Image via flickr/Michigan Municipal League.From his job as a program officer for a large philanthropic organization dedicated to improving the lives of Detroit children, David McGhee often sees the intersection of urban planning and public health firsthand.
From his birthplace and current home -- Flint, Mich. -- he sees it personally.
“Unless you’ve been living under a rock, you know the challenges we’re dealing with,” he said at a panel in Houston Thursday, referring to the city's ongoing tainted water crisis.
The first criminal charges related to the case were filed in April against city and state employees accused of tampering with evidence to disguise lead contamination in the water system, a result of cuts to the system made in the name of cost-savings. Officials were also charged with violating the state’s Safe Drinking Water Act. More charges are expected as the investigation continues. Meanwhile, families and health providers are left on edge.
“People care when it’s convenient,” McGhee continued, speaking on a panel about health and the built environment as part of Next City’s 2016 Vanguard Conference, hosted by Next City and the Kinder Institute for Urban Research in Houston.
The crisis in Flint revealed more persistent neglect when it comes to investment in the urban environment. “The most recent school building was built probably 45 (or) 50 years ago,” said McGhee. “We’re experiencing this firsthand."
“Just because someone is electable, that in turn makes them accountable and responsible -- but it doesn’t make them capable,” he added. He called on health professionals, design professionals and community members to unite to create more responsive, comprehensive design.
“You really have to create ways of making things happen, if you want to look beyond the one-on-one [model of healthcare]” said Anjali Taneja, a doctor and the executive director of Casa de Salud, a clinic in Albuquerque, New Mexico. “We do a poor job [of that] as an industry.”
She argues that within the medical field, there isn’t much focus on treating people beyond the doctor's office. She urged medical professionals to think more comprehensively.
At Casa de Salud, Taneja works with patients who are poorly served by traditional health insurance or not served at all by it. She said she draws on community members to help guide her practice, calling them "content experts," and tries to challenge a medical system where patients only see their doctors for a few minutes each visit.
But there are other ways of improving health outcomes, beyond the clinic.
“The field focuses on the individual,” said Adele Houghton, an architect and green building consultant with Biositu, LLC. But, she warns, that approach may be short sighted. "Analyses show that even doing a limited change of physical environment … can actually have a larger impact on health than doing these very intensive, expensive treatments focused on the individual,” she said.
In other words: you may be able to help individuals more if you focus on improving their environment.
The challenge is getting researchers, designers, health professionals and policymakers to work together. Though limited, there has been some movement in that direction.
“Our public health sector has evolved to encapsulate a lot more factors you might traditionally think of as urban planning,” said Casey Durand, a researcher at the University of Texas Health Science Center at Houston. His current project, a multi-year study of the effect of Houston’s light-rail on the surrounding communities’ health, is an example of that growing overlap. The study will look at everything from how sidewalks, shade, weather and even other factors like the crime rate influences behaviors for residents living along the rail.
Still, the connection between research and policy can be tough. “It’s extremely difficult to prove these work,” he said of changes to the built environment like new sidewalks. “You have to understand big picture data analysis, but you also have to understand the people on the ground who are implementing decisions.”
Such comprehensive projects are still rare. But, said Houghton, “there are some examples out there in the world of evaluations of seeing that these interventions work.” A study in Minnesota, for example, showed that making changes in a home like fixing leaks and improving weatherization led to the reduction or elimination of conditions such as chronic bronchitis, hay fever and asthma, according to Houghton.
Engaging community members, following up and reaching out to decision-makers to assess how much they know about public health are keys to making research recommendations more effective. “You have to go back to these people to implement any changes you might suggest,” Durand said.