Place Matters
Martha Halko, MS, RD, LD
Healthy Kids, Homes, and Places
June 11th, 2010
Objectives
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Provide an increased understanding of the
link between the conditions in which one
lives, learns, works and plays and health
outcomes
Understand the impact of neighborhood
planning on health
Explore approaches to advancing health
equity and healthy land use planning
through the “Cuyahoga County Place
Matters Initiative”
Why Does Place Matter?
Where we work, live, learn and play
impacts health
 Residents in low-income areas live far
fewer years in comparison to higherincome areas – “Place-based” disparity
 These disparities are seen for chronic
disease, low birth weight births,
environmental issues etc.
 Big gap in life expectancy

Urban Dynamic
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Inner-city residents are more overweight,
less physically active, & less healthy
overall than general population
Diabetes & cardiovascular disease are
more prevalent
Major inequities in life expectancy and
mortality driven by chronic diseases
Heart Disease is leading cause of death in the U.S.
Why the disparity?

Research indicates much of disparity is
associated with:
social and environmental issues such as
stress of poverty, racism, violence,
discrimination in health services, food
insecurity
Social Determinants of Health
How Much Does
Place Matter?
A look at Alameda County’s PlaceBased Data
High school grads: 90%
Unemployment: 4%
Poverty: 7%
Home ownership: 64%
Non-White: 49%
High school grads: 81%
Unemployment: 6%
Poverty: 10%
Home ownership: 52%
Non-White: 59%
High school grads: 65%
Unemployment: 12%
Poverty: 25%
Home ownership: 38%
Non-White: 89%
Vacant lot at Coit Road Farmer’s Market – Feb ’07.
89% of all housing in East Cleveland contains
lead based paint
Is This All About Personal
Responsibility?
When the external becomes internal:
How we internalize our environment
Allostatic Load
Inadequate
Transportation
Long
Commutes
Stress
Stress
Stress
Housing
Stress
High
DemandLow
Control
Jobs
Lack of
access to
stores, jobs,
services
Stress
Lack of
social capital
Stress
Crime
Decades of disjointed state, local and
federal policies have caused social
and structural problems that impact
urban community health
Social Inequities
Health Inequities
Segregation
Housing
Income & Employment
Transportation
Air Quality
Physical Activity & Neighborhood Conditions
Access to Healthcare
Education
Food Access & Liquor Stores
Criminal Justice
Social Relationships & Community Capacity
Social Inequities
Cuyahoga County Place Matters Team:
Establishing Partnerships and Building
a movement to improve health
outcomes and address health
inequities through “place-based”
strategies
Place Matters: Nationwide
Initiative of the Joint Center for
Political & Economic Studies,
Health Policy Institute
A National Learning Community
Focused on improving the health of
participating communities by addressing
social conditions that lead to poor health.
www.jointcenter.org
Cuyahoga County Team

Selected by National Association of City
and County Health Officials (NACCHO)
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Cuyahoga County is 1 of 16 teams, across
the US participating in the pilot national
learning community
Place Matters Team Members
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Cuyahoga County Board of Health
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Saint Luke’s Foundation
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Sabrina Roberts
Center for Community Solutions
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Sandra Byrd Chappelle
Cuyahoga County Office of Health and Human
Services
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Najeebah Shine
Martha Halko
Ken Slenkovich
Cuyahoga County Planning Commission

Paul Alsenas
Place Matters - Cuyahoga County
Vision – Cuyahoga County is a place
where people can thrive because there is
equitable access to resources &
opportunities, whether, economic, social
or environmental, that are necessary to
attain the highest quality of life
Place Matters - Cuyahoga County
Purpose – The Cuyahoga County Place
Matters Team will inform, influence
& engage policy makers &
community members to use an
overarching health equity lens for the
development of policies that create
conditions for optimal health
What we intend to accomplish…
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Urban communities will have more choices
regarding, housing, food access, access to
healthcare and education

Allow urban communities to thrive
because they’ll have equal access to
economic, social and environmental
resources
Next Steps for the Team
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Education of Key Stakeholders
Health and Land Use Summit II
MAPP
Health Impact Assessment
Policy Agenda
MAPP stands for:

Mobilizing – community
engagement
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Action – implementation of a
Health Improvement Plan
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Planning – built on strategic
planning concepts
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Partnerships – the public’s health is
more than the concern of the health
department
Connecting Planning & Health
Seeking to answer the question:
“How are existing or planned land use,
community design and transportation
policies, projects, or programs affecting or
likely to affect public’s health?
The Health Impacts of Land Use
Planning
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Air pollution
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Car crashes
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Pedestrian injuries
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Water quality
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Mental health
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Social capital
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Physical activity
Credit: Dr.
Richard
Jackson
Opportunities to Address Health
Through Planning
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Comprehensive Planning/Master Planning
Plan Implementation can further address
health
Zoning ordinances
 Design Guidelines
 Capital Improvements
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Health Impact Assessment (HIA)
What is HIA?

Used by local health dept. staff, planning
staff, academicians, policy makers etc.
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It is a decision support tool for determining
or evaluating potential health impacts of a
project, policy or program.

HIA process engages and empowers
communities
HIA Example
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Utilizing HIA to evaluate the health and
equity impacts (positive and negative) of a
city’s existing land use and zoning
policies.
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HIA can help planners, developers and
other decision makers better recognize
the health and equity consequences of the
decisions they make.
Place Matters: Health & Land
Use Summit II
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Purpose is to advance health equity
through land use planning and building
local capacity for creating:
Healthy, Hopeful and Prosperous
Communities
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Thursday, August 19th, 2010
The expanded E.C. Grows, July 2008
Questions?
For More Information Contact :
Martha Halko, MS, RD, LD
(216) 201-2001 ext. 1535
mhalko@ccbh.net