Jason Corburn

The power and the promise: Working with communities to analyze data, interpret findings, and get to outcomes

Although the intent of community-based participatory research (CBPR) is to include community voices in all phases of a research initiative, community partners appear less frequently engaged in data analysis and interpretation than in other research phases. Using 4 brief case studies, each with a different data collection methodology, we provide examples of how community members participated in data analysis, interpretation, or both, thereby strengthening community capacity and providing unique insight. The roles and skills of the community and academic partners were different from but complementary to each other. We suggest that including community partners in data analysis and interpretation, while lengthening project time, enriches insights and findings and consequently should be a focus of the next generation of CBPR initiatives.

Confronting the Challenges in Reconnecting Urban Planning and Public Health

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.

Bringing Local Knowledge into Environmental Decision Making Improving Urban Planning for Communities at Risk

This article reveals how local knowledge can improve planning for communities facing the most serious environmental and health risks. These communities often draw on their firsthand experience—here called local knowledge—to challenge expert-lay distinctions. Community participation in environmental decisions is putting pressure on planners to find new ways of fusing the expertise of scientists with insights from the local knowledge of communities. Using interviews, primary texts, and ethnographic fieldwork, this article defines local knowledge, reveals how it differs from professional knowledge, and argues that local knowledge can improve planning in at least four ways (1) epistemology, adding to the knowledge base of environmental policy; (2) procedural democracy, including new and previously silenced voices; (3) effectiveness, providing low-cost policy solutions; and (4) distributive justice, highlighting inequitable distributions of environmental burdens.

Health impact assessment in San Francisco: Incorporating the social determinants of health into environmental planning

Abstract The social determinants of health refer to social, economic and environmental factors that influence well-being including economic inequality, residential segregation, sub-standard housing, lack of supermarkets, schools, transit and open-space, and disruptions to family and social networks. This paper asks whether and how the practice of health impact assessment (HIA) can integrate the social and physical determinants of health into planning processes, overcome institutional and analytic barriers for health analyses in environmental impact assessment, and offer a new model for healthy urban planning. This is done by examining how a municipal health agency, the San Francisco Department of Public Health, utilized HIA to conduct health analyses of development projects, collaborate with other city agencies and community groups, and initiate a multi-stakeholder prescriptive HIA all aimed at integrating health into environmental planning practices. This case is important because the San Francisco DPH is the first city agency in the US to experiment with using HIA that aims to capture the physical and social environmental health impacts of projects and plans. The paper finds that HIA can inject the social determinants of health into planning when public agencies embrace an expanded definition of environmental health, organize health advocacy networks within and outside government, and generate a broad scientific evidence base to substantiate policy change.

Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community

Jason Coburn and Alison Cohen discuss the need for urban health equity indicators, which can capture the social determinants of health, track policy decisions, and promote greater urban health equity.

Lessons From San Francisco: Health Impact Assessments Have Advanced Political Conditions For Improving Population Health

Health impact assessment is a structured decision support tool used to systematically characterize the anticipated health effects, both adverse and beneficial, of societal decisions. In San Francisco, the use of health impact assessments has not only produced evidence to inform health policy decision making but has also contributed to the political conditions needed to achieve optimal population health. Health impact assessments have helped increase public awareness of the determinants of health, routine monitoring of these determinants, cooperation among institutions, health-protective laws and regulations, and organizational networks for health advocacy and accountability. Drawing on more than a decade of local experience, we identify the direct and indirect effects of the assessments on the politics of governance as well as on health. We demonstrate that health impact assessment is both an analytic tool and a process that helps build the social institutions that can improve health.

Creating tools for healthy development: case study of San Francisco's Eastern Neighborhoods Community Health Impact Assessment.

The San Francisco Department of Public Health recently completed a 2-year collaborative process, the Eastern Neighborhoods Community Health Impact Assessment (ENCHIA), to evaluate the potential positive and negative health impacts of land use development. ENCHIA resulted in a number of outcomes, including (1) a vision of a healthy San Francisco; (2) community health objectives to reflect the vision; (3) indicators and data to assess and measure the objectives and vision; (4) a menu of urban development strategies to advance the objectives; and (5) the Healthy Development Measurement Tool, an evidence-based tool to support accountable, comprehensive, evidence-based, and health-oriented planning. This case study describes the 18-month ENCHIA process, key outcomes, and lessons learned. The case study also provides an overview of the Healthy Development Measurement Tool and examples of its first applications to urban planning. Given the growing understanding of built environmental influences on health, ENCHIA illustrates the ability of a local public health agency to effectively engage in land use policy as a health promotion strategy.

City planning as preventive medicine.

The health and well-being of rapidly growing urban populations is a global health issue. Cities in the global north and south are faced with rising health inequities - or avoidable differences in health determinants and outcomes based on place, social status and ethnicity. This commentary suggests that focusing only on treatment interventions in cities is likely to fail because populations will be forced to go back into the urban living and working conditions that likely made them sick in the first place. City planning as preventive medicine includes taking a relational and systems approach to urban health, requiring health assessments for all urban policy making, promoting neighborhood health centers as engines of community economic development and gathering place-based health indicator data to track progress and adapt interventions over time as conditions change.

Health in All Urban Policy: City Services through the Prism of Health

In April, 2014, the City of Richmond, California, became one of the first and only municipalities in the USA to adopt a Health in All Policies (HiAP) ordinance and strategy. HiAP is increasingly recognized as an important method for ensuring policy making outside the health sector addresses the determinants of health and social equity. A central challenge facing HiAP is how to integrate community knowledge and health equity considerations into the agendas of policymakers who have not previously considered health as their responsibility or view the value of such an approach. In Richmond, the HiAP strategy has an explicit focus on equity and guides city services from budgeting to built and social environment programs. We describe the evolution of Richmond’s HiAP strategy and its content. We highlight how this urban HiAP was the result of the coproduction of science policy. Coproduction includes participatory processes where different public stakeholders, scientific experts, and government sector leaders come together to jointly generate policy goals, health equity metrics, and policy drafting and implementation strategies. We conclude with some insights for how city governments might consider HiAP as an approach to achieve “targeted universalism,” or the idea that general population health goals can be achieved by targeting actions and improvements for specific vulnerable groups and places.

Urban Planning and Health Disparities: Implications for Research and Practice

In virtually all cities across the world, the worst health problems and premature deaths are highly concentrated in neighbourhoods that also experience a host of other social inequalities, includin...