Oklahoma APA ConferenceSeptember 26, 2016

Re-Integrating Design, Planning, and Public Health

Shawn Schaefer, Michael Birkes, and Amanda Yamaguchi

2009 SOCM Summer Institute Anchoring Lecture

Origins

OU College of Architecture, Dean Charles Graham

Center for Health Systems and Design

Envisioning a Healthy Community

Tulsa Comprehensive Plan

Wayman Tisdale Specialty Clinic

Origins:Pilot Project

OU and Texas A+M Students during site visit

OUUDS Students leading public workshop

Community Leader, Kathy Hinkle

Street Views

Northland Town Center - Aerial View Piazza in Town Center

Students present the Northland Plan toTulsa Mayor Dewey Bartlett at the NorthstarNeighborhood Block Party in July 2011

• Opening of OU Wayman Tisdale Clinic

• City of Tulsa completes and adopts 36th

Street North Corridor Plan

• $5 million for land acquisitions and infrastructure from Improve Our Tulsa

• $3.25 million for Street Improvements

• Alfresco Community Development Corporation announces plans for major mixed-use development

• Re-branding effort by neighborhood leaders leads to the forming of the Phoenix District

Outcomes

Squatter Space at the Tisdale Clinic

SquattingOnly environmental design studio located at a working health clinic

Community Meeting on Cycling in the City

• overcrowding

• sanitation and hygiene

• infectious diseases

Dr. John Snow and his London cholera epidemic map.

From How the Other Half Lives by Jacob Riis.

Origins

Current Issues

Air Pollution

Social Isolation Car Crashes

Obesity

Robert Wood Johnson Foundation

Health Outcomes

Our Mission

Bring together design, planning, and medical professionals to improve community health by better environmental design of buildings, neighborhoods and cities.

Graduate Class on Public Health and the Built Environment

Spring 2014, 2015, and 2016 Students:

• Urban Design• Physical Therapy• Library and Information Science• Public Administration• Public Health

Format:

• Guest Speaker: Topic of the Week

• Discussion

• Team Project

Graduate Class on Public Health and the Built Environment

• Teams are formed combining Urban Design Student with students from Health Disciplines

• Students Identify a Relevant Community Issue for a Semester Project

• Attempt HIA and/or Urban Design Problem

Graduate Class on Public Health and the Built Environment

• Assesses plans, projects, programs or policies BEFORE implementation– Predicts the health impacts of implementation– Makes recommendations to support implementation of

improved health impact• Used both for protection (evaluate hazards) and for

promotion (wellness)• Broad or tight focus

– Increased physical activity vs. occurrence of ER visits due to asthma events

Health Impact Assessment (HIA)

• Screening• Scoping• Assessment• Recommendations• Reporting and

Dissemination• Evaluation• Monitoring

Steps of an HIA

Riders say new bus system leaves elderly behind – KJRH News

OU-Tulsa Students Reviewing Bus Route Changes’ Health Effects – Tulsa World

Tulsa BRT Plan Impact on Inhofe Plaza Residents

Kelly Cook, Michael Detter and Jessica Shelton: May 1, 2014

BRT Route Map

PROPOSED BUS STOP NEAREST TO INHOFE PLAZA

76.08 Census Tract: General Info

• 61st to 71st, Riverside to Peoria

• Population: 2,133

• Mostly Apartment Buildings

• 88.1% Renters

INHOFE PLAZA

76.08 Census Tract: Poverty

• 34.5% of residents are below poverty level• In 2012, $23,283 for family of four or

$11,945 for individual under 65

• Median income in census tract 76.08: $22,872

• 31.3% of households: No workers in last 12 months

• 38.8% of households: 1 person working

• 29.9% of households: 2 or more working

INHOFE PLAZA

76.08 Census Tract: Health

• 55% are 65 and older• 55% of those 65 and older

have ambulatory problems

• 6.4% are disabled

• 5.8% have vision difficulty

• 3.3% have ambulatory problems

INHOFE PLAZA

Site Overview

Building Footprint

INHOFEPLAZA

Parking and Access

INHOFEPLAZA

Sidewalks

INHOFEPLAZA

Bus Stops

INHOFEPLAZA

Barriers

INHOFEPLAZA

Site Analysis – Perimeter

INHOFE PLAZA

66TH PLACE

SOUTH PEORIA

66th Place and Peoria, looking northwest

Site Analysis – Perimeter

South Entrance on 66th Place

BUS STOP NEAR SOUTH ENTRANCE

Site Analysis – Perimeter

East 66th Place , looking East toward Peoria

NO SHOULDER

DANGEROUS DITCH

NO SIDEWALK

Site Analysis – Perimeter

Newport Ave. Northwest Entrance

TULSA TRANSIT LIFT SERVICE

Wheelchair Perspective Video

Inhofe Plaza Resident Profile• 149 units, mostly singles• Must be 62 or older or have a physical or mental

disability• 80 percent don’t own cars

• ~70-80% ride Tulsa Transit• Many use Tulsa Transit Lift service

• To qualify for public housing from Tulsa Housing Authority (THA), a household must earn equal to or less than the following:

Household Size Income Limit

1 $33,850

2 $38,650

• Estimates by Inhofe management • No medical data available due to HIPPA

regulations• 33-50% use a walker• 30% use wheeled mobility

• Very few have power chairs• 20% have automobiles

• 70-80% use the 105 and/or The Lift

Mobility of Inhofe Plaza Residents

Total Census Tract: 55% have ambulatory difficulty

Functional Mobility ScaleInhofe Plaza door to current bus stop = 415 feetHousehold ambulators

– 0 – 0.4 mph– Range ~ 16 feet

Limited community ambulators– 0.4 – 1.8 mph – Range ~ 165 feet

Community ambulators– 1.8 – 3.0 mph– Range ~ 1,600 feet– Goal for physical therapy ~65 ft.

Cross street and normal walking speed– 3.0 mph +

High fall risk

Brown et al., 2010

Fall Risk of Elderly• Elderly at a greater fall risk

– Medication– Impaired mobility and gait– Psychological factors– Nutritional deficiencies– Visual impairments– Foot problems– Inappropriate assistive devices

• 30% over 65 fall each year• 20-30% of fallers suffer injuries that reduce mobility and

independence

World Health Organization, 2004

Metabolic Equivalent (MET) Levels• 1 MET (3.5 ml O2 / minute)

Sitting at rest• 2.5 METS

Walking 2 mph• 4 METS

Walking at 3 mph• Top end of a “Limited Community Ambulator”:

1.8 mph• METS are calculated for a 70 kg person

Sidney & Blumchen, 1990Fritz & Lusardi, 2009

Significance• Ambulation with a walker

– Standard walker • 212% greater O2 demand per meter• 200% greater heart rate

– Wheeled walker• 104% greater O2 demand per meter• 98% greater heart rate

• Powering a wheelchair– 6 METS energy equivalent

Foley, Prax, Cromwell, & Boone (1996)

Significance• .25 mile walk for able-bodied person

– 5 minutes at 3 mph– 4 METS– 14 ml O2 / minute (1 MET=3.5 ml O2/min)– 70 ml O2 (4 METS x 5 minutes x 3.5 ml O2/min)

• Same distance with a walker – 8.3 minutes at 1.8 mph– 3.5 ml O2 /min x 4 METs x 8.3 min x 212%– 246 ml O2

• Same exertion level for able-bodied person as– Running 9.3 mph (2:48 marathon pace) - MET level 14 – Backpacking 6 mph with a 44 lb load up a 5% grade - MET level 13

Sidney & Blumchen, 1990

Dangers of Walking to Bus Stop• No sidewalk next to driveway; residents must walk or

maneuver wheelchairs or walkers on driveway near traffic• No sidewalk or shoulder on 66th Place; residents must walk or

maneuver wheelchairs or walkers on the street near traffic to reach Peoria

• Deep bar ditch on north side of 66th Place • Sidewalk along Peoria is in poor condition• Crossing infrastructure (preferably with lights) needed to

allow safe crossing to east side of Peoria at 66th Place (possible location of future BRT station)

Possible Solutions

Solution 1: Stick with Current Plan Execute current BRT plan as written, eliminating Route 105 bus stop next to Inhofe Plaza driveway at 66th Street. No improvements to infrastructure. Remove section of driveway speed bumps for easier pedestrian and wheeled access.

Pros:• Plan is already funded• BRT route is more efficient; buses run faster• Possible safe crossing infrastructure included in BRT Plan?

Cons:• Inhofe Plaza residents have to travel to Peoria on foot, a potentially

dangerous journey due to lack of sidewalk infrastructure• Residents who are unable or unwilling to walk to Peoria would

need to use the Lift system– Increased cost for fixed-income riders– Increased cost for Tulsa Transit

Solution 2: Keep Inhofe Plaza Loop

INHOFEPLAZA

Solution 2: Keep Inhofe Plaza LoopInclude Inhofe Plaza bus stop loop in BRT plan. Remove section of driveway speed bumps for easier pedestrian and wheeled access.

Pros:– Inhofe Plaza residents continue to board buses close to home,

eliminating the potentially dangerous walk to Peoria Avenue– Increases regular bus ridership; maintains Lift ridership– Other mobility-impaired residents would benefit from a bus stop

close to homeCons:

– BRT route is less efficient; buses run slower– Slippery slope: Opens the door to other potential route diversions– Increased bus traffic on neighborhood streets

Solution 3: Sidewalks to Peoria

INHOFEPLAZA

Solution 3: Sidewalks to Peoria• Build sidewalk from front door of Inhofe Plaza along driveway to 66th Street• Build sidewalk from 66th Street to Peoria

Pros: – Safer route to the bus stop that doesn’t require walking on the street,

other than potential crossing of 66th Street– Improving sidewalk infrastructure of neighborhood would encourage

people to walk more and be healthierCons:– North side of 66th expensive due to bar ditch; south side requires two

additional street crossings– Sidewalk along 66th Street involves work inside right-of-way, making it

more difficult to implement– Limited funding from THA for property sidewalk improvements– More expensive due to enhanced crossing on Peoria

Solution 4: East EntranceThrough Shopping Center

INHOFEPLAZA

Solution 4: East Entrance Through Shopping Center

• Install passage through east fence line, allowing safer pedestrian travel through shopping center to Peoria Avenue

– Pros:• Shorter distance to Peoria Avenue• Doesn’t require walking on busy street• Affordable compared to 66th Street sidewalk option

– Cons:• Limited funding availability from Tulsa Housing Authority to build

sidewalk infrastructure• Acquiring pedestrian easement from shopping center property owner

may be difficult due to fear of liability• More expensive due to enhanced crossing on Peoria

SUMMARY MATRIX

Solution 1: Stick With

Current Plan

Solution 2:Keep Inhofe Plaza Loop

Solution 3: Sidewalks to Peoria

Solution 4: East Entrance

ThroughShopping Center

Ease to Residents • •••• •• ••

Expense •••• •• • •••

Implementation Difficulty •••• ••• • •

Pedestrian Safety • •••• •• •••• Least Favorable •••• Most Favorable

Summary Matrix

• Revive – Housing Violations

• Tobacco Outlet Study

• Missed Appointments

Research Studies

OutreachPanels and workshops for the public with information and methods to help them improve themselves and their environments for better health and well-being.

Panelists Jacki Lentz from the Alzheimers’ Association; Mary Isaacson Ph.D., Professor of Occupational Therapy, OU College of Allied Health; Gina Sides RN, Memory Center Supervising Nurse, Saint Simeon’s Episcopal Home; Julie Lackey ASID, Interior Designer, Matrix AEP; and Connie McFarland FAIA, Principal, McFarland Architects discuss designing for dementia with Moderator, Michael Birkes, AIA.

Topics of Past Programs:

• Designing for Alzheimer’s and Dementia• Tulsa’s Air Quality• Early Childhood Environments• Food Access and Food Security• Cycling as Active Transportation• Tulsa Water Quality and Chloramines• Mindfulness and Stress Reduction• Coping with Chronic Diseases• Pedestrian Safety and Street Design• Tulsa’s New Refuse Disposal System• Storm Shelters for Schools• Housing for Persons with Mental Health

Problems• The Effects of Color on Health

OKC Juvenile Justice Center Library

Design Charrette with Interior Design Students

Group 1 Group 2

Results

Shelves under construction

A CHED-centric Professional Project

Project Goals

Methodology

Slow Traffic on Major Streets

Create Safe Street Crossings

Promote the Walking School Bus

Increase Neighborhood Safety

Increase Sense of Community

• Choose the right team• Involve the residents• Partner with community organizations

Lessons Learned

TeamworkFaculty

Michael Birkes, AIA, Professor of Practice, CHED CoordinatorShawn Schaefer, Urban DesignShowa Omabegho, Ph.D., Regional and City PlanningKen Randall, Ph.D., Physical TherapyMary Williams, Ph.D., Public HealthMia Kile, Hillary Fulton, Hepi Wachter, Ph.D., Interior DesignDave Boeck, AIA, ArchitectureJanette Habashi, Ph.D., Human RelationsNancy Braun, Pharm.D, PharmacyRic Munoz, JD, Julie Miller-Cribbs, Ph.D., Social WorkCecy Brown, Ph.D., Library and Information ScienceMark Fox, MD, Ph.D., Paul Benson, MD, Community MedicineApril Merrill, JD, Alizay Paracha, Project REVIVEApril Schwiekhard, Toni Hoberecht, Lynn Yeager, OU-Tulsa Library

Graduate StudentsAlexis Shahadi, Jason Hainline, Larry Curtis, Meagan Vandecar, Mthabisi Masilela, Glena Wildermuth, Kurt D’Amour, Salma Al Nairab, Michelle Simmons, Aminmahmoud Irani, Paula Thomas, Travis Eslick, Marcae’ Hilton, Jose Villalva, Rebecca Brewster, Jessica Brent, Laura Mauck, Nha Huynh, Liz Amos, Amanda Yamaguchi, Megan Donald, Andy Taylor, Kendall Craft, Lacey Howard, Emily Reed, Kate Wallace, Kolton Barnes, Mike Detter, Kristi Kmetz, Nathan Foster, Curtis Blevins, Ashtin Hoverman, Jessica Shelton, Maryam Moradian, Amanda Bentley, Paulina Baeza

TeamworkCommunity Partners

George Mann, Ph.D., Joe McGraw, Texas A+M Center for Health Systems and DesignRichard Jackson, MD, UCLA School of Public HealthJack Rankin , Arthur Kennedy, Skiatook Family ClinicJim Walker, David Grewe, Dejon Knapp, Youth Services of TulsaJan Creveling, Genie Shannon, Site Coordinators, Tulsa Area Community Schools Initiative Joani Dotson, Lynnsey Childress, Pam Raske, Tulsa Health DepartmentKathy Dodd, Ed.D, Elementary School Principals, Union Public SchoolsReverend Ron Robinson, A Third PlaceScott Swearingen, Penni Shelton, Tulsa Farmers’ MarketThomas Boxley, Tisdale ClinicTracie Chandler, Phoenix DistrictDawn Warrick, Martha Schultz, City of TulsaScott Robinson, R.L. Shears CompanyRen Barger, Tulsa HubJames Wagner, INCOG

In Memorium, Sharon Hanson

• Recognition as a University Strategic Organization: CHEDc

• External Research Funding

• Recruit and Hire Staff

• Strengthen and Expand Partnerships

• School of Community Medicine• Tulsa Health Department• Local Governments• Tulsa Area Community Schools Initiative• Hospitals and Clinics

Next Steps

Contact us!We are always looking for ideas, projects, community partners, students and collaborators.

https://www.facebook.com/CHEDstudio

email: sschaefer@ou.edu

urban design studio website:http://tulsagrad.ou.edu/studio