No Limits: Making Cities Safer and Healthier for All.

Illustration: Fien Jorissen, Heart Agency

cities and health

No Limits: Making Cities Safer and Healthier for All

There are many reasons why the effects of climate change are more pronouncedin cities, such as the impervious surfaces that create the heat islandsdescribed in the song’s lyrics: “Walking on the sidewalk, hotter than a matchhead.” Those same surfaces cause flooding during substantial precipitation,particularly because cities are often coastal.

December 12, 2022
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“HOT TOWN, SUMMER IN THE CITY,” begins “Summer in the City,” a 1966
pop song by The Lovin’ Spoonful.

According to Patricia Fabian, associate professor of environmental health
and the school’s cities and health strategic direction lead, they’re also where
most people live, making them ripe for change—particularly if there’s a significant
reason for change.

I think part of what makes this such a promising area of research and practice is that cities are always changing physically. There’s always something happening in any given neighborhood.”
Jonathan Jay, assistant professor of community health sciences

“Health is a powerful reason for people to do things,” Fabian says. “Maybe
they don’t necessarily see the link between something like solar panels, or land
use changes, or green space. I think that our job is to elevate and connect. . . all
these different interventions we’re doing to health. I think that will help us get
there faster.”

BUSPH is at the heart of change to improve health in cities through the
work of its professors, students, and alumni.

David Jernigan, assistant dean for public health practice and a professor of health law, policy & management, describes how change happens in cities using two major theory buckets: grassroots and grass tops.

He describes grassroots as individuals and advocacy organizations coming together in neighborhood or community meetings until there’s enough momentum to attract the attention of policymakers, and grass tops as somebody with sufficient sway—a spark plug—driving change.

Jernigan is also a senior policy advisor for CityHealth, an organization that works with cities to adopt health improvement policies. City-Health, which reports that more than 80% of US residents live in urban areas, develops evidence-based policy packages for municipalities and awards bronze, silver, and gold medals depending upon how close the city is to adopting all of the policy’s recommended elements.

“What we try to do at CityHealth is give them everything they would need to make that change, and then we motivate them with the medals,” Jernigan explains.

Illustration: Fien Jorissen, Heart Agency

Alum Kate Conquest (SPH’21) is familiar with what these theories look like in action. In fall 2020, she jumped at the chance to enroll in Jernigan’s course, Organizing and Advocacy for Health Policy Change. Conquest was assigned to research policies for City-Health’s 2.0 policy package, the next five-year iteration of policy implementation goals for cities that the organization will begin using in December 2022. All of CityHealth’s policies are evidence-based and have been previously established in at least one venue.

Conquest’s experience in the real world application of public health work complemented her education. Hired full time in 2021 as a CityHealth program associate, she is assigned five cities. One of her first trips was to Louisville, Kentucky, where the city is considering green space and eco-friendly purchasing policies, two additions related to climate change in the new policy package.

“We’ve received a lot of questions about our housing policies, particularly on legal support for renters and getting them right to counsel,” Conquest says. “Green space comes up a lot for park access, and again, I think post-COVID, people started prioritizing park time and outdoor space. Those have probably been the policies we have talked about the most.”

“The theory and everything that we talked about in class is hugely beneficial, and I carry that with me in my job,” she says. “But you have to have been in the room with a lawmaker, talking to them. That’s where you’re going to. . . learn the most, when consequences are on the line, and when you have the ear of people who can actually make the decision and make that change happen.”

Wendy Heiger-Bernays, professor of environmental health, is the public health spark plug in her community just outside of Boston. She has volunteered as chair of the Lexington Board of Health for 22 years, leading policy decisions that are sometimes unfavorable, but grounded in the best data and information currently available. She says her well-resourced community of about 33,000 is an excellent testing ground for forward-thinking policies that can subsequently be implemented elsewhere. Jernigan, having seen cities become more willing to adopt new policies when provided with evidence that they have worked before, concurs that change happens this way.

Heiger-Bernays says that her multiple hats as a toxicologist, professor, and board of health chair are often symbiotic; her research informs her work at the local level, and the work she does at the local level informs her teaching.

This crossover played out when she was researching the effects of PCBs, PCB exposures in the communities around New Bedford Harbor, and in Lexington schools. People may be surprised to find these inadequately regulated chemicals in schools, but, according to Heiger-Bernays, schools lack adequate ventilation and the use of these chemicals in the buildings, furniture, and products may negatively influence the health of children, teachers, and staff.

“It’s invaluable for MPH students to have practical information and practical tools to use, because not everybody needs to, or should, go into research. Public health is a marriage of research and practice. Without the two, all we’re doing is pushing big numbers through computers and nothing ever happens,” she says.

Jonathan Jay, assistant professor of community health sciences, works at the heart of that marriage as an urban health researcher who uses analytics to inform decisions about the built environment that can help reduce violence.

“I think part of what makes this such a promising area of research and practice is that cities are always changing physically. There’s always something happening in any given neighborhood. But sometimes the wrong things are happening in the neighborhoods that are most disinvested from, and most adversely affected by, racial segregation.”

Jay uses analytics to provide cities with data that aids in decision making; he worked with Albany, New York, when the city had plans to demolish abandoned buildings and needed help determining which demolitions would be most likely to contribute to reductions in violence. He has also assisted Portland, Ore., in traffic-calming work to aid in gun violence reduction.

“We can make neighborhoods safer through these simple investments in the built environment. It is work that city agencies do all the time, but often in a way that is not focused on making places safer, which can further entrench racial inequities in access to resources,” he says.

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No Limits: Making Cities Safer and Healthier for All

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