Construction That Focuses on Health of Residents (New York Times)

New York Times
(3/5/2013 8:00 AM, Joe Gose)

Doctors, social agencies and community groups that have long been frustrated by the inability to alleviate environmental conditions that contribute to ailments like heart disease and obesity are promoting the idea that a shift in land-use planning and design can stanch some of the harmful influences.

The concept is being put to one of its earliest and biggest tests in the La Alma/Lincoln Park neighborhood near downtown Denver. That's where the city's housing authority used a relatively new decision-making tool known as a health impact assessment to draft a redevelopment plan that encourages physical activity and environmental sustainability.

To that end, the redevelopment of buildings in the 17-acre project, known as Mariposa, will incorporate ecologically advanced construction materials and practices, and a combination of geothermal and solar power will generate up to 60 percent of the development's energy.

Residents will also find naturally lighted and centrally located staircases enticing them away from the elevators, as well as neighborhood gardens to encourage a better diet.

"As we talked to residents, we began to learn from their perspective that having new housing would be great, but that it alone wouldn't improve their quality of life or create a path to success or sustainability for them," said Ismael Guerrero, executive director of the Denver Housing Authority. "So we came at this from the point of view of, How are we going to transform this neighborhood into a healthy, vibrant community?"

Advocates of health impact assessments hope that Mariposa will convince more developers to use the tool, which examines environmental, economic and social influences on health.

While communities and other organization have conducted these types of assessments in road construction, energy developments and other projects, the studies are also ideally suited to guide transit-oriented developments, infrastructure improvements and urban redevelopment in low-income neighborhoods.

Health impact assessments have been a mainstay in Europe and other countries for several years, but proponents say they did not appear in the United States until 1999. Now some 200 of these assessments have been completed or are under way here, up from 50 four years ago, said Dr. Aaron Wernham, project director for the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and Pew Charitable Trusts that helps finance health impact assessments.

"People in the public health world and in the business and development world are waking up to the need to get at health care problems and bring down health care costs," he said. "So we see a fair amount of uptake in certain sectors — the health impact assessment is out there and growing."

A typical assessment comprises six steps that primarily identify a project's potential health impacts and ways to mitigate them. Community interaction is crucial to the process. In 2009, Mariposa's assessment by Mithun, an architectural firm, and other organizations, included more than 140 community meetings, held 12 steering committee meetings, and received more than 550 comments.

Erin Christensen, an associate principal at Mithun, points to a nine-year-old affordable housing project in Seattle that already can show a link between design and health. The community suffered from a high rate of asthma, and working with the Seattle Housing Authority and others, Mithun called on medical research to create about 60 "Breathe Easy Homes." The homes feature hard floors instead of carpeting, high efficiency air filters and low-allergen landscaping, among other elements aimed at reducing asthma triggers.

A study in 2010 performed by the University of Washington School of Public Health found that the Breathe Easy residents had reduced emergency room and urgent care visits by 67 percent and that symptom-free days had increased by 61 percent.

"As designers, that was the first time that we had really seen a direct relationship shown between the built environment and the health of residents," Ms. Christensen said.

Working on Mariposa gave Mithun the opportunity to take a more "comprehensive and holistic" approach by integrating a health impact assessment into the design process for the first time, she added.

Among other issues, Mariposa's assessment found that more than 55 percent of the neighborhood's predominantly Latino residents were overweight, about 75 percent had high blood pressure or were borderline, and nearly 40 percent had a condition that prevented them from working.

Mr. Guerrero said the plan for Mariposa is largely geared toward attracting private investment to the neighborhood, which is one of the city's oldest, nestled near a light rail station, a higher education campus and the popular Art District on Santa Fe.

To accomplish that, the authority is replacing 250 affordable housing units with 800 mixed-income rental and for-sale units slated for completion in 2018. It has constructed 100 units of senior housing, and this year it plans to complete another 190 units that will be a mix of affordable, work force and market-rate rental apartments, and town homes.

The average income in the neighborhood is around $11,000 a year, Mr. Guerrero said, and he hopes that the project will attract people earning $30,000 to $100,000 annually.

To date, the notion that living and economic conditions can influence health has mostly dominated public project and policy decisions. Private developers are probably not very familiar with health impact assessments, said Patrick L. Phillips, the chief executive of the Urban Land Institute. But that's about to change, he predicted. The institute is about six months away from introducing a major initiative focusing on ways to improve health through the built environment. "What has struck us is how quickly these assessments have emerged as a public concern sufficient to be incorporated within the traditional land-use decision-making regulatory framework," Mr. Phillips said.

Still, a push to widen the use of health impact assessments in real estate developments could run into obstacles.

Right now assessments are largely voluntary, though some federal and state lawmakers have made efforts to mandate them, said Jonathan Heller, co-founder of Human Impact Partners, an Oakland, Calif., company that conducts health impact assessments and trains others to perform them.

Mr. Heller and other assessment advocates anticipate that private developers will see the tool simply as a cost-adding measure or a way for community activists to stall or stop proposed projects.

But Douglas R. Bigley, the chief executive of Urban Housing Communities, a developer based in Santa Ana, Calif, has embraced the assessments. In addition to building affordable housing, the commercial developer also tries to provide services that a neighborhood lacks. He said that the collaborative nature of health impact assessments can reveal information that would alter building and design plans. If an assessment showed that residents lack access to health care, for example, Urban Housing might create a community room designed to accommodate occasional visits from mobile clinics.

"We use the health impact assessments to reach out to the community to figure out what the surroundings really look like," Mr. Bigley said. "The more issues we're aware of, the more we can do to sculpt a development to meet the needs of the neighborhood."