Designing for Health and Well-Being
5 questions with public health and built environment expert Nisha Botchwey
Research shows that our environment is inextricably linked to our health. In fact, as much as 84% of our health outcomes result from our socioeconomic factors, health behavior and the physical environment. This indicates that nature, public space and community amenities — places where people can exercise, learn and build strong social bonds — are critical in supporting longer, healthier lives. But how do we design places that support health, well-being and an improved quality of life for all?
At the recent Reimagining the Civic Commons studio in Minneapolis, Jennifer Patrick, a senior program officer for The JPB Foundation’s Environment Program, hosted a conversation on this topic with Dr. Nisha Botchwey, dean of the Humphrey School of Public Affairs at the University of Minnesota. Dr. Botchwey is an accomplished researcher and educator working at the intersection of health and the built environment, with a special focus on youth engagement and health equity. She recently served as the co-editor of Making Healthy Places, Second Edition: Designing and building for Well-Being, Equity, and Sustainability.
This conversation has been edited for length and clarity.
Jennifer Patrick [JP]: What does research tell us about the role of the public realm — including parks, libraries, trails, community centers and other public spaces — for human well-being? Why is getting the public realm right so important?
Nisha Botchwey [NB]: I started my career interested in understanding and supporting the role of faith-based organizations in community development. Around that time, my parents developed type II diabetes. This shifted my focus to understanding how the place they lived impacted their health.
We know our health outcomes are deeply impacted by our social conditions. Our environment has a greater impact on our health than our behavior, health care and genetics combined. And it’s not just about function and efficiency. Your outcomes are going to be better if you live somewhere with more order, less crowding, more beauty or a greater variety of fun things to do.
Many public policies and practices deeply impact our environments, and thus also our health. For example, if you live near a park or library or have access to trails, your life expectancy is longer. Your level of civic participation is also likely to be higher. In contrast, if you don’t have a significant tree canopy in your neighborhood, crime is likely to be higher and civic participation lower. This leads to worse health outcomes.
Public policies can open up these spaces to a larger group of people. They can allow people to be healthy in a park, learn in a library or daydream along a trail. But these opportunities are not offered equitably across all of our public spaces. As a result, we are seeing significant health disparities across our communities.
JP: Given the increasing urgency of climate change and all we’ve experienced during the pandemic, why aren’t we doing more to invest in the public realm in ways that support our health? What is needed for us to take action at scale?
NB: There’s a high-level philosophical reason and a practical reason. At a high level, we as a society have gone from a group or tribal perspective to an individualistic perspective. This means we often do not think about the effects our decisions have on others or how connected we all are. For example, when people use plastic shopping bags or buy plastic water bottles, they may not be thinking about how their plastic bag may wash up on a far-off community’s beach or how plastics in our oceans are harming the health of fish and the people who ultimately consume them. We don’t see ourselves as a system.
On a practical level, it’s important to develop policies that move us toward mitigating some of these outcomes and taking the burden of systems thinking off of individuals. We need land use planning policies that support resilient, environmentally sound community designs or that make it easier, more affordable and safer to live closer to where we work, if that’s our preference. Building codes should reduce the energy use of all new buildings by requiring efficient or passive energy systems. Transportation systems should make it easy for people to choose to walk, bike or take transit rather than drive.
JP: Akron’s Children’s Hospital recently announced a commitment to the civic commons efforts in Akron, and Philadelphia’s Health Department supports We Walk PHL, an outstanding group walking program hosted in parks across the city. However, in many communities, hospitals and other health-oriented organizations are not investing in public space work. What advice might you give to communities that are interested in engaging health-related entities more fully in these efforts?
NB: Non-profit hospitals around the country play a unique role in community development. They are required to conduct community health needs assessments (CHNAs) every three years to identify the needs of the local community, and the outcomes must be measured. The assessments are made available to the public and take into account the input of people representing diverse needs and interests, including key populations such as the elderly, women and children.
CHNAs have been used to develop implementation strategies to address the identified needs. For example, Bon Secours Health System, a non-profit Catholic health system, established a program that uses low-interest loans to fund community projects such as affordable housing projects and community centers. Bon Secours also partnered with urban design and landscape architecture graduate students at Clemson University to design future projects in the majority-Black Sterling neighborhood in Greenville, South Carolina. This helped the community advance their strategic vision.
JP: What local policy changes should be prioritized to elevate well-being, equity and sustainability? Do you have any examples of communities putting these policies into place and seeing results?
NB: A wide variety of local policies can impact well-being, equity and sustainability. One powerful policy is to develop urban growth boundaries, which reduce sprawl, promote compact development and allow communities to maintain and conserve farmland and green space. Oregon’s statewide policy, enacted in 1973, requires all urban areas in the state to establish an urban growth boundary to protect agricultural land and natural resources. These policies also support climate resiliency.
Housing codes are another powerful tool. They can support health and well-being by guiding construction permitting and housing inspection programs. Currently in the United States, codes often lack requirements about important features of healthy homes, such as ventilation and control of radon, lead and mold. Enforcement occurs only at the local level, largely driven by individual complaints.
Efforts to create housing codes that more effectively protect the health of residents are underway in several U.S. cities, including Dallas, Texas, and Tukwila, Washington. To update their codes, these cities are looking to the National Healthy Housing Standard, a model code in the U.S. developed by the National Center for Public Housing in partnership with the American Public Health Association.
Thinking about public space, pedestrian and bike infrastructure can promote active lifestyles, increase reliable access to transportation and prevent traffic injuries. And greenspace in cities can promote physical activity and social capital while mitigating the floods and high temperatures that are increasingly worsened by climate change.
JP: The challenges we face as a country and globally can sometimes seem insurmountable. But hope can be powerful. Let’s end with that. What’s one thing that gives you hope?
NB: Young people give me hope. I believe they can play an important role as community stewards.
I developed the Youth Engagement and Action for Health (YEAH!) curriculum to help communities meaningfully engage young people in community development. In 2019, Lihue, Hawaii, put this curriculum into action in a partnership between Get Fit Hawaii, the local planning agency and the Boys & Girls Club. The kids who participated identified a local park as a concern and created an evidence-based argument for investing in it. They presented the plan to the city council, and the council approved $80,000 to renovate the park.
Young people have the power to transform our society, but we need to support them to develop evidence-based arguments and follow through to implementation. Transformation can happen if we build bridges to one another and educate, engage and equip young people to lead. Preparing leaders of all ages is the work we do at the Humphrey School of Public Affairs at the University of Minnesota, where students and the community come together to create solutions to the most intractable problems to advance the common good in our diverse world.
Reimagining the Civic Commons is a collaboration of The JPB Foundation, the John S. and James L. Knight Foundation, The Kresge Foundation, William Penn Foundation, and local partners.
