This issue explores collaborations to improve the health of communities across the state, which are paramount to a healthy population, workforce, and economy. The policy forum includes articles highlighting various state departments' visions for healthy communities, as well as articles on planning, health impact assessments, local food systems, and efforts to strengthen the built environment. Original research includes an evaluation of the North Carolina Violent Death Reporting System and Medicaid coverage cost for the uninsured. A farewell and welcome to NCMJ editors in chief and a perspective on the challenge for health policy are also included.
The Blue Ridge Corridor Experience
During the 33 years that have passed since moving to Raleigh at age 16, I have witnessed a dramatic increase in the population of the Piedmont and the influence of that growth on land use. As a primary care practitioner with the rare benefit of living within walking distance to my office on Blue Ridge Road in west Raleigh, I have also become aware of the lack of attention in the modern urban environment to the health and safety of those not traveling by motor vehicle. I am now privileged to be involved in a project that is trying to bring about land-use decisions designed to make our community healthier and more sustainable.
In the mid 19th century, landscape architect Frederick Law Olmsted Sr was a pioneer in recognizing that urban planning should take public health concerns into account. (Olmsted Jr, discussed in Silver’s commentary, did not share his father’s passion for public health.) Olmsted Sr envisioned New York City’s Central Park as the “lungs of the city” . This synergy—between public health and city planning—continued for about a century, and improvements in community infrastructure generally resulted in public health benefits. However, these two disciplines were separated for many reasons over the years, one of which was the advent of automobile-centric urban sprawl during the last half of the 20th century. Indeed, urban planning during this period had unintended negative consequences for individual and population health.
Locally, Raleigh’s land use increased more than 10-fold between 1950 and 2000, growing more than 3 times as fast as the population . Long considered “a city within a park,” Raleigh earned another nickname: “Sprawleigh” . Although the city has a nationally renowned greenway system primarily designed for recreational use, pedestrians, bicyclists, and those traveling by public transportation have rarely been considered during development of the city’s major corridors. During the second half of the 20th century, Raleigh’s thoroughfare plan and buffering and landscaping requirements also created barriers to physical activity through an imbalance of preferred transportation modes .
Over the past few years, the pendulum has begun to swing in the opposite direction both locally and nationally. The economic downturn has forced a reassessment of existing resources, with developers and the public now more likely to join urban planners in recognizing the need to coordinate land use, transportation, and infrastructure. At the same time, a growing body of evidence has developed documenting the role of the built environment in health problems associated with physical inactivity . Additionally, the Centers for Disease Control and Prevention, in conjunction with the US Department of Health and Human Services, has begun to promote the use of health impact assessments as a means of identifying the potential effects of proposed projects on the health of a population. In fact, the national Healthy People 2020 goals incorporate measures of the built environment .
I became interested in the literature on these topics while serving as chair of a group of stakeholders in the Blue Ridge Corridor (BRC) that is focused on coordinating the area’s rapid growth. In my office, I was seeing first-hand the rise in obesity and associated diseases such as diabetes over the past two decades and noted that minimal attention was being paid to the root causes of obesity within the medical literature. Ultimately, my professional interests began to overlap with my role in the BRC planning process.
The BRC group began as a small–scale effort to leverage the expansion plans of Rex Healthcare and the North Carolina Museum of Art into improvements in connectivity, including pedestrian access, on Blue Ridge Road. Over the past 4 years our group has grown, and it now includes stakeholders representing some 2,000 acres in west Raleigh, including the Centennial Authority’s PNC Arena, the North Carolina State Fairgrounds, and North Carolina State University’s Centennial Biomedical Campus. During the course of our discussions, the BRC stakeholders group realized that this district could serve as a statewide model for 21st-century urban planning. This was confirmed by the first-place ranking given to the corridor in the 2011 grant program of the North Carolina Sustainable Communities Task Force, a multiagency group created by the North Carolina General Assembly in 2010 to lead and support the state’s sustainable community initiatives .
In keeping with the goals of the Sustainable Communities Task Force, the corridor offers the potential to bring together the components of land-use planning, transportation, and affordable housing while preserving open space and the environment, enhancing economic development, and optimizing public health. As part of the planning process for the corridor, one of North Carolina’s first comprehensive health impact assessments (funded by the Blue Cross and Blue Shield of North Carolina Foundation) will be conducted through the Gillings School of Global Public Health and the Department of City and Regional Planning at the University of North Carolina at Chapel Hill with the cooperation of the city of Raleigh.
Furthermore, the BRC can also serve as a pilot program for the North Carolina Department of Transportation’s new Complete Streets Policy (which intends to make streets useable by all transportation modes), by collaborating on multimodal transportation options needed to serve the community, including pedestrians, bicyclists, and public transit users. Ultimately, the corridor provides a possible paradigm for statewide healthy development that does not compromise natural systems or the needs of future generations of North Carolinians.
Potential conflicts of interest. S.L. has no relevant conflicts of interest.
1. Fisher T. Frederick Law Olmsted and the campaign for public health. The Design Observer Group Web site. http://places.designobserver.com/feature/frederick-law-olmsted-and-the-campaign-for-public-health/15619/. Accessed May 9, 2012.
2. City of Raleigh. 2030 comprehensive plan. Last revised April 5, 2011:14. Downloadable at http://www.raleighnc.gov/business/content/PlanLongRange/Articles/2030ComprehensivePlan.html. Accessed May 9, 2012.
3. Goldberg, S. Reigning in Sprawleigh. Time. March 25, 2011. http://www.time.com/time/specials/packages/article/0,28804,2026474_2026675_2061559,00.html. Accessed May 9, 2012.
4. Kochtitzky CS, Frumkin H, Rodriguez R, et al. Urban planning and public health at CDC. MMWR Morb Mortal Wkly Rep. 2006;55(suppl 2):34-38.
5. Frumkin H, Frank L, Jackson R. Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities. Washington, D.C.: Island Press; 2004.
6. Health impact assessment. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/healthyplaces/hia.htm. Accessed May 9, 2012.
7. Blue Ridge Road district study. City of Raleigh Web site. http://www.raleighnc.gov/business/content/PlanUrbanDesign/Articles/BlueRidgeRoadDistrictStudy.html. Accessed May 9, 2012.
Stuart Levin, MD chair, Blue Ridge Corridor Stakeholders Advisory Group, Raleigh, North Carolina, and clinical professor, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Address correspondence to Dr. Stuart Levin, Wake Internal Medicine Consultants, 3100 Blue Ridge Rd, Suite 100, Raleigh, NC 27612 (firstname.lastname@example.org).