Abstract
Communities, professionals, and researchers recognize that environmental factors contribute to the health inequities experienced by vulnerable populations in the U.S. These environmental health injustices persist despite well-developed systems for both public health and environmental protection. The root cause of these issues is often "siloed" decision-making by separate health and environmental institutions. Health Impact Assessment (HIA) can be an important tool for bridging these silos to promote health equity at the local level. This raises the question: how can external resources best support local initiatives? This paper examines the interaction between national, state, and non-governmental efforts to promote HIA and local actions to promote healthy and equitable built environment in Duluth, MN. A wide range of local activities in Duluth aimed to alter the long term trends, decision processes, and institutions shaping its built environment. These included integrating health in brownfield redevelopment, local land use plans, food access, and transportation decisions. Technical and financial support from external groups played a key role in developing the community's capacity to promote health equity across public, private, and non-profit organizations. These multiple streams of action culminated in the mayor's declaration in 2016 that health and fairness would be adopted as key goals of the city's new Comprehensive Plan. How did such innovative efforts thrive in a small, post-industrial city with limited resources? Duluth's experiences provide insight into how external governmental, funding, academic, and non-profit entities can more effectively, efficiently, and equitably support the evolution of local initiatives.
Highlights
In her first State of the City address in March 2016, Mayor Emily Larson referenced the 11 year life expectancy disparity between adjacent zip codes in Duluth, and commented that “our right to a good and healthy life should not be determined by our zip code, or our income, education, race, gender or religion...My vision is of a healthy – prosperous – sustainable – fair – and inclusive community” (Larson, 2016)
This work evolved through a complex interplay of external resources and local activities that developed capacity in Health Impact Assessment (HIA)
The literature is rich with examples of communities where initial efforts at Health Impact Assessment evolved into broader adoption of Health in All Policies (Collins & Kaplan, 2009) (Armijo et al, 2019; Calloway, 2019; Rudolph et al, 2013)
Summary
Community groups, public health professionals, and city staff have engaged in a wide range of “policy, systems, and environmental” (PSE) change efforts to promote health equity (Honeycutt et al, 2015) This “Healthy Duluth” work has included several Health Impact Assessments, brownfields redevelopment, transportation planning, and a comprehensive plan update. The HDAC organized a series of activities to highlight the potential for promoting health equity in the built environment Some of these events were inspired by similar efforts in other cities, and supported by local financial and staff resources. The robust network of community and government groups fostered by these activities increasingly integrated health equity considerations throughout their work, notably in the area of transportation planning Despite this highly evolved ecosystem for considering health in a wide range of decisions, these efforts remain decentralized and vulnerable to loss of staff and technical capacity developed through past experience. These ideas have clearly been taken up by the city leadership, as evidenced by Mayor Larson’s declaration that health and fairness would be key goals in Duluth’s 2016 comprehensive planning process (Larson, 2016)
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