Everyone deserves the opportunity to live the healthiest life possible, regardless of who they are or where they live.


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 provides a roadmap to address health inequities rooted in the built environment and create a healthier future for all. 

Recent improvements in health across the New York region have not benefited everyone.1 Too many health challenges are concentrated in poor communities of color, due in large extent to planning and other policy decisions.

Many factors contribute to the health of residents, including where affordable housing and roads are built, the transit system and other infrastructure, and preparedness for climate change. Yet planning decisions continue to prioritize efficiency over health and well-being, or reflect institutional racism and other biases. These attitudes were reproduced in many policies and practices, such as discriminatory housing policies that led to the tri-state region having one of the highest levels of segregation in the United States.2 As a result, low-income residents and people of color are far more likely to be isolated from the resources and opportunities needed to live healthy lives.

We can reduce health inequities by making different investments and policy decisions. We can create better health outcomes in marginalized communities, while expanding our economy and protecting our environment.

After all, connecting planning and health isn’t a new idea. Modern urban planning began largely in response to infectious-disease epidemics. The development of sanitation and water systems, parks, and building codes saved countless lives. The connection between planning and health was recognized in the New York metropolitan region as well. As Thomas Adams, who led the development of RPA’s 1928 “Regional Plan of New York and Its Environs,” told the American Public Health Association in 1926, health was “the first object,” the key goal of regional planning.3

Life expectancy has risen, but the residents of some communities still live significantly longer than others. Factors related to place, such as school quality, walkability and air pollution, affect people’s health—and these vary greatly across the region. Average Life Expectancy, 2010. Source: Institute for Health Metrics & Evaluation

Reconnecting planning and health

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:

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 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:

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.

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