Community Design and Revitalization to Promote Health

This “Community Design and Revitalization to Promote Health: The Track Record After 20 Years” special issue features articles that scrutinize the implementation and results of interventions promoting public health across the built environment fields. Analyzing policies, case studies, pilot programs, and other dimensions of the built environment constructed in communities, cities, and regions in recent years, these special issue articles present the extent to which these interventions result in health improvements in the targeted communities, particularly from an equity perspective.

Since the beginnings of human development, modifications to the built environment have been implemented with the goal of contributing positively to human quality of life. In the 17th and 18th centuries, the fields of public health and city planning came to emerge as modern practices in response to the rapidly growing population and declining quality of life and sanitary conditions of residents in urban places during the Industrial Revolution. Interventions combining built environment and public health knowledge, such as water systems and sewage treatment, were established as a means of addressing overall population health through sanitary reform, but eventually the two fields diverted into distinct practices with limited collaboration between the disciplines.

In the early 2000s, a renewed interest in ideas about connections of the built environment to public health gained traction in both the urban planning and public health professions. Subsequently, empirical analysis, pedagogy, and professional practice linking health and the built environment have increased exponentially. Most noteworthy, a seminal 2003 American Journal of Public Health article, “The Impact of Community Design and Land-Use Choices on Public Health: A Scientific Research Agenda” (Dannenberg et al., 2003), drew on these emerging ideas as presented in a U.S. Centers for Disease Control and Prevention workshop. The authors proposed a research agenda to identify best practices in designing new communities and revitalizing old ones to promote physical and mental health. Since that time, considerable research on these issues has been published, including many significant contributions in the Journal of the American Planning Association, and the implementation of recommendations resulting from this body of work has transformed the health and quality of life in communities, cities, and regions in the United States and abroad.

As the 20th anniversary of the Dannenberg et al. (2003) article approaches, it is appropriate to take stock of the track record of innovations in promoting public health through city planning and design and assess the state of the practice, including both progress made and remaining disparities in achieving community health and wellbeing with a renewed focus on equity. For example, popular interventions like quality public parks and other green pedestrian infrastructure might serve as a community asset by providing opportunities for physical activity, social interactions, and access to nature, in addition to mitigating urban heat islands, flooding, and poor air quality. Conversely, the addition of parks in neighborhoods can lead to the adverse effects of green gentrification, resulting in displacement of socially and economically marginalized groups in communities experiencing environmentally conscious planning efforts. Careful evaluation of the successes and failures of these and other health-oriented interventions in community building is vital to the future health of the populace and will inform the future of planning and design globally.

The Current State of Health and the Built Environment

Recognizing the leading causes of death in the United States, including cancer, heart disease, diabetes, and unintentional injury (Centers for Disease Control and Prevention, National Center for Health Statistics, 2019), the built environment continues to play a role in socio-ecological causes of persistent chronic disease and poor quality of life. Specifically, the socio-ecological model highlights the interconnectedness of individual, interpersonal, community, and societal-level factors that influence an individual’s health outcomes. From the perspective of health and wellbeing, built environment–related interventions at each level of the socio-ecological model—such as schools, workplaces, and homes—can be identified and implemented to affect health outcomes. It is essential that the field of urban planning is acknowledged as a critical platform for promoting healthy behaviors linked to the most pressing issues of disease, life expectancy, and quality of life today.

Health outcomes have increasingly become a tool that planners can use as an argument in advocating for health-promoting policies and practices in the field. For example, through data analysis and stakeholder engagement, health impact assessments (HIAs) have been used to evaluate the potential effects of built environment–related interventions prior to implementation and make recommendations in favor of community health outcomes. HIAs are important tools for health-conscious and community-engaged decision making and have been successful in creating health-promoting outcomes, especially for marginalized populations. For example, a 2014 HIA conducted in Curry County (OR) resulted in the development of a pilot program that allowed low-income residents to repair and replace substandard manufactured housing that was contributing to frequent injuries and respiratory conditions, with upgraded housing that improved residents’ overall health and safety (The Pew Charitable Trusts, 2015).

Within the context of the unique inequities and social injustice issues of today—not limited to climate change, structural racism, and the COVID-19 pandemic—there is a need for revisiting which opportunities exist for urban planners to advance health promotion in their careers and what shifts in practices must be made to address current priority topics of the day. Data analysis and visualization tools and shared vocabulary skills and practices, in addition to meaningful collaboration—including community engagement and partnerships across fields and sectors—present useful opportunities to support efforts toward creating healthy and more equitable communities (Botchwey et al., 2022). Today, a health in all policies approach to community design reflects a shift from siloed thinking to cross-disciplinary knowledge sharing and collaboration.

Through a variety of methods and the use of global-reaching perspectives and case studies, the eight articles in this special issue discuss a range of topics encompassing the effects of community design on population health and wellbeing from a multidisciplinary group of contributors.

Taking a top-down assessment by analyzing existing policies and their implications on community outcomes in “Junk Food Accessibility After 10 Years of a Restrictive Food Environment Zoning Policy Around Schools: An Equity-Focused Simulation Study,” Soon et al. (this issue) discuss the health impacts of food-related zoning by laws near schools by predicting the effects of restrictive policies on high school student’s potential access to healthy and unhealthy foods over a 10-year period. Similarly, in “Pop-Up Cycleways: How a COVID-19 ‘Policy Window’ Changed the Relationship Between Urban Planning, Transport, and Health in Sydney, Australia,” authors Harris and McCue (this issue) use Kingdon’s multiple stream theory to examine the policy development process that led to the rapid installation of pop-up cycleway infrastructure during the COVID-19 pandemic in Sydney.

Using qualitative interviews with urban farmers in Srinagar, Jammu, and Kashmir (India), “Planning and Food Sovereignty in Conflict Cities: Insights from Urban Growers in Srinagar, Jammu, and Kashmir” by Raja et al. (this issue) offers another international perspective by exploring the role and limits of urban planning in experiencing protracted crises and how the confluence of planning and political misgovernance affects food sovereignty in such cities. Conversely, “An Empirical Analysis of the Link Between Built Environment and Safety in Chicago’s Transit Station Areas” by Zandiatashbar and Laurito (this issue) uses quantitative data to examine the importance of balancing amenity growth and accessibility with density and land use diversity by examining the relationship between crime, transit, and built environment features in Chicago (IL). Khojasteh (this issue) also offers a multi-method research approach that explores the impact of immigrant food businesses on wellbeing, food access, and the diversity and density of the food environment in a working-class suburb of Upper Darby (PA) through historical research, surveys, and field observation.

Shifting toward strategies and action, “Enhancing Sharing Capabilities: Housing and Neighborhood Planning Opportunities for Improving Health” by Mukhija and Takahashi (this issue) builds on the evidence that the COVID-19 pandemic resulted in households finding creative ways to share resources that would address isolation, stress, and anxiety. The authors offer a framework for planners to enable and encourage sharing and community wellbeing through housing and neighborhood planning models. Furthermore, in “Getting to Root Causes: Why Equity Must Be at the Center of Planning and Public Health Collaboration,” Chrisinger (this issue) calls for a shift in equity planning research and practice from focusing on the downstream consequences of built environmental inequities to the upstream causes and structural factors that lead to these consequences. Williams et al. (this issue) respond to this call for equity by presenting an intersectionality-based framework for incorporating health equity into the practice of urban planning. Through evaluation tools, coalition building, collaboration, and challenging assumptions and systems of power, urban planners may better understand and alleviate complex inequalities and disparities that affect health disparities.

The perspectives that this special issue brings to the field of built environment professionals concerned with public health highlight the fact that despite clearly established associations and visionary healthy placemaking over the past 20 years, it is still critical to continue this work. This special issue seeks to outline the transformational role urban planners have played—and can play going forward—in ensuring healthy environments for all.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Nisha Botchwey

NISHA BOTCHWEY ([email protected]) is a professor, dean, and Russell M. and Elizabeth M. Bennett Chair in Excellence in Public Affairs at the University of Minnesota Humphrey School of Public Affairs.

Bruce Stiftel

BRUCE STIFTEL, FAICP ([email protected]), is professor emeritus in the School of City and Regional Planning at Georgia Tech.

Christopher Coutts

CHRISTOPHER COUTTS ([email protected]) is a professor in the Department of Urban and Regional Planning at Florida State University.

Catherine Ross

CATHERINE ROSS ([email protected]) is Regents Professor, Harry West Professor of City and Regional Planning/Civil and Environmental Engineering, director of the Center for Quality Growth and Regional Development (CQGRD), and Georgia Power Professor of Excellence at Georgia Tech.

Olivia Chatman

OLIVIA CHATMAN ([email protected]) is a research associate in the Healthy Places Lab at the University of Minnesota Humphrey School of Public Affairs.