New Hampshire Municipal Association
New Hampshire Municipal Association

New Hampshire Town And City

Designing Healthier Communities in New Hampshire

New Hampshire Town and City, March/April, 2017

By Greg Bakos, PE

The reality is alarming: a rising United States (US) obesity rate, soaring medical costs, and a startling decline in US life expectancy. Across the country, health professionals and lawmakers, alike, agree that something must be done to reverse the trends. Our sedentary lifestyles are literally killing us—and our built environment and historical development patterns are partially to blame. Fortunately, Healthy Community Design (HCD) can help.

Healthy Community Design involves designing communities and their built environment in a way that encourages people to live healthy lives. It takes a holistic approach to this goal by providing active transportation options, increasing access to healthy food, improving social connectivity and sense of community, promoting good mental health, and ensuring social equity for all community members. Planning, designing, and redeveloping our towns and cities with HCD principles in mind can help New Hampshire municipalities achieve great public health, community, and economic benefits.

The Importance of Taking a Healthy Community Design Approach

In 2016, the National Center for Health Statistics reported that US life expectancy declined for the first time in 22 years, with physical inactivity and unhealthy diet second only to tobacco use as the main cause of premature death. Associated with heart disease and diabetes, obesity is responsible for an estimated $147 billion in medical costs annually. More alarming, the US adult obesity rate is projected to reach 43% of the population by 2018.

These concerns can also be felt on a local level. Drawing on data released by the Centers for Disease Control and Prevention (CDC), the New Hampshire Department of Health and Human Services (NHDHHS) has reported that approximately one in four adults is obese here, with some counties spiking as high as nearly one-third of adults. While these numbers may compare favorably to national averages, New Hampshire ranks second in adult obesity among the New England states, behind Maine, and our obesity rate has risen sharply since 1990, for example, when it was around 10%. Recognizing the need for action, the NHDHHS’s NH State Health Improvement Plan 2013-2020 sets a goal of reducing this average to 23% by 2020. By adopting HCD principles, New Hampshire’s municipalities can play an important role in helping to improve this picture.

The Relationship Between Health and the Built Environment

People’s ability and inclination to make healthy choices and live healthy lives is influenced by the degree to which their community supports and encourages physical activity. According to Dr. Richard Jackson, a professor at the UCLA Fielding School of Health who has helped pioneer wellness design, “We have built America in a way that is fundamentally unhealthy. Where you live is a big predictor of how long you’re going to live. Our challenge is to redesign the built environment for health.”

Key contributors to a Healthy Community include:

The need to design with health in mind is clear, and our challenge in New Hampshire will be to develop policies and practices that redevelop the built environment in ways that improve public health.

The Healthy Community Design Approach

Healthy Community Design involves much more than specific engineering techniques. It requires an understanding of how communities function and finding better ways to connect people of all ages and economic backgrounds with their places of employment, schools, social services, recreation facilities, healthy food outlets—and, ultimately, each other.

When done properly, HCD engages the entire community in establishing guiding design principles. Examples of HCD principles include:

Every new project and initiative should be evaluated with the community’s established design principles, goals, and objectives, and it should be examined as part of a whole, instead of as singular improvements.

Get Healthy—or Get Left Behind

Health is fast becoming a competitive advantage for cities and towns. People crave places that are walkable and that have active transportation options—and real estate values in areas offering these features are often higher as a result. The Millennials in particular are demanding healthy choices, and they are willing to move to communities where they do not solely depend on automobiles for travel. In the effort to attract or retain the best and brightest emerging professionals, New Hampshire communities are competing with cities like Boston; Portland, Maine; and Burlington, Vermont.

When it comes to incorporating HCD principles, signs of progress are emerging across the state. Organizations like Healthy Eating Active Living (HEAL) NH are promoting HCD-oriented ideals. Concord’s new Main Street, with its road diet and vastly improved pedestrian spaces, is now a hub of pedestrian activity, and new businesses are clamoring for space there. Portsmouth is planning a bike share program for 2017. Manchester is unveiling a new bike master plan, and communities around the state are competing for federal Transportation Alternatives Program funds to build multi-use paths and sidewalks. Concord, Keene, Hanover, and Portsmouth have achieved bronze Bike Friendly Community status with the League of American Bicyclists, and other communities are sure to follow. And numerous communities take advantage of Safe Routes to School funding and bike education programs to help our children get to school under their own power. These are just a few examples of the progress that is being made to enhance active transportation. There is obviously much work to be done, but taking a holistic Healthy Community Design approach will help New Hampshire compete for talent within the region.

The argument in support of taking an HCD approach extends beyond public health and competition for talent, too. It is also a matter of good economic sense. The CDC projects that by 2017, 19% of our Gross Domestic Product (GDP) ($3 trillion) will be spent on health care. How do we convince New Hampshire’s public officials and private developers that HCD is essential to our wellbeing? Show them the economic advantage. Economic sustainability is important when considering a community’s health. A walkable and bike-able downtown will often be more vibrant and economically viable than a downtown that is auto-centric. A recent study conducted at Columbia University found that every $1,300 invested by New York City in building bike lanes in 2015 provided benefits equivalent to one additional year of life at full health over the lifetime of all city residents. That’s a better return on investment than some direct health treatments, like dialysis, which costs $129,000 for one quality adjusted life year. Public investment in active transportation often stimulates private investment in the community, and it can be linked to reduced healthcare costs.

Adopting a Healthy Community Design Practice

With recognition at the federal level that the troubling obesity trends must be reversed, it is very possible that health-focused changes in transportation policy will be forthcoming. With all of its benefits, one would hope that HCD would also be initiated at the local level, without prodding from Washington. This can happen by identifying and empowering a community champion to start the process, or by establishing an HCD task force to define specific HCD-related principles and objectives. Also, the lens of health can be used to convene local stakeholders—including public health professionals and hospitals. There is a growing body of reference material available to help get started, and some design professionals are becoming well versed in HCD. Integrating health-enhancing choices into transportation policy and decision-making in New Hampshire’s communities will provide health, economic, and community-identity benefits that should last for generations.

Greg Bakos, PE, is a principal within the Transportation Engineering services group at VHB in Bedford, NH, and is a member of VHB’s Healthy Community Design Core Group. He has experience in the redesign of New England downtowns, as well as with bike/pedestrian facility planning and design. He also serves on the board of the Bike Walk Alliance of New Hampshire. Greg can be reached at:

Healthy Community Design Resources

Center for Disease Control: Transportation Health Impact Assessment Toolkit:

The Economic Promise of Walkable Places in Metropolitan Washington, DC:

Urban land Institute: Intersections: Health and the Built Environment:

Healthy Eating Active Living (HEAL) NH:


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