As the United States continues to struggle with policies focused on healthcare, leaders could learn from Copenhagen that investing in people and the places in which they live might be a better strategy to improve health outcomes for everyone.
Despite spending more on healthcare than any other country in the world, studies show that Americans are living shorter lives with poorer health. Research suggests that access to quality clinical care only contributes to 20% of overall health outcomes, while health behaviors and social and economic factors, along with the physical environment, account for the rest.
This makes it obvious that a big part of improving health and well-being is creating communities where everyone can thrive and not just survive. In particular, public spaces can create the physical and social conditions that are critical to building healthier communities for all.
Copenhagen, considered the world’s “most livable city,” has led the way in improving the quality of life for its residents through integrated planning that puts people first.
As part of a U.S. delegation of policy leaders hosted by the Gehl Institute and the Robert Wood Johnson Foundation, I recently explored how the greater Copenhagen region achieves more inclusive, healthy, and equitable communities through public spaces.
Denmark, I learned, wasn’t an overnight success. Its leaders had a master plan borne of an energy and financial crisis that crippled urban centers in the 1970s, similar to the experiences of some U.S. industrial cities. Copenhagen chose to rebuild with a focus on housing, transportation, and public spaces, making the city more livable for people, which Danish architect Jan Gehl refers to as, “breathing life between the buildings.”
In the U.S., research has confirmed that where you live is a major factor in your upward mobility and may also contribute to life expectancy, with people in the Deep South suffering more from heart disease, for example, and people in parts of Kentucky and West Virginia facing more respiratory disease. Some U.S. cities understand the issues well and are taking action. Leaders should consider the following transferable approaches from Copenhagen, as well as those from American cities leading the way.
3 Key Lessons
Invest in the built environment and social programs
In Copenhagen, areas of most need receive targeted planning, capital, and social service support. The Government has created an umbrella of policies at all levels of governance, and everything from schools to sidewalks is improved through robust community input, developing neighborhoods in a holistic way. Similarly, the city of Houston recently launched the Complete Communities Initiative, a pilot program to revitalize the city’s underinvested communities in partnership with neighborhood residents. This shift to people-centered planning directly addresses the social determinants of health.
Build on community assets
We must shift the way we conduct community planning and focus on the assets of communities to address local needs, including investing in active transportation and public spaces like parks and civic spaces. In Copenhagen, leaders build on neighborhood assets to co-create plans and investment, while in the U.S. we tend to focus on only the challenges of a neighborhood. Leaders should conduct health impact assessments as decision-making tools to improve public health through community design. Another key point is avoiding a one-size-fits-all approach, focusing instead on policies and programs that address community priorities and culture and then implement them systematically.
Address immediate needs
We have enough plans; it’s time to implement. In Copenhagen, a conscious investment is made to address the needs of residents and incorporate the region’s values. Planners in the U.S. should shift their focus to today not just the next 30 years. We need more resilient plans that adapt to the evolving needs of current, not just future residents, keeping in mind that much of our infrastructure—housing, transportation, and community amenities—reflects the values and inequities of our investments. Copenhagen looks to public space as a common good, promoting equal access to transportation, green space, and playgrounds, as well as prioritizing cycling as a core mode of transport. These actions illustrate how much people’s well-being is at the center of the city’s urban development agenda.
Translating These Approaches Back Home
I recognize that the systems and communities in Denmark differ from American cities. For example, Copenhagen has a single agency oversight for public investment. Our nation’s demographics, racial histories, and experiences of immigration are also very different. However, already across the U.S. cities, regions, and local collaboratives are putting into practice some of the key concepts that led to Copenhagen’s success.
“Health in All Policies” is a national collaborative approach that integrates and articulates health considerations into policymaking across sectors. For example, California created a Health in All Policies Task Force with the Strategic Growth Council to build inter-agency partnerships across state government to address issues of health, equity, and environmental sustainability.
The Chicago Department of Public Health (CDPH) launched Healthy Chicago 2.0, a plan focused on ensuring a city with strong communities and collaborative stakeholders, where all residents enjoy equitable access to resources, opportunities, and environments that maximize their health and well-being.
The local SPARCC collaborative in the Bay Area, Bay Area 4 All, is trying to address the needs of low-income families being displaced by rising housing prices. These families end up farther from job centers and aren’t connected to public transit, increasing their reliance on polluting and expensive transportation. Bay Area 4 All is bringing a wide array of partners together to advocate for policies that preserve affordable housing and develop public land for community benefit.
Everyone has a role to play in building a culture of health, and leaders must invest outside of institutional walls. Everyone should have the right to breathe clean air, drink clean water, live in a healthy affordable home, and have access to quality health care. Put simply, where you live shouldn’t determine how long you live.
My lesson from Copenhagen, let’s invest in what really matters: people. And, let’s start by ensuring the places in which we live, learn, play, and engage with others foster better health for all.