Bridging the Gap Between UrbanHealth and Urban Planning 19

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Chapter 19

Bridging the Gap Between Urban Health and Urban Planning

Marlon G. Boarnet and Lois M. Takahashi

1.0. INTRODUCTION

There is an increasing recognition by health researchers and practitioners that the built environment, land use, and development patterns have a significant role to play in morbidity and mortality in communities across the U.S. While there has been an expanding number of studies by researchers in public health and urban planning that examine the relationship between health and development patterns, built form, and land use regulation, this remains a relatively under-explored topic both by urban planners and urban/public health researchers. This chapter attempts to bridge the divide between the urban health and urban planning disciplines by describing urban planning approaches to urban health, and working to develop a common language with which to approach urban health issues. We posit in this chapter that the nexus between urban health and urban planning provides an opportunity for interdisciplinary innovation to clarify the complexities charac- terizing urban health, and offers opportunities for developing comprehensive and multidimensional solutions to contemporary urban health issues.

In our attempts to bridge this disciplinary divide, the chapter proceeds in the following manner. First, we provide an overview of the primary urban planning approaches to urban issues, highlighting the major conceptual notions that might be relevant to urban health. Following this, we identify studies in urban planning that exemplify the interdisciplinary nature of methods and analysis. Next, we move to the methodological challenges in using urban planning approaches to study urban health, particularly in terms of accommodating distinct conceptual approaches and methodological techniques. Finally, we conclude the chapter by summarizing the major points, and pointing to ways forward in developing an urban health/urban planning research agenda.

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2.0. WHAT IS URBAN PLANNING?

Urban planning, also referred to as city planning, is an applied, multi- and interdisciplinary field that is concerned with the interaction between populations and the environments in which they live. Urban planners are employed in a variety of sectors (public, private, and nonprofit/community based), and their tasks include the preservation of historic districts in downtown areas, the development of legislation that guarantees the reduction of environmental hazards in communities of color, and the creation of strategies to reduce intergovernmental conflict among federal, state, and local government agencies. With this wide range of sectors, tasks, and objectives, the field of urban planning has had to engage conceptual approaches and analytical methods from multiple disciplines, most predominantly economics, architecture, geography, and law. What urban planners have in common across these sectors, tasks, and objectives is the notion that they “use their skills to find solutions to community problems in ways that will carry the community toward its desired long-term goals” (AICP, 2004). The “community” is broadly defined and may refer to nations, states, regions, cities, or neighborhoods. In fact, urban planners work at many of these scales to attempt to address in comprehensive ways the complex challenges that arise from urbanization, economic and population growth and decline, and increasing diversity across multiple dimensions of social life.

One way to understand urban planning from an urban health perspective is to redefine urban health using planning terminology. There are various themes that are used by planners to describe planning objectives and strategies. Five primary themes guide much of what urban planners do especially with respect to issues important to urban health: (1) economic development, (2) urban design, (3) equity and social justice, (4) governance and institutional management, and (5) sustainability (Table 1).

2.1. Economic Development Planning

The first theme that guides a great deal of urban planning is economic development. Broadly defined, this theme includes transportation, housing, and community economic development, and is primarily concerned with the economic vitality of communities, cities, counties, regions, and states. From an urban health perspective, on the one hand, an economic development strategy for investigating urban health might consist of linking urban health disparities with maldistributions of wealth and concentrations of poverty in places and populations. This is relevant for the large public health literature on health disparities that shows that poor and minority populations typically are at greater risk of morbidity and mortality (e.g.

CDC, 2004). Economic development planning seeks to address the sources of disparities in income and access to resources. Urban planners have often argued that uneven distributions of wealth and poverty stem from global economic shifts.

Global economic restructuring has created an expanding service sector providing a growing number of low-wage, temporary and contractual, and limited benefits jobs (Law and Wolch, 1991). The contraction in income-earning opportunities condi- tioned by global economic shifts has consequently led to greater competitiveness for fewer jobs and less-well-paid employment in a context of instability and uncer- tainty. To cope with the fallout of global economic restructuring, urban health researchers and practitioners might look to economic development strategies

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Table 1.Urban Planning Approaches and Foci ApproachEconomic developmentUrban designEquity and social justiceGovernance and Sustainability institutional management Focus•Uneven distributions of •Design of buildings, parks, •Socially, politically, and •Impact of privatization, •Protect and expand wealth and poverty and streets to promote economically disadvantaged increasing emphasis on greenspace, parks, exacerbated by health and reduce diseasecommunitiesvoluntarism and nonprofit habitat for endangered globalizationsectors for service deliveryspecies •Generating wealth for •Role of locations of built •Empowerment for greater •Cooperation,•Short and longer term individuals and houseform elements in steering participation in decisions collaboration, and conflict planning for land use to holds to improve urban individual and population about health funding, among governmental and effectively manage healthbehaviorprograms, and outcomesnon-governmental agenciesnatural resources (water forests)

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coupled with health programs to develop approaches that deal with one of the pre- sumed underlying sources of urban health disparities, that is, economic inequality.

On the other hand, an economic development perspective might focus on ways to increase wealth and opportunities through economic growth and individual/household wealth generation. From this perspective, urban health initiatives might focus on human capital (education and skills building for enhancing wage earning potential), social capital (building trust and reciprocity in communities to leverage existing local tangible and intangible resources), and business development (expanding the number of small businesses and health care agencies through micro-credit and loan programs, mentoring, and tax incentives).

Economic development strategies would focus on the urban health dimensions of transportation (e.g., enhancing transit and automobile access, and addressing the deleterious effects of traffic congestion), housing (e.g., working for more and better quality affordable housing), and community economic development (e.g., expanding economic opportunities in local communities experiencing marginal income earning capacity or relatively low rates of economic growth).

2.2. Urban Design

Urban design comprises an important theme that guides urban planning research and practice, linking physical structures, (what planners refer to as built form), with social environments. Urban design has become a primary emphasis for public health researchers interested in the role of land use and development patterns in obesity and rates of physical activity (Handy, et al., 2002). In terms of urban health, the design of buildings, parks, and streets (e.g., sidewalks, streetscapes, bus stops), the location of these elements, and the interaction between people and these built environment elements influence, though they do not determine, the ways that individuals behave and interact with one another. Planners use urban design elements (e.g., building facades, street signage, lighting, landscaping) to encourage and facilitate economic activity (through e.g., farmers markets and street cafes), civic action (through e.g., areas for social gatherings), and physical activity (through e.g., walking paths), as well as to curb undesirable or unhealthy behaviour, such as property and violent crime (through e.g., expanded and enhanced street lighting schemes) and pedestrian/bicyclist injuries/death (through e.g., street lights, speed bumps, and street alignments), or to cope with chronic illnesses such as dementia (through e.g., room and building design). For more examples, please see Loukaitou-Sideris, (1999), and Cohen and Day, (1993).

To promote physical health, at the regional scale, some have advocated for the co-location of transit, homes, businesses, and shopping opportunities, falling under the broad rubric of “new urbanism” to encourage walking, discourage driving, and increase opportunities for social interaction (Duany and Plater-Zyberk, 1991).

There has been a proliferation of studies that have examined the relationship among urban design, development patterns, and physical activity (e.g. Handy, et al., 2002 or Northridge and Sclar, 2003). For example, The National Research Council recently convened a committee of transportation, land use, and public health scholars to study this topic.

At the local level, urban planners have long been interested in urban park design and location, and the influence of design and location on park use. Such studies also build on the beliefs that the built environment (its design and location) frame, though does not determine, individual, household, and community behav-

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iour, and consequently, can motivate or constrain civic action ( Jacobs, 1961). As a consequence of such beliefs, planners strive to improve, enhance, and expand public spaces and places. In a recent commentary, Banerjee (2001) recommended to planners that they advocate for parks and open space, and support grassroots initiatives, that they facilitate creative solutions by acting as mediators among public, private, and nonprofit groups, that they focus on “reinventing” deteriorating areas, including malls and downtowns, that they support the development of businesses that facilitate conviviality in public life through cultural experiences, that the design of streets and sidewalks are seen as important public spaces for interaction, and that they respond to increasing racial/ethnic diversity, including rapidly expanding immigrant populations.

A related area of longstanding interest within planning is housing – a topic that can be grouped within either urban design or economic development planning.

Planning efforts to improve housing include U.S. government programs that in past decades funded the building of public housing and, more recently, subsidies made available to low income renters. At the local level, many planners work on efforts to ensure that housing is affordable for low and moderate income persons – an especially pressing issue in urban areas with high housing costs. Research has shown that there are links between the quality of the housing stock and both physical and men- tal health. See, e.g., Bonnefoy, et al., (2003) for evidence on housing quality and physical health, and the reviews in Evans, Walls, and Moch (2003) and Evans (2003) for a discussion of the link between housing characteristics and mental health. For example, high rise living is associated with reduced psychological well being in some settings (Evans, Walls, and Hoch, 2003; Evans, 2003). Planning approaches to public housing in the generation after World War II included a large role for high- rise dwellings, with little initial attention to possible adverse mental health impacts on residents, illustrating the need for stronger links between urban health and planning.

2.3. Equity and Social Justice in Planning

Equity and social justice constitutes another primary theme that guides planning practice and urban health. In terms of urban health, an equity and social justice perspective guiding urban planning research and practice would build on the health disparities approach to prioritize improved and expanded health care services to those individuals and populations experiencing the worst health outcomes and who are least able to pay for services, for example, low-income, elderly, racial/ethnic minority, and immigrant households. Such groups often reside in central cities (with aging housing, services, and infrastructure), but many also live in older and newer suburbs (geographically isolated from health care services). From this perspective, urban planning research and practice is “applied, action oriented, problem-solving, . . . particularly concerned with socially, economically and politically disadvantaged populations” and “seeks to promote social justice through such activities as critical analyses of the distribution costs and benefits of public policies and the development of institutions that empower people at the grassroots” (UCLA Department of Urban Planning, 2004).

As with work in economic development planning, planners’ efforts related to equity and social justice have much to offer urban health scholars and practitioners interested in health disparities across income groups, racial or ethnic groups, or persons with differing access to health services. Planners who seek to work in equity

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and social justice issues have increasingly recognized that the power relations inherent in the design and exercise of planning for decision -making must be addressed.

The nature of credible and legitimate knowledge for example in defining the nature of problems and their appropriate solutions require critical self-reflection on the part of planners. Planners have advocated varying ways to accomplish this very problematic task, including code switching, participatory planning, and grassroots mobilization. (Classic works on participatory or advocacy planning include Arnstein (1969) and Davidoff (1965).) Code switching (or changing the codes and interpretation when moving from one language to another, or from one cultural context to another), a relatively new and innovative approach, requires that planners and urban health researchers and professionals, immerse themselves in alternative ways of thinking (e.g., non-Western knowledge bases, cultural knowledge that is recorded through oral histories) (Umemoto, 2001). A more classic approach used by planners is participatory planning, also referred to in urban planning as advo- cacy planning. This approach, drawn from 1960s critique in urban planning of modernist rational planning models and practices, may aim in its most minimal incarnation at greater input from local residents and communities and at its most empowering, the redistribution of power to disadvantaged households and communities. Such planning typically involves designing decision-making processes that incorporate residents and community stakeholders from the definition of problems through to implementation of programs. Finally, a third alternative is to mobilize par- ticipation in grassroots actions alongside communities fighting for better wages and health benefits, better quality housing, better schools, and better living conditions.

However, this final alternative highlights the tension between the professionaliza- tion of planning practice and research (which encourages a social and spatial distance from populations and places being studied), and the need to bridge divides to authentically understand the plight and struggle of marginalized populations.

2.4. Governance and Institutional Management

The fourth prevailing theme among planners that is relevant for urban health is governance and institutional management.

2.4.1. Governance

Governance refers in general to the idea that governing in many places and at many scales has moved from predominantly public sector government policies and methods, to mechanisms that feature a greater reliance on the nonprofit/charitable sectors, on the voluntary sector, and on individuals and communities for providing and sustaining social and community programs. There has been for example in the U.S.

at the local level more reliance on parents to provide time and material resources for schools, greater dependence on the nonprofit sector to develop and sustain urban health programs, and shrinking public sector funds to support what were once programs and services comprising a societal safety net (Takahashi, 1996).

Such increasing privatization of health and welfare programs has impacts on fami- lies and households, as the demands of employment, family/households, and individual needs especially for low-income households mean daily trade-offs that often force individuals and communities to choose between a set of necessary needs (Roy, et al., 2004). For urban planners, a governance perspective has meant a growing focus on the nonprofit/non-governmental sector, where organizations, communi-

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ties, and individuals have strived to fill the gaps created by a retreating public sector, but also have increasingly become important actors in the development and enforcement of regulations. That is, non-governmental agencies, for example, health care organizations, foundations, and community-based organizations, have both experienced an expanding presence in service delivery, but also a growing influence in designing and enforcing regulations as they have become an important sector in health care design and delivery (Wolch, 1990).

These trends, referred to by urban planners as welfare state restructuring, have highlighted the political disagreements over the purpose and appropriate degree of intervention by public sector agencies. In general, the welfare state, most simply defined as the set of government agencies and institutions charged with using public resources for managing social welfare, has moved from the philosophy of striving for egalitarian social and economic conditions (through state centered programs and policies such as the New Deal) to a minimalist approach, particularly since the 1980s, promoting a minimum level of state intervention for social welfare or social programs aimed primarily at economic stability and social control (Gilbert, 1983).

Welfare state restructuring, most notably initiated during the Reagan administra- tion, consisted of narrowing eligibility requirements for using publicly funded and provided programs, shifting policy responsibility to state/local governments (called “new federalism”) or more recently to non-governmental and community- based organizations (both faith-based and secular) and greater reliance on private sector mechanisms (privatization) (Palmer and Sawhill, 1982; Le Grand and Robinson, 1984).

What are the implications of welfare state restructuring for urban health? The shifting governance of the hospital system may provide clues to the future governance issues in urban health. Prior to the 20^thcentury, hospitals were dependent on philanthropic capital, and with fluctuations in the growing industrial economy, such as economic downturns, donations correspondingly fluctuated (Bohland and Knox, 1989). Just as significant perhaps, philanthropists, because of their vital finan- cial contributions, had important policy and governance roles in the operation of hospitals. In the 21^stcentury, hospitals have had to cope with changing objectives to minimize treatment costs and maximize profits (McLafferty, 1989). Treatment decisions for private physical and mental health care providers are increasingly defined by the workplace, characterized by “the ability to pay for services and the need to have work-based insurance coverage” (Smith, 1989). While this is clearly a complex issue, what is important here is that the lens of governance provides a critical component to understanding urban health care systems and the obstacles and opportunities to addressing urban health.

2.4.2. Institutional Management

Institutional management refers to the challenges and opportunities inherent in the intra- and inter-organizational relationships that often define urban health care delivery. In the field of urban health, these would include the geographic placement of health care services and the institutional relationships within and across hospitals, clinics, and health care providers in a metropolitan area. Preventive health services, including health departments, community based advocacy and education organizations, and sewer authorities, sanitation districts, and vector control agencies are also vital parts of the urban health institutional framework. Here we discuss how urban health institutions might interact with urban planning institutions.

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From an urban planning perspective, there are three primary organizational relationships that define intra- and inter-organizational relationships that apply to urban health agencies and researchers dealing with other agencies or organiza- tions: cooperation, collaboration, and conflict (following Gaber, 1996). The first type of response, cooperation, is more reactive, and would for example occur when urban health professionals provided information when requested and insulation from urban design, economic development, or other urban planning researchers, practitioners, or policy makers. Cooperation might also be the response from urban planning agencies or researchers when approached by urban health professionals or scholars. The second type of behaviour, collaboration, entails a more proactive approach, for example, urban health professionals initiating conversations and then working with urban planning agencies to develop standardized procedures and data reporting methods across health and urban planning agencies and organizations, developing clear and formalized organizational connections among agen- cies, and outlining conflict resolution strategies. The third type of strategy, conflict, would also constitute a proactive stance, but opposite that of collaboration. With a conflict-centered strategy, urban health agencies would fight to maintain their autonomy and separation from decisions that steer urban design, economic development, or other perceived planning domains, and cooperate only when absolutely mandated to do so by law, regulation, or legislation. The same could be true for urban planning agencies when urban health policies or mandates breach what planners consider to be their political territory.

Though collaboration seems like the most desirable approach to take when thinking about bridging the divide between urban health and urban planning, there are also costs to consider when undertaking such a strategy. While collaboration offers the potential to leverage scarce resources, share information, and increase efficiency and effectiveness in service delivery, there are also significant challenges in designing and implementing such partnerships, including feeling of turf and territoriality, and difficulties in identifying and addressing differences in communications, organizational, and disciplinary styles and languages (Takahashi and Smutny, 2002).

2.5. Sustainability and Urban Planning

A final prevailing theme among planners is sustainability. Sustainability focuses on the whole of an urban environment, including resource usage, waste and pollution, economic conditions, the physical and mental health of residents, and the institutions, organizations, natural resources, income endowments, human capital, and social capital that influence all of those systems. Sustainability has taken on an increasingly important role as planners attempt to address the multi-faceted issues of environmental degradation and pollution, habitat regulation and protection, and environmental management in the context of economic growth/decline, urban design, equity and social justice, and governance. A sustainability approach might consist of for example encouraging reduction in water demand and the need for landfills through recycling and conservation, reducing air pollution through walking, bicycling, and use of public transit, and addressing the need for environmental justice across a myriad of environmental hazards and marginalized communities. The protection, development, and designation of greenspace, parks, and habitat for endangered species comprise primary activities within this approach.

But in addition to these issues, sustainability also encompasses the development of

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so-called brownfields and formerly toxic sites^*, the identification of uneven patterns of environmental risks and hazards that predominantly affect low-income neighbourhoods and communities of color (i.e., environmental disparities), the effective management of water and other natural resources, and the long-term planning of land development (including slow-growth and growth management policies, growth boundaries, and other strategies under the rubric of “smart growth”). What all these varied issues have in common is the keen recognition that growth and expansion cannot be sustained without a clear understanding of the environmental impacts of development, and that the conjoined relationship between development and environmental quality require that planning and, consequently urban health, require planning and program implementation that focuses on the longer term.

3.0. EXAMPLES OF URBAN PLANNING RESEARCH

In this section, we select studies by urban planners that illustrate the variety of ways that these various themes have been used. These studies by no means comprise a comprehensive literature review, but instead indicate possible means to bridge the divide between urban health and urban planning. Var ying methods were used in these studies, as are used throughout planning research. In this section, we aim to highlight not only the variation in substantive focus (as organized using the themes discussed in the previous section), but also strive to show the distinct methodological approaches used to examine these urban planning issues.

3.1. Historical Approaches

In an article entitled “From Racial Zoning to Community Empowerment: The Interstate Highway System and the black Community in Birmingham, Alabama,”

Connerly (2002) argues that the interstate highway system in one city sustained the racial boundaries erected in a 1920s zoning law, but in addition, that these same federal programs also led to racial change as black were forced to relocate. Using the conceptual themes we outlined earlier in this chapter, this article addresses economic development, equity and social justice, and governance and institutional management. The methods used in this study primarily center on a case study approach, using historical methods (an analysis of archival documents, maps, and zoning regulations), mapping of socio-demographic and highway system characteristics, and descriptive statistics of Census data. Using this historical and qualitative approach, Connerly finds that the highway system in Birmingham designed in the late 1950s and constructed in the early 1960s negatively impacted local black neighbourhoods, and local and state agencies “manipulated the interstate highway program to perpetuate neighbourhood racial segregation”. However, he also finds that

*Brownfields are older, often environmentally contaminated, land uses. These most commonly include industrial sites that pose health hazards to workers or nearby residents. More generally, brownfields refer to existing land uses that are being redeveloped – old or abandoned industrial or commercial sites, for example. While environmental contamination is not necessarily a feature of such sites, more lax environmental regulation and lower environmental awareness in decades past created circumstances that often link older land uses with contamination.

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this highway program also facilitated racial change in Birmingham because the black population was “forced to relocate to other neighbourhoods”, that advocates were very important in helping to protect civil rights, that grassroots mobilization was critical in efforts to lobby for services, and that these grassroots efforts exempli- fied a “long tradition of planning and self-determination in Birmingham’s black community that took place outside of and in competition with the white-dominated traditional planning structure found in the city’s planning department and housing authority”. Such a study highlights the need not only to analyze the role of federal programs in local decision making processes, and the need to monitor equity outcomes in seemingly disparate policy efforts (such as transportation), but also that even within highly disadvantaged communities, there are opportunities for mobilization and political action.

This study also highlights the ways in which planning mirrors contemporary social tensions and perceptions. Though transportation planners do not often see themselves as social change agents or purveyors of social control, Connerly’s study illustrates the ways in which urban planning policies and practices have direct con- sequences for urban health, oppression, and quality of life. As various planning scholars have argued, while urban planning as a profession has its foundation in reform movements, planning has also worked to protect private property, to maintain the status quo, and to protect existing relationships of power. For overviews on this issue, see Brooks (1988), Friedman (1987), or Beauregard (1989).

3.2. Interviews and Qualitative Approaches

Forsyth (2002), in an article entitled Planning Lessons From Three U.S. New Towns of the 1960s and 1970s: Irvine, Columbia, and The Woodlands, examined these three master- planned communities to determine the degree to which private sector experiments in design and development could effectively limit sprawl, support and enhance diversity, and facilitate sustainability. Using our urban planning themes, this study tackles the themes of economic development, urban design, equity and social justice, and sustainability. In this article, Forsyth uses a combination of interview data (140 interviews with developers, residents, and civic leaders, and 26 existing oral his- tory interviews), descriptive statistics of national (census) and local (density data, existing resident surveys) datasets, and an analysis of maps and aerial photographs.

She found that the three developments (Irvine, CA, Columbia, MD, and The Woodlands, TX) tended to meet smart growth goals for higher residential densities, but this higher density did not result in significantly higher use of public transit or reduced driving, that each of these communities tended to regulate the aesthetic quality of buildings and open space through the use of “architectural and land use covenants” that restrict the potential for altering or retrofitting these suburban landscapes,” creating “pleasant and functional” settings, and that most residents in these developments tended to be middle class, though there is ethnic and some income mix (due in part to “government sponsored affordable housing”). She con- cluded that while these development types are effective at preserving habitat, improving building aesthetics, and creating areas that support a high quality of life, they have been less successful at achieving social equity and sustainability. This study makes clear that urban design is critically important in understanding quality of life, but that smart growth and new urbanist approaches (e.g., higher residential densities, pedestrian friendly streetscapes) may not result in reduced driving specifically or environmental sustainability more generally.

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3.3. Quantitative Approaches

Boarnet and Crane (2001a; 2001b) used quantitative approaches to study the link between urban design and travel behaviour. They used detailed data on individual travel patterns for portions of Los Angeles, Orange, and San Diego counties in California. In various econometric models, Boarnet and Crane (2001a and 2001b) regressed the number of non-work car trips made by individuals on the individual’s sociodemographic characteristics (e.g. age, number of children, gender, and income) and measures of urban design near the individual’s home.*

This research combines the themes of economic development planning (as it relates to transportation), urban design, and sustainability. Boarnet and Crane’s focus was on testing the idea, popularized by the New Urbanism, that dense, mixed- use developments along grid-oriented street patterns can reduce automobile travel.

As part of the analysis, the authors developed measures of the grid-oriented character of the street network, population and employment densities, and proxies for land use mix, and used Geographic Information System (GIS) technology to match the values of those variables near each study subject’s residence to the travel data for that subject. Using those data, and testing various econometric models, Boarnet and Crane (2001a; 2001b) found generally weak evidence that urban design elements influence the number of non-work automobile trips made by an individual.

In extensions of that work, Boarnet and Greenwald (2001) applied the same regression specification to travel data for individuals in Portland, Oregon. While the authors obtained results similar to the southern California study of Boarnet and Crane (2001a; 2001b) – namely that urban design characteristics were only weakly related to the number of non-work automobile trips – Greenwald and Boarnet (2002) found stronger evidence that urban design is associated with the number of non-work walking trips made by an individual. This research, coupled with various other studies on walking and urban form (e.g. Handy and Clifton, 2001), highlight a link between urban planning and urban health through the possible promotion of environments that encourage increased physical activity.^†

3.4. Triangulation: Multiple Regression, Photographic Documentation, and Field Work/Participant Observation

An example of a study that uses multiple methods to assess a complex urban phe- nomenon is by Loukaitou-Sideris, et al., (2002), in an article entitled The Geography

*The urban design measures included population and employment densities, the fraction of land characterized by mixed use zoning (commercial and residential uses allowed on the same city block), and the amount of the nearby street network that was grid-oriented (as measured by four-way intersections) as opposed to curvilinear streets with cul-de-sacs and three-way or other non-gridded intersections.

†These finding might seem inconsistent, but part of that can be explained by the change in focus from non-work automobile travel in Boarnet and Crane (2001a; 2001b) and Boarent and Greenwald (2001) to a focus on non-work walking travel in Greenwald and Boarnet (2002). One interpretation is that urban design elements are more robustly linked to walking trips than to driving trips. For a similar interpretation, see Greenwald (2003). More generally, the planning literature on urban design and travel behavior has reched differing conclusions due, in part, to differences in the way urban design is measured and variations in how travel is measured, e.g. as either number of trips, distance traveled, or choice of travel mode across automobile, transit, walking, and bicycling. See the reviews of this literature in Boarnet and Crane (2001b) and Ewing and Cervero (2001).

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of Transit Crime: Documentation and Evaluation of Crime Incidence on and around the Green Line Stations in Los Angeles. The authors examined the link between the social and physical dimensions of the built environment in public transit stations (e.g.

light rail and underground) and surrounding neighborhoods, and crime. The conceptual themes of interest in this study were economic development, urban design, and equity and social justice.

Multiple methods were used in this study to ascertain the built environment’s role in explaining variations in crime at light rail stops. First, multiple regression is used to estimate the role of built environment elements on transit crime incidence using crime statistics, census and ridership data, and built environment attributes, such as the elements in and character of the stations (including proximity to park- and-ride lots and the existence of platforms) and surrounding neighborhoods (including land use patterns). Second, qualitative analysis in this study consisted of field work (including an environmental attribute inventory, that consisted of a standard list of physical elements that the authors have shown in previous work is associated with incidence of crime, such as fencing, visibility and lighting of station platforms, security hardware and equipment) and photographic documentation (to illustrate pictorially the types of built form elements that were associated with crime) and typology of transit station design. Finally, the study used mapping of environmental attributes to assess the spatial dimensions of crime and the built environment; this mapping included “adjoining land uses [to transit stations], the overall condition of the surrounding neighborhood, the concentration of undesirable places (e.g., bars, liquor stores, pawnshops, etc.), the visibility and lighting of platforms and park-and-rides, the flows of pedestrian and vehicular traffic, the degree of formal or informal station surveillance, the existence of fencing and security hardware and equipment at the station, the layout of the platform, and the type of linkages to the surrounding area.” Linkages here refer to physical connections between the stations and nearby neighbourhoods, including, for example, street connectors or pedestrian bridges (Loudaitou-Siderias, et al., 2002).

Using this multi-method approach, the authors found that in general crime rates and types (violent crimes against persons, or non-violent property based crimes) at stations were related to similar rates and types of crime in the surrounding neighbourhood. However, there were important specific connections between crime incidence at transit stations and the sociodemographic characteristics in the surrounding neighbourhood, the urban form characteristics of the surrounding neighbourhood, and transit station design. First, the regression and qualitative results indicated that “[c]rime at the [transit] platforms against people was strongly related to ridership – the busiest stations tended to concentrate the most serious crime” and that these crimes “(assaults, robberies) tended to happen primarily at the station platforms, elevators, and stairs” (Loukaitou-Sideris, et al., 2002).* The multivariate regression models used census data and data from the environmental attribute survey to estimate the influence of various factors on crime rates at light rail stations along with the Green Line. The photographs were used to illustrate sta-

*Although this might seem to be a counterintuitive result, that is, that busier station platforms were related to more crime, this may be related to the low overall crive rates at these light rail stations (1.55 crime incidents per 100 riders). Like Sampson and Raudenbush (1999), the authors find that the relationship between environmental conditions and crime is not a simple direct relationship, but do argue that there are urban design factors that can reduce crime, creating a “station environment whose physical attributes contribute to its better security”.

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tion and neighbourhood types. Second, non-violent and property focused crimes such as vandalism were associated with neighborhoods with higher density, less than a high school education, higher proportions of youth, littered sidewalks, and buildings showing deterioration. The authors recommended a series of design and safety policies to reduce crime at transit stations, with the caveat that there were few reported crimes so these results should be treated with some caution: transit passenger safety should be broadened to include “the public environment that sur- rounds the station” and park-and-ride lots, designs should remove or minimize

“entrapment spots and hiding places” and should increase visibility and lighting;

regular security audits should be used by transit authorities to “reveal the hot spots of crime” and to “guide a targeted deployment of security personnel to the most dangerous stations during the most dangerous times”. This study highlights the merit of using multiple methods to comprehensively examine complex urban issues, such as urban health. Urban design, urban problems, and health and well being are certainly intricately integrated issues, requiring that multi-method approaches and studies be considered and designed.

4.0. METHODOLOGICAL CHALLENGES IN URBAN PLANNING RESEARCH

Bridging urban health and urban planning requires an understanding of the use of methods in planning research. In this section, we describe the methods most commonly associated with each of the five planning themes identified earlier, while highlighting potential applications to health.

Urban planning is a diverse field. There is no single theory or disciplinary approach that informs planning. Similarly, planning draws on multiple methods, from many disciplines. These methods include quantitative approaches such as primary data collection surveys or secondary data analysis, with summaries drawn using descriptive statistics, and regression analysis or econometrics for inferences or hypothesis tests. The bulk of these quantitative empirical methods are informed by the traditions of economics or quantitative sociology or political science. The focus is often on testing hypotheses suggested by theory from social science disciplines related to planning, and often times linear regression models are built to allow researchers to focus on multi-variate relationships. Many variables in such regression models are included simply as controls for putative confounders, and planners often follow in the “hypothesis testing” tradition by focusing only on the coefficients on a few key variables that are specified a priori.

Keeping with the diverse nature of planning research, a large number of qualitative methods are also popular. These include case study approaches, in-depth interviews and focus groups, analysis of archival records, content analysis of media accounts, participant observation methods, and observations of the built environment. Of these, content analysis in particular can be approached from a quantitative perspective, and more generally the division between qualitative and quantitative methods is fluid, as several of the qualitative methods listed above can be approached with varying levels of numerical precision.

The methodological challenges faced by planners are, in the first measure, the challenges inherent in each method. The discussion here will focus on methodological approaches and challenges specific to linking planning and urban health. That discussion will be developed in relation to each of the five planning themes, but first

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we discuss a general challenge that applies to virtually all planning research. Health outcomes are rarely an intended focus of planning research. While this has begun to change in the past few years, and while there are exceptions (e.g., Conner, et al., 2003; Diez Roux, 2003; Jackson, 2003; Northridge and Sclar, 2003; Takahashi, 1998;

Takahashi, et al., 2001), a primary challenge in linking urban planning and public health is incorporating a focus on health into planning research. This will require in part that planners use new data sources that, while common in the health community, are still rarely used within urban planning (see, e.g. Boarnet, 2004). This will include health data bases such as the Behavioral Risk Factor Surveillance System, National Health Interview Survey, and National Health and Nutrition Examination Survey. While those data sets will be useful, even more promising are other health data sets that allow researchers access to address information that provide an ability to link to characteristics of the built environment through geographic information systems. The National Longitudinal Survey of Adolescent Health and the California Health Interview Survey allow access to such detailed address information, although researchers must analyze the data at secure sites to preserve survey respondent confidentiality. For more information, see Boarnet (2004).

4.1. Economic Development

Economic development planning and associated fields such as transportation or infrastructure planning are among the most quantitative areas of planning research. The methods typically used in economic development planning are informed by economics, quantitative geography, and regional science. Regional Science is a field that combines perspectives from analytic geography and urban and regional economics. (See, for example, journals such as the Journal of Regional Science or Papers in Regional Science.) Regression analyses are common, and the focus is typically on testing hypotheses which are often derived from formal economic or geographic theory. This includes studies that have used various advanced applications in regression analysis, including panel data methods (e.g. Boarnet and Bogart, 1996), spatial econometrics (e.g. Boarnet, 1994), and simultaneous equations systems (e.g. Raphael and Rice, 2002; Wassmer and Anderson, 2001). (In health sciences, panel data are sometimes called longitudinal prospective designs. For the purposes of this chapter, panel data are data sets that tracks information on the same individual, city, state, group, or other unit of observation in each of several often regularly spaced time periods.) Simultaneous equation systems allow formal modeling of several variables that are endogenous or determined within the system.

Urban health researchers might be more familiar with structural equation models, which is a similar approach.

The methodological challenges in these econometric studies fill textbooks (for example Johnston and Dinardo, 1997). Having noted that, the methodological challenges encountered and addressed in econometric research related to economic development planning typically fall into two categories: inferring causality and obtaining valid hypothesis tests.

4.1.1. Inferring Causality

Because the data for many planning studies are non-experimental, moving from association to inferences about causality is a key focus of many regression studies.

The most common approach is to explicitly model the determinants of endogenous

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variables by using simultaneous equations methods. An example is the recent work of Raphael and Rice (2002), who while not planners per se studied a question that touches on an economic development issue within planning: does an individual’s labour market experience depend on car ownership? In cities where automobiles are the dominant form of commuting, one might expect that car ownership might be linked to both the likelihood of being employed and an individual’s wage.

The difficulty is inferring the direction of causality. In automobile-oriented cities, owning a car can be both a determinant and a result of labour market success, since owning a car might be necessary to obtain access to geographically dispersed jobs not served by transit, while employment status also provides income to obtain a car.

Raphael and Rice (2002) treat an individual’s car ownership as an endogenous variable, and model the likelihood of car ownership with a separate regression that includes variables that are assumed to be exogenous to an individual’s employment outcomes but that influence the likelihood that an individual owns a car. In particular, Raphael and Rice (2002) model car ownership as a function of state gasoline taxes and average state insurance premiums – both are variables that can influence an individual’s decision to own a car but that are unlikely to have an effect on labour market outcomes. Raphael and Rice (2002) find that, after controlling for the effect of employment on the likelihood of owning a car, individuals who own a car are more likely to be employed. The statistical technique incorporates the two-way causality between car ownership and employment, modeling both variables within the system of equations. The results, because they control for the influence of employment on the likelihood of car ownership, give statistical point estimates that illuminate the impact of automobile ownership on the probability of being employed.* One implication is that labor market policies should be cognizant of the enabling role that car ownership plays in finding and retaining a job in the U.S.

4.1.2. Obtaining Valid Hypothesis Te s t s

There are several instances where ordinary least squares regression will not yield unbiased or consistent estimates of the standard errors of coefficients, and in those cases t-statistics are not valid and so hypothesis tests can be misleading (e.g., cases where regression error terms are not independent and identically distrib- uted). A range of techniques adapts and extends regression analyses to provide valid t-statistics in cases where the classical ordinary least squares assumptions do not hold. One example is recent economic development research by Hansen, and colleagues, (2003). In that work, the authors studied whether recent graduates of Pittsburgh area universities stay in the region, to examine how that region can retain more of its highly educated workforce. The authors used a regression analysis to examine variables that are associated with a graduate’s choice to stay or leave

*Note that this approach is designed to address circumstances where two variables might both cause each other but only cross-sectional data are available. The philosophical approach inherent in simultaneous equations systems does not rely strictly on temporal precedence to determine causality, because in non- experimental settings it will often not be possible to obtain data that establish temporal precedence.

More importantly, given foresight on the part of behavioral actors, temporal precedence may not give a clear signal of causality. For example, persons may buy a car in anticipation of soon getting a job, but if the expectation of a future job offer was important in the decision to buy the car, employment can still be said to have caused the purchase of the automobile, even though the car purchase preceded employment. For a more detailed discussion of causal inference in the behavioral sciences, see, e.g., Cook and Campbell (1979).

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the Pittsburgh metropolitan area. Because ordinary least squares modeling gives biased estimates of regression standard errors when the dependent variable is a dichotomous variable (e.g. “stay” or “leave” the Pittsburgh area), the authors used logistic regression analysis. (Other dichotomous outcome or categorical data analytic techniques include ordinal regression, polychotomous regression, and sur- vival methods.) Hansen, and colleagues (2003) found that, among the individuals surveyed, persons with graduate degrees who were concerned about the cost of living and who valued family ties more strongly were more likely to stay in the Pittsburgh metropolitan area, while persons concerned about salary were more likely to leave the region. The college that a person attended was also a statistically significant predictor of the likelihood of staying in the Pittsburgh area, with Duquesne graduates being more likely to stay compared to University of Pittsburgh graduates, while graduates from Carnegie Mellon were more likely to leave the region, again compared to University of Pittsburgh graduates.

4.2. Urban design

Methodological approaches in planning research related to urban design have been influenced primarily by architectural thought. This includes methods that focus on normative, or non-positivist approaches, descriptive research, typologies, and attempts to measure urban design in ways that are objective and reproducible.

(Non-positivist approaches do not follow classical deductive logic, and so do not test hypotheses. Non-positivist approaches can include inductive case study methods or theoretical statements of appropriate policies or plans without reference to empirical analysis.) These approaches range from those that grapple with the aesthetics of the environment, with few intentions to inform research modeled on scientific method to techniques that are self-conscious attempts to apply or mimic scientific method (attempts to measure urban design in ways that create variables for hypothesis testing).

While the non-positivist approaches might seem foreign to urban health researchers, it is important to understand that scholarship that is explicitly aesthetic and normative follows a long tradition of architectural influence in urban design. The goal in this work is often less about measurement than about developing criteria to understand, classify, and reproduce what Kevin Lynch called, in the title of his 1981 classic, “good city form”. The judgments about appropriate design criteria are based on argument, theory, and persuasion, but often lack the system- atic quantitative data analysis characteristic of many branches of the social sciences.

Kevin Lynch’s (1981) work is a classic example of normative theory development related to urban design. Lynch (1981) examined normative theories of good city form implicit in thought and development patterns from a broad range of historical time periods and cultural settings, and then developed his own theory of city form. That theory is a deep discussion of seven criteria – vitality, sense, fit, access, control, efficiency, and justice. According to Lynch (1981), those seven criteria cap- ture basic dimensions that can be used to judge the quality of cities. Lynch’s (1981) criteria include a broad range of factors too diverse to discuss fully here. To give one a flavour of the scope of Lynch’s (1981) criteria, his theory touches on the biologi- cal (the degree to which a city supports vital functions of human beings and other species), the aesthetic (the link between a city’s urban form and the sensory perceptions of residents), and the economic (the cost, construed more broadly than

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simple monetary cost, of maintaining a city and the distribution of costs and benefits that the city confers on persons). Lynch (1981) articulates each of his seven criteria in detail, building a normative theory and explaining how that theory can be applied to judge the quality of cities.

Unlike efforts at pure theory construction, some normative work on urban design uses experts to judge the quality of particular projects or ideas. This is similar to the use of juries in architecture, where experts judge the quality of a particular project. Juries are a common way to choose design teams for buildings, large developments, and major public projects. The use of a jury as part of the selection of the team to lead the reconstruction of the World Trade Center is a well known recent example (see, e.g., Ouroussof, 2002, for a description of the designs selected by the initial part of that jury process). The concept of judging urban design by either expert evaluation or based on theory and aesthetics extends into planning research that advocates particular design styles. Examples of such advocacy include the writ- ings of the New Urbanists such as Duany and Plater-Zyberk (1991) and Talen and Ellis (2002). In this school of thought, the goal is not to gather data, make measure- ments, and test hypotheses, but to critique designs based on theory or aesthetics and to articulate criteria for recognizing preferred urban designs.

Given the normative focus in urban design, it is not surprising that when urban design research is more data oriented, the use of data is often descriptive. When planners who study urban design systematically measured the built environment, some of the earliest attempts included typologies to classify types of built environments and types of interactions with the built environment. More recently, planners have developed typologies to measure and characterize urban sprawl (e.g. Ewing, et al., 2002, or for related work in public health, see, e.g., Dannenberg, 2003, or Jackson, 2003).

Following on the research that describes and categorizes the built environment, a growing literature has studied ways to measure urban design characteristics. Much of this research attempts to systematically measure the built environment in ways that allow researchers to test hypotheses about the built environment. Examples include Loukaitou-Sideris (1999), who studied how urban design characteristics are linked to crime near bus stops in Los Angeles, and whose work was also discussed earlier in this chapter. This style of research applies the traditional hypothesis testing and scientific method focus familiar to public health research in ways that incorporate urban design. If the built environment is an object of hypothesis testing, then the built environment must be measured in ways that are objective and can be reproduced. Fields related to urban health have contributed to advancing the measurement of the built environment in recent years. Some public health researchers who study physical activity have developed audit methods to measure the built environment by having teams of obser vers answer questions about urban design on a block-by-block basis (e.g.

Pikora, et al., 2002). Other research projects, currently underway, seek to extend that work (e.g. current research funded by the Robert Wood Johnson Foundation, 2004). As part of this work, the measurement focus typical of public health research is being adapted to the study of urban design. In particular, some studies have examined issues such as inter-rater reliability in the use of audit instruments (Pikora, et al., 2002).

The studies that attempt to systematically measure the built environment are of most immediate utility in linking urban health and planning. Several studies have attempted to link travel patterns, including active travel such as walking or

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bicycling, to characteristics of the built environment (e.g. Handy and Clifton, 2001;

Greenwald and Boarnet, 2002). Such studies include, by necessity, measures of the built environment, and the recent round of built environment audit instruments (e.g. Pikora, 2002 or the ongoing studies described at Active Living Research, 2004) are intended to provide methods for measuring the built environment in ways that can support urban health research.

4.2.1. Equity and Social Justice

Like research into urban design, planning research in the area of equity and social justice falls into two categories – normative and positive. (Here we adopt language typical of economics, and positive is distinct from the discussion of non-positivist research methods described earlier. Normative and positive research approaches, in this context, are defined below.)

The normative research, like its counter-part in urban design, articulates theories about power relationships, economic structures, and interprets those ideas while advocating for changes that the authors argue will lead to more just arrange- ments. Such work often critiques government policies that lie at the intersection of the economy and the welfare state. Examples include the work of Castells (1979), and Davis (1990).While compelling work, especially in its examination of the political economy of modern cities, the links to empirically based urban health research are not as direct as the empirical (or positive) research that follows similar themes.

Positive research on equity and social justice has burgeoned in recent years.

Much of this work in planning has leveraged Geographic Information System (GIS) technology to track the geographic nature of patterns of inequality in urban areas.

This includes access or proximity to transportation infrastructure and, through that access, job opportunities (e.g. Shen, 2001), spatial patterns of inequality (e.g. Rey, 2004), and the geographic pattern of proximity to environmental hazards (e.g., Forkenbrock and Schweitzer, 1999; Lejano and Iseki, 2001).

One particularly rapidly growing area of empirical urban planning research related to social justice is commonly called “environmental justice.” Research on environmental justice has been motivated by the observation that environmental hazards often are clustered near low income or minority populations, exposing those less politically powerful groups to larger than average environmental risks (Bryant, 1995; Mohai and Bryant, 1992). Advances in GIS technology have made it possible to map the spatial pattern of environmental risk. This research has a clear link to health, and that link could be made stronger by combining planning’s focus on the spatial distribution of environmental hazards with research on health outcomes.

4.2.2. Governance and Institutional Management

Research on governance and institutional management includes both quantitative and case study approaches. Quantitative approaches include statistical or econometric studies of particular types of government behaviour. This includes studies that examine how local government support for public housing relates to characteristics of that government (e.g. Basolo, 1999) and a large literature in economics that examines the determinants of government tax and spending