Land Use and Community Planning Strategies Can Promote Health Equity

Local land development patterns and zoning policies directly affect many of the critical factors that shape communities’ health, such as the availability and affordability of housing; the presence of pedestrian-friendly neighborhoods; the range of transportation options; levels of crime; and access to education, employment, and other essential goods and services. And that means community planning professionals play a key role in promoting public health through their work.

With funding from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, two national organizations are examining the challenges that communities face and encouraging planners to advance health equity through the use of promising practices and policies.

Including health and equity in comprehensive plans

The American Planning Association (APA) in 2015 created the Comprehensive Plan Standards for Sustaining Places, a best practice guide to help local planners systematically consider sustainability principles, including health and equity, in their local comprehensive plans. With 40,000 professional members across 47 chapters in the United States, the APA advances community planning as an art and science, addressing physical, economic, and social factors at the local, regional, state, and national levels.

The comprehensive plans, generally referred to as comp plans, serve as foundational policy documents for community planners that guide long-term decisions about the built environment, such as buildings, parks, open spaces, and streets, over a 20- to 30-year horizon. In 2018, recognizing low uptake of the standards, APA partnered with the Health Impact Project to seek ways to boost adoption by:

• Identifying local champions who would apply the standards to their jurisdiction’s comprehensive plan development and then promote them to peer planning agencies.
• Developing a practical technical assistance manual to make the standards easy to understand and apply as local officials create their own plans.

As part of this work, APA supported jurisdictional planning agencies in Pinellas County, Florida; Culver City, California; and Fort Collins, Colorado, in using the standards to guide ongoing plan development work. Feedback from those communities drove the content of the technical assistance manual, which includes health and equity-related model language to be included in the comp plans.

APA continues to disseminate the manual to planners and other stakeholders. Public health professionals also have promoted the document as a practical resource to encourage increased physical activity through the comp plans. That can be done by proposing actions to add community features such as bicycle lanes and walking trails.

Promoting health equity using zoning and land use policies

While the comp plans tackle a broad vision for long-range planning, local governments can use effective zoning laws and general planning standards to influence elements of the built environment that promote well-being. Effective rules and guidelines for land use, building placement, density, architectural and landscape design, parking, and street maintenance can all make a difference.

In 2020, the Urban Institute conducted a national study with support from the Health Impact Project to identify built environment changes that small and medium-size cities—with populations of less than 250,000—could make to promote health and equity. Two neighborhood and community design interventions emerged as promising: Complete Streets design principles and comprehensive zoning code reform.

Complete Streets principles seek to ensure safe and comfortable streets as a policy objective and in design practice. The elements vary based on community need and context but often include sidewalks, bicycle lanes, special bus lanes, accessible public transportation stops, and frequent and safe crossing opportunities. And putting such principles into practice benefits community health. For example, jurisdictions could see fewer injuries and fatalities if they decrease the number of car crashes, lower rates of asthma and other respiratory illnesses if they reduce vehicle emissions, and boost access to physical activity if they increase opportunities for walking and biking. Local governments can achieve such outcomes by engaging with residents to identify specific needs and prioritizing neighborhoods where safe driving, walking, and biking are challenging.

Secondly, the Urban Institute found that comprehensive zoning code reform can be a useful tool, allowing local governments to re-examine and rewrite zoning regulations to ensure that new development promotes health and equity. These codes are a collection of regulations that can encourage healthy development patterns and limit land uses with negative impacts on community health. They can promote access to healthy food, for example, by permitting the raising of crops and livestock in urban or residential areas or reduce children’s exposure to unhealthy food by regulating the distance between fast food outlets and schools.

However, zoning also has had a history of causing harm. Exclusionary zoning rules have resulted in residential segregation, which can limit how some low-income communities and communities of color access jobs, high-quality schools, affordable housing, and other resources. In addition, zoning laws have at times exposed these same communities to higher levels of air and water pollution than other populations.

In many jurisdictions, zoning codes have not been updated in decades, and making changes on a case-by-case basis leaves room for inconsistencies in how regulations are applied, which can lead to disproportionate impact on certain communities. The Urban Institute determined that comprehensive zoning code reform, in conjunction with a comprehensive plan update, can lead to better outcomes that reflect a local government’s policy goals.

These projects highlight promising practices and policies that can advance health and equity outcomes through community planning and land use strategies. For these approaches to work, context on an area’s history and needs is critical. By engaging with community partners and residents, planners can ensure that neighborhoods across the U.S. are designed to be safe and healthy for all.

Ruth Lindberg is the director and Mimi Narayan is an officer with The Pew Charitable Trusts’ health impact project.