Land-use patterns, housing, and transportation systems influence public health and environmental quality in a variety of ways. The health and planning professions have joined forces to better understand and highlight these connections. Poor planning can result in automobile-centered communities that lack vital services and amenities, thus limiting access to jobs, health care, and supermarkets. This is especially the case for those who cannot afford vehicles or who no longer drive.
Residents who spend hours traveling long distances to work, shop, or go to school have less time for leisure, family, and civic activities. They may suffer the health consequences of being more sedentary or isolated, including depression, dementia, heart disease, obesity, and diabetes. Residents suffering from these conditions or other chronic illnesses often are not engaged in community life, which can hinder existing relationships and further weaken community ties.
Poorly planned land-use patterns and transportation infrastructure also degrade the quality of air and water, leading to higher incidences of respiratory illnesses among residents of all ages (see Chapter 10, Utilities: Telecommunications, Energy and Other Services—Water and Sewer). This can also result in polluted drinking water and unsafe recreational areas. Such environmental issues are particularly important for older adults, who may have health conditions or functional impairments. These conditions make them more vulnerable to unhealthy environmental conditions.
Federal laws such as the Clean Air Act, Safe Drinking Water Act, and Clean Water Act have made major contributions to improving the environment. They have influenced decisionmaking at the state and local levels regarding pollutants. In addition, the environmental justice movement has studied the concentration of hazards in particular communities (including those with high levels of contaminants) and the development patterns that have exacerbated hazards in vulnerable communities. These include “urban heat island” effects (in which summer heat waves are magnified in urban areas), which disproportionately affect people with low incomes and older adults (see Chapter 7, Health—Public Health).
For the most part, land-use and transportation planning in the US has not included an evaluation of the full spectrum of health implications related to planning alternatives. This is because city and regional planning agencies do not have the resources or expertise to assess the health impacts of planning.
Public health practitioners have begun using Health Impact Assessment (HIA) to fill this gap. HIA is a structured, yet flexible, tool that translates data into practical information decisionmakers can use to anticipate and address the health effects of proposed programs, policies, or projects. HIA brings together relevant public input and available data and uses a range of analytic methods to provide practical, science-based information. By integrating relevant health information into their assessment of a new proposal, decisionmakers can advance well-informed policies that avoid unintended consequences and unexpected costs.
Connections Among Planning, Public Health, and the Environment: Policy
Regulation and public participation
- be granted some flexibility to devise methods to assist or reinforce federal efforts to preserve and enhance the quality of soil, water, and air, along with efforts to maintain and preserve parks, forests, agricultural areas, and wetlands;
- enact and implement public participation provisions in health, safety, and environmental law to solicit and include the public’s opinion in environmental decisions that affect health, safety, or welfare, particularly in communities with racial and ethnic groups that have experienced discrimination, that are rural, or that have a concentration of people with low incomes; and
- inform residents about their roles and responsibilities in creating and preserving safe, clean, and healthy environments.
Policymakers should prepare comprehensive land-use plans to guide community design and development decisions. These plans should address the housing and transportation needs of the community in light of changing demographic conditions. They should also recognize the link between sound planning and public health and should articulate goals and strategies for addressing air and water pollution, as well as global climate change.
Policymakers should conduct a Health Impact Assessment (HIA) for land-use, transportation, and community design projects, all of which can have significant and wide-ranging impacts on the environment and health.
Congress should designate an agency in the White House or the Department of Health and Human Services to lead and coordinate HIA efforts, including provisions to build technical capacity at local, state, and federal levels; funding for demonstration grants; and the establishment of guidelines and standards for HIA practice.
Promoting environmental protection
Policymakers should promote citizens’ awareness of environmental issues and encourage environmentally conscious behavior and volunteer efforts.
Appropriate agencies should investigate products and designs that may contribute to pollution in the home and the community.
Government agencies should ensure that all policies and actions with environmental impacts consider and mitigate any negative effects of those policies on older adults.
Policymakers should preserve the country’s natural resources to ensure future generations’ quality of life. Federal policymakers should direct adequate resources toward resolving environmental problems and should provide technical support and funds to states, localities, and regional groups to maintain and enhance environmental protection.
Congress should promote federal research on indoor-air quality and should develop acceptable pollutant-tolerance levels.
Federal agencies must have sufficient resources to set standards, conduct research and development activities, perform inspections, monitor compliance, prosecute violators, and assist in remedying violations of environmental laws.
Impact of climate change
Policymakers should mitigate adverse and disproportionate impacts of extreme temperature events and climate change on older adults and adults with disabilities. Policymakers should address the needs of people with low incomes, racial and ethnic groups that have experienced discrimination, and people living in the areas most susceptible to climate change; those communities should participate in any related policy development.