FEATURES REFERENCES FIGURE TABLE SPECIAL REPORT Public Health: Seattle and King County’s Push for the Built Environment Karen Roof, M.S. Ngozi Oleru, Ph.D. Introduction The Built Environment Historically, environmental health and In Seattle and King County, Washington, and Broadly defined, the built environment is planning professionals had closer ties. In nationwide, evidence shows that decisions the human-made space in which people the early 1900s, some land use planners about how we use land and build our environ­ live, work, and recreate on a day-to-day championed health as a key issue for the ment have significant impacts on individual basis. It includes the buildings and spaces planning profession. This social planning and population health, safety, and well-being. we create or modify. It can extend overhead movement was expressly interested in ten­ Land use and built environments also impact in the form of electric transmission lines ement housing issues, public health, and community networks, economic growth, en­ and underground in the form of landfills industrial abuse conditions. The planners vironmental sustainability, and social justice. (Department of Health and Human Ser­ were also concerned about how planning In the past century, awareness of the negative vices [HHS], 2004). The design of our decisions could not only control but pre­ health effects and disparities due to impacts built environment affects the possibility of vent diseases such as tuberculosis (Wir­ from the built environment has grown, but a injury related to pedestrian and vehicular ka, 1996). Similarly, prominent planners lack of knowledge, recognition, and viable data accidents, and it also influences the pos­ as late as the 1930s reiterated that good remains about the connection between the sibility of exercise and healthy lifestyles. planning was truly efficacious in creating built environment and health (Jackson, 2003). Lack of physical activity causes overweight social harmony, but only if it “embodied problems in adults and children, increases a genuine rationality and justice in the Background the risk for serious illnesses, and contrib­ structure of society (Fishman, 1977).” But People ask why health professionals are in­ utes to premature death (Frank, Engelke, by the 1940s, with the postwar population creasingly getting involved in land use plan­ & Schmid, 2003). Given the clear relation­ and infrastructure needs, “social” plan­ ning and smart growth issues. Data from a ship between exercise and chronic diseas­ ners’ voices faded and traditional town King County study makes the answer clear: es such as diabetes, asthma, and obesity, planning gave way to a mass housing residents of “walkable” communities are building relationships between planners boom that created new suburbs and vastly more physically active and less overweight, and health officials is both timely and different lifestyles (Kelly, 2000). This was breathe cleaner air, and lead healthier life­ essential. Environmental health profes­ especially true in new communities built styles (Frank, 2005). But long before this sionals can provide added value by giv­ around driving rather than around walk­ study was completed, the Environmental ing planners strong health data to support ing and biking. Health Division of Public Health Seattle and “smart growth” designs and zoning and King County (PHSKC) was already focused initiatives that promote a healthier envi­ Seattle and King County Population on the issue. Specifically, in 2004, PHSKC ronment and improved quality of life for and Obesity chose land use, built environment, and health all. Their involvement also can help make In King County, by 2004, 54% of the 1.8 (LUBEH) as one of its top three strategic di­ the case for effective street and trail con­ million residents were overweight or obese rections. Currently, this project involves edu­ nectivity and design, allowing the public to compared to 37% in 1987; similar increases cating staff about land use planning, building move around smoothly and safely, breathe in obesity and overweight occurred nation­ relationships with planners, engaging in cleaner air, drink clean water, and interact ally. King County is the largest county (by policy development, and planning local land in quieter, more cohesive neighborhoods. population) in Washington and the twelfth use-related projects. This case study presents Conversely, planners can provide health largest in the U.S. King County is approxi­ a four-phase process (see Figure 1) used by professionals with knowledge of zoning mately the size of Delaware, with 39 cities PHSKC, Washington, to promote and inte­ and other planning practices and opportu­ and unincorporated areas. Between 1960 grate public health issues into community nities and options for engagement in the and 2000, the population more than dou­ planning and land use decisions. planning process. bled, adding to transportation deficiencies 24 Volume 71 • Number 1 JEH7-8.08_PRINT.indd 24 7/2/08 6:13:00 PM FEATURES REFERENCES FIGURE 1 Seattle and King County’s Process for Integrating Health into Community Planning and Land Use Decisions PHASE 1 PHASE 2 PHASE 3 PHASE 4 Educate Staff Get Involved in Collect Data to Focus on Health and Build Policy Change Support and Impact Assessment Partnerships and Planning Prioritize Efforts (HIA) TABLE Processes and poor air quality. The county’s southern quality, toxic exposure, safety, injury pre­ Commissioners, King County planning di­ region and metropolitan Seattle have higher vention, environmental and social injustice, rectors, and a variety of regional council populationsSPEC ofIAL low income REPOR residents Tand physical inactivity, obesity and overweight, policy boards. people of color. The south region also has mental health, and social cohesion. a significantly higher average rate of obe­ Several opportunities were then provided Phase Two: Get Involved in sity (60.8%) than the rest of the county. to all staff to become more familiar and en­ Policy Change and Planning Obesity and overweight rates, diabetes and gaged in the LUBEH issue. For example, the Processes heart disease are highest among certain health department hosted presentations by PHSKC next began to focus on policy change ethnic groups, such as African Americans, local and national speakers, including cur­ by incorporating health language into re­ American Indians, and Alaska natives (King rent and former leaders at the Centers for gional and local land use plans. The health County, 2006). These inequities in overall Disease Control and Prevention National department was successful in advocating for health status are based on race, education, Center for Environmental Health (CDC/ the inclusion of public health considerations and economic status (Communities Count, NCEH): Dr. Andrew Dannenberg, Dr. How­ into regional, county, and city planning docu­ 2005). Regrettably, negative impacts from ard Frumkin, and Dr. Richard Jackson. Ad­ ments, including the PSRC Vision 2020 plan, land use decisions are not fairly distribued ditionally, the 2005 environmental health a countywide resolution, and the King County through all communities, thereby resulting education conference was dedicated solely comprehensive plan. in health inequity for populations of color to LUBEH and featured several local public and persons with disabilities. health, planning, and transportation practi­ Puget Sound Regional Council—Vision tioners and experts. 2020 Plan Phase One: Educate Staff and The next task for PHSKC after initiating In 2004, PHSKC learned that the four-county Build Partnerships internal capacity building was to reach out regional plan for the Puget Sound region— PHSKC’s environmental health (EH) division to planners across the region. PHSKC made Vision 2020—was going to be updated. began focusing on the issue of health, land great progress developing partnerships with PHSKC provided a list of health issues and use planning, and the built environment in planning agencies, including the Puget comments on those issues for consideration. December 2003. Discussions began with an Sound Regional Council (PSRC), planning PHSKC also met with PSRC to offer support internal interdisciplinary team called the en­ agencies of King County, city of Seattle, and and expertise. PHSKC convened the other lo­ vironmental health community assessment a number of suburban cities. PHSKC cur­ cal health directors in the region to discuss team (EHCAT). The team consisted of the rently consults with planners from these the importance of land use policies, and the EH director, deputy director, health educa­ organizations on a routine basis, not only need for local health jurisdictions to be at the tor, and the section manager, all from the about individual development plans, but table and advocate for a chapter on health in EH division. Other members include staff also for jointly conducting outreach and the Vision 2020 plan update. The regional from the community-based public health advocacy activities. For example, PHSKC council invited the regional health depart­ practice unit (regional health officers and participated in planning meetings for the Se­ ments to draft a health issue paper titled, health educators), epidemiology, planning attle neighborhood business district strategy “What’s Health Got to Do with Growth Man­ and evaluation unit, and the prevention di­ and the Seattle street design manual. The agement, Economic Development, and Trans­ vision. EHCAT was convened to facilitate planning agencies