Blog Archives

Urban Design that Fights Obesity and Promotes Physical Activity

Sure, we all know that regular exercise and eating well are essential components of a healthy lifestyle and are important in fighting obesity. But rather than just telling people to go to the gym, how can we make physical activity a more realistic (and exciting!) option that will encourage people to abandon their sedentary lifestyles?  

The authors and collaborators of the NYC Active City Guidelines propose active urban design as the key to promoting more physical activity and fighting the obesity epidemic. The Guidelines are the product of a collaborative effort between NYC public health professionals, architects, urban designers, and urban planners.

 The Guidelines are grounded in the idea that the design of the built environment can have a crucial and positive influence on improving public health.

They propose interesting strategies as to how planners can transform the built environment to encourage more active lifestyles for its residents and visitors through stair climbing, walking, bicycling, transit use, active recreation, and healthy eating.

While they focus ostensibly on New York City, the Guidelines can also be applied to other cities and communities.

These are my ten favorite suggestions, and perhaps the ones most pertinent to communities in the LehighValley:

1. Consider shared-use paths in areas with viewing attractions.

  • Check out Allentown’s plans to encourage active transportation: This Morning Call article discusses the plan to connect local bicycle and walking trails.

2. Explore bicycle share programs to increase access to bicycles for both city residents and visitors. 

3. When designing sites that include parking, consider how the provision of parking can affect the use of more active modes of travel such as walking, bicycling, and public transit. In general, when parking is available, people use it. Research in California indicates that increased parking supply may result in reduced active transportation and public transit use. Design car parking so as to reduce unnecessary automobile travel, particularly when walking, bicycling, and public transit are convenient alternatives.

4. Locate new projects near existing public and private recreational facilities and encourage development of new facilities, including indoor activity spaces.

5. In the design of parks and playgrounds, create a variety of climate environments to facilitate activity in different seasons and weather conditions. For example, include sunny, wind-protected areas for use in the winter and shaded zones for use in the summer.

6. Design plazas that allow for diverse functions. Plazas can accommodate physical activities like dance and volleyball, passive activities like sitting and chess, and cultural events such as concerts, exhibits, and historical celebrations. Plazas can also provide space for café style seating and farmers’ markets. When programming plazas, consider the needs of users with varying mobility levels. Seek partnerships with community groups to maintain and program plazas.

7. Incorporate temporary and permanent public art installations into the streetscape to provide a more attractive and engaging environment. Seek collaborations with local arts organizations, philanthropic institutions, or other nongovernmental groups to create and help maintain the artwork.

8. Provide safe walking and bicycle paths between densely populated areas and grocery stores and farmers’ market sites.

9. Further develop Greenways—alternative routes that are integrated into the regional park system. Greenways feature relatively few intersections, many plantings, and a dedicated bicycle right of way. These routes can serve as commuter corridors during the week and recreational paths on the weekend. Connect Greenways to street bikeways.

10. Design stairs to be more visible, in order to encourage their everyday use.

A Financial Case for Public Health

Pay now or pay later. States face this choice every day, particularly with how and when they invest in clinical preventive health services leading to prevention and reduced economic burden in terms of length of hospital stay and general health care costs.

The rewards of paying now are better known than ever before. Research has demonstrated that supporting healthy early childhood development–from before through age 5–generates substantial educational, social and financial benefits for individuals, families and communities.

A major study, The High Costs of Failing to Invest in Young Children produced by Partnership for America’s Economic Successhighlighted that the price society pays when a single person experiences child abuse, drops out of high school, or abuses alcohol can range up to tens to thousand dollars over that person’s lifetime. The study’s purpose was to help policy makers and the public fully evaluate the consequences of their present funding decisions.

The latest RWJ/University of Wisconsin County Health Ranking (CHR) revealed that morbidity numbers are rather low in Lehigh County (37 out of 67 counties) and Northampton County (a shocking 60 out of 67). Morbidity is a term that refers how healthy people feel in the community while alive and it captures the Birth Outcomes along with Health-related quality of life (HRQoL) within the community. Birth Outcomes are measured using low birth weight (LBW) that represents child’s current and future morbidity. Low birth weight is reported to be higher in both Lehigh Valley (8.3%) and Northampton County (8.7%) as compared to the State average of 8.2% and way higher than the national average of 6.0%, according to CHR report.

It was mentioned in the blog on County Health Ranking Across Pennsylvania that the public health spending in Pennsylvania is extremely low as compared to other states in U.S. In this context of scarce resources, the advantage of economic analysis is that helps substantiate present action in terms of investing in prevention and public health. Such an analysis helps providers in managing an individual’s health and administrators in appropriately focusing resources, and — moreover — illustrates the return on investment (ROI) for public health initiatives. According to a study in Western New York, a positive ROI was demonstrated for a prenatal program developed at the Managed Care Organization using a model of economic analysis.

In general clinical preventive services are cost-effective; some are cost-saving. Some clinical preventive services prevent disease or injury (e.g. cervical cancer screening); some preventive services catch disease in early stages when treatment is most effective and least expensive (e.g. STI screening). Because clinical preventive services can prevent or reduce the need for treatment, they provide a cost-offset. Lehigh County has the highest number of sexually transmitted infection rates as compared to state or national average, according to CHR report. Key studies have been done that support the cost-offset value of prevention.

Below are the examples of cost-offset of clinical preventive services recommended in the Plan Benefit Model conducted as part of study that provides rationale to our current work on establishing a regional health department for Lehigh Valley. Of particular note is the cost offset by screening for Chlamydia and Sexually Transmitted Diseases (STDs). Screening for gonorrhea and Chlamydia allows for early recognition of diseases that could prevent the costly implications of late stage complication such as Pelvic Inflammatory Disease (PID). The average life-time cost of PID and its major complications for women have been estimated to be in the range of 1,060-6,840 US dollars. Check out the image below for details on how investment in prevention saves financial resources over the long term.

County Health Rankings Across Pennsylvania

When the annual County Health Rankings were released late last month, the Morning Call, Express Times and Patch reported on the very high morbidity numbers in Northampton County and Lehigh County. Meanwhile, these county rankings received coverage that looked at how other parts of the state were faring as well. Union County was ranked the highest [Check out WNEP news for more info] and Philadelphia was ranked the least in regards to health outcomes and health factors [Here’s the link]. Closer to home, both Montgomery and Bucks Counties ranked in the top 10 of Pennsylvania counties in terms of overall health [Here’s the link here for phillyburbs.com article].

Generally, the rankings showed that counties located in south and central Pennsylvania performed better than did counties in the northeast and northwest. Also, more of the urban counties are ranked in top half than the rural counties — this using the definitions of “urban” and “rural” developed by the Center for Rural Pennsylvania (The Center defines rural vs. urban Pennsylvania based on population density).

Amid these overall regional trends, in some cases the rankings show significant differences even among neighboring counties. Consider the area to the north of Harrisburg, where Union and Snyder Counties both are amongst the top five counties statewide in overall health, while adjacent Northumberland County is ranked in lower one-third. The factors that contribute to such great disparities among neighboring counties would lend itself to further analysis that could shed light on the local conditions that contribute to – or stand in the way of – good health. (As a side note: For an interesting resource on county-level conditions across economics, demographics, and other areas, check out Patchwork Nation – an interactive data site.)

While considering how Pennsylvania counties fare among themselves, it is important to look at where Pennsylvania stands nationally on support for public health. Public health infrastructure in Pennsylvania clearly lags that in others. For its population size, Pennsylvania has the lowest number of public health professionals. Also, according to a study released last month, public health spending in Pennsylvania is very low itself. Here’s the link.

Ultimately, failing to adequate support public health is a short-sighted policy and an unwise investment of public dollars. As noted in the local coverage of the county health rankings [Patch article], we either invest upfront in public health and prevention or we spend far more on what it takes to address illness and injury after they occur.

What is impressive and valuable about the County Health Rankings is not only the numbers themselves, but the huge potential to use these data to improve the health of our communities. Look here to see how people can take action. Patrick Remington, who is the University of Wisconsin Professor and has lead the County Health Rankings report, remarks that the County Health Rankings report is a teaser to catch interest. The point is get people to take some action towards the health of their community.

The current work on establishing a regional health department for the Lehigh Valley represents an important step toward building a strong system of prevention and health promotion for our region. For more information on this effort, visit RenewLV’s Regional Health Initiative page.

LV and Beyond: Regionalizing Public Health in Other States

Just last month, the Robert Wood Johnson Foundation released this short report summarizing the overall challenges to improving public health capacity through cross-jurisdictional relationships, conditions for successful relationships, and moving forward with regionalization.

Information was gathered through in-person interviews and site visits with executive leadership and important staff at organizations such as CDC, NACCHO, PHAB, and HRSA.  Researchers interviewed various local public health leaders and policymakers either interested or currently involved in regionalization in Colorado, Wyoming, South Carolina, Connecticut, New Hampshire, Nebraska, and Illinois.

Although these efforts are specific to location, the report provides insightful generalizations about regionalizing public health. Here’s a short outline of its key points:

Key barriers to improving cross-jurisdictional relationships:

  • A gap exists between elected officials and public health leaders in understanding population health.
  • There are differences in understanding, appreciating, and operationalizing cross-jurisdictional relationships within the public health practice community.
  • No common language or frame of reference exists for discussing cross-jurisdictional sharing.
  • Cross-jurisdictional sharing and regionalization are occurring in a range of ways.
  • Regionalization does not necessarily result in improved public health capacity or performance, but cross-jurisdictional sharing often does.

Conditions for successful cross-jurisdictional relationships:

  • Clarity of purpose (Policy makers and public health leaders must be clear about their purpose)
  • Incentives, especially financial, are helpful
  • Willingness on both sides—public health leaders and elected policymakers
  • Attention to environment, culture, and history (interplay of history, culture, and relationships must be addressed)
  • Role in governance (all parties should feel that they have sufficient voice and control)

So, how should we move forward with collaboration?

  • Elected state and local policymakers need to be involved in national public health systems development work.
  • Understanding of the local environment is essential to successful public health endeavors.
  • Cross-jurisdictional relationships vary greatly in their details and address a wide variety of needs, but they do not have to develop further beyond their original purpose.

The conclusion?:

Public health leaders and policymakers found that cross-jurisdictional relationships improve local public health. Although accreditation was not a central focus of the report, the public health leaders acknowledged that cross-jurisdictional sharing will likely be necessary for health departments applying for national accreditation.


Visit RenewLV’s Regional Health Department page for information about local efforts in the Lehigh Valley.

Better Prevention as Better Health Policy

This really is a surprise to no one by now, but a forthcoming article in the American Journal of Public Health states that US medical costs could drop significantly if there were a greater investment placed in public health and preventative measures. Bloomberg Business Week reports on this fiscal sense:

The study authors concluded that reducing the prevalence of diabetes and high blood pressure by 5 percent would save the nation about $9 billion a year in the near term. In addition, conditions related to those health problems would also be reduced, which would increase the savings to about $24.7 billion a year in the medium term.

It seems that a slight investment in public health upfront means big payoffs in long-term costs. Thoughts?

Check Out EPA’s Policy on Clean Water & Water Infrastructure

I’m not sure that we ever posted the new EPA sustainability policy on clean water and drinking water infrastructure, but it is something that we link to on our Regional Water Infrastructure page and tend to mention often in our presentations.

It’s noteworthy that the policy places a tremendous focus on long-term planning approaches and sustainability. This is very similar to RenewLV’s own water and wastewater policy, and we are pleased to be aligned with the EPA’s standards.

Check out the policy here. What are your thoughts on this document?

Want to keep up to date on RenewLV’s work on water/wastewater resource management? Make sure you subscribe to this blog via our RSS feed and sign-up for our e-mail list on our Join Us page.

Moving Forward on Regional Collaboration

At last week’s Building One Pennsylvania summit in Lancaster, many organizations — both large and small — came out and preached the message of regionalism. As numerous older communities across Pennsylvania are struggling, newer developments are receiving federal and state subsidies and focus government assistance away from the urban cores.

Leaders from Pennsylvania’s communities, advocacy groups, and the urban planning field discussed the need to change state and federal policies that encourage cheap developments in greenfields. If history has anything to teach us, it is that such developments are unsustainable in the long-term. Many of our older communities were also the recipients of such government assistance many decades ago — and now these municipalities are struggling to keep up with rising costs of fixing crumbling infrastructure and taking care of students in the school districts.

What can we do moving forward? The message I took away from the summit was to keep working on regional collaboration and keep spreading the message of regionalism within our respective communities. With enough outreach, legislation and policies will begin to materialize that promote better and more coordinated planning that encourages new development in places that already have existing infrastructure (preferably, in brownfields).

RenewLV will keep working on regional collaboration issues within the Lehigh Valley. While the Lehigh Valley Health Department did not pass the Health Commission meeting last night, there are still many opportunities for moving forward with regionalism here within the Lehigh Valley and we will continue partnering with regional entities on various initiatives.

Come Show Support for Regional Health Tonight, 6:30pm in Easton

This is a reminder that the important meeting of the Lehigh Valley Health Commission — at which county legislators from Lehigh and Northampton Counties will be voting to move forward on the bi-county health department — is TONIGHT (July 19) at 6:30 p.m. in County Council Chambers at the Northampton County Courthouse, 669 Washington Street in Easton [map].

Community support for this effort is strong, as evidenced by the recently-approved $500,000 grant from the Two Rivers Health & Wellness Foundation for the proposed regional health department. This grant is contingent on the approval of the plan and budget for the department by the counties’ legislators. A Morning Call op-ed by Dr. David Lyon and Ilene Prokup of the Lehigh Valley Board of Health focuses on the details of the proposed budget, including the fact that, as it stands, the counties’ investment will be only 10% of the full health department budget, with private grants and state funds leveraged for the remaining 90%.

It is important for community members to attend and show their support. Show up tonight to offer brief remarks (during Public Comment) as to why the elected officials should approve the Lehigh Valley Health Department.

If you are unable to attend, we ask that you contact your county representatives to urge them to support the Lehigh Valley Health Department. Visit our Contact Your Elected Official page.

This department will provide many essential services that are not available uniformly throughout the Lehigh Valley — services such as timely and frequent restaurant inspections, access to flu vaccines, inspections of public pools and child-care facilities, and education regarding nutrition and exercise. For more information, visit RenewLV’s Regional Health Initiative page.

Five Reasons for Why We Need a Regional Health Department

The Lehigh Valley Health Commission meeting is exactly a week away. At this meeting, county legislators from Lehigh and Northampton Counties will be voting on the future of the bi-county health department. We are encouraging all community members to attend this important meeting next Monday, July 19th at 6:30 pm at the County Council Chambers, Northampton County Courthouse in Easton.To learn more about the effort to establish a regional health department, visit RenewLV’s Regional Health page.

But why do we need a regional health department? Here are a few reasons:

1) It will provide essential services uniformly to all residents of the Lehigh Valley. Right now, services such as timely restaurant inspections, access to immunizations, cancer prevention services, and screening for communicable disease are ensured within the cities of Allentown and Bethlehem (which have excellent health bureaus), but are not so readily available outside of these cities.

2) Let us not forget about those spotty restaurant services that the Morning Call reported on back in 2005. This would not be a worry if we had a regional health department. [Morning Call Editorial, 8.7.2005]

3) The region is missing out on millions of dollars in state funding for public health services — money that the Valley’s residents are paying in taxes but are currently not getting back.

4) The health department will serve as a single point of contact for regional public health emergencies — including emergencies brought on by a natural disaster or an epidemic/pandemic.

5) If you live outside of Allentown or Bethlehem, you will no longer have to wonder: Where do I go to get my flu vaccine? Recall the scramble of the region’s school districts during the H1N1 scare.

Some have argued that many of the services that the Lehigh Valley Health Department would provide are already being provided by the state Department of Health (PADOH). While this is true in some cases, we must ask ourselves how effectively these services are provided. There are currently two PADOH offices in the region that are only staffed part-time. This places our region’s population at a risk — and this is unacceptable.

Since both counties in the Lehigh Valley work under a home-rule charter, it would seem that our leadership would prefer to have our public health services under local control. After all, one of the key roles of local government is ensuring the health and safety of its residents.

To receive updates about this effort, sign up for our supporter list by visiting our Join Us page and clicking the box next to ‘Health’ when sending your information.

Have You Checked Out Our Regional Health Page?

With the upcoming meeting of the Lehigh Valley Health Commission (at which members of the county legislatures will be reviewing the plan and budget for the Lehigh Valley Health Department), I wanted to make sure our readers were familiar with RenewLV’s Regional Health Initiative page.

On our website, you’ll find useful resources, including our fact sheet about the regional health department, a list of organizations that have endorsed the department, and — most importantly — a Contact Your Elected Official page that facilitates communication with your elected county legislator.

We’ve mentioned all the various ways that a regional health department will benefit our community. Now we need the community to come out in support of this at the upcoming Health Commission meeting on July 19. The meeting is set for 6:30 pm in County Council Chambers at the Northampton County Courthouse, 669 Washington Street in Easton [map]. County officials need to hear that the Lehigh Valley cannot afford to go without a regional health department any longer.

For more information, e-mail us at health@renewlv.org or call us at 484-893-1062.