1. The Healthy Communities Agenda: How We Can Work Together Dee Merriam, FASLA Community Planner National Center for Environmental Health U.S. Centers for Disease Control and Prevention “ The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.” June 13, 2009 Congress for the New Urbanism

2. U.S. Health Care Expenditures as Percent of GDP Projections Keehan et al: Health Affairs March/April 2008 27: 145-155

3. For every age group from 3 through 33--crashes were the No. 1 cause of death Injury -Vehicle Crashes

6. Climate- The European Heat Wave of 2003 Source: Earth Policy Institute Excess deaths France 14,802 Germany 7,000 Spain 4,230 Italy 4,175 UK 2,045 Netherlands 1,400 Portugal 1,316 Belgium 150 TOTAL 35,118

7. Climate

15. Strength of Community Positive Interactions Know People on Floor Know Next Door Neighbor Unity / Cohesion not at all a little quite very somewhat No Trees No Trees No Trees trees no trees

16. Strength of Community Positive Interactions not at all a little quite very somewhat No Trees No Trees No Trees Many Visitors Daily Socialize within Bldg. Know People in Bldg. trees no trees

17. Strength of Community Positive Interactions not at all a little quite very somewhat No Trees No Trees Acknowledge Each Other Help Each Other trees no trees

18. 0 .1 .2 .3 .4 .5 .6 spiteful threatened to hit threw or smashed threw at partner Proportion Yes Aggressive behavior against partner Negative Interactions No Trees No Trees No Trees No Trees trees no trees

19. 0 .1 .2 .3 .4 .5 .6 Hit with something Hit with fist Beat them up Used gun or knife Proportion Yes No Trees No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions trees no trees

20. Aggressive and Violent Behavior No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Psychological Aggression Mild Violence Severe Violence Mean Values trees no trees

21. Inactivity, Overweight & Health Evidence links inactivity and overweight with… Inactivity Overweight Increased mortality   Cardiovascular disease   Cancers   Depression   Gall bladder disease  Osteoporosis   Dyslipidemias   Hypertension  

22. United States 1990 to 2000

23. Relationship Between BMI and Risk of Type 2 Diabetes Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481. Age-Adjusted Relative Risk Body Mass index (kg/m 2 ) Men Women 1.0 2.9 1.0 4.3 1.0 5.0 1.5 8.1 2.2 15.8 4.4 27.6 40.3 54.0 93.2 6.7 11.6 21.3 42.1 <22 <23 23 - 23.9 24 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 31 - 32.9 33 - 34.9 35+

24. Percentage of US Adults with Diagnosed Diabetes - 1994 1 state exceeds 6%

25. Percentage of US Adults with Diagnosed Diabetes - 2001 2 states exceed 9%

26. Percentage of US Adults with Diagnosed Diabetes - 2007 10 states exceed 9%

31. &quot;Outstanding in Its Field&quot; Hubbard Lake Elementary School, Hubbard Lake, Michigan.

33. Destinations are not connected. PP slide courtesy of Doug Allen Sam’s house Park Joe’s house

37. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 10% 1985 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 2 001;286:10.

38. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1990 Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

39. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 15% 1991 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

40. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1992 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

41. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1993 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

42. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1994 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

43. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1995 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

44. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1996 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

45. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1997 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. 3 states over 20%

46. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1998 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

47. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1999 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

48. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2000 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.

49. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2001 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. Alabama over 25%

50. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2002 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

51. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2003 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

52. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2004 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

53. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

54. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

55. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Only 1 state under 20%

56. NHANES -- Measured NHANES – In person interview-- self-reported BRFSS – Telephone Interview BMI US Females 1988-1994

57. download from CDC at: www.cdc.gov / nccdphp / dnpa / obesity / trend / maps The data shown in these maps were collected through the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) .

59. Walking good for… Obesity! Heart disease! Cancer! Depression! Diabetes! Gall bladder! Social life!

60. Higher density and connectivity  Lower obesity Atlanta study 2004

61.  Physical activity  Air pollution And by the way…  Infrastructure costs  Social capital  CO 2 emissions  Depression  Injuries  Osteoporosis

62. The sidewalk level: The National “ Never Walk” Campaign 12 Strategies

63. Strategy #1: Don’t Build Sidewalks

66. Strategy #2: Build Repellant Sidewalks

68. Strategy #3: Allow Sidewalks to Disintegrate

70. Strategy #4: Build Treacherous Sidewalks

72. Strategy #5: Obstruct Sidewalks

75. Strategy #6: Use creative design.

78. Strategy #7: Crosswalks should be dysfunctional, if not silly.

82. Strategy #8: Combine Multiple Strategies

85. Strategy # 9: Never place an interesting or useful destination within walking distance of where anybody lives

87. Strategy #10: Just Say It

89. Strategy # 11: Turn places to park into architectural icons.

91. Strategy # 12: Make everything car-accessible. Everything !

92. Pharmacies

93. Dry Cleaners

94. Baked goods

95. Groceries

96. Booze

97. Tobacco Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation

98. Gambling Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation

99. Auto Service

100. Fine Food

101. Coffee

102. Banking A nice touch… Braille buttons for blind drivers

103. Mail Boxes

104. Utility Bills

105. Drive-thru sewer payments: Mt. Juliet, Tennessee

106. Tunnel of Vows Drive-Thru Wedding Chapel Las Vegas, NV

107. Drive-up wedding windows

108. Child support payments

109. Drive-Thru Funerals Gardner Memorial Chapel Davidson, TN Junior Funeral Home Pensacola, FL

110. Trees…then

111. Trees…now

112. The next frontier of drive-thru: Health care?

113. Parking

114. ?