Dissertations / Theses on the topic 'Urban planning and health'

Coordinating care is of particular concern in Alaska due to expansive geography, difficulty of travel, and often limited behavioral health care resources. This study explored how individual, organizational, and systemic factors influence clinicians' use of video teleconferencing to conduct "live" discharge plans from urban psychiatric facilities to rural communities.

Semi-structured key informant interviews were conducted, in person and by telephone, with urban clinical staff (n = 10), urban administrative staff (n = 6), and rural outpatient staff (n = 14). Two researchers analyzed the transcribed interviews in a recursive manner using a grounded theory methodology.

Participants described infrequent, but generally positive experiences with live discharge planning: connecting patients to providers, temporarily joining treatment teams, evaluating patients for appropriate placement, engaging patients in their own care, addressing medication issues, and coordinating with family and village resources. Providers recommended hiring interns or dedicated staff, installing equipment "on unit," or using wireless tablets. Rural participants ascribed a greater value to emergency psychiatric consultations at admissions than coordination at discharge.

Continued selective use of live discharge plans is indicated with patient length of stay being an important consideration in determining feasibility. Future implementation should involve dedicated resources and use video teleconferencing to formally enhance other transitional services. Once issues of organizational readiness are addressed, a Knowledge-Attitudes-Behavior framework may be useful for managing providers' underuse. Future research could evaluate rural, village-based intensive case management supported by consultation with the psychiatric hospital via video teleconferencing.

Climate change is a significant public health danger, with a disproportionate impact on low-income and communities of color that threatens to increase health inequities. Many important social determinants of health are at stake in California climate change policy-making and planning, and the distribution of these will further impact health inequities. Not only are these communities the most vulnerable to future health impacts due to the cumulative impacts of unequal environmental exposures and social stressors, they are also least likely to be represented in climate change decision-making processes. Therefore, it is imperative that public health and social equity advocates participate in climate change policy-making that protects and enhances the health and well-being of vulnerable communities. Regions have emerged as important policy-making arenas for both climate change and public health in California, because many drivers of climate change are also social determinants of health (e.g. land use, housing, and transportation planning); these play out regionally and are under regional governmental authority. However, the public health sector is not engaged adequately with climate change planning given the magnitude of risks and opportunities inherent for health. Examination of where public health and equity partners have engaged in regional climate change planning and policy-making may offer lessons for how to change the drivers of health inequities and climate change through this work.

This dissertation examines why the public health sector in California is not more engaged with climate change work and regional scale planning given current threats to and opportunities for health, and whether and how public health and social equity stakeholders’ participation in climate change solutions and regional scale planning can improve health and inequities outcomes and decision-making processes. The overarching goal of this research was to inform efforts to increase public health work on climate change and regional-scale planning, strengthen partnerships between public health, social equity, and climate change stakeholders, and formulate strategies that address climate change and health equity.

The first chapter of this dissertation was conducted in conjunction with a study at the Center for Climate Change and Health at the Public Health Institute, where we conducted semi-structured in-depth interviews (n=113) with public health and climate change professionals and advocates. I performed structured coding and conducted inductive-deductive thematic analysis within and across respondent groups. I found that individual-level barriers to public health engagement with climate change include perceptions that climate change is not urgent, immediate, or solvable, and insufficient understanding of public health impacts, connections, and roles. Institutional barriers include a lack of public health capacity, authority, and leadership due to risk aversion and politicization of climate change; a narrow framework for public health practice; and professional compartmentalization. Opportunities include integrating climate change into current public health practice; providing support for climate solutions with health co-benefits; and communicating, engaging and mobilizing impacted communities and public health professionals.

In the second chapter, I conducted two case studies of Sustainable Communities Strategies planning to achieve greenhouse gas reduction targets through integrated regional land use and transportation planning under California Senate Bill 375 (San Francisco Bay Area and Southern California). I used in-depth interviews (n=50) with SCS planning participants, public document review, and participant observation. I analyzed interviews using thematic analysis in an iterative inductive-deductive process. In both regions, climate change planning was a major lever for increasing the language, consideration, funding, and measurement of health impacts into the SCS plans. Public health’s analytic skills and social determinants of health conceptual framework were valuable for both regional planning agencies and equity groups. Political context influenced the priority concerns, framing, and outcomes. Desire to improve public health was influential in both of these environments. In the Bay Area, a health equity frame promoted regional solutions that can improve health, equity, and climate change. In SCAG, a public health frame increased awareness, language, and future funding for active transportation. Public health was a less contested and commonly held value across diverse political jurisdictions that may be an entry point for future discussions of equity and climate change. In both regions, reform of regional governance processes was pursued to sustain institutionalization of health and equity concerns and improve regional democracy. I discuss implications and recommendations for engaging in multi-system integrated regional planning that can simultaneously improve climate change, health, and equity.

In the third chapter, I analyze the same data as a case for understanding regional-scale public health, social equity, and regional planning staff efforts to slow climate change and improve social determinants of health and social equity. In both regions multi-year SCS planning processes, public health and equity stakeholder engagement was instrumental in getting health goals, targets, and indicators into plans. In the Bay Area, advocacy efforts yielded health and equity language in policies and implementation funding guidelines and changes to the basic governance structure. In SCAG, advocacy efforts yielded significant future funding for active transportation and more metrics to monitor the health and equity impacts of planning. Participants in the SCS planning process described their motivations for engaging at the regional level, the barriers to effective regional planning, the achievements of their engagement, and recommendations for improving future efforts. In the interviews, three main themes emerged related to the opportunities and challenges of working at the regional scale: (1) Building regional identity as a foundation for advancing health and equity; (2) The importance of governance structures for health and equity, and the need for regional governance reform; (3) The prospects and barriers of building regional coalitions both within public health networks and with regional equity partners. I discuss implications and recommendations for public health’s engagement with regional planning agencies, creation of coalitions, and reforming of regional governance structures to sustain better consideration of climate change, health, and equity.

This study defines and determines the characteristics of super pedestrian trips in Washington, D.C. Super pedestrian trips are defined here as trips greater than the third quartile distance based on data from the Metropolitan Washington Council of Governments (MWCOG) Household Travel Survey 2010/2011. In this case, super pedestrian trips are quantified as greater than 0.6 miles; super pedestrians are those completing the trip. A trip is defined as one complete segment of travel (i.e., walking directly from home to the office). Using data from the MWCOG Household Travel Survey 2010/2011, this study determines who makes super pedestrian trips in Washington, D.C. and assesses their socio-demographic characteristics using a linear regression model. The results from the linear regression model show that super pedestrians are likely to be young, low-income, male minorities without driver’s licenses or access to vehicles within the household. Pedestrians traveling the farthest distance may do so only out of necessity. The bulk of current planning and transportation literature focuses on the shortest pedestrian travel distances for trips typically less than one-quarter mile. However, pedestrians are walking greater distances and it is worth understanding from a planning and policy perspective the implications of these trips for livability and design of the urban environment. The core findings from this research contribute to the growing body of research on pedestrian behavior by illuminating the socio-demographic characteristics of those walking the farthest distances.

Issues of food accessibility and food insecurity receive high attention in the United States, due to evidence of disparities in the location and level of accessibility to nutritious food sources amongst neighborhoods of different economic classifications identified in several studies. However, most studies focus on grocery stores or convenience stores without considering other options available for food insecure residents. This research examined the different economic classes of neighborhoods in the Triple Cities of Broome County, New York and their proximity to grocery stores, food pantries and convenience stores, to establish the level of accessibility to food sources for residents of these different neighborhoods using ESRI ArcGIS for spatial analysis and Chi-Square for statistical analysis. The Findings reveal a positive relationship between the location and density of grocery stores, convenience stores and food pantries to low-income populations. Moreover, high-income neighborhoods are more disadvantaged in terms of physical access to food stores by distance. However, there exists an over-concentration of convenience stores in low-income neighborhoods compared to grocery stores and can have a negative impact on their diet choices and expenses on food.

Urban air pollution is responsible for high levels of morbidity and mortality in exposed populations due to its effects on cardiovascular and respiratory function. Transportation-related air pollutants account for the majority of harmful air pollution in urban areas. Forests are known to reduce air pollution through their ability to facilitate dry deposition and atmospheric gas exchange. This work characterizes the interactions between transportation air pollutants and urban forests in Hillsborough County, Florida. A highly spatially resolved passive air sampling campaign was conducted to characterize local concentrations of nitrogen oxides, benzene, toluene, ethylbenzene, and xylenes (BTEX) in Hillsborough County, Florida. Sampling locations included a proportion of densely forested urban areas in order to determine the effects of Hillsborough County's urban forest resources on localized concentrations of selected transportation pollutants. Recommended approaches for the use of urban forests as an effective air pollution mitigation technique in Hillsborough County were generated based on results from the sampling campaign. Results show mean concentrations of 2.1 parts per billion and 6.5 µg/m3 for nitrogen oxides and total BTEX, respectively. High spatial variability in pollutant concentrations across Hillsborough County was observed, with the coefficient of variation found to be 0.61 for nitrogen oxides and 0.79 for total BTEX. Higher concentrations were observed along interstate highways, in urban areas of the county, and near select point sources in rural areas. Differences in concentrations within forested areas were observed, but were not statistically significant at the 95% confidence level. These results can be used to identify elements of urban design which contribute to differences in concentrations and exposures. This information can be used to create more sustainable urban designs which promote health and equity of the population.