The industrial era of the 19th and early 20th centuries created cities that provided economic opportunity to millions of foreign immigrants and migrants from rural and small-town America. But with so many people moving into cities, overcrowding, poor sanitation, substandard housing and high poverty rates contributed to widespread outbreaks of infectious diseases, such as cholera and tuberculosis. The new professions of public health and urban planning developed in response to the desire to improve living conditions in growing urban centers.

As decision-makers, local officials can play a critical leadership role in efforts to improve community health, because there are so many ways that local decisions can affect residents’ health and well-being.

A wide array of local officials — those elected to serve on the city council or county board of supervisors, residents serving on advisory boards and commissions as well as local agency administrators and staff — have many opportunities to integrate health considerations into local programs and policy decisions. Some of the most important types of local decisions with health implications are outlined below.

How local officials choose to plan and lay out communities — through the general plan, zoning and other land-use regulations — affects health.

For example, if homes, stores, schools and other places people need to go are near one another and connected by safe and convenient walking and bicycling routes, people are more likely to walk or bike than if these amenities are located farther from one another. Studies show that when residents take advantage of these opportunities to increase their everyday activity, it reduces their risks of obesity, diabetes and other chronic health conditions.²⁵ Spending less time in cars gives people more free time to spend with their families and communities, which can improve emotional well-being.²⁶

Decisions on how buildings are designed, constructed and renovated have implications for health.

Many communities have established architectural standards, green building requirements and other local policies that affect the health and safety of residents and tenants. For example, incorporating “universal design” principles into residential construction — such as simply requiring that at least one entry to each new or renovated residence be accessible for people with disabilities — can make a neighborhood safer for people of all ages and abilities.

Decisions on the type and character of public facilities and infrastructure affect the health and safety of residents.

For example, neighborhood streets that carry fast auto traffic can be modified through traffic-calming measures to slow vehicle speeds. “Complete streets” programs can provide safe routes for vehicles, bicycles, pedestrians and people with disabilities (for more about complete streets, see “An Overview of Planning Concepts for Health and the Built Environment.”) These programs can help seniors and those with limited mobility cross busy streets and make it easier for children to safely walk and bike to school. As a result, the rate of injuries and deaths from traffic accidents typically declines.²⁷

Decisions about the programs that are funded through the city or county budget can affect health.

This applies to decisions beyond those typically thought of as health related, such as funding for clinics, senior meals and other traditional health and social services. For example, responding to a local budget crunch by closing parks or limiting the hours they are open can make it more difficult for residents to be physically active, even in neighborhoods where quality recreational facilities can be safely reached by biking or walking. This in turn can lead to declines in levels of health and fitness.