more than our genetics or our access to medical care do so this this image that we're showing now really helps to kind of clarify you know what we have learned over the last two decades and what the field has really come to learn in to embrace in some ways around why focus on changing behaviors and really changing the environment in which people make behaviors is important it's overwhelmingly the the factor that influences health so this plays out as inequities and health and safety outcomes such that we see large differences in life expectancy within communities that are just a few miles away from each other so many of you might be familiar with this type of media platform communications this one is an example from the California Endowment that really kind of brought the data to light and how in different zip codes many of which are you know right next to each other life expectancy can change and be different and there be a gap of more than ten years and so why is that the case I think what would want to do and explore in this conversation our way in which planning and Public Health can work to address the root causes of these inequities and come together to figure out ways to assess them in a way that's comprehensive and that is supportive of the communities that we are working with another way that we think about this and that we talk about this with partners is that decisions that that you are making in your day-to-day work decisions that are made in the land-use system or on transportation work or on zoning or Community Design those decisions and investments made in those fields they influence not just our sort of population level exposure to toxins and pollution but they also really influence the degree to which health promoting resources are available to community residents so these are things like how much access people have to clean air and whether it is easier or more difficult to drive versus walking biking or taking public transit our decisions and investments influence why some neighborhoods have parks for example and others don't or why in some places we see more fast-food outlets than grocery stores it also influences things like who can access loans to buy homes or start businesses in communities and what we've seen really at a global level from the World Health Organization playing a leadership role in the Centers for Disease Control and Prevention as well as national organizations like APA and the American Public Health Association is that there are a number of factors that influence people's likelihood of being healthy and safe they sort of are collectively referred to as the determinants of health and the World Health Organization has really pointed out that structural drivers are a key determinant of Health and we mentioned this because this is some of what we're going to be speaking about pushing back against through the decisions and investments make what I mean by that and by structural drivers is really forces like the distribution of power of resources of money and opportunity even things like medical services and access to health care these directly influence people's health and one way that they do that is by shaping the conditions of the communities where people are born where they grow up where they live and learn and work every day so those of us who work on community conditions planners and public health folks and are many many allies and colleagues it gives us the opportunity in our day-to-day work in our decisions in our investments as a field to push back against some of those forces that we know can erode people's health in inequitable ways and really strengthen those conditions to support health at the local level at the regional level state level national and even globally and the way that we have come to think about this as our field has evolved is really at policies and practices in our field of planning and transportation and so on they have been many ways limited entire communities from being healthy and that we who work on community conditions we can now re-engineer our policies and our practices really the way we do our work to create opportunities for health for all communities so we're going to spend the next six months really as a learning community talking about that we're going to talk about some of the things that that will require partnerships across sectors and with communities we're going to talk about what it's going to take to build our skills and capacities in the field we're going to talk about the strong messaging that's needed to communicate the importance of our work and the value of our work and what it's going to take to develop the political will and creative funding to reach health equity for all thanks Rachel I think that really helps to sum up why we think it's important that we're here that we're all together and having this discussion and we want to make sure you know that this is a space that feels really valuable to you all because someone – the work is happening at the local level whether we mean you know local towns and cities or regions or even states there's a huge opportunity there and we know that there's a lot of traction around things like healthy equitable transportation where planners and public health practitioners are thinking together about how to promote physical activity through Complete Streets policies for example we're seeing lots of innovative work around rezoning land allowing for more dense mixed-use more community ownership of green spaces so kids have safe places to play and elders have inviting places to facial eyes you know one thing that really came up for me in thinking about the work that many of you are involved with are just the various threads and opportunities that are coming up in cities and in communities that experience their own arc of opportunity and challenge over time and how really it's important to align those local regional state priorities with the strategies and the tools and frameworks that will feel most important so I wanted to bring up the example that has come up from Wichita Kansas which like many cities across the country is seeing an aging of their community and also seeing on the sort of social side that a significant number of grandparents who provide regular care for their grandchildren sometimes because they are babysitting and taking care of kids and teens while parents are at work and in some cases while many are actually raising their their grandchildren and so in 2013 local efforts that were supported by the AARP of Kansas working with the city of Wichita really thought it'd be an important priority of the community to create a place in a space where people of all ages could come together for healthy safe play so the idea really championed by the mayor at the time mayor Carl Brewer the Parks and Recreation Department local agencies and community community-based organizations were to come together to raise funds to utilize some empty space and convert to empty lots into a park that would feature exercise stations that were geared toward people ages 50 and older that would also have a playground for children paid trails and park benches and that would really serve as a space for multi generations of community to come together and we think this is such a great example of the work that is already happening and the work that many of you are wanting to be involved with to bring this intersection of public health and planning to light so today we're focusing on assessing the healthy communities landscape this is a core component of both your planners for health project and the practice of healthy planning more broadly speaking so we wanted to tee up some questions and considerations for you to keep in mind things that we'll revisit through this six-month series so some of the topics that we'll be covering are on the screen you see that there's a breath and a depth there and we're very much looking forward to bringing in your own experience and insight into each one of these topics and to really underscore that they are aligned in so many ways so while they're you know framed of topics they clearly work along with each other and we'll bring that thread throughout so in thinking about the healthy land healthy community landscape you know asking questions of your of your teams and of your groups around you know why are things the way they are who needs to be involved in changing conditions what's in it for them as well as what's in it for me are incredibly important so there's a lot of opportunities out there and it will require partnerships with those outside of your own planning world and even the public health world and we're all in it together to figure out ways to bring those partnerships to light so with those big questions in mind we've covered a lot we're now going to hear from two people working at this intersection of planning and public health who have addressed these questions in different ways in their work so following the presentations we'll come back together for a discussion begin to digest this a little bit more so I have a pleasure at this moment of introducing Karla Blackmar who is a project manager for the Public Health Alliance of Southern California the Alliance is a collaborative of local health departments in Southern California whose members collectively have statutory responsibility for the health of sixty percent of California's residents to give you all a sense of what that means in an area as large not only of California but Southern California that covers about 20 million people so we're really thankful that Carlos has some time to be here today and to learn about her recent work that has focused on developing clear guidance on how to maximize health co-benefits of investments and plans ranging from statewide grants and regional planning to local active transportation projects so Carla thank you so much for being here and we're really excited to learn more about your work and following Carla's presentation were also going to hear from Laura Dearing field who's joining us from Austin Texas where she serves as the active transportation and Street design division manager manager excuse me for the city of Austin's Transportation Department Laura is also a leader of the plan for health coalition in Austin and is going to be sharing more about her plan for health work laura brings 15 years of experience in transportation planning public policy and community based nonprofit organization leadership and she and her team at the city have been working on a number of different things around healthy equitable transportation like pedestrian safety bike network connectivity and transit improvements they've also ushered in dozens of new community-based events and classes that have been encouraging Austin residents to walk bike and ride transit so we're so excited to hear about both Carla and Laura's work and then we'll bring it back for the whole group to have a discussion thank you guys so much this is Carla black mark and everyone hear me thanks Pat great hi so thank you for the opportunity and I'm so excited that APA has taken on this efforts is a wonderful project that you guys are working on so I'm here today representing I think what is a slightly different type of organizational beast from some that you may have worked for before or worked with again I work for the Public Health Alliance of Southern California which is an organization of public health departments and our model is actually based off with a similar type of an organization that exists in the Bay Area called bar high that's been around actually for for a substantial length of time I think since the late 90s and our organization began in 2012 in response to funding that came from the Centers for Disease Control that really focused on upstream chronic disease prevention through policy systems and environmental change and as our health department's began working on projects that were intended to really change the way our communities are structured health department's began to realize that some of these projects were far outside the purview of just our individual city health department's or County health departments and actually required some degree of of regional collaboration so as an example if you think about a expansion of a of a freight corridor that is something that often crosses multiple counties we have two very important ports of entry ports in our in our region and moving goods between them and the distribution warehouse is typically caught crosses at least three different County lines and so making a significant impacts on large-scale planning decisions required our health departments to begin to band together and to think about how we could collaboratively address population health our Public Health Alliance vision that we developed when we formed in 2012 is that all Southern California communities are healthy vibrant and sustainable places to live work and play and while we know that some of our communities may be getting close to realizing that vision we were bringing up the same graphic from the California Endowment are aware that there are tremendous disparities between our communities and because their focus is on population health we are concerned not just with you know health delivery to individuals but with situations where we see significant differences in life expectancy between demographic groups and between neighborhoods and really trying to get to an understanding into truly changing the levers of what influences our health our life expectancies in our quality of life in their individual communities when we began we actually started just by looking at kind of the basic recipe of health our caloric imbalance how much and what type of food we eat and how we what are you know whether we burn off that food with exercise so we started with just two initiatives healthy food systems and healthy transportation our plan yeah tell us are you advancing your slides just quick I am are you guys not seeing it I don't think we don't see that moving Trier is I'm sorry um let me make sure that I am actually happens I'm going in on my own screen okay sorry there we go how am I meant to be advancing them because I'm not seeing that that's possible can you guys I had an arrest them for me oh I'm doing it okay yep okay all right I'm so sorry I was I was showing the presentation of my own screen and assuming you guys were all seeing it at the same time thanks everybody okay great thank you so once again we had to sort of initial priority initiatives through which we were trying to do this work through healthy transportation and healthy food systems and they were supported by kind of getting to this question of assessing your landscape of health and planning by a data initiative that was really designed to develop metrics through which we could understand both what the current state of affairs was in terms of health and planning into the built environment and also to develop targets and goals for where we thought that should go and as they've gone along over the past four years we've added in I would say to kind of cross-cutting lenses on our work one is equity um really beginning to realize that unless we are thinking about how our funding and our systems are disproportionately assisting some and disadvantaged you making advantage that we will not be able to realize our goals of broader population health and to really try to be conscientious in how we're addressing and thinking about funding prioritization and equity in all of our work and the other that we've taken on is climate change and recognition of the fact that it is a growing threat and presents tremendous challenges to population health and also in recognition of the fact that many of the strategies that are most effective in terms of delivering changes in in terms of our population health can also benefit our efforts to reduce and prevent climate change and prepare for the effects of it as it begins to unfold an example of one of these Co benefit areas that we feel transects equity health communication transportation is promoting active transportation strategies and this slide I think enumerates why is such an important area of research for us the co benefits of active transportation are really substantial and this is based on a study that comes from the Bay Area where they they assumed that rather than meeting the greenhouse gas reduction targets for 2050 through you know using electric cars or other means that those greenhouse gas reduction targets were met through active transportation alone envisioning a very substantial increase in the amount of time the population on average spent walking and biking and the population health benefits from that are tremendous including a 13% reduction in cardiovascular disease a 13% reduction in diabetes a 5% reduction in breast cancer and colon cancers 7% reduction in depression and 9% reduction in dementia and projected out across the entire population these types of disease reductions are unprecedented and I think really kind of stand to demonstrate that if we were to be very ambitious and realizing our active transportation goals that we could simultaneously address many of the challenges that we have in our contemporary societies at the same time we know that this isn't as simple as it seems with our current sort of auto focused infrastructure active transportation is often dangerous and unappealing many people don't have the resources to do it safely they're in in our communities that use active transportation than most you see that we have very high traffic related injury and collision deaths from sort of an adequate infrastructure and so for really to begin to realize this vision of active transportation as a solution we need to get upstream and start thinking about in many different ways in which our decisions impact people's decision and ability to use active transportation safely just to illustrate this we've done some work about what influences no choice and this may be familiar to many of you but it kind of relates to the idea that in order to make these changes we have to move beyond health itself you know there are individual level factors that control whether people or influence whether people have the option to walk or bike as part of their daily as part of their daily completion of their work or activities and those range from age and gender and physical ability but there are other levels that are far outside of the power of the individual to change including how safe their communities are what their perception of safety is in their communities whether or not the temperature in the climate is comfortable for engaging in physical activity whether they're actually close destinations that can be accessed through active transportation and you know again these kind of basic things that influence our individual calculations about whether we can use active transportation are influenced by even larger social determinants of health related factors including crime and poverty the quality of the streets and the facilities in our area the locational density whether there are coupling constraints such as children who need to be transported and whether that's something that's possible or or very unsafe through an active transportation mode and so I think that what you know just taking us simple example like this something that we all know we need to do kind of illustrates the need for the type of organization that we've formed to try to move these issues some of the challenges you know as we've mentioned that our organization has tried to solve our these issues of levels of government and jurisdictional mismatch so you know again Lennie's decision-making being held at a city or jurisdictional level where public health is typically something that's done at a county level where counties do have some land use control but are often not the fundamental deciders of who gets the transportation funding or how its allocated we also see what we call the wrong pocket syndrome where the externalities are created by our transportation systems so you know the construction of additional auto based infrastructure is not borne by the agencies doing that construction and is instead borne for example by our health delivery system so trying to connect the dots between basically what makes us sick and the the people who are paying for it and then other kind of in some in some ways simpler challenges that we've been trying to address include the lack of common language across health and planning and the lack of granular metrics that help us understand what the current landscape of health and planning is in our communities to begin to address these challenges the basic kind of organizational structure our organization is created is a monthly working group that is consists of our core public health department membership and these are staff who typically work very closely on policy systems and environmental change work and they get on a call monthly in conjunction with some of our very important decision-makers and the folks who are actually holding some of our purse strings in terms of how our programs are designed and where we put our funding priorities and those folks include folks from our County Transportation Commission's and councils of government folks from our regional Metropolitan Planning organizations that through our regional transportation plan some of our state agencies including Caltrans our California transportation agency and the office of planning research which is our local planning our statewide planning arm as well as some of our very valuable nonprofit partners such as the Francis School National Partnership and Prevention Institute so we have both transportation non-government organizations and health non-government organizations and we all get together once a month the recovery it's a very large geography we typically do much of our work remotely and we really begin to think about how various programs and structures can support the best health outcomes and really kind of trying to move the dial on the many different factors that we know influence people's ability to make the Healthy Choice the easy choice so and one of I think the most important things as we've begun to do this work is to try to understand a little bit like what rachel is talking about the social determinants of health and to really begin to measure those and to think about you know what are the factors that are leading to this type of you know tremendous disparity and life expectancy between nearby zip codes and what are the things that on the ground we can do to really start moving that dial so we've made it I think one of our primary ambitions as an organization to really bring the data we noticed that the early days of involving health and planning that there's a tendency of Public Health to say what else should be at the table but often is failure to specify what exactly we were looking for and what we thought would make the biggest difference and so we began by thinking about what we call the social determinants of health which is abbreviated here in the center of the circle and again those are the sort of factors that influence our decisions based on the places where we live work and play and so they include things such as the neighborhood and built environment economic stability education social and community context and health and health care based on that we've actually created a statewide index that goes down to a census track level and uses publicly available data to help us understand what the what the factors are within people's neighborhoods that influence their health and also help us prioritize which areas may be the most assistance if we're going to be prioritizing our funding and so we've based this off of our understanding of what the primary drivers are of health one of the most significant drivers of health as we understand it is economic resources people's pop you know whether it's people are living in poverty factors related to sort of their housing availability cost and quality their ability to access a car and you know their ability to have sort of like basically the solid income and solid economic foundation building on top of that we add other areas including social resources which includes factors like lists and lists ik isolation educational opportunities people's access to health and health care environmental hazards and complete neighborhoods and again using all this public publicly available data we've created an index with various weights that is again projected out statewide and it's designed to help us understand which areas may have the greatest opportunity to improve their health through changing these various levers of the social determinants this is a screenshot of how our map works and it's linked here so if you get the slides afterwards I encourage you to come and peruse our tool and this is not something that typically exists at a national level at this time but it is certainly something that your planning department your city your county could take on as a similar type of project there are some similar projects out there including the Virginia health opportunity index that you may want to look at and really it's a the basic idea is is not terribly complicated and it's really just looking at these social determinants and pulling the publicly available data layering it to identify where your highest areas of needs might be so if you click on an individual area you'll see that it pulls up a wide range of the component pieces of the index and shows both where the what the shear value is for each component as well as a percentile ranking which allows you to understand for example how your jurisdictions housing cost or this particular census tract housing cost might compare to that of other census tracts in your area and in the state finally one of the things that we're working on with this project is connecting the data itself to policy guidance and so for example using that high housing cost component of our tool were in the process of actually building out a guide that talks about what the indicator measures and then how it's connected to health and then finally and I wasn't able to screenshot this and put it in there but what local jurisdictions can do about it so I think that our hope is that if Public Health is very clear about what the components are that lead the sort of people being able to live healthy productive lives that we'll really be able to move it at a local level and see for example increased focus on the provision of affordable housing which is the substantial crisis here in our southern California communities so finally just wanted to briefly mention some of the outcomes that have come from our project and go to that page so I think that you know this is a constant work in progress but through sort of some of this effort we have been able to make some substantial accomplishments including really identifying some shared best practices for health departments when they're doing built environment work and that includes things like many of our health department's give out many grants to our partner jurisdictions or cities and county agencies for things like active transportation planning helping people understand how to structure that type of grant developing healthy development checklists where there are clear sets that health practitioners can go through when they're reviewing plans are participating in broader efforts with planners to understand how to promote health and then just kind of generally helping our health departments move into work with cross-sector partners the first time you know if you're a health practitioner that you go into a room with the transportation planner it can be very overwhelming there's a tremendous number of acronyms as we know in both of our fields and so we've done a lot of work to try to make sure that we bridge that gap and speak each other's language we've also had some success in the being metrics and getting them approved to advance health and our regional planning processes we provide feedback to our MPs on their regional transportation plan and both of our regional NCOs now have health elements within their transportation plans and are moving towards having specific metrics that measure their ability to promote active transportation and other health promoting back health promoting factors within their long-range transportation plans and finally we've provided a lot of input on state programs including working to preserve and increase the share of funding for active transportation prioritizing funding to communities with poor health outcomes and then designing programs that really maximize health co-benefits so here in California we have for example the greenhouse gas reduction fund and there's always a lot of discussion about whether that funding should focus more on electric vehicles or whether it should focus more on changing the way that our cities are built and I believe that we've been a consistent voice for really thinking about how our communities can have more transportation options rather than simply elect electrifying our vehicle fleet so over time I believe we have begun to sort of move the needle in our region towards towards a better integration of health into planning thank you so much and I hope that we can answer some of your questions at the end of the presentation and then I'm not totally sure how to turn this over but I'm going to give it a shot that's that's great Thank You Carla I've actually just given the keyboard controls over to Laura so we're ready for you to switch our floor if you can okay can you hear me all right yep yeah um all right I think I just advanced it successfully well I thank you again to the entire plan pro team at the American Planning Association for the invitation and for the chance to really immerse oneself in it and a fantastic discussion that we just had I'm very much in the transportation realm sort of building projects and so it's really nice to to be reminded of why we're building this infrastructure and utilizing all the really incredible tools as Carla just shared with us I think what we were asked to do on this webinar is to provide some real experience from Austin on how we built a coalition of planners and public health professionals and transportation engineers and community stakeholders to advance best practice in healthy eating and active living as one of the funded cohorts in cohort 1 for the plan for health initiative so I would love to take you all through our experience share we know how our coalition was put together and what we did with the resources provided from the American Planning Association and then some of our lessons learned and sustainability strategies that are really coming to to life in in big ways even from conversations today we've had with our partners in the office of sustainability so with that I'll just share a little bit about what it is we took on as our as our planet as the pond cross Austin Coalition we the principal partners in this effort were the city of Austin's office of sustainability and they led a district food planning effort this is based on best practice in food planning from cities like Vancouver Canada Edmonton and other cities in the u.s. Northwest and really looking at how to identify the whole entire lifecycle of the food system how it is produced how it is brought into the community just distributed accessed by people consumed and then the whole waste and recovery cycle and then my team at Transportation Department initiated a first really first in the state of Texas we believe transportation options program called Smart trips and some folks on the call may be familiar with successful smart trips programs throughout the u.s. notably in Portland Oregon Chicago and other cities Austin is a very sprawled City over 300 square miles and we were working in in a particular area in the North sort of north central part of the city one of the two most disparate areas in terms of health outcomes and one that had a lot of transit youth and and walking as well not as much biking but an area that we really wanted to encourage more active transportation through this through this program so our main goals were to increase the selectivity through through the smart trips program and then improve access to nutritious food through this neighborhood food systems planning program and all of this was really led by our city's comprehensive plan called imagine Austin that called for increasing local food production decreasing food insecurity and supporting an affordable and healthy community by providing a safe transportation network which integrates physical activity into daily life so moving on to the next slide believe that work one too far so this diagram attempts to explain sort of how we all worked together under the plan for Health grant we really were committed to pursuing both the food healthy eating strategy as well as an active living strategy so my team in on the the left side the red boxes we were the ones pursuing these transportation options program and then Edwin Marty my colleague in the office of sustainability here at the City of Austin his team was pursuing this food-based planning effort so we we essentially engaged in sort of a 3 part 4 part strategy in slightly different ways the food systems effort was really a planning effort and the active transportation side was really a programmatic effort but we really didn't know what we were doing to be honest on the programmatic side this is the first time we've ever attempted to do a transportation options program so we started out with some intense planning around how we would actually do this smart trips program and on the food side they were looking more deeply into the food system in this particular part of Austin once we kind of had a handle on how we were going to do things then we engaged in some pretty intense community outreach and in some of the lessons learned I'll share more but this was probably the hallmark of our of our work in the community the outreach was extremely intense and it it really demanded a lot of us in building relationships and sustaining those throughout the program and we we six we were successful and less successful in you know depending on some of the aspects of the program so there's a lot to share and how to sort of build and sustain relationships from a city role so you know I think for the folks on the call that represent city governments probably doesn't come as any surprise to you that it can be very difficult to be through agile and nimble with the community be responsive and be as present as you need to to really build those relationships often in my experience anyway nonprofit community based nonprofits can be extremely good partners in really extending the resources of the city into the community in ways that the city just is not well equipped to do and that certainly was something we learned through our process let'em the community outreach strategies that we used involved just a whole lot of community engagement at existing events tabling at certain cultural festivals and other other gatherings neighborhood association meetings and the like as well as standing up our own engagement programs around walking biking and transit and encouraging existing groups to take advantage of those of those programs on the food side in terms of our community outreach strategies it was actually really a successful partnership with the University of Texas's public policy school the LBJ School the edwin's team recruited a number of students and train them on how to conduct focus groups and other outreach with the community around the food system and they did a whole lot of focus groups I think over 600 people were involved in that effort and on the active living side we had a reach of over 27,000 but in terms of the depth really worked very very closely with about 315 households out of that kind of blanket approach to getting the word out and then in terms of just how we really got into the meat and potatoes of our program from the planning side on and the blue boxes there the food systems approach really looked at getting developing a plan that would help to identify ways to increase access to healthy food and that has really led to on some exciting work citywide around food food access and from the programmatic side on for active transportation we were focused on getting a number of resources out to the community that would encourage them to use active transportation get thereby get more physical activity day-to-day so moving on I'll talk a little bit about the coalition's I think that was a most interest to to the folks putting this together but we had convey you underpinned by the resources made available through the American Public Health Association and some of the technical expertise made available through the American well resources from American planning and then technical expertise for American Public Health Association we really built sort of a three-part coalition the community partners included many of our local high schools and elementary school contacts for things like meeting venues for parent-teacher types of engagements volunteer groups any way that we could work with the community especially on the active living side to act getting engagement from student populations for for the physical activity side of things and then we also worked a lot with neighborhood associations that's a very common way that people organize here in Austin and then we as I mentioned worked very closely with University of Texas students and also some key partners institutional partners in the particular neighborhood we were working with included the YMCA they have a beautiful recreation center up there that became really a hub for a lot of our community-based programs and goodwill of Central Texas offers one of the only places that one can get a GED if they're over 26 years old there's kind of a peculiarity in the law here in Texas and the goodwill offers a really essential service to people that are really trying to establish good-paying jobs in meaningful careers who have for whatever circumstance didn't get a high school diploma the other part of our coalition included there we go our City of Austin partners so this was a very robust City Department led effort we had our staff from Health and Human Services the medical director of the City of Austin was a key partner in fact attended many of the plan for health engagement that were made available to us as a coalition of course Austin transportation off sustainability as previously mentioned myself and Edwin Marty and our teams our Parks and Recreation staff were extremely supportive and helpful in the food access component and our Planning and Zoning Public Works capital planning and our police departments also played a big role in moving the all the entire program forward and then outside of the city we we did quite a bit with our transit agency to encourage use of transit and worked a lot with health clinics and social service agencies to convene meetings where a lot of their clients would be already present I'm going to move along talk a little bit more about the smart trip side of things this is really nearest dearest to my heart because this was the work that my team did but we really created our fully bilingual transportation options programs that create a very customized maps and walks and mobility guides and safety brochures really focused on active modes and those were distributed to 315 households we had over 5000 pieces of literature or safety devices lights pedometers things like that that were delivered to households and those are delivered by a community nonprofit called bike Austin that we partnered with which turned out to be a great way for them to build a relationship with that this part of town and households in this part of town as to our overall outcomes we experienced a 2.2 percent average relative decrease in driving trips and 44 percent of our program participants actually did decrease their driving trips in some fashion we had an eleven point eight percent average relative increase in active trips meaning we had you know between the folks trips taking trips before and after we had about eleven point eight percent increase so that was really exciting for us and of all of our program participants you know 15 percent increase their active trips and then 75% of our folks said that they felt that their knowledge of transportation options increased which was one of our sub objectives I guess you'd say in the inactive living side of our work and so overall it was a great experience and we have since moved on to do smart trips in other parts of the city taking the lessons learned from this program as I mentioned a couple of times just wanted to reinforce really having the city work in an area that has a lot of health disparities and a lot of need was extremely challenging we really overcame that by establishing community partnerships with nonprofits that either had a direct interest in in becoming more established in the community or were already established and that has led to some really exciting and sustaining efforts so for example the photographs that you see there of the young woman on bicycles that was a program that was initiated by one of our community partners called the G solo cycling initiative and they have since established a bicycle hub they call it it's a shipping container converted into a bicycle shop in a place that you doesn't have a bicycle shop for miles and that continues to offer places for kids to keep their bikes maintained as well as has a fleet of bikes for kids to use on a trail network that is right there at the Recreation Center that's just one of many many things that continue to serve the community that we were in from an active living perspective and then from the from the food system side the our City Council actually passed a policy to call for the work that was done in North Austin to be done throughout the city so there's some really exciting work being done in Austin to really better understand the food network and and how we access it and in particular my team is focused on supporting that through physical infrastructures of sidewalks by gleams and things like that so I'm going to end there and turn it back over to the presenters to kick off the Q&A thank you so much Laura and thank you Carla so we're going to hand it over to Anna and the APA team in just a moment to open it up to the full group for some reflections discussion and questions first we just sort of wanted to bring it back to the topic that we are addressing today which is assessing the healthy communities landscape and I think both Carla and Laura really spoken about some key questions that come up in assessments in interesting ways one thing you know speaking at a chapter level for APA chapters an assessment might look different than for example a community-based project assessment would so your planners for health assessment may not be the same sort of Charette assessment that you may do in your day job one thing we would like to sort of queue up for people is the notion of looking for levers of opportunity in the systems that you're working in I think Carla spoke to this really nicely when talking about how the public health alliance of Southern California saw that there were levers of opportunity in regional transportation plans and processes and that by bringing really strong health data and metrics that they could influence transportation decision-makers to build health concepts into their ongoing work and I think you know as Laura just described in Austin a lever of opportunity that they saw the plan for health coalition saw was that in the communities that were experiencing the greatest inequities there were already strong community-based organizations and that the coalition could help dedicate some of its resources in time by building partnerships with those existing community-based organizations who could then bring community residents to the table to share their perspectives so what those levers of opportunity are in the specific context you're working in at your chapter level and even in your day to day work in healthy planning those are going to depend on the context we just wanted to mention that as a way to be thinking about going into your planners for health assessment to really you know be asking the question of what are those health issues affecting your population and who is most impacted why are things the way they are you know what are those underlying determinants of health that have led to these issues and who then needs to be involved in changing those conditions who's already working on this who has strong relationships and alliances who can bring those community perspectives that may be missing from the process and as we move forward in future planners for health conversations and sessions we're going to start to get into some questions about what's in it for those different partners and how do you build those strong partnerships and expand into maybe some new sectors and bring new perspectives to the table so you've heard a lot from a lot of us and we are looking forward to really broadening this dialogue and discussion so maybe you know we'll hand it over to you to get us going on that part sure yes thanks looking forward to having some folks call in or expand in your questions question box on the right that if you haven't seen yet feel free to chat a question to us and it's possible you might have be able to see an audio that you can use to unmute yourself and/or raise your hand and we can unmute you so that you can actually speak on the call we have we still have over 200 folks in the room with us so that's been wonderful that we've had so many people have they welcome – those are from not art formally in the planners for health program or plan for health but are joining us to learn more about project how you've lessons in your own work so we want to hear from everyone about what you're thinking but I do have one question or both answer this question and it's about you know when you're thinking about when you're kind of developing your program trying to figure out what was currently going on in your community both of you sort of referred to it but didn't get into the deepest discovered what other existing efforts could be linked with your own goals and maybe Carlos is the first and then Laura to talk a little bit about how you how did you do to outreach to find those programs and find those people who are working on related efforts hi this is Carla and I think part of what was fortunate for us is because we are a network of health departments and a lot of our health departments have their own healthy communities planning efforts where they aggregate bring together partners from their member cities talking about healthy about healthy communities so that was a place where we started yeah and I'll add oh can you me okay yes okay yeah we we really benefited I think this is a testament to how APA and APHA sought to kind of pool resources and leverage the power of professionals in public health and planning but we really we had the benefit of the work that our Public Health Department had done on health disparities around the city to know that the particular area that we were looking at was had a high degree of need and our transit agency planners had been the really the pioneers in wanting to bring a transportation options program to the city so and then as far as the community-based work that was really something that we I to be honest rather clumsily assembled to in not really appreciating just how many organizations were working in the area how some of them had a good reputation some didn't and aligning with those that are not aligning with the right folks and also appreciating that even if some sort of a rough reputation for example unfortunately our police off was doing some really good work funded by the Department of Justice but it was you know there was it's hard work to do and they had some Community Relations issues to navigate and so we just we had to really learn that a bit the hard way and really throw ourselves into some intense community building to help to establish our kind of where this coalition it could fit within the mix of folks that were already there and just appreciating that there was great work going on and not just up on those toes but to be supportive of what was already going on and appreciate that our public health professionals and transit planners had led us to the right place but really once we got there we needed to really build those community-based relationships and then I would say we also brought people brought organizations to the community that we're working elsewhere in our world we deal a lot with the bicycle pedestrian advocacy community and those folks really didn't have a foothold quite yet in north austin and so through this plan for health effort we were able to bring those organizations to north austin and they remain very active in those areas today which i think is part of a successful sustainability strategy and getting community-based nonprofits the resources they need to really continue to do their mission driven work thank you for those answers that's really it's really neat to hear the leadership from public health and outreach to planning and also leveraging existing work one of our folks has raised his hand very client just unmuted you if you want to speak there well we're still at it still learning our technology here a little bit we do have another question from oh hello yes hi Barry you can go ahead oh hi great um so I had a question on the with the first speaker somebody had some real interesting quantified percentages of reduced chronic diseases and I was wondering are those just general statistics or were you able to figure those out on a local level and if so how did you do that yeah hi this is Carla Blackmar those statistics are those are using a tool called Isum which is something that we would be happy to include that perhaps can be sent out to the group but it is actually a model that is a relative risk model that looks at the risk of physical like physical inactivity and then or increased amounts of physical activity spread across across the population what the likely reduction in chronic disease rates are based on which ever increased scenario you you choose and so for that particular scenario they chose a very aggressive increase the doctor transportation to meet the carbon reduction goals for San Francisco and so those are local numbers that come from a projected scenario for that area and you can use the item tool it exists as a spreadsheet to do similar projections in your community and if you're clever with data you can also calibrate it based on what you know about your existing communities active transportation levels excellent thank you so another it was cool to hear that both Laura and Carla talked a little bit about health care there was a question about what is the role of health care organizations in your coalition if you could talk a little bit more about that either Carla or Laura well both this is Carla I'll start just briefly and I'll say that one of the things that we're very interested in moving or is working with our hospitals in our community health care foundations to connect an existing source of funding that they have called Community Benefit dollars that comes from their required IRS reporting if they're a nonprofit Hospital to to really start to connect that funding which is meant to improve community health to some of the types of built environment projects that were interested in promoting into things like active transportation promotion and so we're increasingly partnering with some of our organizations of healthcare systems and hospitals to begin to talk about how to make that funding really work for prevention and I would say that that's the primary way in which we we are currently working with healthcare delivery yeah could you repeat the question this is what I get it right that you're looking for how we're working with health healthcare delivery organization yeah yep and and as are they part of your coalition or are you working with them in some other way yeah I can't speak mostly to our work in active transportation not so much into the food systems part of it but from an actual transportation side we have been focused on through our vision zero program working with our healthcare providers on hospital utilization data and other other data sources to really better understand both folks that are being cited for traffic violations and involved in crashes and then the victims as well so that's really where the interface is with our team from a traffic safety perspective and it's it's seeming a point to some very much richer understanding of traffic safety from a public health perspective that didn't necessarily grow out of our plan for health coalition well actually I take that back I it actually did in that you know through the plan for health work that we did the relationships with the Austin Public Health Department as well as all of their community the coalition of partners that they've assembled really helps helped us to know who to go to once the our vision zero efforts got underway and for folks who might not be aware that's really looking at traffic safety from a public health perspective and figuring out how to essentially eliminate serious injury and fatality traffic related crashes over a you know in our case we're hoping to do that over a ten-year period and this is Rachel Bennett from prevention Institute I wanted to underscore that health care systems and hospitals and providers can and should see themselves as a part of these efforts you know particularly when we're talking about changing community conditions like land use or transportation or food systems they influence these conditions in many ways oftentimes hospitals and health systems their major landowners or developers they are employers in the community their service providers certainly but they're also trip generators in transportation speak so many people come and go from health care facilities they also procure supplies and foods and they make investments in the community in the form of community benefits investments if they're a non-profit hospital or healthcare system so I think a great place to start if you're not already working with Healthcare Partners is to reach out to community benefit departments or other folks who are already working on community health and prevention side of things and see what they're interested in and what they might be able to bring to the table thank you thank you all for that we had another participant raised her hand Helen burdock I've unmuted you so you can speak can you hear me okay yes yes oh great thank you so I'm a planner that works in a rural county in New York State that is second to last in the Health Rankings according to the Robert Wood Johnson Foundation so we are starting to work with a coalition of partners to address trying to move that needle so to speak where second-to-last only to the Bronx but we are in a very rural area so I guess I have sort of two questions number one is we've gone through the coalition building process and we're now in the process of sort of identifying the low-hanging fruit of you know what we can actually do to make a difference in our health statistics and it seems kind of overwhelming so the second webinar may be helpful when you discuss metrics but I just have a general question of how do you figure out where to start and where to focus your efforts initially and then the second part of my question is just anecdotally without the data to back it up we identified transportation really as an issue and the low-hanging fruit but we were focusing on access to care and not necessarily active transportation and I just wanted to know based on your experience you know any of the things that you did transportation related in an urban area like Austin Texas is that transferable to a rural area that really has no public transportation you know network not a lot of sidewalks that kind of thing does that make sense yeah and congratulations on the tough work of building the coalition I mean just knowing you have o willing partners coming to the table is not ever to be underestimated I would just offer that you know you know you know you have a you've identified the problem you want to solve and if it is access to care you know I would say where we found the most success is looking at really best practice around the country and then trying to translate it for Austin and that would be where I'd say to start so it might not be an active transportation solution it might be some kind of paratransit or some other you know what have rural communities done well I actually come from the Hawaiian Islands originally and I know rural health access is a huge issue in fact there's associations devoted to it so I'd be happy to put you in touch with some of my former colleagues if they can be of help in some of the strategies that they embraced but I would just say there's got to be someone who's figured out something that's working well and comb the your networks to find that and then figure out how we would apply that using your coalitions resources and perhaps that seems too basic but it's really trying to build on what others have learned and and focusing on the problem you have at hand great and I would just add to that you know I think that it is extremely difficult and especially in rural environments to come up with some of these solutions or you know I think it's important to both listen to your community and see you know what of the highest priority to them in terms of improving their health and they will likely know if you go out and survey them or get their input through other means and also to you know active transportation is not always a solution for everyone and triaging your approach you know if there's a issue accessing health care to begin with you know starting with that is a really important step great thank you yes and this is Anna and we have had a number of rural communities as part of plan for helps some of whom are working into the collectivity others working on food access so our Ojo Arizona community our Eastern Highlands Connecticut which is sort of sort of near you in New York State and also Shawano and Menominee counties in Wisconsin are all very rural areas that were working on solutions for in plan for health so if you look at our website which I can plug now plan the number for health plan for helped us you can see more information about those three communities across the two cohorts Thunder coalition's on that website and you can also contact us for more information as well we have some resources that we can share about how taking Laura's suggestion to look at what some other places or have done and see if you can adapt it to your community but that's a great question it's one of the challenges that we hear about frequently is how to adapt these kinds of strategy in less populous areas I have one more question from Jeff Lynch that's come in on their chat and she says you mentioned opportunity levers and that seems like a good component to include in our assessment there she's actually working on a planners for health project what approaches or tools do you take to identifying opportunity levers for the speakers are there particular levers on the horizon that you would recommend the rest of us think about as we embark on our planners for health project it's also a broad question but any thoughts that you have to share or Rachel and Sandra yeah great um great question thank you Jeff so I think what we would add here this is Sandra from prevention Institute is that there is just I think a treasure trove of different types of resources and frameworks and tools that can really help you think about the needs and opportunities within you know the sort of range of communities that you're working with I know for prevention stitute because we really think that the sort of community determinants of health you know safety transportation parks and open space food that's sold and promoted in neighborhoods access to education etc are where you can both push back against these broader structural drivers and still have an impact at a population level or a community level that tools and frameworks that identify levers as you mentioned there are incredibly important so one that we've helped to develop and disseminate is one called thrive which is tool for health resilience and vulnerable environments we'll be happy to send that out to this entire group that really sort of identifies those community conditions and determinants and can help you think about how to prioritize that in the context that you're working with and there's a bit of like an assessment and prioritization that can go along with it and that might be helpful for your group to consider so we'll send that out and then just kind of continue to think about some of those tools and frameworks because I think you're totally route about seizing the policy and levers and those firms that are really ripe in your community yeah this is Laura I think just appreciating the concept of levers of opportunity is is really empowering and every you'll see you know you know and when you see them probably to some extent because every context and community is different but I just the top of my head just thought about sort of funding and and understanding what how you pull those levers so for example in my role at the city just you know understanding the procurement process understanding the budget process the seasonal aspect of budgeting the influencers that you need to leverage or you know access to resource the actions that you're identifying would be probably it's one way to think about using levers of opportunity from resourcing or funding perspective and appreciating that might take time but that if you understand the system how to pull the levers you can hopefully you know expect to see those that funding come forward in some fashion I think and then from a policy perspective you know we I can just watching my colleagues at the office of sustainability really successfully pilot district based food planning offer that as a as a process to the City Council and then having the City Council asked for that for the whole entire city was it was really inspiring and now we're working as partners to find ways for example how we can help to you know fund sidewalks that help people access major food retailers that offer healthy options better so it has really deepened our relationship with our colleagues that are doing this food access research and how we from a transportation perspective support that and then I think the levers opportunity that the community offers in articulating their needs is another one to really better understand and and figure out how to pace yourself so you don't burn out but here those and then translate that into programs or policies or plans that that start to move forward towards solutions and that can always be tricky because there's such amazing amounts of need and you can't pull all those levers at once but being selective and strategic about what you do take on and do it well and then move to the next is I guess just can be a tried-and-true approach this is Rachel from prevention and today I wanted to offer one quick additional thought on this which is sometimes an important lever of opportunity is as Laura was just saying to see something through well so to implement well I'm a trained planner and I love planning things and then when it comes to implementation it's not always under our purview in the same way but for example one community that we've worked in worked really hard to get a strong parks policy on the books at the county level and it will give a set-aside of funding to communities that were identified as being high need for park access and now the challenge is to make sure that the policy is implemented in the way it was designed and to make sure that funds are spent first and most intensively in those communities that were identified as high needs that's something that's going to require the watchful participation of advocates of strong agency staff of coalition's so it may be that as you're thinking about what you would like to work on at your chapter you may want to look at what's already in the pipeline and making sure that those things are implemented in ways that really do push through on the health and equity results that's great thank you so much for the in-depth answers to that and actually following up on Laura's question Laura's comments about looking at assets and neighborhoods and particularly on the food system side I noticed that you had a mapping element it's a very planning activity to sort of map some of the assets in neighborhoods could you just talk briefly about what that was to create massive new Hadassah sure and I'm speaking a little bit secondhand because a lot of the food mapping was done by Office of Sustainability but what they did was look at all of the food permits and of all kinds and started there in terms of mapping and then refined that to understand the quality of the food retail itself and then as a complementary effort you know we provided or yeah compliment or effort we provided sidewalk layers in GIS so that you could see from an accessibility standpoint for walking the ways that those food retailers were were the paths of travel I guess you'd say and then we added transit service and bike bicycle facilities and that is work that we're still trying to do at a citywide level to better understand physically you know the infrastructure and where food retail is and then on the other side of it you know seeing where we know there are food deserts and where food retail can be better we you know where we need to invest in it and then in terms of mapping as a planning activity we also did quite a bit of that you know on the active transportation side just more for the purposes of showing people what routes they did have and then creating sort of value-added I guess mapping tools with specific routes that showed people how you could get from your home to the library or to or to the store to the rec center by walking or by bus or by bike I think just zooming out chapter level because we are you know representatives of eight chapters here thinking about what are those lessons learned on the community-based project level that could be transferable across different locales and what are the skills and the capacities that were needed for at the table to really work together well I think you know one opportunity that's so great through planners for health is that we get to come together as leaders of the field of healthy planning and share lessons about what has worked often I think at conferences and other opportunities we tell each other what we did and I think this gives us an opportunity to tell each other how we did it and what was really difficult and what worked really well kind of what was that secret sauce to make the project work or that kept a project from working and I think that as planners for health hubs and as state or regional chapter representatives you can be a hub for holding that kind of information exchanging it and building that capacity within your chapter yes that's completely right we have one more minute and we had someone else raise their hand and to speak Janice if you want to ask your question I only have one minute left maybe Janice is not there anymore I I am here hello there you are hi I I was just wondering if we would have access to the slides oh yes of course so that's actually a great wrap-up question we will be sharing all of this information and we did record the webinar as well so we'll have an audio-visual recording of the webinar available for everyone and say thanks for joining us and fabulous to have so many folks on the line today and hearing the bow cleaners for health in our work thank you to Sandra and Rachel for facilitating this and for sharing your expertise and lessons learned from the field from California and Texas respectively wonderful to hear about how it's actually working so please join us again next week for art and we will talk to you again soon thank you everyone thank you bye

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