Neighborhood & Built Environment

Social determinants of health (SDOH) are non-medical factors that influence health outcomes. They are the conditions in which people are born, live, learn, work, play, worship, and age, and the wider set of forces and systems shaping the conditions of daily life.

SDOH are grouped into five key areas. This discussion guide focuses on the area of neighborhood and built environment. This area refers to the connection between where a person lives—housing, neighborhood, and environment—and their health and well-being.

Before the Discussion

If you have not already done so, please take the following steps:

• Review the introduction and discussion guide instructions for information on how to use this guide.
• Learn more about SDOH (e.g., neighborhood and built environment), key issues, and how people experience their neighborhood and built environment (i.e., understanding of your audience).
• Familiarize yourself with local voluntary organizations active in disaster (VOAD) and the services they provide.
• Create a list of partner government and community-based agencies to invite to your discussion. Use the prework questions to help you decide who to invite. Invitees should include VOAD whose services improve conditions in neighborhoods and built environments.
• Decide if you will distribute the prework questions to participants in advance of the activity or answer the questions as a group before the activity. If you opt for the former, ask participants to record their answers and bring them to the activity.

Neighborhood and Built Environment

Neighborhood and built environment includes key issues such as quality of housing, access to transportation, and neighborhood crime and violence. These issues can make it difficult or impossible for people to prepare for and respond to an emergency to the best of their abilities. For example,

• People without access to ready and reliable transportation may find it difficult to evacuate.
• Public transportation may be negatively impacted during an emergency.
• People may not evacuate if they fear someone might damage or burglarize their homes.

The objectives of this discussion-based activity are to help emergency planners

• better understand how conditions associated with neighborhood and built environment affect how people prepare for and respond to emergencies.
• identify gaps in emergency planning and partnerships associated with the impacts of neighborhood and built environment on people’s preparedness for and response to emergencies.
• ideate ways to build new and leverage existing partnerships in the whole community to reduce or remove barriers to personal health preparedness for and response to emergencies.

Just promoting healthy choices and protective actions won’t eliminate the barriers related to SDOH. Public health departments and their partners must act to understand and address conditions in neighborhoods and built environments in their planning and processes.

Scenario Overview

The discussion guides in this series will all follow the same scenario: a mass evacuation. Mass evacuations are possible in response to many different types of emergencies, including hurricanes, chemical spills, and wildfires.

An evacuation order may raise questions in the minds of many people in the community.

• “Should I go or should I stay?”
• “Can I go?”
• “Where will I go?”
• “How will I get there?”
• “Will my home be broken into while I’m gone?”

Often, it’s not a matter of following an evacuation order; it’s a matter of ability (e.g., physical fitness, stable health condition) and access to the means (e.g., services, supplies, support) necessary to leave and stay healthy throughout an evacuation.

Please note that neither this scenario nor the discussion questions address all key issues associated with neighborhood and built environment. Examples and evidence of SDOH impacts and interventions are likely to evolve with additional research and experience.

Lessons from the Field

Review the below key issues and barriers that a mass evacuation might cause members of your community.

Think of past events that caused perceptible preparedness and response challenges in/to your community. Incorporate identified gaps and lessons learned from those events into your discussion. Lived experiences can add depth to your discussion.

Key Issues & Barriers

An evacuation order has been issued in your community.

Many people do not own a personal vehicle.

Public transportation services play an important role for people in your community who are unable to drive, including those without access to personal vehicles, children, individuals with disabilities, and older adults. As a result, some community members need evacuation assistance, while others may refuse to evacuate.

Furthermore, some community members do not know an evacuation order was issued.

Discussion Questions

• What forms of public transportation are available in your community?
  • Who in your community relies most on public transportation for movement and to meet daily needs (e.g., access to jobs, food, education, healthcare services, etc.)? Public transportation services play an important role for people who are unable to drive, including those without access to personal vehicles, children, people with disabilities, and older adults.
  • Are there identifiable gaps between the level of transit service (supply) and the needs of the whole community (demand)? This is referred to as a transit desert.
  • How might an emergency, including a disease outbreak or natural disaster, impact people’s access to and the availability of public transportation?
• What plans, procedures, and memoranda of understanding (MOUs) does your community have for providing evacuation assistance to people who rely on public transportation?
  • Do evacuation plans include rerouting typical public transportation routes? How might this affect community members dependent on these resources?
  • Clearly defined evacuation assembly points are important. These are predesignated areas where people can go to be transported out of the impacted area. What plans are in place for assisting community members who cannot get to these evacuation assembly points unassisted?
• What plans, procedures, and MOUs does your community have for providing evacuation assistance to people who need specialized transportation? Specialized transportation services provide essential transportation and independence for those who have difficulty using traditional fixed-route services because of disability, age-related conditions, or income constraints.
  • What forms of specialized transportation are available in your community?
  • How are specialized transportation services used in an evacuation?
• What plans, procedures, and partnerships does your community have for communicating about an evacuation?
  • How is evacuation preparedness information communicated to people before an emergency?
  • How are evacuation instructions communicated to people during an emergency?
• What plans and procedures does your community have to prevent crime (e.g., looting, burglarizing) in evacuated communities?
  • Does this protection apply only to local businesses? If it does, how can this protection be extended to include residences?
  • For what length of time can this protection be provided?

After Your Discussion

A lot of useful information should come out of your discussion. Use this information to take actions that better prepare your community. Next steps may include the following:

1. Collect written or typed notes and any additional feedback from the note taker and participants. If the meeting is virtual, consider reviewing the transcript for additional insights, if you chose to record the meeting.
2. Summarize the discussion and detail any after actions in a written report (optional). A simple follow-up e-mail with highlights of the discussion and action items can ensure these ideas are implemented in future planning and response efforts.
3. Stay informed of contributions to the preparedness and response knowledge base and evidence-based resources related to neighborhood and built environment. Evidence of SDOH impacts in emergency response is likely to evolve with additional research and experience.
4. Seek out promising practices (i.e., interventions that include measurable results and report successful outcomes) that have removed or reduced the impacts of neighborhood and built environment on people’s preparedness for and response to emergencies. Examples of SDOH interventions are likely to evolve with additional research and experience.

Promising Practice

The City of New Orleans has experienced numerous hurricanes over its long history, including Hurricane Katrina in 2005. The city has applied lessons learned from past hurricane responses to create city-assisted evacuation. This promising practice was developed by the City of New Orleans Office of Homeland Security and Emergency Preparedness.

Resources

The below list of resources is not exhaustive. Neither the inclusion nor the mention of a resource in this discussion guide suggests an endorsement of a group, product, or service by CDC.

1. About Social Determinants of Health, CDC
2. How Do Neighborhood Conditions Shape Health?, Build Healthy Places Network
3. Improving Neighborhoods and the Built Environment, Rural Health Information Hub
4. Neighborhood and Built Environment, Michigan Department of Health and Human Services
5. Public Health Action Guide: Public Transportation, CDC Foundation
6. Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health, CDC
7. Environmental Public Health Impacts of Disasters: Hurricane Katrina, National Academy of Sciences
8. Evacuation Stakeholders’ Roles and Responsibilities, U.S. Department of Transportation