Shared-Use ROOSEVELT HEALTH IMPACT ASSESSMENT. Executive Summary. April Project Funders

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1 Executive Summary April 2016 Project Fuders WeArePublicHealth.org This project was supported by a grat from the Health Impact Project, a collaboratio of the Robert Wood Johso ad The Pew Charitable Trusts, with fudig from the de Beaumot Foudatio. The opiios expressed are those of the authors ad do ot ecessarily reflect the views of the Health Impact Project, Robert Wood Johso Foudatio, de Beaumot Foudatio, or The Pew Charitable Trusts.

2 About this Executive Summary This documet provides a summary of the Shared-use Roosevelt Health Impact Assessmet (SHUR), which took place from late 2014 through summer SHUR was coducted i order to better iform future decisiomakig ad fudig allocatios related to the expasio of shared-use, or the commuity-use of school district owed properties, withi the Roosevelt Elemetary School District i South Phoeix. The SHUR team also recogizes that may school districts ad jurisdictios are explorig ad udertakig similar decisios throughout the Uited States, ad hopes that the results of this health impact assessmet (HIA) are valuable to those etities as well. Special Thaks The authors would like to ackowledge the over 300 South Phoeix residets, eighbors, ad commuity members that participated i this HIA through surveys, focus groups, key iformat iterviews, ad commuity mappig sessios. The SHUR commuity advisory board, or Isight Committee, also deserves special recogitio for their commitmet throughout the etire HIA process ames ad affiliatios of the committee members ca be foud i the full report. This HIA would ot have bee possible without our experieced, isightful, ad thorough techical assistace providers: Amber Lehart, the Health Impact Project, ad Steve White ad Emily Heke, Orego Public Health Istitute. The full HIA report, HIA video ad appedix ca be foud at

3 Backgroud A commuity s health is largely iflueced by social factors such as educatio, ecoomic opportuities, coditios of eighborhoods as well as access to healthy food, safe spaces to recreate, reliable trasportatio, ad quality housig 1. (See figure below: Social Determiats of health). As rates of chroic disease cotiue to rise, geographic areas with higher rates of poverty ad fewer resources ted to be most greatly affected. The Ceters for Disease Cotrol ad Prevetio, alog with orgaizatios such as the Robert Wood Johso Foudatio, are ow statig that zip code is a better predictor of health tha geetic code. 2 A recet study led by Virgiia Commowealth Uiversity s Ceter o Society ad Health revealed a fourtee year life expectacy gap betwee zip codes i the greater Phoeix area 3. Due to iequities related to the aforemetioed social factors, idividuals bor i orth Scottsdale (85258) are livig o average 85 years Zip code is a better predictor of health tha geetic code. while those bor just south of dowtow Phoeix (85004) are oly livig 71 years. Efforts to reduce chroic disease ad improve health equity must iclude targeted approaches to create ad sustai political, social, ad evirometal coditios that support health. A strategy termed shared-use, sometimes called joit-use, is spreadig i commuities throughout the Uited States. Shared-use is defied as opeig school buildigs ad grouds durig o-school hours for commuity use 4. Through shared-use, schools ca provide safe spaces to play ad gather whe other recreatioal spaces are lackig, usafe, or i poor coditio. The Study Area The Roosevelt Elemetary School District () was fouded i Its 21 schools serve over 12,000 studets ad 1,200 employees. Curretly, although is takig great strides i the right directio, after-hours use of school properties by the commuity has bee limited to agreemets o a cotractual or evet-by-evet basis. I order to expad access to District-owed properties to be used more regularly by the commuity, the District expressed iterest i participatig i a Health Impact Assessmet (HIA) to help iform ad improve future shared-use decisio-makig. Social Determiats of Health Racism Social Cohesio Housig Food Access to Political Participatio Dicease Vectors Parks Educatio Air, Water & Soil Quality Commuity Ceters Diet Exercise Social, Ecoomic & Political Factors Livig & Workig Coditios Public services & Ifrastructure Idividual Behaviors Idividual Factors Age Geder Geetics HEALTH Addictio Workig Eviromet Trasportatio Ecoomic Copig Dev Segregatio Care Jobs Health Beefits Wages & Noise Iequality Poverty SHUR Project Goals Better uderstad the curret health ad well-beig of the commuity that the Roosevelt School District serves Predict the impacts o the social determiats of health from shared-use of district properties Provide recommedatios that help to expad ad promote the commuity use of district-owed properties i the Roosevelt School District safely ad resposibly Preset data ad iformatio o shared-use that is useful for other districts locally ad elsewhere Page 1

4 Shared Use Roosevelt HIA: Schools & Parks with a 0.5 Mile Radius This map represets the City of Phoeix parks located withi the SHUR study area boudaries. Literature idicates idividuals are willig to walk 0.5 miles to spaces of recreatio. Areas that remai pik have limited access to recreatio. Areas i blue are potetial spaces for recreatio if shared-use is implemeted Miles ± Map Leged Roosevelt School District 0.5 Mile Park Radius 0.5 Mile School Radius Public parks Schools withi Distric Sources: City of Phoeix, Arizoa Departmet of Educatio Health Impact Assessmet: A Commuity Drive Process HIA is a tool that helps decisio-makers cosider the health effects of a proposed policy, project, pla, or program. Through the six steps of HIA [Screeig, Scopig, Assessmet, Recommedatios, Reportig, Moitorig ad Evaluatio], direct ad idirect impacts of a decisio are assessed before the decisio is made i order to aticipate outcomes, both positive ad egative, o the health of a commuity 5. Equity is a core value of HIA. Therefore, HIA also addresses the reasos why low-icome people, commuities of color, ad other uderserved populatios experiece poorer health as a result of iequities i society 6. Itetioal commuity-ivolvemet is ivolved at each step of HIA. Data Sapshot Existig coditios data, which cosisted of demographics, deaths, ad hospital discharge data, were used to examie the characteristics ad health status of the commuity withi the study area. Demographics The SHUR study area houses a youger ad lower-icome populatio as compared to the rest of Maricopa Couty. Media age i the study area was 29.5 years vs years i the couty ad 23.8% of residets live below the federal poverty level vs. 11.6% i the couty. I additio, the study area has a larger Latio ad Africa America populatio, resultig i a larger umber of Spaish speakig residets as compared to the etire couty (46.8% vs. 20.5%). Therefore, HIA also addresses the reasos why lowicome people, commuities of color, ad other uderserved populatios experiece poorer health as a result of iequities i society. Page 2

5 Health There is defiite cause for cocer i the health status of the study area, especially related to diabetes, asthma, ad obesity. This ca be evideced by data which reveal that deaths due to complicatios related to diabetes are 38% higher i the study area tha i the rest of Maricopa Couty (32.9 per 100,000 vs. Diabetes Related Hospitalizatios SHUR Study Area Maricopa Couty Diabetes Related Hospitalizatio Asthma Related Hospitalizatios 0 White Hispaic Black Diabetes Related Hospitalizatio by Race/Ethicity Diabetes Related Hospitalizatio by Age SHUR Study Area Maricopa Couty Asthma Related Hospitalizatio 0 White Hispaic Black Asthma Related Hospitalizatio by Race/Ethicity Asthma Related Hospitalizatio by Age SHUR Study Area Maricopa Couty Page 3

6 23.8 per 100,000). Rates of both ipatiet ad emergecy room hospitalizatios related to diabetes as well as asthma i the SHUR study area are higher across almost all age groups from 5 to 84 years of age i compariso to the rest of Maricopa Couty - especially i Latio ad Africa America Populatios (see graphs above). I additio, hospitalizatios that are obesity ad heat related are also higher i the study area tha i the rest of Maricopa Couty. These baselie data helped to iform the Isight Committee to develop iovative, effective, ad sustaiable solutios to address the social determiats of health such as: access to recreatio, access to healthy food, ecoomic developmet, affordable housig, ad availability of quality educatio, all of which are large cotributors to these disparities i health outcomes. Methods The Isight Committee A commuity advisory group made up of represetatives from local govermetal, academic, ad commuity-based orgaizatios the Isight Committee provided leadership for the HIA. The Isight Committee was preseted with the existig coditios data shortly after beig coveed for the first time. These data, alog with the committee member s persoal experieces ad relatioships with their commuities, helped to guide the HIA process. At the oset of the Scopig phase, through actively cosiderig the social determiats o health, the Isight Committee foud that the greatest health impacts of the policy decisio to expad shared-use agreemets i came through five key pathways. The study s research questios ad methods were built withi these pathways. Pathways to Health 1. Commuity Erichmet/Civic Pride Whe commuities gather together, they ca icrease their sese of social cohesio, belogig ad trust all of which have bee show to improve physical ad metal health. 2. Healthy Eatig District owed vacat lots, ope spaces, ad commuity kitches ca serve as spaces for both youth ad adults to grow, prepare, ad eat healthy foods. 3. Physical Activity Whe schools ope up their recreatio spaces to commuity members after hours, levels of physical activity with both youth ad adults ca icrease, especially whe facilities are i good order (e.g., clea, graffiti-free, ad properly lit). 4. Neighborhood Impacts ad Public/ Persoel Safety Improvig safety ad security must be priorities if school facilities are to be shared by the public. Amout of staffig/supervisio, level of police presece, quality of lightig/ ifrastructure, ad level of commuity iteractio ca all impact how safe people feel ad crime rates. 5. Maiteace/Operatios Commo costs for share-used iclude, but are ot limited to: maiteace, cleaup, repairs, staff, security, ad utilities. However, costs ca be reduced through greater owership ad ivolvemet by the commuity. Page 4

7 The Pathway Diagram The purpose of developig the pathway diagram was to help preset a clear visual of the ways i which the policy decisio of expaded shared-use ultimately impact the health of studets ad commuity residets i the study area. Pathway Diagram POLICY DIRECT OUTCOMES INTERMIDIATE OUTCOMES HEALTH OUTCOMES Commuity Erichmet/ Civic Pride Positive Metal Health Expaded i the Roosesevelt School District Icreased Access to School Facilities ad Properties for Public Use Access to Recreatioal Spaces Access to School & Commuity Gardes Access to Commuity Meetigs/Gatherig Spaces Healthy Eatig Physical Activity Neighborhood Impacts/ Public & Persoel Safety Chroic Disease Culture of Health Heat Related Illess Respiratory Illess/health Ijury Maiteace/Operatios Stress o Staff & Commuity The study s five pathways ad associated research questios helped to guide the commuity egagemet ad assessmet activities for the HIA. The assessmet phase was broke dow ito two stages: 1) uderstadig the existig health coditios of the commuity (previously discussed) ad 2) assessig the predicted health impacts of expadig shared-use. A multi-method approach resulted i the collectio ad aalyses of demographics data, hospital discharge data, ad crime data, as well as extesive literature review. Data collectio ad aalysis were performed by the Office of Epidemiology at the Maricopa Couty Departmet of Public Health (MCDPH) ad literature review was performed by the Arizoa State Southwest Iterdiscipliary Research Ceter (ASU SIRC). I total, over 300 idividuals that live, work ad/ or go to school i the studyarea commuity were ivolved i the assessmet processes. Additioally, staff from the ASU SIRC worked with promotoras (commuity health workers) from Ulimited Potetial Arizoa ad Southwest Behavioral Services to perform primary data collectio i the commuity. This data collectio icluded focus groups with youth ad adults (25 idividuals), commuity surveys (225 idividuals), key iformat iterviews (19 idividuals), ad commuity mappig sessios (39 idividuals). I total, over 300 idividuals that live, work ad/or go to school i the study-area commuity were ivolved i the assessmet processes. Page 5

8 Fidigs Assessmet phase results showed that residets withi the Roosevelt School District care deeply for their commuity ad value expaded shared-use, particularly for the opportuities it might ope up for icreased activity ad educatio amog youth. Additioally, residets oted a desire ad commitmet toward improvig their commuity for curret ad future geeratios. Although data may reveal discouragig disparities i health outcomes, the commuity members ad those orgaizatios that support them see may opportuities for the health of residets to improve over time. The primary perceived beefits of expadig shared-use iclude: 1) the opportuity for commuity erichmet through collaboratio/partership ad 2) physical activity improvemet. Shared-use might lead to happier commuity members. Commuity Erichmet Through icreased access to commuity gatherig spaces as well as more ope commuicatio chaels betwee the school district ad the commuity, social cohesio i the commuity, sese of owership for school properties, ad parterships based o accoutability ad trust ca improve all of which ca icrease the health of the commuity as well as help to address issues with safety ad security. Oe keyiformat oted that shared-use might lead to happier commuity members. Physical Activity Shared-use ca also potetially improve physical activity i the area by directly providig icreased access to recreatioal spaces. I SHUR, this appeared to be especially true for youth rather tha adults. Youth were more likely to state that they would take advatage of ope schools, especially if they lived i eighborhoods where local parks were ot close. A strog emphasis was placed o the eed for orgaized ad plaed physical activities for local youth so that improvemet i physical activity could be supported i a structured maer. There was also a desire for ope idoor gyms to address issues such with excessive heat ad pollutio. For example, idoor gyms could be opeed durig high pollutio advisory days or excessive heat warig days. Oe teacher advocated for ope-use of gyms, statig, If they had a gym available, the kids would be there every day. Barriers/Cocers Despite these two primary perceived beefits Commuity Erichmet ad Physical Activity - residets, leaders, ad District persoel emphatically emphasized that a umber of barriers, cocers, ad eeds must be addressed i order for expaded shared-use to be successfully implemeted. The most importat cosideratios iclude those related to safety, security ad crime. Agai ad agai throughout the HIA process, commuity members expressed their cocers over the safety of the streets i their eighborhoods. May commuity members avoided physical activity durig the ight time or aroud dagerous itersectios. However, by ehacig safety protocols at the District ad City levels, creatig stroger parterships with commuity orgaizatios as well as law eforcemet, elistig voluteers, ad implemetig programs such as Safe Routes to School, may of these cocers ca be addressed. Page 6

9 Predicted Health-impacts of Expaded Shared-use The purpose of this table is to predict the impacts o health withi the cotext of each pathway ad to serve as a summary for the assessmet phase. Overall, accordig to the literature ad data, expaded commuity use of District-owed properties will positively impact public health; however, special cosideratio must be placed o methods to mitigate respiratory illess, ijury as well as stress o staff ad the commuity movig forward. Health Determiats ad Outcomes Likelihood Quality of Evidece Overall Public Health Pathway #1 Icrease access to school facilities for public use Icreased Commuity Erichmet/Civic Pride Positive Metal Health + Chroic Disease + Culture of Health + Pathway #2 Icreased access to school Facilities for public use Icreased Healthy Eatig Positive Metal Health + Chroic Disease + Culture of Health + Pathway #3 Icreased access to school facilities for public use Icreased Physical Activity Heat Related Illess + Respiratory Illess/Health - Chroic Disease + Culture of Health + Positive Metal Health + Ijury - Pathway #4 Icreased access to school facilities for public use Neighborhood Impacts/Public Safety Ijury - Stress o Staff ad Commuity + Pathway #5 Icreased access to school facilities for public use Maiteace/Operatios Stress o Staff ad Commuity - LEGEND: Likelihood Directio of arrow idicates effect o coditio: or = Possible, more likely to happe tha ot. or = Probable, very likely to happe. or = Defiite, will happe. Quality of Evidece = No direct evidece to support OR evidece is icoclusive. = Direct evidece but from limited sources, icludig published studies. = Direct strog evidece from a rage of data sources collected usig differet methods. = Overwhelmig strog evidece from a rage of data sources usig differet methods. Overall Public Health Impact - positive (+) or egative (-). Page 7

10 Recommedatios I order to maximize the health beefits of expaded shared-use while mitigatig the potetial egative health outcomes, the SHUR IC worked to develop ad prioritize a list of 21 recommedatios to various resposible agecies ad orgaizatios. These recommedatios were the groud-truthed through a fial commuity focus group (11 commuity members). The top three recommedatios for each pathway are preseted below. The full list ca be see at Pathway to Health Commuity Erichmet/ Civic Pride Rec. # Recommedatio 1.1 Hold commuity evets ad activities o school grouds i order to gather commuity members ad foster icreased social cohesio. 1.2 Gather a ivetory of existig services ad school or commuity-based activities. Advertise ad promote services ad activities through schools ad commuity agecies. 1.3 Work with the City of Phoeix to improve street ifrastructure aroud schools ad parks i order to icrease safe eighborhood gatherig ad commuity pride. Healthy Eatig 2.1 Implemet school gardes that grow fruits ad vegetables by egagig studets, parets, ad commuity members. Physical Activity 2.2 Coduct ad promote healthy cookig, utritio ad home gardeig classes for families ad commuity members. 2.3 Brig farmers markets ad pop-up stads to schools, commuity ceters ad parks i the study area. Create parterships with local food retailers ad farms. 3.1 Create Parterships with commuity agecies to provide free or low-cost structured physical activity courses for youth ad commuity members durig shared-use/ope-use periods 3.2 Implemet shared-use that icludes ope gyms to accommodate idividuals with health issues such as asthma ad other respiratory illess. Agecy(ies) Resposible Roosevelt School District () Cooperative extesio Girl Scouts City of Phoeix Parks ad Rec/FIT PHX Southwest Behavioral Health MCDPH City of Phoeix Parks ad Recreatio Local media outlets City of Phoeix Streets Trasportatio Dept. City of Phoeix Complete Streets Advisory Board APS/SRP Iteratioal Rescue Committee Cultivate South Phoeix UofA Cooperative Extesio School with shared-use Welless Ceter/Brooks Commuity School Uiversity of Arizoa Cooperative Extesio Valley Permaculture Alliace Arizoa Farmers Market Associatio City of Phoeix Plaig ad Zoig Iteratioal Rescue Committee Cultivate South Phoeix (CUSP) Tiger Moutai Foudatio Maricopa Couty Food System Coalitio FIT PHX City of Phoeix Parks ad recreatio Local ruig groups Commuity members for voluteerig/ supervisio Block watch groups Asthma Coalitios Page 8

11 Neighborhood Impacts/ Public Safety Maiteace/ Operatios 3.3 Coduct physical assessmets of schools (visual observatio of space, lightig, shade etc.) i order to idetify best cadidates for shared-use that are safe ad accessible to the commuity. 4.1 Esure facilities cosidered for shared-use are assessed for safety. Cosideratios may iclude: access to the school, pedestria/bicyclist safety, playgroud equipmet, cogestio/parkig, gags ad lightig. 4.2 Develop policies that are safety mided related to supervisio, trash, dogs, hours. Assess how supervisio might impact stress o staff (custodias, teachers, security). 4.3 Create or ehace eighborhood block watch groups that are able to supervise ope facilities durig oschool hours. 5.1 Estimate costs of shared-use activities. Idetify fudig sources (existig ad potetial) for shareduse related costs. 5.2 Establish shared-use fudig committee with PTOs ad commuity members. 5.3 Create a commuicatio chael withi the District to distribute iformatio related to shared-use ad to elist voluteers (parets, curret staff). MCDPH ASU Plaig PTOs MCDPH City of Phoeix Streets Trasportatio Phoeix Police Phoeix Neighborhood Services City of Phoeix City of Phoeix PTOs Commuity Developmet Corporatios Local Busiesses, foudatios, orgaizatios No-profit hospitals Coclusio Overall, accordig to the literature ad data, expaded commuity use of District-owed properties will positively impact public health i the commuity especially through icreased commuity erichmet, social cohesio, ad physical activity. I additio, Curret efforts by groups such as the TigerMoutai Foudatio, the Orchard Commuity Learig Ceter, Cultivate South Phoeix ad the District itself poit to the fact that healthy eatig ca also be improved i the commuity through creative use of lad, iteractive commuity garde developmet, ad utritio educatio. Nevertheless, special cosideratio must be placed o appropriate methods to mitigate safety cocers, bicyclist ad pedestria ijuries, as well as added stress o staff movig forward. The study s 21 recommedatios, if implemeted, ca be a startig poit for, MCDPH ad may commuity parters to begi implemetig better policy, developig better supportive programmig, fosterig better collaborative efforts, ad most importatly, better workig alogside populatios facig health iequities to improve the health ad wellbeig of the commuity. If you are iterested i learig more about how to support implemetatio of the SHUR recommedatios, feel free to reach out to Keeth Steel keethsteel@mail.maricopa.gov. To lear more about Health Impact Assessmet i Arizoa, please visit the Arizoa Alliace for Livable Commuities website: Page 9

12 Citatios 1 World Health Orgaizatio, Commissio o Social Determiats of Health, Closig the Gap i a Geeratio: health Equity Through Actio o the Social Determiats of Health While most ted to equate shareduse with playgrouds, shared-use ca also iclude the creative reuse of vacat lad. After sigig a lease with the Roosevelt School District to occupy a 18 acre plot of lad, Cultivate South Phoeix has helped jump-start Spaces of Opportuity, a commuity-based iitiative to refashio the food system i south Phoeix ad to promote healthy food access, healthy literacy, ad ecoomic developmet. More ifo at: 2 Arki, E., Bravema, P., Egerter, S., & Williams, D. (2014). Time to act: Ivestig i the health of our childre ad commuities. Priceto, NJ: Robert Wood Johso Foudatio Commissio to Build a Healthier America 3 Virgiia Commowealth Uiversity Ceter o Society ad Health, Updated 04/05/ Youg, D. R., Spegler, J. O., Frost, N., Eveso, K. R., Vicet, J. M., & Whitsel, L. (2014). Promotig physical activity through the shared use of school recreatioal spaces: a policy statemet from the America Heart Associatio. America Joural of Public Health, 104(9), Natioal Research Coucil (US) Committee o Health Impact Assessmet. (2011). Improvig health i the Uited States: The role of health impact assessmet. Natioal Academies Press (US). 6 Heller, J., Gives, M. L., Yue, T. K., Gould, S., Jadu, M. B., Bourcier, E., & Choi, T. (2014). Advacig efforts to achieve health equity: Equity metrics for Health Impact Assessmet practice. Iteratioal joural of evirometal research ad public health, 11(11), WeArePublicHealth.org