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Building Healthy Places

Photograph of a cyclist riding in a bicycle lane next to a row of businesses. A bus is visible in the background. ULI’s Building Healthy Places Toolkit highlights several strategies to encourage physical activity, including using sidewalks, bike trails, and connected street and trail networks to promote walking and biking. Credit: Dan Reed, Creative Commons.

After improving for several years, health indicators for the U.S. population are now headed in the wrong direction. According to the Urban Land Institute’s (ULI’s) Building Healthy Places Toolkit: Strategies for Enhancing Health in the Built Environment, one in three adults is obese, an increase from one in eight in 1970, and only one out of every five adults meets overall physical activity guidelines. In addition, data from the National Center for Health Statistics’ most recent brief on mortality indicate that life expectancy in the United States decreased slightly between 2014 and 2015. Few of these health outcomes depend solely on the quality of medical care; rather, several factors, including the built environment, affect health. As a result, organizations involved in land development can positively impact health outcomes. A session at ULI’s Housing Opportunity 2017 conference in New Orleans, Louisiana, Building Healthy and Culturally Vibrant Communities, focused on fostering good health through the built environment. Panelists described the value of healthy housing and neighborhoods, discussed how their organizations are supporting healthy housing and development, and highlighted how developers can make the most of funding dedicated to active design components.

Health and the Built Environment

Homes and communities can be designed, built, and redeveloped in ways that promote good health, according to moderator Rachel MacCleery, senior vice president of content at ULI. ULI’s Building Healthy Places Toolkit highlights several strategies to encourage physical activity: making indoor staircases more visible and available can encourage their use; mixing land uses can help people access amenities on foot; and sidewalks, bike trails, and connected street and trail networks can promote walking and biking. Panelist Bob Simpson, vice president of affordable and green financing at Fannie Mae, noted that affordable, healthy homes and communities, especially those with access to public transit, can produce many benefits for families, including financial stability, improved physical and mental health, better cognitive performance, and increased community and neighborhood engagement among residents.

According to MacCleery, consumers have shown that they prefer healthy land use practices, indicating that demand exists for healthy homes and communities. Although people desire healthy places, “we are not building those communities, by and large,” said MacCleery. ULI’s report on its 2015 national survey of Americans’ preferences and priorities found that half of all Americans and 54 percent of millennial Americans (defined as those between the ages of 18 and 36) felt that walkability was important, and 52 percent of all Americans and 63 percent of millennial Americans wanted to live in an area where they did not need to use a car very often. When asked about their community priorities, most respondents assigned top or high priority to access to healthy foods as well as green space. However, high percentages of respondents felt that their communities did not have enough bike lanes or parks. Smaller percentages of respondents also felt that walking in their community was unsafe because of traffic and suggested that finding fresh food in their communities was difficult. However, some local and national organizations are addressing these concerns by implementing strategies intended to promote the development of healthy places.

Funding Incentives for Healthy Development

Organizations that fund affordable housing development, such as banks and other lenders, can help shape healthy development through incentives. In May 2017, Fannie Mae launched its Healthy Housing Rewards program, which encourages the development of healthy, affordable housing by offering an interest rate reduction, a discount of 15 basis points off Fannie Mae’s Multifamily Affordable Housing grid pricing, and flexible loan terms to affordable multifamily borrowers for eligible properties. Qualifying properties must achieve a score of 90 or more on the Center for Active Design’s Healthy Housing Index, and at least 60 percent of the units must be reserved for tenants whose incomes do not exceed 60 percent of the area median income (AMI). The Healthy Housing Index awards points for design and operations strategies in eight categories: accessibility, entrances and ground floor, indoor environment, location, neighborhood scale, outdoor spaces, shared and living spaces, and stairwells.

According to Simpson, by late 2017, Fannie Mae will expand the program to affordable multifamily housing projects that provide resident services. Under the expanded program guidelines, a property would be eligible if at least 60 percent of the units are reserved for tenants whose incomes do not exceed 60 percent of AMI, if the development and services provided meet a certification standard currently under development by Stewards of Affordable Housing for the Future, and if the borrower agrees to provide resident services for the full loan term. Fannie Mae is collecting data to determine whether these investments correlate with positive health outcomes.

Pursuing Open Space Projects

Business improvement districts and other organizations with a stake in local growth can also help foster healthy development by planning and implementing green and open space projects. The Downtown Development District (DDD) of New Orleans, the first assessment-based business improvement district in the nation, is currently planning to encourage physical activity by improving access to parks and open space in the downtown area. Research shows that people who live within a half-mile of a park exercise more, on average, than those who do not. According to panelist Kurt Weigle, president and chief executive officer of DDD, following resident feedback highlighting a need for playgrounds, parks, and multifunctional open space, DDD partnered with ULI Louisiana in 2014 to conduct a Technical Assistance Panel on green space in downtown New Orleans. In response to the panel’s recommendations, DDD is in the process of developing a Green Space Master Plan. DDD has also made an agreement with the city to redesign Duncan Plaza, an underutilized public space near the city’s biomedical district. Weigle hopes that the improvements to the park will result not only in better health outcomes but also in a stronger neighborhood and additional business investment in the downtown.

Choosing Healthy Design Features

Developers can also contribute to healthy communities by adding active design and wellness features and services to their developments. For example, to support physical activity as well as social interaction, developers could consider including fitness centers with exercise equipment, an interconnected network of sidewalks and trails, protected bike lanes, and community gardens. In addition, developers could offer wellness seminars and fitness classes as part of their communities’ programming.

Developers do not need to dedicate a substantial amount of money to health and wellness amenities. ULI’s Building for Wellness report examined 13 developments and found that features and components intended to improve residents’ health accounted for a minimal percentage of overall development costs, especially when they were included in the early stages of planning. Panelist Roger Heim, finance director at the for-profit affordable housing developer Vitus, highlighted two projects in which the cost of active design components amounted to less than 10 percent of the budget. In the rehabilitation of Pavilion Apartments in East Orange, New Jersey, the cost of active design features, including a community kitchen, a garden, a fitness area, and an outdoor recreation area, made up approximately 2 percent of the budget. And in the renovation of the Century North Apartments in Oakdale, Minnesota, active design components such as a playground, an outdoor fitness center, a garden, a pavilion, and a bicycle maintenance area constituted only 8 percent of the total budget.

Developers can also partner with other organizations to promote health. Lack of access to healthy food, which is correlated with higher rates of type 2 diabetes and obesity, is a major concern for communities across the nation. According to Simpson, one way developers can ensure that residents have access to healthy food options is to partner with grocery stores and include them in developments.


As the indicators of health decline, it is important to consider the role of the built environment in promoting positive health outcomes. Healthy homes and communities have the potential to provide many benefits to residents, and research has shown that consumers desire healthy land use practices. Organizations involved in land development have many opportunities to meet this consumer demand by incorporating health and wellness into their programs and projects, whether through funding incentives, improvement projects and plans, or the presence of health and wellness features and services.

Published Date: 23 October 2017