Planning Healthy Communities: Abating Preventable Chronic Diseases

Abstract

While creating healthy communities through built environment interventions became an objective of international health organizations, such as the World Health Organization since the mid-twentieth century, abating preventable chronic diseases continues to be a global concern. Consequently, there are few examples of mainstream application of local policy to include health priorities explicitly into community planning. This chapter discusses the case of Atlanta, Georgia, as a demonstration for prioritizing health and utilizing a health impact assessment in the region’s long-term comprehensive plan. PLAN 2040 envelopes key elements of the built environment (e.g., land use, transportation, access to health) known to impact population health. Further, the Atlanta Regional Commission incorporated economic development and sustainability principles to positively influence these factors as social determinants of health outcomes. The chapter introduces foundational definitions and philosophical frameworks to illuminate the legal basis for health inclusive community planning in Atlanta and discusses relevant frameworks for future application.

Glossary

Built environment

The built environment from an urban planning perspective consists of the land use and transportation systems that influence the patterns of human activity across space and time as well as the arrangement and appearance of the physical elements in a community, such as buildings, parks, and other infrastructural elements; referred to as the physical environment or that which is constructed by human activity

Complete streets

A combined urban design and transportation policy approach for street design that can accommodate users of all ages, abilities and transportation mode; ideally allows for various traffic such as driving, pedestrian, cycling, and public transportation

Effluents

Gases/pollutants emanating from water, land, or other sources

Embodiment

The physical manifestation of abstract factors; the concept in this chapter explains how the human body “soaks up” the social and physical environment surrounding it and health outcomes become a physical expression of these environments

Exposome

The sum of all exposures (physical and social environments) accrued by an individual from conception through death, their interaction with genetic and biological factors and the related health outcomes

Exurbs

Regional designation of an area outlying the suburban limits of a city; often inhabited by individuals and families with high socioeconomic status

Local or collector streets

Streets are assigned a hierarchy based on their functions, capacities, and speeds in transportation and urban planning ; local and collector streets occupy the lower levels of the hierarchy as they have lower volumes of traffic and lower speed limits

Miasma theory of disease

The predominant theory of disease causation in the early to mid-nineteenth century espousing that disease was caused by foul air/gases produced from decaying organic matter

Neighborhood cohesion (social cohesion, social capital )

A characteristic of communities with a strong, trusting network of social relationships where residents have shared values and norms leading to social networks that can facilitate cooperation—a collective action within and among groups; social epidemiologists has shown that neighborhood cohesion is an important determinant of overall health and well-being

Social determinants of health (SDOH )

The social and economic conditions of the places in which individuals live, work, and play can influence their health outcomes as well as the distribution of these outcomes among various population scales such as local, national, or global; often characterized on a spectrum of macrosocial (e.g., culture, mass media, political systems, the economy, climate change, and migration) to microsocial determinants such as community-level conditions in a neighborhood or county

Socioecological model (SEM )

A theoretical model for understanding the multilevel and interactive effects of personal and environmental factors that determine individual-level health behaviors and outcomes; a typical SEM model has five nested levels: individual, interpersonal, community, organizational, and policy/enabling environment; can also identify behavioral and organizational leverage points for public health interventions

Spatial mismatch

Spatial mismatch generally refers to the geographical discordance between the location of low-income communities and spatial access to employment opportunities.

The germ theory

The germ theory of disease causation succeeded the miasma theory of disease towards the late nineteenth century. The germ theory postulated that infectious diseases were caused by microorganisms called pathogens.

Upstream determinants

See Social Determinants of Health and macrosocial factors.