Making Room at the Development Table: A Public Health Director's Perspective
At the International Making Cities Livable Conference held in Portland, Ore., last month, Lou K. Brewer RN, MPH, director of the Tarrant County Public Health in Fort Worth, Texas, led a session about a toolkit she and a colleague are creating to help communities track health indicators and the progress made on improving them. The toolkit should be available by the fall and is likely to be a very valuable tool for many departments starting to track indicators in their community as both a resource for key measures and an adaptable tool largely ready to use. But Brewer’s experience as part of a Texas team shaping the future of the state around smart growth, community development, land use and transportation is equally valuable as a blueprint for collaboration to bring health to the table as communities across the country look ahead in creating their development plans.
NewPublicHealth: What brought you to the Making Cities Livable conference?
Lou Brewer: The presentation was about a set of indicators that I and a planner in a neighboring region created. We researched existing health indicators and decided to create a useful toolkit for planners and health professionals, using materials that were already available.
NPH: Why is a toolkit necessary?
Lou Brewer: Well, I’ve been part of Vision North Texas classes, run by planners and the Council of Governments to look at what stakeholders—including elected officials, planners, health educators and citizens—want the area to look like in 2030. Our population is supposed to double and that brings with it lots of challenges and opportunities, and so they’ve done an extensive visioning process, including a yearly summit.
We invited ourselves to the table as a public health entity, and we really wanted to be able to also ask the questions of the impact on health of whatever decisions were made. So we developed a health research team with wide representation and one recommendation was for this health indicator set [to measure progress on health impact], and then we decided we probably needed a toolkit as well. I also have a personal interest in all this because I’m a doctoral student in urban planning and policy, and that’s because I really see an incredibly strong connection between the built environment and health.
NPH: Who else was on the team?
Lou Brewer: We had the immediate past State Health Commissioner for Texas and the current Medical Director of Blue Cross Blue Shield. We had the Assistant City Manager of one of our larger municipalities who’s also a planner and the organizer for the Vision North Texas process. We also had two hospital representatives, a CEO and a community planner, someone from the School of Nursing faculty, and from the Texas Health Institute, and, of course, members of our own public health agency.
NPH: What critical steps did you take as you researched the toolkit?
Lou Brewer: We didn’t want to reinvent the wheel if it was already out there, so we really spent a lot of time going through the literature and looking at websites, and we borrowed heavily from the San Francisco Department of Public Health. They’ve done extensive work in health impact assessments and developing indicators. We also looked at materials from the state of Michigan and the National Association of County and City Health Officials and the American Planning Association. The health research team told us to really concentrate on physical activity and access to nutritious foods, and so we reviewed the literature again to pick out indicators that supported those two objectives and so that’s what helped us come up with them.
Indicator examples include: How far do people have to walk to transit, to schools, to grocery stores? We’re looking at vehicle miles traveled. And we’re looking at the ratio of bicycle routes to vehicle routes—lots of different things that all speak to and support physical activity and access to nutritious foods.
NPH: What response did you get when you spoke about the toolkit?
Lou Brewer: I had a lot of people come up to me afterwards wanting to get a copy. It’s in the draft stage, so I told people who asked that I’d send them a copy, but really wanted them to review it and give me feedback. We’ll have a final version to release soon.
NPH: What were some of the lessons learned?
Lou Brewer: We tied our work to the annual summit and that’s a long time to wait to keep people’s attention. We could have expanded the role of the health research team earlier.
And, while we had representation from faculty, which was great, I think I would have also asked for some student involvement and perhaps they would have had some time and interest in helping us develop some of this.
I’m glad we did involve Vision North Texas, and they in turn are some of the decision-makers for the region, so I think we had support early on. I think they were very respectful of the health piece of this, and I think they were also very glad to have another layer on their argument. We were always asked to be part of any funding opportunities and to make our case there, and so that’s been really great, because there is still a group out there that the light bulb hasn’t quite gone off yet for them in terms of why is health at the table.
NPH: What’s next for the toolkit?
Our next step is going to be feedback from this conference. and feedback from a few more people in the region and we’ll either post the toolkit it to our website sometime this summer or wait for the Vision North Texas Fall Summit and introduce it at a workshop. And then we’ll ask people for feedback on usability and modifications at the summit.
Weigh In: Have you been invited, or invited yourself, to key stakeholder conversations that didn’t have health in the title?