Land Use and Health Team
Capital Area, Michigan 
July 2005                                

OVERVIEW

 The Land Use and Health Team is a collaborative effort in the tri-county, mid-Michigan area that involves planners, university faculty, business and public health. The purpose of the Team is to educate and engage the community regarding impacts of the built environment on health, and facilitate improvement through refinement and promotion of a health impact assessment tool.

There is growing body of evidence that design of the built environment influences the physical and mental health of residents.  The population of the mid-Michigan region is shifting from urban centers to farmlands, a process that has resulted in land uses changes with health consequences to urban and rural residents. The Team has increased public engagement in regional planning by increasing awareness of local land use trends and health impacts.

The Team is refining and promoting use of a health impact assessment tool to encourage discussion among planners and developers and others about health impacts of proposed developments.

The most important element of this practice is involvement of a broad based team of interested stakeholders who represent expertise and resources.  Staff support to coordinate activities is necessary to maintain the practice.

Team work is not completed. The Team reviews accomplishments on a regular basis and  makes adjustments, as needed.  The Team has experienced success in increasing community engagement in regional planning and pilot tests of the assessment tool have resulted in design improvements that will increase walkability and will likely increase physical activity. If Team efforts resulted only in improved physical activity in the area there would be significant health and financial returns to the community.

 PLANNING

Responsiveness

·        What is the public health issue the practice addresses?

There is a growing body of evidence that design of the built environment influences water and air quality, noise, physical activity, injury, social capital, health equity and consequently the physical and mental health of residents.   The capital area of Michigan is a tri-county regional of nearly 500,000 people.  In this area, population growth and development has shifted over the past fifteen years from urban centers to rural farmlands.  This relocation of our population has resulted in land use changes with health consequences for urban and suburban/rural residents. According to survey of 10,000 planners conducted in 2003 by the American Planning Association, planners are beginning to appreciate the relationships between land use and health but they do not recognize it as a planning issue.  Consideration of health impacts is not typically a major part of their planning and review processes.  Additionally, local public health and the general public usually play a small role in reviewing development plans and attendant health consequences. The purpose of the Land Use and Health Team is to develop collaborative relationships with area planners, academia, developers, public health and others to improve our understanding of land use and health relationships, increase community understanding and engagement, and facilitate positive change. 

·        How was it determined that the issue is relevant?

Land use can influence health of residents in several ways. One important example is the impact of land use on physical activity.  A defining characteristic of the pattern of development in our rural areas is large distances between homes and destinations. A consequence is increased reliance on automobiles and reduced engagement in physical activity, which negatively affects obesity, diabetes and heart health. The northern portions of the capital area is one of the most sprawling in the U.S. Local behavior risk factor surveys (conducted with CDC protocol) show over 30% of the population in northern capital area is inactive – far from the Healthy People 2010 goal of 10% inactive, and there is a relatively high incidence of hypertension in that area. Overall, the percentage residents who are overweight has increased to 60%, obesity exceeds 20% and diabetes is the seventh leading cause of YPLL.

How does the practice address the issue?

 The Team addresses the issue in two ways:

 1.   The Team is increasing awareness in the planning and development communities and among residents about concepts of land use and health issues. For example, the Team provides support for implementation of the Regional Growth Project (RGP) – a three year visioning project conducted by the Regional Planning Commission.  The project was designed to take in residents’ ideas regarding land use and community development through a series of urban and rural town meetings.  In the beginning, resident participation was low.  The Team created and widely distributed a series of newsletters about health implications of land use, including photos of local areas illustrating examples of desirable and undesirable situations. Surveys at subsequent town meetings showed attendance by neighborhood residents increased significantly because of the newsletters.  Because of this the RGP plan will more accurately reflect community values.

 2.   The Team is refining and promoting use of a health impact assessment tool to encourage health impact discussion among planners and developers and improve development projects.  The Health Impact Assessment (HIA) tool is a refinement of the prototype checklist developed by NACCHO. The tool has two components, one is a planning matrix that considers several factors including impacts on water and air quality, noise, physical activity, injury prevention, health equity, and consistency with RGP objectives.  The matrix identifies why these factors are being considered such as “to enhance health outcomes in all age groups, by removing barriers to functional and recreational physical activity.” Other matrix elements relate to groundwater recharge, impacts on traffic volume, compatibility with adjacent uses, nuisance noises, interaction between neighbors, sidewalks and pathways and mobility options, diversity of housing types and affordability, resident involvement in planning, and others. The second HIA component is a user friendly Geographic Information System (GIS) encompassing the tri-county area.  The GIS contains several electronic data layers including aerial photos, land use maps, service areas for municipal systems, water chemistry, locations of underground storage tanks, land cover, soil types, zoning layer, radon, data layer of destinations like public facilities and churches, grocery stores, census data, health data, vacant land, and RGP boundaries for green space preservation and urban development. The HIA tool provides a basis for substantive discussions that can influence change.  Clearly, HIA discussions are more effective if they take place in the very early stages of project planning when changes are least expensive  

Innovation

How does this practice differ from other approaches used to address the public health issue?

This practice differs from past planning approaches by improving public education and engagement regarding planning, and by promoting consideration of health impacts through use of assessment tools.

Historically in the capital area, there has been little public engagement in planning.  This practice shows that public involvement can be increased by increasing awareness of relationships between built environment and community and personal health, especially if the discussion is placed in a local context with local information.  This kind of public education has increased pubic participation in capital area regional planning.

In the mid-Michigan area, health impact considerations in development plan reviews are often very limited.  Through the HIA tool, this practice offers a focus for considering important impacts that can affect physical and mental health of residents.  The tool has been pilot tested for several months in a large and rapidly growing township and experience so far has been positive.  Several discussions engendered new ideas for improvement that have been incorporated into the plans.  

Collaboration/Agency and Community Roles

What is the local public health agency’s role in this practice?

The Ingham County Health Department has several roles and responsibilities:  

a.   articulate the land use and health concept;
b.   develop partnerships with area planning, academia, and development community, others;
c.    provide support to projects in the community such as Regional Growth Project;
d.   collection and organize data and information related to land use and health, especially at the local level;
e.   facilitate development and use of  assessment and improvement tools;
f.     apply for grants and funding.

What is the role of stakeholders/partners in the planning and implementation of the practice?  

Partners in this project include Tri-County Regional Planning Commission; Michigan State University Departments of Urban Planning, Remote Sensing, Resource Development, and MSU Extension; City of Lansing; Meridian Township; developers and builders; Greater Lansing African American Health Institute, and is open to others. 

Land use and health is a major issue for the Ingham County Board of Health, which serves as an advisory board for county commissioners and the health department.

·        Team members have been essential to this practice.  They have taken on several roles: 
a.   provide data and information;
b.   assist with information analysis;
c.    assist in communicating with respective colleagues and associations;
d.   promote use of  information, develop and refine assessment tools;
e.   assist with grant applications;

What does the local public health agency do to foster collaboration with community stakeholders and further goals of the practice?

The health department fosters collaboration with stakeholders by:
a.   identifying areas of common interest, such as improving community health, increasing public involvement, improving public education;
b.   helping partners meet their organization’s objectives in related activities, such as public participation in planning commission’s town meetings, enhancing site plan  review processes;
c.    provide practical examples of  topical public health/planning concepts for research, evaluation, and academic curriculum development;
d.   jointly submit proposals;
e.   co-author articles;
f.     co-present at conferences;
g.   participate at trainings;
h.   collaborate on future direction of the Team practice.

Ultimately, successful collaboration in this practice involves developing positive personal relationships among individual members.

One other note about collaboration with the general community – public interest in these matters is strong.  Local survey results clearly show that personal health and environment are very important to capital area residents. For example, residents indicate that compared to family and work, their environment is “extremely important” to them. Surveys reveal that people think of environment as the natural environment and neighborhood/ built environment. Other survey work shows that there are strong positive correlations between community health, environmental quality and social factors.    

IMPLEMENTATION

What are the specific steps that achieve each objective of the practice?

This practice has several objectives and is progressing in all of them. The following are objectives and a description of steps taken so far.

·        articulate the concept of land use and health.

The Team draws from existing CDC, NACCHO, APA publications and websites to develop clear statements about relationships between land use and health.  The Team drafts written statements to help in communication with grantors, partners, and the public.

·        convene a broad based group to consider land use and health.

The Team was developed in large part by building on existing relationships with individuals and organizations that have an interest in land use and health. It was necessary to build new relationships with non-traditional partners such as planners, builders, others.

·        increase understanding of land use and health relationships.

Team conducts meetings, develops newsletters, make presentations regarding land use and health within the planning, public health, and business communities, and to the public.  The Team describes local status of air and water quality, walkability, pedestrian injuries, and other health factors related to land use.  The Team disseminates information and encourages community participation.

·        facilitate positive change.  

Health Impact Assessment tool provides information, focuses questions and facilitates discussion about desirable changes in projects, including discussion of incentives to promote healthy change.

·        Develop measurable goals and objectives.

Purpose is to be able to evaluate performance over time.

 What is the timeline for carrying out these tasks?

The Land Use and Health Team is three years old and improvements are made on all of the objectives mentioned above. 

The following activities were started in the first year:
~ articulating land use and health concept
~ forming and maintaining the Land Use and Health Resource Team
~ community education and participation in the Regional Growth Project.  
~ identifying products that would be useful to our community.

The second year included continued work on all of the above steps, as well as collecting information about local status.  A major report on local status is planned for July, 2005.

The third year to present involves continued refining a Health Impact Assessment tool, completing the GIS data base for the HIA tool, expand piloting effort in Ingham County, workshops with planners in all 50 civil divisions of the capital area, and discussions with community leaders about land use and health concepts and tools for change.

Costs and Sustainability

What are the practice costs (staff time, resources, in-kind contributions, financial amounts)?

·        1 FTE (in the case of Ingham County Health Department 1 FTE represents combined involvement of a Health Analyst and project manger) plus indirect costs, for each year.

·        $8,000 total printing costs.

·        $15,000 contract to develop GIS data base for HIA tool.

·        $65,000 for community survey and data gathering to improve walkability in urban center.

·        In kind contributions from 12 Team members, ranging from 2 to 6 hours per month.  

What funding sources support this practice? 

·        Funding for staff time is Ingham County general fund.

·        Michigan Department of Community Health supported funding for urban community survey

·        Support for the GIS contract from Michigan State University, Land Policy Program.

Is there sufficient stakeholder commitment to perpetuate the practice?      

Commitment of Team members over the past three years has been significant and encouraging. There has been some turnover in membership as the practice moved from one phase to another but enthusiasm remains high, especially as products are developed. 

It is our expectation that funding for this practice will continue as state and federal agencies and Michigan State University continue to address America’s obesity epidemic and the relationship between obesity and other health matters and community design.

Based on positive experience of piloting the HIA tool in one of our townships we expect the HIA tool will be incorporated into the review process there. The township is well respected in the capital area; by their example, and training of key people, use of an HIA tool could become widespread in the area.  Use of Team products could become self sustaining.

Describe plans to sustain the practice over time and leverage resources.

·        The health department sees significant public health value in this effort and will continue to request county general fund support.

·        Health department staff and Team members will continue to apply for grant support. Team members feel outlook is good.

EVALUATION

Process evaluation

How was it determined that tasks outlined in the Implementation section is an effective strategy?  

The general outline of implementation of this practice follows the strategy used in a successful community health assessments practices in the capital area.  The essential step is engagement of  key community people.  From the beginning, community engagement seemed like a sensible and timely strategy because residents’ responses at town meetings of the Regional Growth Project and on scientific surveys of the region and city showed that residents feel very strongly about the built and natural environments.  Many residents feel that current type of development (sometimes called sprawl) is undesirable and would like to see greater redevelopment in the City of Lansing, rather than the current trend of relocating out of the city. Residents also want to be able to act on their concerns and HIA tool that can be used to facilitate change.

Describe challenges encountered when carrying out these tasks.  What was done to address them? Was the timeline met?

One of the biggest early challenges was taking on the broad issue of land use and health, the risk was that it was too broad and encompassing.  To help overcome this problem the Team focused on one specific project at a time, building public participation in the Regional Growth Project, and the health impact assessment tool.  The current plan is to maintain the comprehensive vision but recognize that advances will likely come one project at a time.  Also, concerns about timeline increase when stakeholders believe the practice is not making progress.  The practice will need to continue to demonstrate its progress to maintain support.

What are lessons learned about procedures and tasks involved in implementing the project?

·        This practice is more likely to work if it is built on past successes. For example, this practice learned from community health assessment experiences and it is recommended that other communities consider building on their successful processes.

·        The broad based expertise needed for this type of practice is usually not available in a local health department. Obtaining this experience through the Team was very significant.

·        Attitude of the individuals representing the various partner organizations is very important. The ideal member is optimistic and ready to contribute.

What other lessons would be helpful to agencies seeking to adapt or replicate this practice?

The Team has found that many people, professionals and neighborhood residents, believe that the built environment influences individual and community health.  This has been a continuous source of energy for the project.

Outcome Evaluation   

Please note - This practice is not completed, work is ongoing and staff and Team will review accomplishments on a regular basis and make adjustments, as needed. At this stage it is reasonable to compare progress on some objectives of the practice.

 Objectives – and accomplishments so far:

·        convene a broad based group to consider land use and health –  Team has been convened and been active for a three year period.

·        increase understanding of land use and health relationships – Team newsletters about land use and health were distributed through community centers, government offices. Surveys at subsequent town meetings showed that these newsletters resulted in increased attendance at town meetings.  As a result, planning commission staff are working to implement a Regional Growth Project vision that more accurately represents community values.

·        facilitate positive change – As a result of the practice, one of the biggest and fastest growing townships in mid-Michigan has piloted the health impact assessment tool and is changing criteria by which it reviews proposed projects. Planners met with developers to discus improvements.  This planning department is well respected in mid-Michigan and may have influence throughout the area.

·        conduct workshops with area planners – Initial workshop discussions on land use and health and HIA have been productive and positive.

Is the practice worth the resources invested in it? Why?

Yes. The practice may change the way development projects are reviewed in this area, which in turn could result in healthier communities.  We will continue to monitor health behaviors, such as physical activity, obesity, heart health, walkability, social capital over the next few years to see if there are detectable changes in these outcomes.  Based on a 2003 assessment conducted by the Governor’s Fitness Council, the annual cost of physical inactivity in our mid-Michigan area is roughly $250 million dollars.  Land use changes that improve physical activity, even if that is the extent of improvement, could have significant return to the public.

Does this practice achieve the goals/objectives outlined earlier?

Yes. Land use change is a process that requires logical intermediary steps. The goals and objectives outlined above are necessary intermediate steps.