Healthy Community

Vision: In 2040, Roanoke engages a holistic and equitable approach to building and ensuring the physical and mental health of our community by empowering citizens with the knowledge and resources to achieve healthy living and to strive for accountability as individual members of a connected society.

Introduction

Community health is a complex issue, one that has not been addressed in past planning efforts. City Plan 2040 considers wellness in its most broad sense and explores how safety and security, poverty, transportation systems, housing, access to food, and access to support services interrelate in ways that shape the health of the community.

In addition to supporting health at the individual level, agencies interested in improving community health work to influence the conditions that affect health outcomes. These conditions are identified as the social determinants of health.  The US Department of Health and Human Services defines social determinants of health as the environmental conditions “that affect a wide range of health, functioning, and quality-of-life outcomes and risks” and organizes them into the five domains identified in the graphic below.

As with Interwoven Equity, policies that address the social determinants are embedded in every theme of this plan. Community health has an inextricable link with equity because of neighborhood-level disparities in social determinants like transportation, housing, land use, local economy, the built environment, and so on.  Accordingly, planners worked to integrate policy ideas to influence social determinants of health in a positive direction, particularly those within the Economic Stability and Neighborhood and Built Environment domains. The Healthy Community theme directs some of the specific interventions that work within the Health Care Access and Quality and Social and Community Contextdomains.

Health in All Policies

As we developed City Plan 2040, City staff and partners participated in the Change Lab Solutions’ Building Healthy, Equitable Communities for Children & Families project. This technical assistance project shaped thinking about community health and underscored the importance of considering all the different factors that influence health. Singular focus on a particular factor doesn’t yield the desired improvement in overall community health.  The idea that we need to press all the levers of influence at once has spurred progressive communities to adopt a health in all policies approach. Because city planning is so policy oriented, it is appropriate to consider the health in all policies approach as we develop ideas among the different themes of this plan.

Wellness

A holistic view of wellness is needed to assess community health and develop corresponding public policy. The Department of Health and Human Services identifies eight dimensions of health and wellness. Physical health related to exercise, nutrition and rest is the most recognized of these element. Physical health, along with the other elements of emotional, financial, social, spiritual, occupational, intellectual, and environmental health form an interconnected state of wellness. Lack of security in any of these areas can lead to impacts to mental or physical health.

Some of these elements are largely addressed within this theme while other aspects, such as financial and environmental health are largely addressed in other theme area. This demonstrates the breadth of public health concerns.

The social and emotional components of wellness can be more difficult to identify and then address, and have a lasting effect on a person’s overall wellbeing. Approaching these elements requires a proactive and lasting approach, beginning at an early age. The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration has extensive tools and resources on multi-pronged, trauma-informed approaches to addressing health issues. The trauma-informed approach recognizes how violence, abuse, neglect, loss, and other emotionally harmful experiences impact health.

The social and emotional components of wellness can be difficult to identify and address than the physical ones. Because of their lasting effect on a person’s overall wellbeing, approaching these elements requires persistent and deliberate attention, beginning at an early age. The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration has extensive tools and resources on multi-pronged, trauma-informed approaches to addressing health issues. The trauma-informed approach recognizes how violence, abuse, neglect, loss and other emotionally harmful experiences impact health.

When it comes to physical health, obesity and chronic disease, are serious problems in our communities – in some more than others.  Chronic diseases, influenced in large part by tobacco use, alcohol abuse, lack of exercise, and poor diet,  affect 6 in 10 adults and are a leading cause of death and disability in the U.S. Some 80% of health outcomes are determined by people’s behavior, environment, or social and economic conditions. As might be expected, health outcomes vary widely by neighborhood based upon social and economic conditions.

More recently, mental health and substance abuse issues have gained attention, particularly with the opioid epidemic, highlighting the need for more holistic discussions about health.

Safety

During the listening phase of the planning process, Roanoke residents discussed how transportation, infrastructure, law enforcement, and a sense of community influence community safety and feelings of security. Residents identified safety as both a strength and a challenge for the community. This sentiment was further emphasized in the Healthy Community working group discussions that recognized important linkages between security and health. For example, regular exercise is a key building block of health, and walking is the easiest form of exercise available to most people. But what if people don’t feel safe going for a walk in their neighborhood or worry about their personal security when they go to a park?  Safe Wise’s “State of Safety” reports that 58% of Americans are concerned about their safety at some point of every day. We are all familiar with priorities of preventing safety hazards and preventing crime, but actual and perceived safety can also be created with infrastructure like sidewalks, crosswalks, and bike accommodations on streets.

Safewise Reported Level of Daily Safety Concern (U.S. %)

Safe and Healthy Homes

Good housing is key determinant of good health outcomes. It is important to not just have access to housing, but healthy housing. While most of Roanoke’s housing is well-maintained and healthy, some housing units are not. Census data indicates that about 4% of Roanoke’s housing is substandard and lacks complete plumbing or kitchen facilities. Roanoke’s Office of Real Estate Valuation identified 431 structures that are in poor or very poor condition.

Environmental hazards in some of Roanoke’s older housing stock can be a challenge. Over 80% of homes were built before 1979 and, while historic homes add to the character of the city, some have the potential for lead based paints, asbestos and other materials that are now recognized as health hazards. Until updated, older houses may not have electrical systems suitable for modern appliances or other structural or maintenance issues that represent potential safety hazards.

The Building Safety Division, the Code Enforcement Division work to improve housing conditions.  Improving home and building safety includes consideration of age of housing stock, sanitation, other health risks such as mold, lead and asbestos, and hazards related to building systems (e.g., wiring) to which renters and low-income individuals are especially vulnerable. Community Resources Division through housing rehabilitation projects and programs like Lead SAFE Roanoke have eliminated environmental hazards in hundreds of homes.

Age of Roanoke Housing Stock (U.S. Census)

Access to Health and Support Services

The percentage of uninsured Americans has increased; 8.5% of people lacked health insurance in 2018. Coinciding with the increase in uninsured individuals, the Medical Expenditure Panel Survey shows that office-based health care is on the decline and the number of people relying on hospitals as a source of care has increased.

While the recent expansion in Medicare has aimed to fill these gaps and has provided new access for approximately 9,000 Roanoke residents, access to health care is still an issue for varying reasons, including high cost, inadequate insurance coverage, lack of availability of services, poor provider trust, and lack of culturally competent care. Removing barriers like these would create more equitable access.

Lack of access to services health and support services can be even more pronounced for those that are homeless or those that suffer from mental health or substance abuse issues. In addition to barriers associated with cost, insurance, and availability, there is an added barrier to access related to siting facilities.  People frequently object to treatment or care facilities in their neighborhoods. The equity dimension can be complicated.  Facilities are needed and they need to be accessible and they need to be distributed throughout the city.

Access to Affordable Healthy Food

The Kroger and Mick-or-Mack stores that once bristled with activity in neighborhoods like Melrose and Belmont disappeared in the 1990s. Before then, people had the choice to walk or drive to get their weekly groceries. These stores were replaced, however, with larger stores in shopping centers near the outskirts of town. Located far from any residences, they are accessible only by car or bus. Meanwhile, large neighborhood areas are left with no access to groceries within the community. Despite strong community support to attract grocery stores back to neighborhoods, there is little indication that will happen given the scale and markets required. Public intervention in some form may be needed to address this issue.

Suburbanization of grocery stores has led to so-called food deserts in urban neighborhoods. Food deserts lead to food insecurity.  The Oxford Dictionary defines food insecurity as “The state of being without reliable access to a sufficient quantity of affordable, nutritious food.” In 2018, 11% of U.S. households experienced food insecurity. Particularly, Virginians have seen a marked increase in the number of low-income individuals with low access to food stores. While many residents are able to drive to pick up groceries, this is especially difficult for vulnerable populations such as low-income people, children, and seniors. Food insecure households are more likely to shop at convenience stores, where healthy food choices are rare or nonexistent.

Health Equity

Perhaps the most important observation about community health is how it varies among different populations.  Many of the health factors above merge to create remarkably different health outcomes from one community to another. We see inequity in patterns in life expectancy and disease rates among different neighborhoods, and this is where issues of health and equity intersect. Equitable health outcomes should be the ultimate goal.  All policy and action should be oriented to reducing these inequities.

Priority One: Wellness

The National Wellness Institute recognizes that “wellness is a conscious, self-directed and evolving process of achieving full potential”, in addition to being “multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the environment”. Achieving this priority requires policies that address each of the many aspects of wellness.

Improving public health is a complex endeavor and involves partnerships between the City, health professionals, large and small healthcare providers, non-profit community organizations, businesses, and the City’s residents. Defining the City’s role in this partnership is important and will likely involve the City playing the role of leader, facilitator, communicator and supporter, depending on the situation and circumstance.

Action Items:

  • Adopt a Health in all Policies approach where community health is considered in all significant policy decisions
  • Establish an advisory body to guide and assess the City’s policies as they relate to community health
  • Develop a community health plan with specific priorities, policies, actions, and data measurement related to health in the City
  • Consider representation from health professions on boards and commissions
  • Partner with Healthy Roanoke Valley and the organizational partners to focus on improving social determinants of health

The community highlighted health access and connectivity during the planning process. The actions of this policy aim to bridge the gap between a wide range of often disconnected resource providers and recipients through increased coordination, access, and education.

Action Items:

  • Create a central resource hub that provides access to health information, tools, and resources
  • Initiate community education programs on food preparation, exercise, tobacco cessation, obesity, diabetes, etc.
  • Push health services and information out to neighborhoods through mobile events, in libraries, and at other community facilities

Good access to parks and recreation has a number of benefits including reduced stress, improved mental health, higher physical activity, and lower obesity rates. Creating equitable access to recreation for all parts of the community is one step to improving overall health.

Action Items:

  • Address age, condition, and equitable distribution of current recreation centers
  • Facilitate shared use of schools and other institutional facilities for recreational activities
  • Provide a comprehensive network of greenways, trails, blueways, and parks

Social connection is a key component for overall health and wellness, specifically among seniors. Increasing social interactions among residents is also part of creating an inclusive culture. 

Action Items:

  • Improve opportunities for social connection by providing public gathering spaces
  • Encourage and enable integration of senior-oriented housing and other group care or living arrangements in neighborhood settings including co-housing
  • Partner with local groups and nonprofits to improve social connections and networks for older adults and disabled populations. Create and support intergenerational social connection through volunteer programs and events
  • Support and strengthen neighborhood associations and their efforts for community engagement

Priority Two: Safety

Communities in which residents feel safe and comfortable create an environment where residents can be active, healthy, and thriving.

A study by the U.S. Department of Justice confirmed that informal contact with officers improved community perception of the police. This type of interaction also has the potential to reduce biases held by police officers against community members. Increasing friendly engagements between the community and law enforcement is a step to improving trust within minority and low income areas.

Action Items:

  • Engage communities in developing policing strategies
  • Improve education for patrol officers through third party training sessions that address sensitive neighborhood concerns
  • Use updated data and research to predict problems and incorporate Crime Prevention Through Environmental Design (CPTED) principles to reduce crime
  • Continue to use the RCPD RESET Coordinator as a liaison between the police department and the community
  • Improve neighborhood contact with the RPD Crime Prevention Unit and encourage stronger neighborhood watch programs
  • Institute community walks that include area citizens and an interdisciplinary group of City service representatives, including city planners, code enforcement, police, fire/ems, and schools

The City’s police, fire and emergency response services are nationally accredited and strive to meet national standards for response time and other performance measures. As the City plans for emergencies, adaptation to a changing environment must be considered along with how responses serve our community in an  equitable manner.

Action Items:

  • Ensure Fire-EMS plans provide for services to meet desired response times and level of service across the City and address specific needs for vulnerable populations
  • Update disaster recovery and preparedness plans to consider effects of climate change
  • Assess current disaster recovery and preparedness plans for adequate coverage of vulnerable populations including preparation for emergencies, contingencies for public facility shutdowns, and communication methods during emergencies
  • Create a strong communication system with hospitals and health care providers in preparation for pandemics and other public health emergencies
  • Continue collaboration between neighboring localities for delivery of Fire and EMS services

Reinforcing the Complete Streets Policy will prioritize safe bicycle connections and pedestrian circulation with access to parks, schools, and other destinations that encourage active living with an emphasis on pedestrian safety. Pedestrian motor vehicle crashes and fatalities are increasing in Virginia. Improving pedestrian safety is important for creating a healthy community and allowing equitable mobility within the City.

Action Items

  • Review, update, and readopt the Complete Streets Policy and the Street Design Guidelines
  • Consider general reductions in speed limits throughout the City, particularly in neighborhood settings
  • Redesign and retrofit streets to encourage slower and more appropriate vehicle speeds for the context
  • Improve street lighting as needed to increase the sense of safety and encourage pedestrian activity
  • Identify areas with high pedestrian activity in community plans and recommend appropriate infrastructure such as sidewalks, paths, lighting, and crosswalks to provide pedestrian safety and comfort

Ensure buildings are constructed, retrofitted, and maintained for safe environmental conditions.

Action Items:

  • Administer building maintenance codes as a remedial strategy for improving building conditions, and as a preventative strategy to halt further decline of Roanoke’s well-designed but aging residential buildings
  • Continue and enhance rehabilitation programs to improve existing housing conditions and construction programs to provide safe new housing in core neighborhoods (such as the various programs provided by the members of the Roanoke Housing Partnership in CDBG target areas)
  • Consider new strategies for improving the safety of the City’s residential housing & institutional buildings as health sciences progress
  • Raise awareness of household risks through public outreach
  • Provide funding and incentives for household upgrades that reduce health risks
  • Consider ways to incorporate energy and environmental quality audits within the development review process
  • Assess and improve environmental quality of public and institutional buildings

Priority Three: Access to Health and Support Services

In order to improve access to health care and resulting health outcomes, barriers to health services need to be reduced.

Public health concerns like substance abuse, trauma, domestic violence, and homelessness are stigmatized and, to some extent, are even criminalized. This marginalization stands in the way of connecting needs with assistance to manage or resolve such issues. These issues, which virtually every community has, cannot be addressed until they become part of public dialogue.

Action Items

  • Improve public education of current health resources and develop new support services
  • Increase public awareness of domestic violence and other family issues and the availability of family services
  • Support development of adequate inpatient and outpatient medical and rehabilitation facilities for substance abuse or mental health disorders that are small in scale, accessible, and distributed across the City
  • Remove barriers to treatment, disease management, and support for those with substance abuse and mental health
  • Encourage educational programs that raise awareness of substance abuse and mental health
  • Explore therapeutic recreational programming

Being proactive and providing equitable support services to at-risk populations will help to improve overall community health and wellbeing.

Actions Items

  • Improve connections among local service providers for homeless people and people living in poverty
  • Expand after care resources for previously homeless individuals
  • Examine and address risk factors associated with substance abuse and mental health disorders
  • Consider Alternative-to-Incarceration programs for nonviolent offenders with substance abuse or mental health disorders
  • Create programs and incentives to help formerly incarcerated people move back into society, and remove the barriers to the same

Barriers such as high cost of care, inadequate insurance coverage, lack of availability of services, poor provider trust, and lack of culturally competent care limit health care access.

Actions Items

  • Support community assessments of gaps in the health networks that exist within the City
  • Support various programs and providers that service areas or individuals of need

Priority Four: Access to Affordable Healthy Food

Feeding American calculates that over 16% of Roanoke residents are food insecure. Public-private partnerships must be strengthened in order to remove barriers to food equity and find innovative solutions for improving access and health education.

The market for grocery stores has become increasingly competitive with the addition of big box stores and supercenters. Profit margins are slim, with most retailers using quantity of sales as part of a successful business model. Small grocers face significant challenges without a niche market or loyal following.  As such, many of the local, neighborhood-based grocery options within the City are disappearing.

Food access can be challenging in areas of the City that lack access to remaining neighborhood stores or regional shopping centers. Battling the economic climate and increasing access to healthy foods in these areas requires consideration of new approaches and partnerships.

Action Items

  • Incentivize affordable, healthy food grocers within food desert areas through partnerships and public funding
  • Support partnerships with nonprofit food providers and technology like ride sharing and delivery applications to expand food access
  • Continue the success of the Summer Feeding Program through Roanoke City Public Libraries, and extend it to include local food partners
  • Promote SNAP, TANF and other existing programs and incentivize the purchase and consumption of healthy foods
  • Partner with Roanoke City Schools to develop creative ways to encourage healthy eating at school and at home
  • Consider restrictions on convenience stores in food swamps that do not provide some level of fresh produce or create public safety concerns

Farming and food production is a valuable economic industry for the region. Bridging the gap between local food producers and consumers will strengthen the local economy, while improving access to healthy food for residents.

Action Items

  • Continue working with the RVARC and neighboring localities on regional food planning
  • Encourage local food production and urban agriculture
  • Improve food distribution infrastructure (markets, mobile produce vending, commercial kitchens, food hubs)
  • Support farm incubator programming in coordination with other regional stakeholders
  • Advocate for state policy that increases healthy food production and access
  • Create incentives for merchants to sell and promote healthy, local, fresh food options
  • Research urban agricultural practices and investigate ways to encourage and support context sensitive agriculture production and farming

Education is a key component of a healthy lifestyle. Increasing health education in schools can help improve learning ability and long-term student health.

Action Items

  • Create more programming for nutrition education and meal preparation for a healthy diet
  • Incorporate nutrition, food, and health education into the curriculum of schools at all levels
  • Partner with nonprofits for educational events regarding local food services

Introduction

Community health is a complex issue, one that has not been addressed in past planning efforts. City Plan 2040 considers wellness in its most broad sense and explores how safety and security, poverty, transportation systems, housing, access to food, and access to support services interrelate in ways that shape the health of the community.

In addition to supporting health at the individual level, agencies interested in improving community health work to influence the conditions that affect health outcomes. These conditions are identified as the social determinants of health.  The US Department of Health and Human Services defines social determinants of health as the environmental conditions “that affect a wide range of health, functioning, and quality-of-life outcomes and risks” and organizes them into the five domains identified in the graphic below.

As with Interwoven Equity, policies that address the social determinants are embedded in every theme of this plan. Community health has an inextricable link with equity because of neighborhood-level disparities in social determinants like transportation, housing, land use, local economy, the built environment, and so on.  Accordingly, planners worked to integrate policy ideas to influence social determinants of health in a positive direction, particularly those within the Economic Stability and Neighborhood and Built Environment domains. The Healthy Community theme directs some of the specific interventions that work within the Health Care Access and Quality and Social and Community Contextdomains.

Health in All Policies

As we developed City Plan 2040, City staff and partners participated in the Change Lab Solutions’ Building Healthy, Equitable Communities for Children & Families project. This technical assistance project shaped thinking about community health and underscored the importance of considering all the different factors that influence health. Singular focus on a particular factor doesn’t yield the desired improvement in overall community health.  The idea that we need to press all the levers of influence at once has spurred progressive communities to adopt a health in all policies approach. Because city planning is so policy oriented, it is appropriate to consider the health in all policies approach as we develop ideas among the different themes of this plan.

Wellness

A holistic view of wellness is needed to assess community health and develop corresponding public policy. The Department of Health and Human Services identifies eight dimensions of health and wellness. Physical health related to exercise, nutrition and rest is the most recognized of these element. Physical health, along with the other elements of emotional, financial, social, spiritual, occupational, intellectual, and environmental health form an interconnected state of wellness. Lack of security in any of these areas can lead to impacts to mental or physical health.

Some of these elements are largely addressed within this theme while other aspects, such as financial and environmental health are largely addressed in other theme area. This demonstrates the breadth of public health concerns.

The social and emotional components of wellness can be more difficult to identify and then address, and have a lasting effect on a person’s overall wellbeing. Approaching these elements requires a proactive and lasting approach, beginning at an early age. The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration has extensive tools and resources on multi-pronged, trauma-informed approaches to addressing health issues. The trauma-informed approach recognizes how violence, abuse, neglect, loss, and other emotionally harmful experiences impact health.

The social and emotional components of wellness can be difficult to identify and address than the physical ones. Because of their lasting effect on a person’s overall wellbeing, approaching these elements requires persistent and deliberate attention, beginning at an early age. The U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration has extensive tools and resources on multi-pronged, trauma-informed approaches to addressing health issues. The trauma-informed approach recognizes how violence, abuse, neglect, loss and other emotionally harmful experiences impact health.

When it comes to physical health, obesity and chronic disease, are serious problems in our communities – in some more than others.  Chronic diseases, influenced in large part by tobacco use, alcohol abuse, lack of exercise, and poor diet,  affect 6 in 10 adults and are a leading cause of death and disability in the U.S. Some 80% of health outcomes are determined by people’s behavior, environment, or social and economic conditions. As might be expected, health outcomes vary widely by neighborhood based upon social and economic conditions.

More recently, mental health and substance abuse issues have gained attention, particularly with the opioid epidemic, highlighting the need for more holistic discussions about health.

Safety

During the listening phase of the planning process, Roanoke residents discussed how transportation, infrastructure, law enforcement, and a sense of community influence community safety and feelings of security. Residents identified safety as both a strength and a challenge for the community. This sentiment was further emphasized in the Healthy Community working group discussions that recognized important linkages between security and health. For example, regular exercise is a key building block of health, and walking is the easiest form of exercise available to most people. But what if people don’t feel safe going for a walk in their neighborhood or worry about their personal security when they go to a park?  Safe Wise’s “State of Safety” reports that 58% of Americans are concerned about their safety at some point of every day. We are all familiar with priorities of preventing safety hazards and preventing crime, but actual and perceived safety can also be created with infrastructure like sidewalks, crosswalks, and bike accommodations on streets.

Safewise Reported Level of Daily Safety Concern (U.S. %)

Safe and Healthy Homes

Good housing is key determinant of good health outcomes. It is important to not just have access to housing, but healthy housing. While most of Roanoke’s housing is well-maintained and healthy, some housing units are not. Census data indicates that about 4% of Roanoke’s housing is substandard and lacks complete plumbing or kitchen facilities. Roanoke’s Office of Real Estate Valuation identified 431 structures that are in poor or very poor condition.

Environmental hazards in some of Roanoke’s older housing stock can be a challenge. Over 80% of homes were built before 1979 and, while historic homes add to the character of the city, some have the potential for lead based paints, asbestos and other materials that are now recognized as health hazards. Until updated, older houses may not have electrical systems suitable for modern appliances or other structural or maintenance issues that represent potential safety hazards.

The Building Safety Division, the Code Enforcement Division work to improve housing conditions.  Improving home and building safety includes consideration of age of housing stock, sanitation, other health risks such as mold, lead and asbestos, and hazards related to building systems (e.g., wiring) to which renters and low-income individuals are especially vulnerable. Community Resources Division through housing rehabilitation projects and programs like Lead SAFE Roanoke have eliminated environmental hazards in hundreds of homes.

Age of Roanoke Housing Stock (U.S. Census)

Access to Health and Support Services

The percentage of uninsured Americans has increased; 8.5% of people lacked health insurance in 2018. Coinciding with the increase in uninsured individuals, the Medical Expenditure Panel Survey shows that office-based health care is on the decline and the number of people relying on hospitals as a source of care has increased.

While the recent expansion in Medicare has aimed to fill these gaps and has provided new access for approximately 9,000 Roanoke residents, access to health care is still an issue for varying reasons, including high cost, inadequate insurance coverage, lack of availability of services, poor provider trust, and lack of culturally competent care. Removing barriers like these would create more equitable access.

Lack of access to services health and support services can be even more pronounced for those that are homeless or those that suffer from mental health or substance abuse issues. In addition to barriers associated with cost, insurance, and availability, there is an added barrier to access related to siting facilities.  People frequently object to treatment or care facilities in their neighborhoods. The equity dimension can be complicated.  Facilities are needed and they need to be accessible and they need to be distributed throughout the city.

Access to Affordable Healthy Food

The Kroger and Mick-or-Mack stores that once bristled with activity in neighborhoods like Melrose and Belmont disappeared in the 1990s. Before then, people had the choice to walk or drive to get their weekly groceries. These stores were replaced, however, with larger stores in shopping centers near the outskirts of town. Located far from any residences, they are accessible only by car or bus. Meanwhile, large neighborhood areas are left with no access to groceries within the community. Despite strong community support to attract grocery stores back to neighborhoods, there is little indication that will happen given the scale and markets required. Public intervention in some form may be needed to address this issue.

Suburbanization of grocery stores has led to so-called food deserts in urban neighborhoods. Food deserts lead to food insecurity.  The Oxford Dictionary defines food insecurity as “The state of being without reliable access to a sufficient quantity of affordable, nutritious food.” In 2018, 11% of U.S. households experienced food insecurity. Particularly, Virginians have seen a marked increase in the number of low-income individuals with low access to food stores. While many residents are able to drive to pick up groceries, this is especially difficult for vulnerable populations such as low-income people, children, and seniors. Food insecure households are more likely to shop at convenience stores, where healthy food choices are rare or nonexistent.

Health Equity

Perhaps the most important observation about community health is how it varies among different populations.  Many of the health factors above merge to create remarkably different health outcomes from one community to another. We see inequity in patterns in life expectancy and disease rates among different neighborhoods, and this is where issues of health and equity intersect. Equitable health outcomes should be the ultimate goal.  All policy and action should be oriented to reducing these inequities.

Priority One: Wellness

The National Wellness Institute recognizes that “wellness is a conscious, self-directed and evolving process of achieving full potential”, in addition to being “multidimensional and holistic, encompassing lifestyle, mental and spiritual well-being, and the environment”. Achieving this priority requires policies that address each of the many aspects of wellness.

Improving public health is a complex endeavor and involves partnerships between the City, health professionals, large and small healthcare providers, non-profit community organizations, businesses, and the City’s residents. Defining the City’s role in this partnership is important and will likely involve the City playing the role of leader, facilitator, communicator and supporter, depending on the situation and circumstance.

Action Items:

  • Adopt a Health in all Policies approach where community health is considered in all significant policy decisions
  • Establish an advisory body to guide and assess the City’s policies as they relate to community health
  • Develop a community health plan with specific priorities, policies, actions, and data measurement related to health in the City
  • Consider representation from health professions on boards and commissions
  • Partner with Healthy Roanoke Valley and the organizational partners to focus on improving social determinants of health

The community highlighted health access and connectivity during the planning process. The actions of this policy aim to bridge the gap between a wide range of often disconnected resource providers and recipients through increased coordination, access, and education.

Action Items:

  • Create a central resource hub that provides access to health information, tools, and resources
  • Initiate community education programs on food preparation, exercise, tobacco cessation, obesity, diabetes, etc.
  • Push health services and information out to neighborhoods through mobile events, in libraries, and at other community facilities

Good access to parks and recreation has a number of benefits including reduced stress, improved mental health, higher physical activity, and lower obesity rates. Creating equitable access to recreation for all parts of the community is one step to improving overall health.

Action Items:

  • Address age, condition, and equitable distribution of current recreation centers
  • Facilitate shared use of schools and other institutional facilities for recreational activities
  • Provide a comprehensive network of greenways, trails, blueways, and parks

Social connection is a key component for overall health and wellness, specifically among seniors. Increasing social interactions among residents is also part of creating an inclusive culture. 

Action Items:

  • Improve opportunities for social connection by providing public gathering spaces
  • Encourage and enable integration of senior-oriented housing and other group care or living arrangements in neighborhood settings including co-housing
  • Partner with local groups and nonprofits to improve social connections and networks for older adults and disabled populations. Create and support intergenerational social connection through volunteer programs and events
  • Support and strengthen neighborhood associations and their efforts for community engagement

Priority Two: Safety

Communities in which residents feel safe and comfortable create an environment where residents can be active, healthy, and thriving.

A study by the U.S. Department of Justice confirmed that informal contact with officers improved community perception of the police. This type of interaction also has the potential to reduce biases held by police officers against community members. Increasing friendly engagements between the community and law enforcement is a step to improving trust within minority and low income areas.

Action Items:

  • Engage communities in developing policing strategies
  • Improve education for patrol officers through third party training sessions that address sensitive neighborhood concerns
  • Use updated data and research to predict problems and incorporate Crime Prevention Through Environmental Design (CPTED) principles to reduce crime
  • Continue to use the RCPD RESET Coordinator as a liaison between the police department and the community
  • Improve neighborhood contact with the RPD Crime Prevention Unit and encourage stronger neighborhood watch programs
  • Institute community walks that include area citizens and an interdisciplinary group of City service representatives, including city planners, code enforcement, police, fire/ems, and schools

The City’s police, fire and emergency response services are nationally accredited and strive to meet national standards for response time and other performance measures. As the City plans for emergencies, adaptation to a changing environment must be considered along with how responses serve our community in an  equitable manner.

Action Items:

  • Ensure Fire-EMS plans provide for services to meet desired response times and level of service across the City and address specific needs for vulnerable populations
  • Update disaster recovery and preparedness plans to consider effects of climate change
  • Assess current disaster recovery and preparedness plans for adequate coverage of vulnerable populations including preparation for emergencies, contingencies for public facility shutdowns, and communication methods during emergencies
  • Create a strong communication system with hospitals and health care providers in preparation for pandemics and other public health emergencies
  • Continue collaboration between neighboring localities for delivery of Fire and EMS services

Reinforcing the Complete Streets Policy will prioritize safe bicycle connections and pedestrian circulation with access to parks, schools, and other destinations that encourage active living with an emphasis on pedestrian safety. Pedestrian motor vehicle crashes and fatalities are increasing in Virginia. Improving pedestrian safety is important for creating a healthy community and allowing equitable mobility within the City.

Action Items

  • Review, update, and readopt the Complete Streets Policy and the Street Design Guidelines
  • Consider general reductions in speed limits throughout the City, particularly in neighborhood settings
  • Redesign and retrofit streets to encourage slower and more appropriate vehicle speeds for the context
  • Improve street lighting as needed to increase the sense of safety and encourage pedestrian activity
  • Identify areas with high pedestrian activity in community plans and recommend appropriate infrastructure such as sidewalks, paths, lighting, and crosswalks to provide pedestrian safety and comfort

Ensure buildings are constructed, retrofitted, and maintained for safe environmental conditions.

Action Items:

  • Administer building maintenance codes as a remedial strategy for improving building conditions, and as a preventative strategy to halt further decline of Roanoke’s well-designed but aging residential buildings
  • Continue and enhance rehabilitation programs to improve existing housing conditions and construction programs to provide safe new housing in core neighborhoods (such as the various programs provided by the members of the Roanoke Housing Partnership in CDBG target areas)
  • Consider new strategies for improving the safety of the City’s residential housing & institutional buildings as health sciences progress
  • Raise awareness of household risks through public outreach
  • Provide funding and incentives for household upgrades that reduce health risks
  • Consider ways to incorporate energy and environmental quality audits within the development review process
  • Assess and improve environmental quality of public and institutional buildings

Priority Three: Access to Health and Support Services

In order to improve access to health care and resulting health outcomes, barriers to health services need to be reduced.

Public health concerns like substance abuse, trauma, domestic violence, and homelessness are stigmatized and, to some extent, are even criminalized. This marginalization stands in the way of connecting needs with assistance to manage or resolve such issues. These issues, which virtually every community has, cannot be addressed until they become part of public dialogue.

Action Items

  • Improve public education of current health resources and develop new support services
  • Increase public awareness of domestic violence and other family issues and the availability of family services
  • Support development of adequate inpatient and outpatient medical and rehabilitation facilities for substance abuse or mental health disorders that are small in scale, accessible, and distributed across the City
  • Remove barriers to treatment, disease management, and support for those with substance abuse and mental health
  • Encourage educational programs that raise awareness of substance abuse and mental health
  • Explore therapeutic recreational programming

Being proactive and providing equitable support services to at-risk populations will help to improve overall community health and wellbeing.

Actions Items

  • Improve connections among local service providers for homeless people and people living in poverty
  • Expand after care resources for previously homeless individuals
  • Examine and address risk factors associated with substance abuse and mental health disorders
  • Consider Alternative-to-Incarceration programs for nonviolent offenders with substance abuse or mental health disorders
  • Create programs and incentives to help formerly incarcerated people move back into society, and remove the barriers to the same

Barriers such as high cost of care, inadequate insurance coverage, lack of availability of services, poor provider trust, and lack of culturally competent care limit health care access.

Actions Items

  • Support community assessments of gaps in the health networks that exist within the City
  • Support various programs and providers that service areas or individuals of need

Priority Four: Access to Affordable Healthy Food

Feeding American calculates that over 16% of Roanoke residents are food insecure. Public-private partnerships must be strengthened in order to remove barriers to food equity and find innovative solutions for improving access and health education.

The market for grocery stores has become increasingly competitive with the addition of big box stores and supercenters. Profit margins are slim, with most retailers using quantity of sales as part of a successful business model. Small grocers face significant challenges without a niche market or loyal following.  As such, many of the local, neighborhood-based grocery options within the City are disappearing.

Food access can be challenging in areas of the City that lack access to remaining neighborhood stores or regional shopping centers. Battling the economic climate and increasing access to healthy foods in these areas requires consideration of new approaches and partnerships.

Action Items

  • Incentivize affordable, healthy food grocers within food desert areas through partnerships and public funding
  • Support partnerships with nonprofit food providers and technology like ride sharing and delivery applications to expand food access
  • Continue the success of the Summer Feeding Program through Roanoke City Public Libraries, and extend it to include local food partners
  • Promote SNAP, TANF and other existing programs and incentivize the purchase and consumption of healthy foods
  • Partner with Roanoke City Schools to develop creative ways to encourage healthy eating at school and at home
  • Consider restrictions on convenience stores in food swamps that do not provide some level of fresh produce or create public safety concerns

Farming and food production is a valuable economic industry for the region. Bridging the gap between local food producers and consumers will strengthen the local economy, while improving access to healthy food for residents.

Action Items

  • Continue working with the RVARC and neighboring localities on regional food planning
  • Encourage local food production and urban agriculture
  • Improve food distribution infrastructure (markets, mobile produce vending, commercial kitchens, food hubs)
  • Support farm incubator programming in coordination with other regional stakeholders
  • Advocate for state policy that increases healthy food production and access
  • Create incentives for merchants to sell and promote healthy, local, fresh food options
  • Research urban agricultural practices and investigate ways to encourage and support context sensitive agriculture production and farming

Education is a key component of a healthy lifestyle. Increasing health education in schools can help improve learning ability and long-term student health.

Action Items

  • Create more programming for nutrition education and meal preparation for a healthy diet
  • Incorporate nutrition, food, and health education into the curriculum of schools at all levels
  • Partner with nonprofits for educational events regarding local food services

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