Health

Goal

By 2040, everyone in the tri-state region should live longer and be far less likely to suffer from mental illness or chronic diseases such as asthma, diabetes or heart disease, with low-income, Black and Hispanic residents seeing the greatest improvements.

The Fourth Regional Plan would restore the connection between planning and health with actions that would correct past injustices and improve the lives of coming generations. As described below, the plan’s recommendations seek to intentionally improve health while addressing challenges in four key areas: climate change, transportation, affordability, and governance.

Reform institutions to incorporate health into decision making.

Institutional reform is a precondition to the implementation of any plan. This presents an opportunity to embrace a “culture of health.” Agencies would recognize they are responsible for the public’s health and make decisions through the lens of health equity. Health impact assessments would be commonplace and funding tied to outcomes. Communities would shape their own future and the health sector would be a key stakeholder in decision-making. To achieve these outcomes would require the following:

• Reorient our transit agencies toward health as part of the transformation of the way we govern and pay for transportation. Agencies should set health as a goal when evaluating planning and capital budget decisions. Health equity and the full range of social determinants of health, where relevant, should be considered. A chief health officer could promote a health agenda within the organization, guide implementation, and serve as a link to the health sector.
• Integrate health into the core missions of newly created institutions to tackle climate change. A new regional coastal commission should use health as a lens through which to communicate about climate change, and health should be incorporated into the funding criteria of an adaptation trust fund. Expanded carbon pricing together with investment in community led efforts could help ensure reductions in carbon emissions benefit the communities most exposed.
• Leverage reforms to the local planning process to make it more inclusive, predictable, and efficient to include health. Engage from the get-go all community members, especially those not traditionally included in decision making. Incorporate health impact assessments—and technical support for them—into master planning. Leverage universities and hospitals to spur neighborhood reinvestment and promote partnerships between anchor institutions and local communities by engaging them as key partners in the process.
• Integrate health into the public realm through a new 21st century regional census agency. Start by developing consistent measures of street and public space conditions related to health. As data-driven decision-making advances, these measures could serve as inputs in street-management decisions. Prioritize street redesigns in low-income communities as a tool to improve health and increase participation in local government.

Rebuild and expand the transportation network to serve everyone.

A rebuilt and expanded transportation system would connect more low-income communities, be usable by all, and limit negative environmental impacts. New rail service would open up the region’s downtowns to more jobs and other opportunities, and enable more walkable communities. New York City’s subways would be safer, cleaner, quieter, and fully accessible to people with disabilities. The region’s bus system would be fast, reliable, and integrated with other transportation options. Fewer communities would be burdened by poor air quality. And safer streets would have more room for more people of all abilities to enjoy the health benefits of walking and biking. Achieving these outcomes would require the following:

• Create a regional public transportation network by using commuter rail to connect job centers and underserved areas throughout the region with fast, reliable service and fare structures that allow more people to afford it.
• Increase the subway’s capacity and reliability. Improve the riding experience by adopting new technology for fast, reliable subway service and creating spacious and healthier subway stations and making them accessible to all.
• Extend and build new subway lines to underserved areas, such as the Third Avenue corridor in the Bronx, neighborhoods along Northern Boulevard in Queens, and Utica Avenue in Brooklyn.
• Expand the transit system. Provide more and better transit options in suburban areas with affordable, on-demand service and reform and expand the paratransit system.
• Improve bus service and introduce new streetcar and light rail lines in both urban and suburban areas, connecting communities, reducing auto traffic, and promoting walkable neighborhoods.
• Remove, bury, or deck over highways that blight communities of color and repurpose them to serve the communities they are in and expand nature into urban areas.
• On city streets, prioritize people over cars by closing certain streets to cars, limiting parking in others, prioritizing pedestrians, cyclists, and sustainable transit, and making goods movement more efficient, thus reducing congestion, air pollution, and noise.

Meet the challenge of climate change by creating a healthier environment.

Preparing for climate change would prevent countless injuries and deaths from extreme heat and flooding, and fewer people would be displaced or live in damaged homes. Cleaner air and water would reduce disease. And many more people, especially communities of color, would enjoy the region’s abundant nature and open spaces. To achieve these outcomes would require the following:

• Create a greener and greater energy system. Modernize the electrical grid and sharply reduce carbon emissions by charging industry and consumers for the amount of carbon they produce, and investing in building energy efficiency, electric-vehicle infrastructure, and renewable energy sources.
• Protect densely populated communities along the coast from storms and flooding by deploying natural and built infrastructure and transitioning people away from places that can’t be protected in a way that preserves social cohesion.
• Mitigate the urban heat island effect. Reduce rising temperatures in urban areas by creating new design guidelines and community greening initiatives to cool our communities.
• Connect open spaces. Create a tri-state trail network that connects people who have limited mobility and those without cars to nature via accessible walking and biking trails.

Create affordable and healthy communities.

Measures such as fair-housing rules enforcement, land trusts, and support for homeownership will ensure that in the future, growth in the region happens in a way that benefits existing residents, particularly communities of color. More high-quality housing, jobs, public spaces, and services will result in more communities where living a healthy life is the easy choice. To achieve these outcomes would require the following:

• Provide affordable housing for all incomes, ages, races, and ethnicities through strategies such as mandatory inclusionary housing across the region, enforcement of fair-housing rules, reforms to housing subsidies programs, and incentives for transit-oriented development.
• Protect low-income residents from displacement and homelessness by preserving existing affordable housing, strengthening tenant rent protections and homeowner protections, and enabling existing residents to capture more of the wealth created from rising property values.
• Make all housing healthy housing by adopting routine inspections for health hazards in at-risk communities, new technology to detect problems, and streamlined remediation processes that address multiple hazards at once.
• Expand access to more well-paying jobs by prioritizing investments in older cities and downtowns, preserving manufacturing, and expanding affordable internet access across the region.
• Expand healthy, affordable food access in the region by prioritizing the needs of food-insecure communities, supporting a diversity of food options, and integrating food planning into regional institutions.

If implemented, these actions could help everyone lead the healthiest life possible, regardless of who they are or where they live. But for that to happen, broad consensus around challenging topics will be necessary. Health could be a way to build new alliances, promote equity, understand the true value of different investments, and promote civic engagement.

<sub>1. RPA, “State of the Region’s Health,” 2016
2. Regional Plan Association, “Spatial Planning and Inequality,” 2015
3. American Journal of Public Health, “Regional Planning in Relation to Public Health,” 1926</sub>