In anticipation of our first Neighborhood and Physical Environment workgroup meeting on September 25, 2020, I have taken the liberty of putting together a list of discussion questions for consideration by the team.  This is by no means intended as an inclusive list.  Recognizing the challenges of starting with a blank page, it is my hope that this will give us a jump start.  Please feel free to suggest different questions and topical areas as well as to suggest revisions and deletions. Are these the right questions for us to consider?  What other questions would you propose?

The principal goal of the National Action Agenda Neighborhood and Physical Environment workgroup is to develop a handful of actionable recommendations that ultimately could be implemented to improve equity and the social determinants of health focusing on interoperability and information-sharing.

Here are some initial ideas for our discussion -- please feel free to share your ideas and/or comment on any of these:

  • Conditions in the neighborhoods surrounding our homes can have major health effects. Social and economic features of neighborhoods have been linked with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease, as well as with mental health, injuries, violence and other important health indicators.
    • How can we encourage initiatives that promote equity and inclusion and promote smart growth and community design to improving community health along with neighborhood economic development to improve physical, social and service environments? Should we consider establishing timelines and metrics for measures such as:
      • Reduce the percentage of families that spend more than 30% of their income on housing
      • Increase the percentage of the population that lives in a jurisdiction that adopted the Climate Smart Communities pledge
      • Increase the proportion of people who commute using alternate modes of transportation, i.e., public transportation, carpool, bike/walk, telecommute
      • Decrease the percentage of people who live greater than 1 mile from a supermarket or grocery store in urban areas, or greater than 10 miles from a supermarket or grocery store in rural areas
      • Increase the percent/number of buildings that meet the US Green Building Council's LEED (Leadership in Energy and Environmental Design) green building and neighborhood standards, or any other comparable set of standards.


  • What legal/regulatory actions need to be taken to facilitate data sharing (e.g., across healthcare providers, housing providers, food providers, etc.) and leverage data in a way that helps to identify and find housing for people experiencing homelessness? How can we promote interdisciplinary teams to achieve these goals?


  • Should we encourage healthcare systems to fund housing recognizing that housing is health? What data is needed?  What would we propose?


  • Should we consider “environmental justice” interventions that seek to reduce toxic exposures especially in the physical environment in communities with large concentrations of low-income residents, particularly low-income black and Hispanic residents if research demonstrates that hazardous wastes, pollution and other toxic substances are differentially concentrated in such communities?


  • Should we consider strategies to reduce residential segregation along socioeconomic lines, for example through: zoning measures; expanding the supply of affordable housing in neighborhoods that offer opportunities for employment and quality schools; enforcement of fair housing laws, including the Federal Fair Housing Act; and a range of other initiatives?


  • What actions could we take to increase the accessibility and affordability of healthy food including bringing retail food markets into disadvantaged communities that now have the most limited choices and increase access to affordable farmers markets for low socioeconomic status communities?


  • At the federal level, should we propose provisions to the omnibus farm and transportation measures that present opportunities for new policy directions?
    • Success could bring more accessible and affordable healthy foods and a transportation system that supports physical activity—safe streets, safe routes to school, and bike and pedestrian paths, for example.


  • At the state and local levels, should we propose oversight by regulatory agencies and boards (e.g., for clean air or healthy homes) to promote positive changes in core components of a healthy community?


  • Should we consider home-sharing programs such as Silvernest ( to expand housing options, keep people in their homes, and reduce loneliness given limitations on affordable housing capacity?


  • Should we propose expanding programs such as the South Dakota Governor’s House Program nationally? South Dakota Housing’s Governor’s House offers a low-maintenance, attractive dwelling that is attractive, reasonably sized and budget-friendly for those who are income-qualified. With 2,000+ sold since 1996, it’s part of how South Dakota Housing makes homeownership more affordable for all across the state. Built through a partnership with the Governor’s Inmate Training Program at one of the state’s prisons, participating inmates can learn skills and trades in building the Governor’s House properties to prepare them for related work upon release. Affordable housing and promoting job training.


  • How can we match revitalization strategies to neighborhood conditions and align policies, programs, and investments across sectors, levels, and systems?


  • How can we promote more parks especially to serve vulnerable communities?
    • Conduct an assessment to identify barriers to accessing parks, fields, and recreational facilities in redeveloping, underserved, or economically challenged communities.
    • Develop recommendations for providing parks and non-traditional park amenities for communities that are redeveloping, underserved, or economically challenged.


  • Recognizing that only half of adults and about a quarter of high school students get the amount of physical activity recommended in national guidelines, how can we promote walkability?
    • Encourage people to promote walking and make their communities more walkable including sidewalks, bike lanes, special bus lanes, comfortable and accessible transit stops, frequent crossing opportunities, median islands, accessible pedestrian signals, and curb extensions.
    • Design and maintain streets and sidewalks so that walking is safe and easy.
    • Adopt community planning, land use, development, and zoning policies and plans that support walking for people of all ages and abilities.
    • Locate schools, worksites, businesses, parks, recreational facilities, and other places that people regularly use within walkable distance of each other.


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  • To further our collaboration, I offer a basic set of definitions for considering the improvement of our nation's population HEALTH and it's healthcare.  See pages 4-11 at

    Any consideration of social mobility must first consider each person's capabilities to exit adolescent maturation as a courageous independent person.  See the attached reference to the lasting neurological effects of Childhood violence. see pages 4-11 at    https://doi.10.100/jamanetworkopen.2020.17850

    Finally, the rationale for the need to focus on primary determinants of population HEALTH.  See reference for "The Capability Trap: Prevalence in Human Systems" by Landry and Sterman at MIT

    community centered reform
  • An increased level of residents walking in their neighborhood has been shown to increase the level of trust among their neighbors.  Trust and well-being have been shown to exhibit reverse causality.  See Giordano and Linstrom 2016 at  

  • Excellent points -- accessibility and visitable are also important!  Thanks!

  • Eric - let's consider adding ensuring that housing is not only affordable but is also physically accessible and "visitable" by family, friends and neighbors.


  • Glad to see you are accelerating the pace at the start!  Exactly what we are hoping for is for each group to form and forge a pathway that fits them and contributes to the ultimate actionable things to go do in 2021!

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