Written by: Laney Rupp, Kimberly Snodgrass, Rick Sadler
When people think of health promotion they might envision taking an exercise class or visiting the doctor. But health promotion extends far beyond individual behavior. Our environmental surroundings can either hinder or facilitate health and well-being.
Residents of Flint, Michigan, are particularly privy to this reality. The Flint Water Crisis in 2014 shed light on how health is impacted by the surrounding environment. Beyond water quality, the environment can influence our health in a plethora of ways including access/exposure to green space, the safety of walking and biking routes, housing conditions, environmental pollution, and more. In addition to the aging water infrastructure and catastrophic state government decision that caused the water crisis, Flint is beset by a range of other built environmental health risks, including one of the highest residential vacancy rates in the nation.
Despite these challenges, dozens of community groups and residents across Flint strive to improve their built environment, many with the mission of ultimately improving residents’ health. Local initiatives include demolishing derelict buildings, creating community gardens, installing walking pathways, and maintaining abandoned properties, among others. Community organizations also work to educate residents about how to interact with their built environment, through initiatives such as safe biking education.
Yet we lack an understanding of how these initiatives may affect health outcomes in Flint. We still need to identify what strategies work so best practices can be translated to other communities across the country. This is the goal of the Prevention Research Center of Michigan’s (PRC-MI) core project, ‘Health Promotion Through Environmental Design,’ commonly referred to as HPTED (pronounced HEP-ted).
Building on the PRC-MI’s previous project: Crime Prevention Through Environmental Design
HPTED adapts and expands on the notion of CPTED—Crime Prevention Through Environmental Design—to focus on ways that the environment can influence health more broadly. CPTED is a crime prevention strategy that uses simple environmental changes like lighting, lawn maintenance, and fencing to improve visibility, signal positive ownership, and ultimately increase neighborhood safety. In our previous evaluations of CPTED, we found that these strategies can help reduce violent crime. These findings suggest that crime prevention is not simply about addressing risky behaviors, but also about changing environments in ways that create safer, more connected communities. In HPTED, our hypothesis extends this logic beyond crime to include physical and mental health.
HPTED engages three core partners: Michigan State University College of Human Medicine, the Healthy Flint Research Coordinating Center (HFRCC) Community Core, and the University of Michigan School of Public Health. This team is guided by the HPTED Partners, a Community Advisory Board (CAB) of six organizations. In the summer of 2020, researchers at the PRC-MI spoke with staff representatives at the CAB organizations: The University Avenue Corridor Coalition, Neighborhood Engagement Hub, Flint Neighborhoods United, the Community Foundation of Greater Flint, Genesee County Land Bank, the Crim Fitness Foundation and the Healthy Flint Research Coordinating Center Community Core. We asked the partners to define HPTED in their words and describe how they see HPTED through their work and in their everyday lives.
“I think health promotion through environmental design really looks at what makes a healthy neighborhood. It starts with a good foundation. HPTED [improvements] reduce barriers to walkability and active living, lessen the threats of violence or criminal activity, and connect people,” says Tom Wyatt, a longtime community organizer and newly employed director of Flint’s Neighborhood Engagement Hub.
Cade Surface, Program Manager of the Active Communities Team at the Crim Fitness Foundation based in Flint, expands on this:
“HPTED means creating a community that is built to make healthy decisions the easiest decisions. We need to design our environment so the de facto thing that we’re doing isn’t also an unhealthy thing,” says Surface.
Meeting the needs of the HPTED Partners and the greater Flint community
One out of every three Flint residents is involved in efforts to improve their neighborhood or community. That equates to dozens of block groups, neighborhood associations, faith-based organizations, and nonprofits mobilizing for action. These groups are involved in mowing vacant lots, painting murals, boarding up abandoned homes, facilitating safe bike education events for children, and activating public places (things like outdoor concerts or exercise classes), to name only a few.
Even further, the organizations in HPTED Partners (CAB) are experts in urban revitalization. Some, like Flint Neighborhoods United and the Community Foundation of Greater Flint, offer resources such as technical assistance, tools, or grants to support local neighborhood groups implementing HPTED strategies. Others, like the Genesee County Land Bank, work directly with and in communities to improve neighborhood conditions, promote neighborhood connectedness, and more.
Given the HPTED Partners’ expertise, we wanted their input on project development. Through conversations, we recognized that project resources could be used for the evaluation of existing work to help HPTED Partners document and understand the effects of their work on community health and well-being. The HPTED Partners helped us identify avenues for the PRC-MI to have a role in HPTED work in Flint.
“Our HPTED Partners helped us see how a city-wide evaluation of the HPTED work happening in Flint could help build an evidence base about HPTED’s influence on community health,” says Laney Rupp, a project manager at the PRC-MI.
“We’re always looking for ways to understand what our impact is. And I think that absolutely requires an independent perspective,” says Cade Surface when asked how the PRC-MI could help the Crim Fitness Foundation.
This sentiment was echoed over and over again during meetings in the summer of 2020 with the partners.
“We’d like to better understand the impact of blight and crime on health. The research could show both the negative consequences of certain environments and the positive impacts of projects or interventions,” says Christina Kelly, Director of Planning & Neighborhood Revitalization at the Genesee County Land Bank.
After collectively identifying the strong need for evaluation, the Center began to discuss ways to operationalize a city-wide evaluation of HPTED.
“This lines up neatly with my broader team’s work on the built environment and health,” says Rick Sadler, Associate Professor in the Division of Public Health at MSU. “We’ve shown that greening and beautification are associated with decreased crime and improved mental health. We also know that neighborhoods with more amenities tend to be viewed more favorably and promote healthy lifestyles. This work will give us more of an evidence base to advocate for the things we know work in building healthy cities.”
An evaluation of this scale had never been done in Flint before despite community leaders wanting to know the impact of their work and the level of intervention needed to make neighborhoods safer, support healthy behaviors, and help neighbors feel more connected.
“We also wanted to understand what types of HPTED strategies are needed,” Rupp adds, “meaning we wanted to see the effect of things that change the built environment, such as demolitions and property maintenance, but also the influence of other strategies like food access, community events, or safety and security initiatives.”
Current plans: tracking environment change initiatives in CAB members and across Flint
Now, the Center is working to track existing environmental change initiatives implemented by an array of groups across the city from government agencies to local block groups. Simultaneously, PRC-MI evaluators will track health outcomes in these areas and then analyze the two against each other to assess effects.
So far, we’ve identified over 100 groups and agencies whose work would classify as HPTED. The Center will work with our HPTED Partners to track their HPTED activity, but it will also reach out to individual groups outside of the HPTED Partners to capture a wider view of what’s really happening on the ground. We are exploring ways to draw from existing records to minimize the reporting burden on local groups and organizations.
Simultaneously, we are compiling data to help us understand whether the work of community groups has an impact on residents’ health and well-being. Demonstrating this impact is tricky, but we are measuring neighborhood disorder (via a tool our team uses called the NIfETy) alongside a survey of resident activities, health behaviors, and perceptions of their neighborhood. In addition, we will be integrating existing data on the built environment and crime and violence into our work. All of this will be joined together using geographic information systems to see if there are differences in HPTED work by neighborhood and whether these differences correlate to specific types of neighborhoods. We will be able to answer, for example, whether neighborhoods with more HPTED activities have lower disorder, or whether residents in neighborhoods with fewer HPTED activities report feeling less secure and less active in their community.
More on the horizon
The Center is exploring avenues to disseminate the findings in an accessible way that can be used by community members themselves, not just those in academia. In fact, some of our HPTED Partners expressed the need for accessible tools that show organizations’ impacts.
“I think we need easy-to-use data tools that residents could use. It’s important to make it obvious how they could take that data and do something with it,” says Surface. He says the Crim Fitness Foundation has previously tried to map out their efforts for some initiatives, namely traffic calming and safety initiatives, but would benefit from additional capacity and support from the research team to track their efforts more broadly.
We are adding another community advisory board to bring a community focus to the activities of our Center rather than just the HPTED project. “Intentional community engagement in research efforts is critical to strengthen projects designed to address community concerns. Understanding the perspectives of CAB members is necessary to ensure the project meets the needs defined by the community, in useful ways. This may require some reshaping of the original project; however, it may also lead to more robust outcomes,” says E. Yvonne Lewis, PRC-MI Community Director, Co-Director HFRCC Community Core. Center Manager Susan Franzen stated, “I look forward to expanding our partnerships in Flint. We hope to gain a diverse perspective and insight as we grow the Center”.
Additional plans include developing an actionable and feasible evidenced-based toolkit for communities interested in adopting HPTED.