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Health In All Policies

​The health of the City of Boston is about so much more than just medical care. While our city has world-class medical resources, where we live, learn, work and play also have a significant impact on shaping our health and well-being. Community design and public policies affect our access to physical activity, nutritious food, healthy housing, good jobs, clean air, and safe public places. 

We’ve made great strides towards transforming Boston into a healthier city – from the establishment of Complete Streets guidelines to the expansion of Farmers Markets in almost every neighborhood – but there is still more work to be done. Neighborhoods just a mile apart can still vary greatly in the social and environmental factors that affect health.  Data from the Boston Public Health Commission’s annual Health of Boston report illustrate drastic differences in health outcomes based on neighborhoods or zip codes. These differences follow patterns of racial segregation and poverty concentration that have historical origins in discriminatory policies and practices.

Working together, we can narrow and eliminate these differences in health outcomes, which we call “health inequities” because they are avoidable and unjust. That’s why, in 2012, the Boston Public Health Commission (BPHC) convened the Boston Health in All Policies Task Force to ensure that every resident lives in a healthy community. 

The “Health in All Policies” approach has two basic ideas.  First, incorporate health considerations into decision-making across all the agencies and organizations that influence community design, including transportation and development. Second, engage residents, who best understand the community context, into these processes. City departments and private developers are already leading the way in this effort. Ongoing projects include:  
  • The Boston Transportation Department established Complete Streets guidelines that ensure that all street redesign projects support walking, cycling, and public transit uses that are equally safe and accessible as driving a car, allowing residents to incorporate more physical activity into their daily travel.

  • The City’s taxicab fleet now includes hybrid vehicles through the CleanAir CABS Initiative​ - a collaborative effort between BPHC, Boston Police Hackney Division, the Mayor’s Office of Environment and Energy, MassPort, Boston taxicab companies, and residents. In addition to saving fuel costs by the reducing consumption of gasoline, this effort improves the cit​​y’s air quality through reduced tailpipe emissions from hundreds of thousands of vehicle miles traveled each year, reducing risk factors for asthma and respiratory problems.

  • In 2013, in partnership with the Boston Society of Architects, we launched the Fit City Boston initiative which brings together planners, architects, developers, public officials, academics and residents to explore how physical activity can be supported by the design of our streets and buildings. At the Fit City Summit in May, 100 participants brainstormed ideas. Moving forward,  designers, public health officials and residents will work to apply these concepts to in an effort to inform upcoming planning processes.

  • The city agencies and community groups represented on the Health in All Policies Task Force initially convened to explore the practice of using Health Impact Assessments (HIA) to examine the impact of planning decisions and other policies on health. Through group trainings, a pilot HIA on a project in Roxbury, and working closely with the Commonwealth on additional HIAs, the task force has gained an understanding of the most sustainable interventions that can be used to promote health in projects and policies.
HIAs are one tool that can be valuable in assessing the positive or negative health effect of proposed policies, developments, and budgetary decisions.  HIAs are an emerging best practice defined as "a combination of procedures, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, program or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects."  In 2012, the HiAP Task Force completed a pilot health impact assessment​ on the 35 Northampton Square redevelopment project.

In Summer 2013, the task force partners created preliminary healthy development priorities for incorporating health equity into street design, housing developments, building projects and park planning throughout the city. The Task Force is now working to identify mechanisms for sustainably integrating these priorities moving forward.

 Healthy community design

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