The Key to Healthy Cities and Hearts Might Come from the Ground

Debra Burke grew up in the middle of a 500-acre forest in Hardin County, Kentucky. 

With no electricity or running water, she drank milk that wasn’t pasteurized, cooked with water from a nearby spring and ate vegetables caked with dirt.  

So when she moved an hour north to Louisville, Kentucky, 23 years ago, it was a bit of a culture shock, she told NationSwell.

She scoured the urban landscape for a forested pocket to meet her tree needs. “I kept looking for a community that reminded me of home,” she said.

After living in the city for about six months, she finally found it near Iroquois Park, a 725-acre expanse filled with a few of Burke’s favorites: red maples and white oaks. 

A few months ago, Burke was on her daily walk there when a yard sign caught her attention. It talked about the Green Heart project, a scientific study assessing how health is impacted by tree canopy, the percentage of a city shaded by trees.

Burke, a 59-year-old barber, is familiar with the power of trees — not just how they beautify cities, but how they transform the lives around them — so she wanted to get involved. Now she’s one of over 800 residents participating in a health assessment to track how trees and vegetation affect their cardiovascular health. 

Her neighborhood is one of the four neighborhoods in south Louisville that has embarked on a $15 million, five-year study that will once and for all answer if health is tied to an area’s tree canopy. The study launched in 2018 when researchers collected baseline information about the neighborhood’s air pollution and resident’s heart health. Over the next three years, they’ll plant trees and monitor those same residents. In 2022, they’ll observe any changes. 

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The Green Heart project will be the first controlled scientific study assessing the impact of tree canopy on heart health.

As early as 1984, researchers were beginning to understand the role greenery plays in health. Roger Ulrich watched as patients with tree-facing windows had shorter hospital stays compared to their counterparts who looked at brick walls. The links between health and vegetation have continued for decades. Scientists saw the benefits of trees in everything from absorbing auto emissions to cooling sidewalks. They studied how greenery correlates to decreases in stress levels, heart rates, muscle tension, asthma and blood pressure.  

There’s a well-known link between health and greenness. But an important component was missing from the story: a controlled scientific study. 

The Green Heart project will be the first-ever experiment to see if increasing an area’s tree canopy will improve residents’ health.

Ted Smith, the director of the Center for Healthy Air, Water and Soil at the University of Louisville’s Envirome Institute, compared it to a drug trial “except the drug is trees and bushes,” he told NationSwell. Researchers will use a control group and a test group to see if the “drug” is effective or not. 

In this study, a control group of two neighborhoods will not receive any changes to their environment, but the test group will. Test neighborhoods will have 8,000 trees and plants added to their lawns, backyards and public spaces. Green Heart’s team surveyed public and private land in search of gaps in greenery, and the greening team went door to door asking residents if they’d like trees to be planted in their yards for free. These trees will raise the community’s tree canopy by 10% — an amount that’s “consistent with the literature of seeing a clinical benefit,” Smith said.

After about a year and a half, researchers will look at whether health improved, worsened or stayed the same between the groups. 

While it’s a study that can apply to almost every urban environment, Louisville is a compelling place to start. The city’s average tree canopy is only 28% — 16% lower than the recommended percentage, Smith said. That means a little over a quarter of the city is shaded by trees, whereas a healthy city should have a canopy of 44%. Instead of increasing, Lousiville’s tree canopy has continued to decline. About 54,000 trees are lost in Louisville each year to factors like development, age and invasive species. 

In the four neighborhoods researchers are studying, the numbers are even lower. Their tree canopy averages out at just 22%. But it wasn’t just their low tree canopy area that made these neighborhoods strong candidates: They each have high owner occupancy, which means they’re less likely to be gentrified as a result of the greening; they’re decent sizes (about 40,000 residents cumulatively); and they’re ethnically and socioeconomically diverse.

“If we can provide some evidence that there is an important effect of greenness on human health, in particular, the risk of heart disease, then that will send a case in trying to preserve the tree canopy,” Aruni Bhatnagar, the director of the Center for Diabetes and Obesity Research at the University of Louisville and lead researcher for the study, told NationSwell. 

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Aruni Bhatnagar speaks at Green Heart’s tree planting.

The $15 million study is funded by the National Institutes of Health, which supports the medical testing, and The Nature Conservancy, which is funding the vegetation. Collaborators include the University of Louisville, Louisville’s metro government, Washington University in St. Louis, U.S. Forest Service, Cornell University and Hyphae Design Lab.

“You don’t see projects come together like this very often, and we’re really trying to make sure this isn’t the only time unusual funders get together to get things done that aren’t just being done,” Smith said. 

Before planting began, the Green Heart team found more than 800 residents to complete a health assessment. Hair samples, nail clippings, urine, blood and questionnaires were all collected to assess each individual’s health. In about two years, after all the planting is done, their health will be reassessed. 

Bhatnagar and other scientists will be looking for changes in their health. For heart health, they’ll look at arterial stiffness, where increased stiffness is associated with an increased risk for heart events.

Kentucky is part of the Coronary Valley, a region of the U.S. that has the highest coronary heart disease mortality rates. While this area has higher concentrations of heart deaths, it’s a risk that everyone faces, said Bhatnagar, who has spent his career at the intersection of heart health and nature.

“We can treat it with lots of different things, stents and statins and whatever, but it’s very hard to prevent,” he said. “So prevention approach is severely and sorely needed.”

Bhatnagar hopes this study could create a blueprint for other urban cities to follow.

“If we can provide some evidence that there is an important effect of greenness on human health, in particular, the risk of heart disease, then that will send a case in trying to preserve the tree canopy. ” Bhatnagar said. “Not just in Louisville, but I think globally.”

Beyond heart health, scientists are looking at other connections between trees and people. 

Smith, who is leading the ancillary studies, said the team is conducting additional research to look at variables like sleep, noise, asthma, depression, social cohesion and biodiversity. 

Overall the study has been well-received. 

The Green Heart team is present at town halls, neighborhood meetings and community events. They’re there to spread awareness about the study but also show that they’re not just planning on extracting data from the community — they’re there for the long haul.

Nicole George, one of the two council representatives in the study’s neighborhoods, said Green Heart’s presence has helped shaped community attitudes towards the study.

“Their commitment is not just planting the tree, collecting a little health survey data and leaving,” she told NationSwell. “Their commitment is to the community.”

So whether it was Green Heart members helping a resident clean debris after a tree fell on her home or sending a birthday card to a resident, this is more than just a study.

“We’re not here to fix your neighborhood or clean up your neighborhood,” Smith said. “We’re here to figure out how to have a healthier neighborhood.”

More: To Build a Healthier City, Atlanta Is Opening Its Schoolyards to Everyone

When Cities Get Connected, Civic Engagement Improves

With tighter budgets and fewer resources, local governments are turning to technology to stay connected to residents and improve their systems. According to the Digital Cities Survey published by Government Technology magazine, four major tech trends are visible across most of the participants, which range from cities with populations of 50,000 to more than a million.
1. Open data
Transparency is important for governments and thanks to technology, it’s easier to achieve than ever. Leading the pack of cities with easily accessible data records is New York City. The Big Apple started its open data system in 2012 and now has 1,300 data sets available for viewing. Chicago ranks second with over 600 data sets, while San Francisco scores the highest rating in U.S. Open Data Census for open data quality.
Open data isn’t limited to the country’s biggest cities, however, as mid-size Tacoma, Wash., offers 40 data sets and Ann Arbor, Mich,. has financial transparency data that is updated daily, according to Governing.
2. Stat programs and data analytics
These types of initiatives originated in the 1980s with the NYPD merging data with staff feedback, but have expanded to other cities. Louisville, Ky., now has Louiestat, which is used to spot weaknesses in performance and cut the city’s bill for unscheduled employee overtime.
Governing reports that data analytics are also a popular tool to gauge performance. In Denver, Phoenix and Jacksonville, Fla., local governments use them to sort through all their data sets in search of patterns that can be used for better decision-making.
3. Online citizen engagement
As social media becomes more prevalent in daily life, governments are getting on board to stay connected. Through social media sites and online surveys, local governments are using social media to engage their residents in local issues.
One such city is Avondale, Ariz. (population of 78,822), which connects a mobile app and an online forum for citizen use. Citizens can post ideas on the forum and then residents can vote yay or nay.
4. Geographic information systems
Although it’s been around for a long time, cities are updating the function of GIS to help make financial decisions that will, in turn, improve performance, public transit and public safety as well as organize social service and citizens engagement activities.
Augusta, Ga., recently won an award for its transit maps, while in Sugar Land, Texas, GIS is used for economic development and citizen engagement with 92 percent survey respondents citywide.
Based on all this, it seems that cities have embraced the tech craze.
MORE: Which 3 Cities are Fighting Poverty Through a Tech Cohort?

Which 3 Cities are Fighting Poverty Through a Tech Cohort?

As more cities embrace the civic innovation movement to tackle local problems, Philadelphia, Nashville and Louisville are harnessing new technology to reach out to residents in most need of help.
In collaboration with nonprofit Living Cities and the nonprofit arm of global bank Citi, the Citi Foundation, the three cities will form the first cohort under City Accelerator, a program with the goal of helping nine cities innovate solutions to tackle everyday challenges facing low-income residents.
Louisville, Nashville and Philadelphia have been selected to spend the next 18 months implementing tech-driven solutions with guidance from coaches and other municipal innovators to create solutions faster and promote more proactive governance. But unlike other philanthropic programs aimed at municipal innovation, there’s no monetary incentive.
Instead, each city receives $3 million worth of technical assistance and consulting to implement their respective innovative projects.
Louisville plans to use its established innovation toolkit as part of the pilot program, focusing on services for people suffering from mental illness and substance abuse while Nashville officials plan to collaborate with other city agencies and local nonprofits to combat homelessness through affordable housing and more economic opportunity, according to Governing.

“Both the public and private sectors in Nashville are filled with dedicated individuals who work hard every day to help more citizens share in our city’s economic success,” says Nashville Mayor Karl Dean. “Our Office of Innovation is working to bring all of those entities to the same table, because we know separate efforts can be much more impactful when our strategies are unified and everyone is willing to consider new approaches.”

Meanwhile, Philadelphia’s innovation team will partner with city departments to assist low-income residents in accessing benefits and tax relief.

As a cohort, all three cities will also rely on each other to share ideas and resources as they implement solutions to their local problems.

“Cities are getting better at making incremental improvements to the way they deliver services,” says Nigel Jacob, co-founder of the Mayor’s Office of New Urban Mechanics for the City of Boston, who is leading the first cohort.  “This is important, but it is not enough to solve our greatest challenges. Cities need to be able to find breakthrough ways of solving problems on an ongoing basis.”

The goal is to get more urban communities on board with innovating faster, creating more universal solutions that can be consistently applied elsewhere. The three cities were selected from 35 other cities and six finalists, and two more City Accelerator cohorts are expected to launch in spring and fall of 2015, according to a press release. Living Cities also plans to regularly update an innovation guide.

“There’s a cacophony of activity around ‘cities need to be doing different things,’” says Ted Smith, chief of civic innovation in Louisville. “We’re now at a point where we’re trying to get some focus on the way that cities rationalize, organize and prioritize this kind of effort in a sustainable way.”

MORE: Can $45 Million Worth of Data and Technology Improve U.S. Cities?

5 Cities That Are Using Water Bills to Identify People in Need

Earlier this year, Detroit ignited controversy when the city government shut off water service to more than 4,000 residences who were late on utility bills. While the crackdown sparked negative press, a pilot program is using the same concept to help low-income residents in financial distress in five cities across the country.
The National League of Cities (NLC) is rethinking the way in which we identify people needing support by using late bills as a signal of distress through a two-year project known as LIFT-UP.

The cities of Houston, Savannah, Ga; Louisville, Ky.; St. Petersburg, Fla. and Newark, N.J. have partnered with NLC to launch an initiative that uses utility bills to help residents with financial and economic stability, according to Governing. While each city’s pilot program is different, all five underscore the idea of supporting residents with outstanding bills in low-income communities.

Outstanding public utility bills are common in most large urban sprawls. In Detroit, half of its customers were past due this year with owing up to $90 million. Some argue that many customers have the money to pay but choose not to.

“I think it’s been common knowledge that the water bill has been placed on the back burner [by some customers], in part because we haven’t been aggressive enough,” said Gregory Eno, a spokesman for the Detroit Department of Water and Sewerage. He points out that after the city shut down services to 4,531 customers in May, 84 percent paid the bills to regain service within 48 hours.

But others contend that while people may prioritize paying off other bills before utility costs, cracking down could make the situation worse. Which is why LIFT-UP is using the process to educate truant customers.

Savannah, which launched a pilot last August, has signed up at least 50 residents allowing them to pay smaller amounts as well as extend the repayment time frame. To apply, residents must have had their water cut off at least once in the past two years, owing an amount ranging from $150 to $500. Customers can pay 25 percent of their bill rather than 50 percent of what’s owed.

Part of the southern city’s initiative, which is run by nonprofit Step-Up Savannah, also entails a one-on-one financial counseling session with a nonprofit provider to help residents budget for bills as well as help them find out if they’re eligible for public aid. After completion, participants receive a $50 credit to their next water bill, which is provided by private foundations partnering with the program. Savannah has seen 13 customers complete the program since its inception.

Detroit is also getting on board with reframing the conversation. The city has planned a financial assistance program through a $1.1 million fund — paid for by voluntary 50-cent donations from water — which will help match monthly payments from low-income customers who have had water services shut off or are at risk.

MORE: Which City Has the Best Tap Water?

Louisville Stretches to Help its Public Workers

Reach for your toes, reach for the sky, hold for 10 seconds…
This is what Louisville, Kentucky public works employees hear every morning before heading out on their routes.
Granted, it sounds a little odd. But a morning stretch is just one aspect of Louisville’s plan to prevent injuries among its garbage collectors. A little extra agility is never a negative, and over the past two years, city officials have been promoting it with their workers as well as incorporating it into their own policies.
Why?
January 2012 began with 32 percent of Louisville garbage collectors not working or having their duties limited due to serious injuries. Comparably, two years later in January 2014, that number was reduced to 15 percent. This staggering drop is a result of a three-part plan initiated by the city as part of its metrics-driven performance improvement.
Step one is the stretching routine that begins at 6 a.m. sharp every morning. Before the employees head out,  all of them — including administrators — join together for a wake-up stretch led by a different designated leader each day. In a circle, everyone participates in the toe touches, jumping jacks, and squats to prepare for the busy day ahead.
Step two is the Accident Review Committee. For the committee, every injury is important, and it reviews each one — leading to a list of suggested measures to prevent them from recurring. Their recommendations are passed to department management who then compiles a final list and passes it down to the staff.
The final step is the modified duty policy. Typically, a worker is out for six to ten weeks following a serious injury. This new policy, though, gives them the option to return to work after one week, performing less strenuous office work.
The beginning of 2012 also saw the formation of the Office of Performance Improvement whose greatest accomplishment is the establishment of the Louie Stat — which increases communication between the mayor and all city departments by holding regular meetings during which relevant metrics are reviewed and plans are established for future improvement.
Just like the workers who wake up every morning to stretch their muscles, Louisville city officials clearly have taken the extra step to expand their programs and influence to benefit their workers.
 

Kentucky’s Says It’s Time to Fill the State With Quitters

With the Great American Smokeout on the way, and recognizing that 22% of its state population still smokes, Kentucky has started state-wide community challenge to get people to stop smoking. American Lung Association in Kentucky and Anthem Blue Cross and Blue Shield have partnered to bring the “Quitter in You” program to the state. Since about 60% of quitters aren’t successful in their first try, this community effort doesn’t just provide support for people who are quitting. It adds a clever second layer, a robust toolkit for people who want to help a family member, friend, or co-worker quit. It even has specific resources for helping kids. Louisville, hub for the Kentucky program, has seen a slight decrease in its local smoking rates, but the city and still wants to curb tobacco use, which is tied to four leading causes of death: cancer, heart disease, chronic lower respiratory disease, and stroke.