Why Place Matters: Building a Movement for Healthy Communities PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works.® Design by: Leslie Yang COVER PHOTOS COURTESY OF (from left to right, top to bottom): ©iStockphoto.com (Danny Warren), ©iStockphoto.com (kon- stantin32), ©iStockphoto.com (Thania Navarro), Harlem Children’s Zone, ©iStockphoto.com (Christopher Hudson), ©iStockphoto. com (Justin Horrocks), p.37: ©iStockphoto.com (kajetan), ©iStockphoto.com (Inger Anne Hulbækdal), Youth UpRising. 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PolicyLink 2 Why Place Matters: Building a Movement for Healthy Communities PolicyLink Table of Contents Case Studies 4 Preface 5 Executive Summary 6 Introduction 13 I. Class, Race, Ethnicity, and Health 18 a. Socioeconomic Status (SES) and Health 18 b. Race, Ethnicity, and Health 19 c. The Health of Immigrants 20 II. A Framework for Healthy Communities 22 a. Economic Environment 24 b. Social Environment 30 c. Physical Environment 36 d. Service Environment 44 III. Themes from the Case Studies: Lessons Learned 49 IV. Recommendations: Moving Into the Future 51 Notes 62 3 PolicyLink Case Studies Harlem Children’s Zone: Focusing on 100 Blocks and One Child at a Time 16 Moving to Opportunity 25 Health Impact Assessment in San Francisco: A Tool to Build Healthier Communities 26 Metro Denver Health and Wellness Commission: A Broad Coalition to Address Health in Schools, Worksites, and Communities 27 Using Food Stamps to Buy Fresh Produce at a Local Flea Market 28 Fresno Works for Better Health: A Partnership to Improve Health Through Economic and Leadership Development 29 Kids Make A Stand in Shasta County 32 The Blue Cross and Blue Shield of Minnesota Foundation: Grantmaking to Address Community Conditions That Impact Health 33 Youth UpRising: A Center for Youth Leadership and Community Transformation 34 Looking at Transportation Planning Through a Health Lens 37 The Greening of Los Angeles: Improving Health Through a Movement for Urban Parks 38 Keeping Housing Away from Freeways and Toxic Polluters 39 City of Richmond: Considering Health in the General Plan 41 Improving Health by Improving Homes: Research and Advocacy in Three Cities 42 Kaiser Permanente: A Health System Looking Beyond Health Care 45 Colonias in California’s Central Valley: Working for Basic Infrastructure 46 Data + Community Collaboration = Policy Change 47 Community Coalition: Promoting Healthy Neighborhoods Through Leadership Development and Community Involvement 48 Unnatural Causes 53 Moving the Golden State towards Health: The Governor’s (and Advocates’) Vision for a Healthy California 55 The Bay Area Regional Health Inequities Initiative (BARHII) 57 Reading, Writing, Arithmetic, and Health: Lessons Learned from School Efforts to Combat Obesity 58 4 Why Place Matters: Building a Movement for Healthy Communities PolicyLink PrefacePreface PolicyLink and The California Endowment have Why Place Matters offers examples of promising long recognized that place matters. Our work practices from across the country, with many is informed and driven by the recognition that concentrated in communities throughout California. neighborhood environmental factors—from local Some groups are working with planners to develop economic opportunities, to social interactions with strategies for improving residents’ transportation neighbors, to the physical environment, to services options; some are joining with city governments such as local grocery stores where people can to create plans for neighborhood economic buy nutritious food—all affect individual health. revitalization; some are linking healthcare services to We’re extremely enthusiastic about the growing prevention, and others are working with the private movement that’s developing place-based solutions sector to better serve their communities’ social and to place-based problems. service needs. We trust each of them will illuminate the connection between people and place in new We know that residents of low-income communities ways, facilitate collaboration and the exchange of and communities of color suffer disproportionately ideas, encourage cross-sector partnerships, and from negative environmental factors: poor air quality stimulate action. as a result of over-exposure to toxins such as diesel exhaust from highways and bus depots, poorly We appreciate the participation of everyone who maintained homes with mold, lack of healthy food shared with us those best practices that are working options, and the lack of clean, safe open spaces well in communities, near and far. It is our hope such as parks and playgrounds. Social, economic that these successful strategies will be used by and service components—lack of access to good advocates and policymakers, government and jobs, inadequate healthcare and other crucial business, researchers and educators, city planners and services, and fractured social networks—also present community builders, and all others who want to be a obstacles. As detrimental as these are, we know part of the movement to build healthy communities. that, unfortunately, they represent only a few of the factors that cripple far too many neighborhoods and This report benefi ted signifi cantly from research the people who live in them. Understandably, there’s and writing by Diana Bianco, a health care policy much work to be done. consultant. The PolicyLink Center for Health and Place team—Mildred Thompson, Rebecca Flournoy, We believe that an equitable approach to building Glenda Johnson, Mary Lee, Rajni Banthia, Iman Mills, healthy communities requires a number of diverse and Erika Bernabei —contributed throughout, from tactics from multiple stakeholders. Collaboration the initial conceptualization to fi nal editing. The across a broad range of sectors and groups, including California Endowment was represented by Marion the private sector, is necessary to create the type Standish who provided overall vision and oversight, of healthy communities we want for ourselves and and George Flores who added useful comments and our neighbors. And the experience and voices of editing suggestions. Paulette Robinson, consultant, community members—particularly people of color— provided excellent editing support. We thank them must be an integral part of discussions and strategic all for their dedication and hard work. thinking around sustainable change. We’re not alone in our belief. The organizations and coalitions profi led in this report—many led by visionary leaders—demonstrate that environmental factors, which strengthen and enliven communities, can be created and replicated to benefi t everyone. No one approach works for all communities, each is Robert K. Ross Angela Glover Blackwell particular to the place and the people they are meant President Founder and CEO to serve, and the goals they want to achieve. The California Endowment PolicyLink Preface 5 PolicyLink Executive Summary Driven by the knowledge that where physical and emotional health of residents, you live determines how you live, a new understanding that every service from the movement is building. It is spearheaded effective delivery of medical care to the use of by local leaders and anchored by the belief recreational programs has health implications. that a broad array of communities and interests must be engaged. Advocating for The framework described in this report equitable policies and practices to establish provides a way to understand the relationship healthy communities, this movement draws between community conditions and health, from a broad framework, incorporating a analyzes the connections among all of the community’s physical, social, economic, and environmental factors that contribute to service environments. Traditional single-issue a healthy community, and identifi es both boundaries are being broken, forging new protective and negative environmental effects connections and alliances across diverse on community health. Why Place Matters sectors. Efforts are underway to infl uence and builds on the growing movement to improve change environmental factors so communities the health of individuals through a focus on can thrive. community and illustrates how organizations and groups are employing effective “place- The leadership of this movement is based” strategies throughout California and appearing in many parts of society. Public the country. health offi cials, planning offi cials, and educators are studying a neighborhood’s I. Class, Race, Ethnicity, physical or “built” environment—the safety of its streets and parks, the condition and Health of