From Pamphlets to Playgrounds: Why Public

Health Officials are Concerned about

Greenways and TrailwaysAnn Stahlheber, M.S., R.D.,

L.D.Creating Healthy

Communities

Today’s Objectives

1.The relationship between the built environment and human behavior.

2. The impact that the built environment has on health and chronic disease.

3. Review some intervention strategies in our communities.

The Built Environment

• man-made surroundings that provide the setting for human activity, ranging in scale from personal shelter to neighborhoods to the large-scale civic surroundings.

Fact:•The choices we make are shaped by the choices we have

Sooo….What kind of choices do we have?

Nutrition Environment

• Local grocery stores/supermarkets• Corner stores/gas stations• Farmers’ Markets• Restaurants (dine in and fast food)• Food assistance programs • School/Institution foodservice• Gardens, community/home/school

Fact:•On average, there are 4 times as many supermarkets in predominantly white neighborhoods as there are in predominantly Black or Latino neighborhoods

•This correlates to less optimal nutrition intake

Distance to Grocery (Miles)Unweighted

0.03 to 11 to 1.51.5 or Greater(No Population)

Grocery > 25,000 S.F. Avg. Dist.(Miles)

Cuyahoga

1.4

Suburbs 1.3

Cleveland

1.6

Distance to Fast Food (Miles)Unweighted

0 to 11 to 1.51.5 to 3.3(No Population)

Fast Food Avg. Dist.(Miles)

Cuyahoga

0.5

Suburbs 0.7

Cleveland

0.4

Food Balance Ratio Weighted by Population Share

0 to 11 to 2.52.5 or More(No Population)

Grocery > 25,000 S.F.

Fast Food

Food BalanceScore

Cuyahoga 2.5

Suburbs 2.0

Cleveland 4.5

Food Balance Ratio Weighted by Population Share

0 to 11 to 2.52.5 or More(No Population)

Grocery > 25,000 S.F.

Fast Food

Households Without Vehicles

Physical Activity Environment

• Parks• Playgrounds• Safe walking/biking paths/lanes• Public Transportation• Recreation facilities (pools, tennis,

basketball courts)• School/institution facilities/activities• Community programs for physical

activity

Fact:•Fewer recreation facilities, parks, and playgrounds exist in higher need communities

•This correlates to less physical activity

Fact:•Where we live, work, play and pray impacts our health

The Built Environment and Health

Health Impacts in Cuyahoga County

Heart Disease is leading cause of death in the U.S.

Cleveland:395 per 100,000Suburbs: 289 per 100,000

Cancer Deaths per 100,000 Population300 or Over250 to 299.9 200 to 249.9Under 200

Municipalities and Cleveland SPA's*City of Cleveland

N*SPA's, or Statistical Planning Areas, areCleveland neighborhoods grouped by census tracts.

Sources: Ohio Department of Health, U.S. Census Bureau

Cancer death rates higher among blacks… Second leading cause of death in the U.S.

Cleveland:261 per 100,000Suburbs: 205 per 100,000

Hough 64.0

Lyndhurst 88.5

In a survey of East Cleveland residents: More than half of those surveyed do their grocery shopping outside of East Cleveland

Almost all East Cleveland residents surveyed (in the city’s Master Plan survey) expressed the need for improving youth programs

Strategies to improve the built environment

Overall – health department• Focus on systems, policy and

environmental changes• Enhancing our infrastructure to

address social determinants of health

• Healthy Land Use policies• Looking at Health Impact

Assessment• Connecting the dots between the

natural environment, the built environment, and human health

Policy change

• Healthy Land Use Policies– Partnership with CCPC for creating

healthy municipal plans– Partnership Cleveland Cuyahoga Food

Policy Coalition– Garden Zoning, ordinances to

promote/support gardening– Transportation plans

• Nutrition/Physical Activity specific policies– Healthy vending policy within

schools/institutions– Comprehensive nutrition policies– Policy to support increased physical

activity in schools

Environmental/Systems Change• Nutrition

– Community gardens• Build new gardens• Build systems to support and sustain the

gardens– Enhance farmers markets

• EBT programs• Resources for promotion, signage• Food safety assistance

– Promote alternative access points• Community Supported Agriculture• Healthy Corner Stores

– School Nutrition Interventions• Farm to School• School gardens• Community Supported Agriculture

Environment/Systems Change

• Physical Activity– Build Playgrounds

• Create systems for maintenance– Safe Routes to School

• Infrastructure and education to create safe routes for kids

• Increases walking and biking to school– School Physical Activity Interventions

• Trainings for teachers, principals, to Promote Playtime/outdoor time in School

• Recess in School – Brownfield reutilization

• Greenspace, gardens, playgrounds – Develop Walking Clubs

• Clevelanders in Motion

East Cleveland

• Creating Healthy Communities Program

• Cuyahoga County Board of Health• Partners

– Ohio State University Extension – County Planning Commission

Reduce the leading causes of death by developing environmental, systems, and policy changes that promote healthy behaviors

East Cleveland Health and Development CommitteeThree focus areas1. Gardening and Nutrition2. Physical Activity3. Environmental Redevelopment

Focus on upstream social determinants of health to make East Cleveland a healthy place to live

Improving Food Access in East Cleveland• Quality of Life Survey (E.C. Master

Plan)– Over 50% of residents reported that they

grocery shop outside of E.C. (before Tops moved out)

• Community Food Assessment of 2008– E.C.’s score is 4.5 (any score over 1.0 puts

residents at higher risk for obesity)– 7th worst in the county (county average 2.5)

• Health and Development surveys– Most were unhappy with grocery store

options in E.C.– Solutions included adding a grocery store,

community gardens, and improving the Coit Road Market

Priorities identified

• Assist to develop community gardens

• Assist Coit Road Market with EBT program

• Explore the possibilities for a new grocery store with County Dept of Development

• Promote additional programs (City Fresh, other Huron programs, School Nutrition programs etc)

Gardening and Nutrition committee• Community Gardens - Policy• Coit Road Farmers’ Market• City Fresh East Cleveland• School nutrition programming

Vacant lot at Coit Road Farmer’s Market – Feb ’07

Composting workshop at E.C. Grows

Community Gardening• Currently 8 community gardens in

East Cleveland• 6 gardens in 2009• 3 gardens in 2008• 1 garden in 2007

Community Gardening impacts Nutrition• Increase fruit and vegetable

consumption• Children who participate in gardening

are more likely to eat more vegetables than their peers

• Improved nutritional content of produce • 95% of community gardens share their

produce with neighbors, shut-ins, food pantries, etc. to spread the healthy harvest

• In Cuyahoga County, community gardeners consume more than the 5 a Day recommended

Coit Road Market

• Electronic Benefits Transfer program – infrastructure grant provided in 2008 (fall)

• More promotions for EBT conducted in 2009

• Sales for EBT for 2009 = $2500• Also accept WIC and Senior

Farmer’s Market voucher programs

Huron/School Nutrition Programs• City Fresh East Cleveland

– Started in 2007 (90% staff)– 2009 (90% community residents)– Average of 35 shares per week

• Schools – ODE Fruit and Veggie grant recipient– Consideration for Farm to School– Consideration for Community

Supported Agriculture (coordinate for families)

Questions?

Developed land 1948

Developed land 2008