In conjunction with development of City Plan 2040, city staff and partners participated in the Change Lab Solutions Building Healthy, Equitable Communities for Children & Families project. It is well documented that there are a number of health related issues facing our communities. Obesity is increasing and leads to lasting consequences with chronic disease and other problems. Chronic diseases affect 6 in 10 adults and are a leading cause of death and disability as well a leading driver of our nation’s increasing health care costs. 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.
Four lifestyle factors greatly influence chronic disease or prevention thereof: use of tobacco, excessive alcohol consumption, exercise and nutrition. Eighty percent 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 social and economic conditions.
The Healthy Community section begins the analysis of health issues and health determinants for the city and develops policy and action that can be taken to improve health outcomes for the community.
During the listening phase of the planning process, Roanoke residents discussed transportation, infrastructure, law enforcement, and a sense of community in regards to safety. Individuals identified safety as both a strength and a challenge for the community. This sentiment was further emphasized in the Healthy Community working group discussions. Regular exercise is a key building block of health, and regular walking is the easiest form of exercise available to most people. How can we have a healthy community if many do not feel safe to go for a walk in their neighborhood?
Safe Wise’s “State of Safety” reports that 58% of Americans are concerned about their safety on a daily basis. While mitigating fears of crime is often a priority, maintaining a sense of safety includes all aspects of daily life. Sense of safety also covers adequate sidewalks and street crossings, street lights and maintenance of that infrastructure. Policies that seek to improve public safety strategies, provide adequate infrastructure, and aim to protect public health are part of creating a safe and thriving community.
Safewise Reported Level of Daily Safety Concern (U.S. %)
A holistic view of wellness is needed when assessing community health and developing 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 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, rauma-informed approaches to addressing health issues. The trauma-informed approach recognizes how violence, abuse, neglect, loss and other emotionally harmful experiences impact health.
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. Census data indicates that nearly 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.
Additionally, Roanoke has an older housing stock with over 80% of homes built before 1979. While historic homes add to the character of the city, houses built prior to 1979 have the potential for lead based paints, asbestos and other materials that are now recognized as presenting health hazards. Older houses may not have electrical systems suitable for modern appliances or other structural or maintenance issues that represent potential safety hazards.
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.
Age of Roanoke Housing Stock (U.S. Census)
Access to Health and Support Services
The percentage of uninsured Americans has increased from 2017-2018, with 8.5% of people lacking health insurance at any point in the year 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 individuals relying on hospitals as a usual 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. These reasons include: high cost of care, inadequate insurance coverage, lack of availability of services, poor provider trust, and lack of culturally competent care. Removing barriers such as these is a priority for creating equitable opportunity for a healthy life.
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, inadequate insurance, lack of available services, etc., there is an added barrier in that many do not like these types of treatment or care facilities near their place of residence or business. This added equity dimension can be complicated in that these types of facilities are needed, need to be accessible, and yet should also be distributed throughout the city, not clustered in specific areas.
Access to Affordable Healthy Food
The Oxford Dictionary defines food insecurity as “The state of being without reliable access to a sufficient quantity of affordable, nutritious food.” In 2018, 11.1% 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 individuals, children, and seniors. As such, food insecure households are more likely to shop at convenience stores, which contributes to an unhealthy lifestyle.
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.
- Appoint an advisory committee to assist in the development of the city’s health policy
- In conjunction with our partners, develop a community health plan with specific priorities, policies, actions, and data measurement related to health in the city
- Develop a Health in all Policies policy that requires the city to assess public health in all significant decisions
- Consider representation from health professions on various boards and commissions
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.
- Create a central resource hub that provides access to health information, tools, and resources; and promote through various media outlets, health care providers, and related entities
- Encourage partnerships and education programs focused on food preparation, exercise, tobacco cessation, obesity, diabetes, safety nets etc.
- Provide mobile services through local libraries and other resources
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.
- Address age, condition, and equitable distribution of recreation centers
- Facilitate shared use of schools, places of worship, and other institutional facilities for recreational activities
- Provide a comprehensive network of greenways, trails, blueways, and parks to promote health and social connections through physical activity
Roanoke ranks in the bottom-third for social engagement on AARP’s Livability Index. 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.
- 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.
- Include community collaboration when determining community policing strategies
- Improve education for patrol officers through third party training sessions that address sensitive neighborhood concerns
- Use updated data and research to predict problem areas and reduce crime through design standards (CPTED)
- 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.
- Ensure updates to Fire and EMS plans provide for services to meet desired response times/level of service across the city and address specific needs for vulnerable populations
- Update disaster recovery and preparedness plans to account for 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 local governments 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.
- Improve street lighting to increase the sense of safety and encourage pedestrian activity
- Reduce speed limits in needed areas to improve pedestrian safety
- Upgrade crosswalks to be clearly delineated through pedestrian friendly design
- Ensure crosswalks and signals are installed in areas with high pedestrian traffic and signals timed for elderly and ADA needs
- Identify areas with high pedestrian activity in order to target necessary infrastructure to improve pedestrian comfort as part of neighborhood, area and corridor plans
- 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, such as substance abuse, trauma, domestic violence, homelessness, and the like are often stigmatized, and obscured as a result. These issues cannot be addressed until they become part of public dialogue.
- 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 in-patient and out-patient medical and rehabilitation facilities for substance abuse or mental health disorders that are distributed across the city
- Remove barriers to providing effective 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.
- Improve connections among local service providers for the homeless and impoverished
- Expand/extend after care resources for previously homeless individuals
- Examine risk factors associations with substance abuse and mental health disorders and create proactive approaches to address and educate at-risk populations
- Consider Alternative-to-Incarceration programs for nonviolent offenders with substance abuse or mental health disorders
- Create programs and incentives to help incarcerated individuals move back into society
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.
- 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.
- Identify food deserts and incentivize affordable, healthy food grocers within these areas through partnerships and public funding
- Assist in coordination of/partnership with nonprofit food providers and technology advancing services like ride sharing and delivery applications to expand the reach of service
- 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
- Restrictions on additional 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.
- Continue working with the RVARC and neighboring localities on regional food planning
- Encourage local food production such as, gardens, urban agriculture, bees, chickens, greenhouses and other environmentally controlled measures
- 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 legislation
- Create incentives for merchants to sell/stock 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.
- Create more programming for nutrition and cooking education
- Improve nutrition/food/health education in schools
- Partner with nonprofits for educational events regarding local food services