Safe and Healthy Places Are Made, Not Born

Charles Branas is a Penn IUR faculty fellow and professor of epidemiology at UPenn’s Perelman School of Medicine. 

Interest in health and safety programs that focus on improving the places people live, work, and play has grown over the past decade. A renaissance seeks to move beyond a focus on individuals and lifestyle changes—for example educating people about nutrition or relying on them to always drive safely and mind pedestrians— to embrace a broader emphasis on the environmental contexts within which individuals live. This means changing and improving the very structure of neighborhoods; for example, designing sidewalks that encourage walking but also separate pedestrians from traffic, or implementing policies and infrastructure to bring supermarkets—and fresh fruits and vegetables— to neighborhoods with only a corner bodega. If done right, place-based programs have the potential to become truly transformational policies for the health and safety of large populations. 

Engineers and urban planners prominently figured into some of the earliest and largest place-based public health successes. Electrical power grids, water chlorination, building codes, and roadway redesign did more to enhance the health of the public than many (maybe any) other programs, including medical care. These programs were widely successful because they focused on places or structural changes while being cost-effective and readily scalable to cover entire communities, thus impacting large numbers of people for long periods of time. For example, it has been estimated that clean water technologies alone (filtration and chlorination) were responsible for nearly half of the total mortality reduction in major cities between 1900 and 1936, and helped to nearly eradicate typhoid fever, a major public health threat of that time.¹

In the last decade, a select few programs that change the places people live, work and play have been shown effective at some of the highest levels of scientific evidence. One such program that I have studied is the Philadelphia LandCare Program, a joint effort between the City of Philadelphiaand the Philadelphia Horticultural Society that transforms some of Philadelphia’s trash-strewn and blighted vacant lots into clean, green, neighborhood spaces. In a study that analyzed the program over a 10 year period, my colleagues and I found that the program’s health and safety benefits reached far beyond its immediate aesthetic improvements in a given neighborhood. The transformed lots were associated with a marked reduction in gun crime, as well as improved health behaviors for neighborhood inhabitants, such as increased exercise and decreased stress levels.

The UPenn effort to study urban phenomena, such as vacant properties or the Philadelphia LandCare program, has been highly multidisciplinary and growing over the past several years. Epidemiologists, statisticians, business analysts, criminologists, geographers, anthropologists, economists, and others have been involved in what has turned out to be an extraordinarily worthwhile research endeavor. Perhaps the attraction for all these different scientists, who often do not work with one another, is the potential for real-world impact that they see in this line of research. To date, several peer-reviewed scientific articles have been produced on the subject by Penn investigators.^{2 3 4 5 6} Enthusiasm for this topic at the university-level is only exceeded by the dedication of the many private and municipal partners who are the real impetus behind urban blight reduction strategies such as the Philadelphia LandCare program – the Pennsylvania Horticultural Society, the Philadelphia Office of Housing and Community Development, the Philadelphia Department of Licenses and Inspections, the Philadelphia Police Department, the Philadelphia Department of Public Health, and the Philadelphia Managing Directors Office.

The results of our research on the Philadelphia LandCare Program are promising, but more— much more— scientific evidence is needed to effectively design and implement future place-based programs. Such evidence would provide guidance on which place-based programs warrant research investments at the highest levels, including which should perhaps be selected for randomized trials. Successful programs should be quickly disseminated and unsuccessful programs retooled (or abandoned) as part of a larger rapid cycle learning process. As a basic guide to selection, we should consider programs that have three cardinal features: (1) they make basic structural changes to places, (2) they are scalable to large populations, and (3) they have reasonable sustainability. Programsdesigned to improve the health and safety of the community writ large will increase in the coming decades. This will, and should, prominently include place-based programs. 

Creating vibrant, livable spaces, particularly in areas suffering from urban decline, requires that city planners, public health experts and engineers work together to create large-scale and sustainable place-based programs. Such programs do not simply grow and develop organically; they must be carefully designed and implemented—and they require resources if their impact is to be felt. The growing public policy and academic interest in place-based health and safety programs is encouraging. However, to implement such programs on a large scale will require a shift in focus toward the broader contexts of public health and safety, as well as significantly more research. Over time, this investment in time and resources has great potential for transforming urban spaces, and dramatically affecting the quality of many lives. It is an investment that will require long-term thinking, creative program design and a good deal of work. And it will require a commitment to the idea that safe and healthy places are made, not born.

¹  Cutler, D. and Miller, G. (February, 2005). The Role of Public Health Improvements in Health Advances: The Twentieth-Century United States. Demography, vol. 42, no. 1, 1-22.

²  Susan M Wachter, Grace Wong (2008), What is a Tree Worth? Green City Strategies and Housing Prices, Real Estate Economics, 2008, 213-239.

³  Branas CC, Cheney RA, MacDonald JM, Tam VW, Jackson TD, Ten Have TR: A difference-in-differences analysis of health, safety, and greening vacant urban space. American Journal of Epidemiology 174: 1-11, 2011.

⁴  Branas CC, Gracia N, Rubin D, Guo W: Vacant properties and violence in neighborhoods. ISRN Public Health 2012: 1-23, 2012.

⁵  Garvin E, Branas CC, Keddem S, Sellman J, Cannuscio C: More than just an eyesore: local insights and solutions on vacant land and urban health. Journal of Urban Health 12(7): 9782-7, 2012.

⁶ Garvin E, Branas CC, Cannuscio CC: Greening vacant lots to reduce violent crime: A randomized controlled trial. Injury Prevention 18(5): 1-6, 2012.