Prevention and Land Use Planning.

One of the few things we can predict come, certainty is that change will come. Success is often defined by how well we recognize the need to change and can adapt. Now, an emerging public health issue--land use planning--is calling for a change in the dominant approach of health and environmental professionals. In many areas of the United States, growth and development are among the top issues on the agenda of communities, elected officials, and policy makers. The question is how to manage growth in a manner that maintains--or enhances--the viability of a community by preserving health, environmental resources, and quality of life.

The extent to which local public health officials and, in particular, environmental health professionals participate in the land use and development process varies among jurisdictions. Frequently, the role of health officials is limited, because planners often do not recognize the value of the expertise offered by environmental health professionals. Furthermore, many environmental health professionals see the development process as politically charged and therefore an unfriendly forum for health and environmental protection issues. Finally, many predictions of risk are laced with assumptions. It is difficult for policy makers to base land use and development decisions on the instincts of health experts about the long-term risks unless the predictions are based in sound science.

What kind of information can environmental health professionals bring to the table to strengthen land use decisions? The development of new land or the redevelopment of other properties provides an opportunity to apply the concept of primary prevention to community health and environmental protection. Environmental health involvement may begin with an assessment of vulnerable areas that could be influenced by a proposed development. That analysis might consider groundwater recharge areas, surface-water sources that collect stormwater or provide a drinking water supply, air quality, natural and man-made hazards, and the location of spills, underground storage tanks, and so forth. The next step would involve discussion of alternatives to ensure protection of vulnerable areas.

Other land use issues for which environmental health expertise may be valuable include

* adequate and effective wastewater disposal;

* water quality, including consideration of well head and aquifer protection, surface water protection, and efficient use and reuse of water;

* best management practices for control of nonpoint-source pollution spread by factors such as stormwater and erosion;

* air quality, including odors, transportation planning, and source control;

* noise impact from sources such as airports, traffic, and commercial/industrial facilities;

* pollution prevention, including identification of incentives for businesses to reduce the use and disposal of toxic materials;

* assessment of hazards such as fires, floods, spills, and landslides;

* proper solid and hazardous waste disposal; and

* safe redevelopment of federal facilities and brownfields areas.

While planners and policy makers typically recognize the importance of such concerns, the issues outlined above may not always get meaningful attention in the land use decision-making process. The advocates for health and environmental protection often are not at the table early in the process challenging developers or planning departments to recognize and respond to environmental health issues. True, planning commissioners have been heard discussing their concerns about the long-term impact of development on air, land, and water resources, as well as quality of life, but they often lack the information and technical support that would confirm or assuage their fears. In such situations, local environmental health professionals could assist by engaging in the discussion.

Besides day-to-day dialogue about specific development proposals, the role of environmental health should include participation in the local comprehensive-planning process. The most protective planning decisions may be made at the level of the comprehensive plan. The process of developing such a plan allows consideration of all issues within geographic boundaries of a political jurisdiction. The plan then establishes a framework for development and enumerates some basic principles for the protection of resources and health. The development of the plan is an ideal occasion for local health officials to enter the process and call attention to important health and environmental issues.

The following generic principles may be useful in guiding the involvement of local health officials in the comprehensive-plan development process:

* make prevention the tool of first choice;

* preserve existing resources;

* protect vulnerable resources;

* apply a long-term vision to the evaluation of current decisions;

* support sustainability;

* maintain a regional perspective, keeping in mind the influence of development on neighboring jurisdictions; and

* balance health and quality of life with the economic and other benefits of development. When one lives in an area where congestion is increasing and the rate of growth is high, it is easy to complain about the perception--and possibly the reality--of degraded environmental resources and quality of life. There are at least two distinct approaches to addressing the health and environmental issues associated with development. In the tradition of our past experience in managing environmental issues in the United States, we can rely on end-of-the-pipe treatment to clean up the mess after it is made. In development terms, that would mean emphasizing certain factors, such as the economic virtues of development, while ignoring the external costs associated with environmental impacts and quality of life. It would also mean that in the future, when the risks to health and the environment cross the threshold of acceptability dramatic action and significant resources might be required to mitigate the damage.

An alternative is to practice prevention first, where possible, and to build protection into our communities as they are developed. That approach will involve a shift in our traditional view giving prevention priority as a tool. A prevention model does, however, already exist in the environmental arena--the pollution prevention model, with incentives for business to embrace the concept.

The endorsement of increased emphasis on prevention in the planning process also will require a change in the vision of planners, policy makers, and technical experts with respect to health and environmental issues. As the guiding principles outlined above suggest, the greatest need, initially is not a lot of new science but an opportunity to participate in the discussion. For example, environmental health professionals could be engaged in the comprehensive planning process or participate in a dialogue with developers and planners early in the process to ask how a specific proposal addresses environmental issues.

A traditional creed of municipal policy makers seems to be that growth = a healthy local economy = a healthy community. That creed might be enhanced to read, effectively managed growth = an economically viable and healthy community. Thus, there is a role for local environmental health officials in the planning and development process. In fact, the quality of growth over the next decade will likely be an important determinant in establishing the extent to which local environmental health professionals will practice prevention as an intervention as opposed to responding to the real and perceived health risks associated with past failures in the planning and development process. By altering our perspective concerning the role of environmental health professionals in land use planning, we can help prove a new equation for the new millennium: Prevention = a healthy community at the lowest total cost.