- Hopkins experts, city health officials want residents’ health part of new zoning code

How much do your local zoning code and your overall health have in common? A lot, according to a new report by Johns Hopkins experts and Baltimore City health officials examining the impact of public space on public health.

The Zoning for a Healthy Baltimore report, currently under consideration as part of the official comments to the draft zoning code before the Sept. 10 deadline, offers insight into how making even small changes in building design and land use can go a long way toward improving the health of city residents.

Among the report’s specific recommendations:

• Favor developments that improve access to healthy foods, such as farmers markets, fresh-produce grocery stores and community gardens
• Increase areas in the city that combine residential and commercial uses, believed to encourage walking to stores and services
• Limit new liquor stores in areas that already have many of them as liquor stores are linked to higher crime rates
• Require that buildings, landscaping and lighting be designed in a way that discourages crime by making an area highly visible and easy to observe

The authors say their findings should serve as a reminder to council members that zoning decisions can and do affect the health of city residents

“When weighing the pros and cons of a proposed development, city officials should not consider merely the city’s economic health, but they should think about the likely impact on the physical well-being of its residents,” says Johns Hopkins Children’s Center pediatrician Jonathan Ellen, M.D., one of the report’s authors.

“This report clearly outlines how our built environment can be planned to make healthy living options the default options,” says Oxiris Barbot, M.D., Baltimore City Commissioner of Health.  “It fits into the Health Department’s overall agenda of utilizing different strategies to address health disparities.”

In their analysis, Ellen and colleagues examine the effect of land use and green space on four key dimensions of public health: Nutrition, physical activity, violent crime, and obesity and obesity-related illnesses. They found many ways in which zoning can influence public health, such as ensuring the availability of healthy food and shaping the environment in a way that invites physical activity and deters crime. While the authors recognize that zoning is only one of several factors shaping these outcomes, they say codifying the report’s recommendations into the new zoning law will ensure that private developments are carried out with the public’s health in mind.

Individual health and, by extension, public health are the combined product of genes, lifestyle and environment. An environment that promotes healthy behaviors is a critical component of good health. People are reluctant to walk and spend time outdoors if they live in dangerous neighborhoods, as many of Baltimore’s neighborhoods are, the authors say, and the effects on public health are clear.

A staggering 35 percent of Baltimoreans are obese, and another 33 percent are overweight, past research indicates. A Baltimore City resident is 34 percent more likely to die during any given year than any other Maryland resident. The higher risk of death among city residents stems from higher rates of heart disease, HIV, obesity and homicides. On average, Baltimore City residents die six years earlier than their fellow Marylanders, and life expectancy can vary by as much as 20 years from one city neighborhood to another neighborhood, the authors say.

The health disparities between city residents and their fellow Marylanders are striking, according to the report, but some of them could be reduced or eliminated by encouraging land use and building designs that are conducive to healthy behaviors.

The impact of living space on public health has been markedly absent or, at best, a mere afterthought, in most U.S. cities’ approach to land use and development, but the tide is turning and Baltimore City should stand on the forefront of this new trend, the report states.

Baltimore City is now in the process of revising its 40-year zoning code, a lengthy process that is expected to conclude in late 2011 with the Baltimore City Council enacting the new code into law.

Co-authors on the report are Rachel Thornton, M.D., Ph.D., a pediatrician at Hopkins Children’s; and Caroline Fichtenberg, Ph.D., an epidemiologist, formerly at the Johns Hopkins Bloomberg School of Public Health.