A wide variety of factors determine health of individuals within a community, although most attempts to address this issue deal only with the delivery of medical services. Other factors such as poverty, environmental issues, and employment have a major impact on medical care beyond the actual availability of medical facilities.

The GO TO 2040 plan aims to address these factors and identify the underlying relationship between land use, education, civic engagement, and other strategies to improve health globally throughout the region.

In coordination with an advisory committee of regional experts, University of Illinois at Chicago School of Public Health has prepared general recommendations for improvement within the long-term context of the GO TO 2040 plan. The recommendations cover:

• Prevention based on health determinants

• Data for planning and monitoring

• Public health infrastructure improvement

A report that provides more details on these recommendations is forthcoming and will be posted in this space when available; an executive summary is currently available.

Effect of physical planning decisions on health

The purpose of the questions below is to understand how today's planning policy and investment decisions – covering transportation, land use, housing, economic development, and the natural environment – might affect health in our region in 2040.

How would health be affected by different economic development policies: focusing on investments in human capital (improving the region's workforce); infrastructure (investing in physical infrastructure such as transportation facilities); or innovation (including but not limited to technological innovation)?

• Investments in human capital, particularly in the area of education, would improve health outcomes, as education and income are good predictors of health, and more educated people tend to make healthier choices. Also, the workforce needed to support a good health system would be improved by investments in human capital; there is an increasing gap between the number of trained workers that the health system needs and those that are available.

• Investments in infrastructure are also needed, particularly to provide clinics and specialty care in underserved areas.

• Increases in technology could improve health services tremendously. Using electronic medical records for real-time health data access helps medical professionals make more informed decisions. Data sharing and dissemination can help health providers better match resources to needs and respond to demographic changes. Technology can also help to link health issues and data to planners and policymakers outside of the health field.

• The type of jobs in the region is less important than the incomes of workers in these jobs. Incomes and health outcomes are strongly linked, and improving incomes, particularly among currently low-income people, would have positive health impacts; so would increasing the number of jobs that provide health insurance as a benefit.

• Economic profiles that result in lower levels of pollution would lead to better air and water quality and less contaminated land, with corresponding health impacts. This does not mean that any one economic direction is necessarily preferable, but that health impacts of different business types should be considered.

• Economic policies that have the effect of increasing public safety in higher crime areas will improve health, particularly in children as a safer environment creates more opportunities to be outdoors and for social interaction. As covered in the report on crime and justice, improving local economic conditions can be part of an effective solution to reduce crime.

How would health be affected by different transportation investment alternatives: focusing on major infrastructure investments (road or rail expansions); low-capital operational improvements (improved bus service, sidewalks, and trails); or technology (including real-time information or improved traffic signal timings)?

• Transportation improvements that encourage active transportation – walking and bicycling – have positive impacts on health. In particular, obesity, diabetes, and cardiovascular disease can be linked very strongly to exercise.

• Transportation improvements that increase safety and reduce injuries due to vehicle accidents would also have positive impacts on health. This is true also for improvements that increase safety for bicyclists and pedestrians, as the use of these modes should be supported.

• Environmental quality is linked to health outcomes, and transportation systems – regardless of type – that improve air and water quality would improve health as well.

• There is also evidence that long commutes negatively affect health. Transportation improvements and strategies that address jobs-housing balance have the potential to reduce commute times, increase the time for physical activity, and decrease muscle and joint pain associated with prolonged sitting.

• Transportation is also necessary to access health care facilities, and access by transit is particularly important. Paratransit systems in less dense areas also provide necessary links to health care, and improvements to these would improve overall access to health care.

How would health be affected by different land use policies: focusing on dense, infill development; moderate densities with emphasis on community-centered design; or low-density new development?

• Allowing "aging in place" within communities – providing a mix of housing to allow elderly residents to stay in the communities they know – can reduce social isolation and improve health outcomes for senior citizens. This is less related to density than community design.

• As noted above, community design features that allow active transportation modes increase physical activity, with positive health impacts. This requires more than just transportation investment, but is also linked to land use planning and providing reasonable opportunities for walking and biking. Access to open space is also shown to have positive health impacts.

• Increasing investment and development in low-income communities could increase prosperity in these areas, leading to the income-related health impacts described above.

• Targeting development in existing areas allows more resources to be devoted to providing services rather than providing new facilities, as existing denser communities are generally well-served by hospital infrastructure. Providing health services is more difficult and less efficient in less dense areas.

How would health be affected by different land conservation policies: focusing on preserving large areas open space for biodiversity; providing parks for community access; or providing open space as part of new development?

• Providing access to parks has been demonstrated to lead to greater physical activity, particularly among children. This can lower childhood obesity and related diseases, with lifelong positive impacts. Parks that promote a variety of activities, including sports, recreation, and community interaction, have particularly positive impacts on health.

• Overall environmental protection measures that reduce air, water, and land pollution or contamination will have positive public health impacts as well.

How would health be affected by energy policies: focusing on adopting clean energy sources; reducing the energy consumption of buildings; or reducing the energy consumption of the transportation system?

• Energy-efficiency retrofits of medical buildings can reduce operating expenses – and these budget savings could be directed toward other needs. Also, conversion to clean energy sources, to the extent that it reduces pollution, would also support public health as described above.

How would health be affected by housing policies: preserving existing affordable housing; creating new affordable housing near transit and jobs; or reducing housing costs through energy efficiency improvements?

• Providing affordable housing options can reduce the amount of money that is needed to be spent on housing, allowing households to spend more on health or in other areas related to health, such as consuming fewer processed, high salt, high fat foods. Also, all older housing stock, particularly that built before 1975, should be subject to screening for lead-based paint and mold, which can still be a significant precipitating cause of health problems.