Building Healthy Community Environments: A Public Health Approach

The quality of the environment has a powerful effect on people’s health. In the United States, the health problems linked to the environment are increasingly chronic diseases like asthma, heart disease, and cancer — not just the sudden illnesses people often associate with pollution.

At the local level, public health workers have realized something important: many of the decisions that shape environmental quality and health fall outside what traditional health departments can control. Things like where homes are built, how neighborhoods are designed, what transportation options exist, and how energy is produced all affect health. Making smart choices about these parts of the built environment requires collaboration across many different groups.

Environmental health professionals have a real opportunity here. By bringing data and practical tools to decision-makers, they can help shape healthier communities and address the growing burden of chronic disease.

This article serves as a guide for community leaders who want to consider the health effects of decisions about the built environment. It introduces a new way of thinking — moving away from isolated, one-off solutions and toward a systems approach that brings together experts from different fields and sectors.

The article also walks through practical tools that can help, including:

• Health Impact Assessments, which evaluate how a proposed project or policy might affect community health
• Environmental public health tracking, which monitors health and environmental data over time
• Cumulative risk assessment, which looks at the combined effect of multiple environmental stressors

Finally, the authors identify priorities for research, practice, and education, including making Health Impact Assessment a core skill for environmental health professionals. They call for stronger communication, research, and training that brings together planners, transportation experts, energy specialists, and public health professionals. The goal: a truly collaborative, systems-based approach to today’s toughest environmental health challenges.

Abstract

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today’s environmental challenges.