How to Provide Healthier Environments in Big Cities

Local Health Policy: Philadelphia

In the article by Brownson, et al., the authors assert that environmental changes and certain policy interventions can have a positive impact in terms of reducing the incidence of chronic disease in a community. The authors go on to explain how interventions and environmental policies in a community can "…provide opportunities, support, and cues to help people develop healthier behaviors" (Brownson, et al., 2005, p. 17.2). This article also posits that pursuing a healthier environment benefits everyone in the community, which is a policy that makes sense from a public health standpoint because "changing the behavior of one person at a time" is short-sighted (Brownson, 17.2). Among the interventions that Brownson reviews are: a) tobacco use reduction (through clean air laws; taxes; restriction of availability); b) advertising; and education; c) better access to fitness facilities and school-based physical education programs; d) encouraging healthy eating in schools and at worksites; and e) taxing snack foods and reduced pricing on healthy foods (Brownson, 17-2-17.9).

Philadelphia Public Health Policies

In Philadelphia, the public health policies put forward are strikingly similar to those presented by Brownson and colleagues in their peer-reviewed article. The Philadelphia Department of Public Health (PDPH) shows its deep concern for its citizens because it plans to apply for public health accreditation in 2015; and even though public health accreditation is not a requirement of a public health agency (in terms of future funding), in Philadelphia they know that grant awards in the future may not be available for those communities that are not accredited. Meanwhile, in its "Community Health Assessment" for 2014, the PDPH reports that 40% of the premature deaths in Philadelphia are due to "behavioral patterns," 15% are due to "social circumstances"; 30% are due to "genetic predisposition"; 10% are because of poor healthcare; and 5% result from "environmental exposure" (PDPH, 2002).

Those 40% of premature deaths due to "behavioral patterns" certainly include the issue of tobacco use, and includes the foods (healthy or not) that a person eats as well. In Philadelphia public health officials team up with elected officials to enact legislation that supports a healthier environment. For example, there is an ordinance against restaurants using artificial "trans fats"; there is a "smoke-free" workplace law; there are support groups for smoking cessation; and there is a menu label law regarding the nutrition (or lack of it) in food that is offered by restaurants, caterers, and others in the food business (PDPH).

Philadelphia works to improve public health through environmental engineering; in its "preventing chronic diseases" section the city explains the inspections it conducts in order to ensure the health of its citizens. These inspection services include: a) sewage disposal systems; b) "waste storage & disposal" (infectious / hazardous waste handling); c) sanitation and safety inspections of schools, hospitals, prisons, and "other public establishments"; d) public bathing inspections; e) all public water supplies; f) tattoo, piercing and "cosmetic make-up" inspections; g) mold problems; and h) barber and beauty shops (PDPH).

Two Potential Impacts of "Get Healthy Philly"