摘要：Local health departments (LHDs) have a key role to play in developing built environment policies and programs to encourage physical activity and combat obesity and related chronic diseases. However, information to guide LHDs’ effective engagement in this arena is lacking. During 2011–2012, the New York City Department of Health and Mental Hygiene (DOHMH) facilitated a built environment peer mentoring program for 14 LHDs nationwide. Program objectives included supporting LHDs in their efforts to achieve built environment goals, offering examples from DOHMH’s built environment work to guide LHDs, and building a healthy built environment learning network. We share lessons learned that can guide LHDs in developing successful healthy built environment agendas. Obesity is the second leading cause of preventable death in the United States. 1 Nationally, 66% of adults and 30% of children are overweight or obese, placing them at risk for cardiovascular disease, diabetes, and related conditions. 2 Cross-sectional research suggests that improving the built environment (BE) may be an essential component of a comprehensive public health strategy to curtail the epidemics of obesity and related chronic diseases. 3–6 Typically, the BE is defined as comprising buildings, streets, and neighborhoods, including parks and other amenities. As prospective research is developed to further explore this topic, US public health authorities including the Centers for Disease Control and Prevention (CDC), 7 the Institute of Medicine, 8 and the US surgeon general 9 concur that sufficient evidence exists to support designing communities to encourage walking, bicycling, and active recreation and to enhance access to healthy foods and beverages as a means of supporting healthier behaviors and improving health outcomes. 3–5 Local health departments (LHDs) can play a key role in the development and implementation of BE policies and programs in the communities they serve. 10,11 In the late 19th and early 20th centuries, public health leaders overcame the most urgent threat of that era—infectious disease—by working with urban planning professionals to improve living conditions, overcrowded housing, and hospital environments. 12,13 Similarly, today LHDs can collaborate with other agencies to improve building design, land use patterns, and other aspects of the BE as a means of combating obesity and obesity-related noncommunicable diseases. Since the mid-20th century in the United States, infrastructure that prioritizes passive movement such as use of automobiles, elevators, and escalators has engineered physical activity out of many residents’ daily lives. 14 Collaboration between LHDs, other governmental agencies, community-based organizations, and private institutions with roles in BE design could help to reverse this trend by influencing policy and promoting practice-level change. 5 There is great potential for interagency collaboration to improve health outcomes through BE initiatives; however, coalition building among different entities, each with its own unique mission and some with complex bureaucracies, can by stymied by institutional and jurisdictional challenges. For example, although municipal governments are responsible for most land use decision-making in the United States, regional bodies and state governments often control transportation planning and other areas that influence BE issues. Thus, fostering walkable, active local communities requires agreement among all 3 governmental levels. As another example, LHDs, although expert in health promotion and disease prevention, may lack expertise in land use, transportation, and design issues, rendering LHD staff unprepared to offer feasible project alternatives to BE-oriented organizations or agencies that could prove to be valuable partners if goals are aligned. Conversely, local parks or transportation departments may lack awareness of how urban design affects health. Enhancing communication across these sectors to illuminate common goals is essential to breaking down barriers between these municipal agencies and developing strong coalitions to improve the local BE. Perhaps the most important challenge facing LHDs is that, despite the emphasis that health organizations and funders place on the importance of BE research, policy, and program development, 15,16 few guidelines exist to direct LHDs’ engagement in this area. Recently, Kuiper et al. 10 advocated that increased technical support and resources be allocated to strong, transformational leaders within LHDs to help them define, manage, and market a healthy community design vision with measurable goals. With sustained funding for public health agencies in decline both nationally and locally, 11 developing innovative, affordable technical assistance packages for LHDs is critical. We describe lessons learned about healthy BE work from the experiences of the New York City Department of Health and Mental Hygiene (DOHMH) and 14 other LHDs from across the country. We also discuss the Built Environment Mentoring Program, a 2011–2012 initiative led by DOHMH and implemented with support from the CDC’s Communities Putting Prevention to Work initiative (CPPW). This initiative provided technical assistance, tools, and coaching for 14 LHDs across the country working on healthy BE initiatives. 17 The key challenges encountered and successes achieved by participating LHDs, as well as the critical lessons learned, can help LHDs nationwide in their efforts to facilitate successful BE work.
