Western Avenue Corridor Health Impact Assessment by Danielle Drinkuth

WESTERN AVENUE CORRIDOR HEALTH IMPACT ASSESSMENT

2022

Acknowledgements The Western Avenue Corridor Health Impact Assessment was supported by Katharyn Hurd, AICP of the Chicago Department of Planning and Development and by Lindsey Realmuto, MPH of the University of Illinois at Chicago (UIC) College of Urban Planning and Public Affairs. The Health Impact Assessment (HIA) team would also like to acknowledge the contributions of the many community members who participated in outreach focus groups conducted by the Chicago Department of Planning and Development as part of the broader Western Avenue Corridor Study. The HIA team was comprised of the following UIC graduate students: Danielle Drinkuth, MUPP + MPH Joanna Madigan, MUPP Eric Mueller, MUPP Feliciano Ocegueda, MUPP Henry Siegel, MUPP + MPH

Table of Contents Executive Summary ………………..………………………………………...…………………4

Introduction .................……………………..…………………………………………………..6 Screening and Scoping……………………………………………………..…………………10 Community Health Assessment ………………………………………………..…………….13 Stakeholder Engagement………………………………………………………..……………25 Assessment of Health Impacts……………...……………………………………..…………29 Strategy 1: Activate and Develop Underutilized Sites………………..……………………..33 Strategy 2: Update and Improve Public Realm and Transportation………..……………...39 Strategy 3: Increase Access to and Diversity of Neighborhood Amenities ………………45 Recommendations ………………………………………….…………………..……………..50 Monitoring, Evaluation, and Limitations…………….………………………………………..54 Conclusion…………………………………….……………………………………..…………58 References ………………………….………………………………………………….………60 Appendix A……………………………………………………………………………..……….66

Western Avenue Corridor Study HIA 2022

EXECUTIVE SUMMARY -executive summaryintroduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 4

Western Avenue Corridor HIA

Executive Summary

Joining a nationwide trend to plan for communities with attractive neighborhood design, affordable housing, employment opportunities, and multi-modal transportation options, the City of Chicago’s Department of Planning and Development (CDPD) along with the Chicago Department of Transportation (CDOT) is leading a community-based planning initiative that strives to create a new vision for a five-mile section of North Western Avenue corridor. The planning initiative seeks to (1) increase density along the corridor; (2) promote a greater mix of land uses; (3) improve how development relates to the surrounding, lower-scaled residential areas; and (4) enhance pedestrian safety. This Health Impact Assessment (HIA) evaluates the following Western Avenue improvement strategies proposed by CDPD for potential health impacts on residents who live along the northernmost section of the corridor: (1) activate and develop underutilized sites; (2) update and improve the public realm and transportation; and (3) increase access to and diversity of neighborhood amenities. This HIA exclusively focuses its evaluation on the northernmost section of Western Avenue located in the West Ridge community area because of its comparably high rates of both chronic diseases and negative socioeconomic indicators, and the presence of a large and diverse resident population. A baseline analysis of demographic, socioeconomic, and health indicators in the West Ridge community area found health inequities between West Ridge residents and Lincoln Square and North Center residents. Compared to Lincoln Square and North Center, West Ridge residents, who are most vulnerable to changes in the built environment, have less access to fruits and vegetables, higher rates of chronic disease, and higher rates of pedestrian traffic fatalities, amongst other disparities. Based on a literature review and input from stakeholders, this HIA found that CDPD’s proposed improvements to Western Avenue could positively impact the following six health outcomes: (1) stress, anxiety, and depression; (2) cardiovascular health; (3) overall quality of life; (4) traffic fatalities and injuries; (5) mental health; and (6) diabetes. However, the assessment also found that there is a high risk for the occurrence of gentrification and displacement due to the likelihood that increased neighborhood investment will result in a rise in housing costs. Displaced residents, along with those at risk of displacement, are at increased risk for negative consequences including worse mental health. Based on these findings, the HIA offers recommendations to limit the negative health effects associated with gentrification and to ensure that strategies to improve the Western Avenue corridor are implemented in a way that improves the health of West Ridge residents. In addition to adopting these recommendations, CDPD, CDOT, local aldermen, and residents can use this HIA as a way to continue the conversation about healthy corridor improvements and to begin monitoring how the neighborhood environment along Western Avenue impacts the health and well-being of residents. 5

Western Avenue Corridor Study HIA 2022

INTRODUCTION executive summary -introductionscreening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 6

Introduction As demand increases for more urban and less auto-centric lifestyles, a movement is building across the country towards developing multi-purpose, flexible neighborhoods and away from designating separate zones for working, living, and entertainment. Cities like Miami, San Francisco, and Pittsburgh exemplify this trend through their efforts to ensure every neighborhood is bikeable, walkable, and has easy access to basic amenities like groceries, fresh food, and health care.1 Although the idea that residents should be able to meet their basic needs within a short walk or bike from their home has been popularized by Parisian Mayor Anne Hidalgo and French-Columbian scientist Carlos Moreno, 15-minute cities can thrive in the United States too through communitybased planning and urban design solutions. ● Residents of every neighborhood have easy In the City of Chicago, the amenities access to goods and services, particularly and connectivity that complete a 15groceries, fresh food, and healthcare. 2 minute city have traditionally been ● Every neighborhood has a variety of housing geographically dispersed across racial types, of different sizes and levels of affordability, lines, and thus require transportation to accommodate many types of households and and travel time which is limiting for enable more people to live closer to where they people who may not have the means work. 2 or be physically able to travel. As ● Residents of every neighborhood are able to proximity to amenities can be a driver breathe clean air, free of harmful air pollutants, of socioeconomic and health outcomes and there are green spaces for everyone to enjoy. for residents, disparities in equitable 2 access are an important consideration ● More people can work close to home or remotely, for both present and future planning thanks to the presence of smaller-scale offices, efforts in Chicago neighborhoods. As retail and hospitality, and co-working spaces. 2 part of this larger trend to plan for communities with attractive neighborhood design, affordable housing, employment opportunities, and multi-modal transportation options, the City of Chicago’s Department of Planning and Development (CDPD) along with the Chicago Department of Transportation (CDOT) is leading a community-based planning initiative that seeks to create a new vision for a five-mile section of North Western Avenue corridor. Particularly, the planning initiative seeks to (1) increase density along the corridor; (2) promote a greater mix of land uses; (3) improve how development relates to the surrounding, lower-scaled residential areas; and (4) enhance pedestrian safety through a forward-thinking design and planning process through the creation of new neighborhood centers. These neighborhood centers would contain following the ingredients inspired by the 15-minute city: ● ● ●

Mixed-use neighborhood centers Transit service Institutions 7

● ● ●

Commerce (bodegas, salons, pharmacies, restaurants, etc.) Thriving public realm (art, walkability, convenience, comfortable for people of all ages and abilities) Housing (variety of types for all income levels)

The five-mile section of the North Western Avenue corridor includes portions of some of the most diverse communities in Chicago including North Center, Ravenswood, Lincoln Square, West Ridge, and West Rogers Park. More than 2,000 Rohingya refugees, people of a Muslim ethnic minority who for centuries lived in Buddhist Myanmar but have not been recognized as citizens since 1982, have settled in West Ridge because of the neighborhood’s diverse culture along with its easy access to social services.3 Potential planning, policy, and urban design strategies related to the North Western Avenue corridor study must be carefully designed to ensure that everyone benefits, including the very people who stand to benefit the most: low-income people and people of color. As CDPD and CDOT lead this planning initiative, it will be imperative to understand how community changes related to implementing the core principles of a 15-minute city might influence the cultural and social environment and the community’s health outcomes.

Western Avenue Corridor Health Impact Assessment CDPD and a team of graduate students in the Master of Urban Planning and Policy graduate program as part of the University of Illinois at Chicago College of Urban Planning and Public Affairs (CUPPA) partnered together to conduct a health impact assessment (HIA) of the various elements of a 15-minute city that would lay the foundation for the strategies behind the redevelopment of a portion of the North Western Avenue corridor. A health impact assessment was the tool of choice because of its ability to help the CDPD discern which planning strategies and best practices related to mixed-use development, the public realm, transit, housing, and neighborhood institutions would be most health-promoting for residents who live along the corridor. CDPD has been working closely with the Western Avenue communities through a public planning process launched in early 2021. The students collaborated with CDPD to support the engagement of community residents in the health impact assessment process. The goals of the Western Avenue Corridor Health Impact Assessment were to: ●

●

Assess the impacts of the Western Avenue Corridor Study’s recommendations on community health, health inequities, and the underlying built environment conditions that determine health along Western Avenue. Ensure positive health benefits are maximized in planning and decision-making processes.

What is a Health Impact Assessment (HIA)? Figure 1. Health Impact Assessment Steps

According to the Society of Practitioners of Health Impact Assessment, health impact assessment is “a process used to identify how a project, policy or program might influence health.”4 HIA uses a combination of procedures, methods, and tools to systematically judge the potential, and sometimes unintended, effects of a proposed project, plan, or policy on the health of a population and the distribution of those effects within the population.4 HIA also produces recommendations that aim to enhance the health benefits of the project, plan, or policy and mitigate their potential harms.

Source: Centers for Disease Control and Prevention

HIA typically follows a standard process that includes six steps as shown in Figure 1 below. This document is written for CDPD, Western Avenue community members, and the aldermen who represent the communities along the Western Avenue corridor as a way to demonstrate the connections between corridor planning strategies, health, and equity outcomes.

Western Avenue Corridor Study HIA 2022

SCREENING AND SCOPING executive summary introduction -screening and scopingcommunity health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations, monitoring, evaluation, and limitations conclusion references 10

Screening The screening phase of an HIA establishes the value and importance of the HIA within the context of a particular policy proposal or plan. Key aspects of the screening process include a focus on how long the HIA process will take to assess the health impacts of a proposal, including answering questions such as: ● What will the health impacts of a particular proposal ultimately be? ● How might the proposal impact the equity of the stakeholder and/or communities in question? ● What might be the potential impact of the findings and the completion of the HIA process? Finally, the screening phase should determine how much stakeholder interest there is and the capacity for stakeholder engagement. The development of this HIA - which addresses the health impacts associated with the Western Avenue Corridor Study of six key focus areas located in the northernmost part of the City began in January 2022 and was completed in May 2022. The HIA team was provided with this corridor study for a UIC Graduate School assignment as part of a course designed to teach students about the basics of HIAs. Through additional research and discussion with the Chicago Department of Planning and Development (CDPD), the HIA considered this study an Western Avenue Corridor Study important guiding force for supporting future community and economic development, pedestrian and bicyclist safety, and neighborhood cohesion, sustainability, and vitality. Image Source: Chicago Department of Planning and Development

Scoping The purpose of the scoping phase was to identify the timeline for this HIA, relevant research questions, the geographic scope of the project, priority issues, and important health impacts. Given the nature of the project and its rapid timeline, the scoping phase began early in the process after meeting with a project manager from the City of Chicago who is working directly on the development of the Western Avenue Corridor Study. The HIA team began by narrowing the scope of the project from the original six Focus Areas along the study corridor to only three.

These include Focus Areas 4, 5, & 6 which span from Devon Ave on the South to Touhy Ave on the North. The reason for the narrowing of the selection was to focus on the portion of the study area where the socioeconomic and health disparities were greatest among the residents of all six Focus Areas. A community health assessment is utilized and presented in this HIA to provide details on the health status of the community along with a justification for why a focus on health and health equity is so important for residents who live in or around the selected focus areas. In addition, the limited timeline of the study suggested that a targeted approach to the HIA would be a more efficient and equitable use of the HIA team’s resources. Priority strategies for the assessment portion of the HIA were identified by speaking with a Image Source: Chicago Department of Planning and Development member of CDPD and reviewing relevant materials used in the development of the study. In addition, the HIA team attended two focus groups facilitated by CDPD to gain community input on the proposed study’s recommendations. Community members also provided the HIA team with valuable input on specific health determinants of concern in Focus Areas 4, 5, and 6. These include: ● ● ● ● ● ● ● ●

Increased housing density Increased mixed-use development and ground floor activation Reduction in vacant or underutilized properties/storefronts Public Realm improvements aimed at increasing walkability Improvements to pedestrian/bicycle infrastructure Increased use of bus infrastructure Improved social connection Encouragement of placemaking and the arts

Based on this feedback, the HIA team identified a series of strategies for further investigation that impact the highest priority health outcomes within the HIA’s study area.

Western Avenue Corridor Study HIA 2022

COMMUNITY HEALTH ASSESSMENT executive summary introduction screening and scoping -community health assessmentstakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 13

Community Health Assessment Western Avenue Corridor Study Focus Areas 4, 5, and 6: Context The study area for this HIA spans a portion of the Western Avenue corridor from Devon Avenue on the south to Touhy Avenue on the north. In addition, given the importance of the 15-minute city concept to the development of the corridor study, this HIA emphasizes not only the commercial centers that exist at each major intersection but also the surrounding area within a radius of about 0.75 Figure 2: Mixed-Use Neighborhood Centers miles of each center (See Figure 2). The ultimate focus of this HIA is the impact that CDPD’s interventions along this stretch of the corridor will have on the Chicago community of West Ridge. All three Focus Areas that the HIA team has chosen to examine lie within West Ridge. Therefore, it is important Source: CDPD to understand the historical, socioeconomic, demographic, and health context of the West Ridge neighborhood.

Historical Context Originally home to the Native American Potawatomi, the West Ridge community area, also known as West Rogers Park, did not become a part of Chicago until 1893. Population increases began in West Ridge in 1910 when the brickyard industry started to increase its activity in the neighborhood which attracted German and Scandinavian immigrants. 5 The neighborhood owes much of its bungalow and two-flat development to a population boom and subsequent housing boom following World War I. It was during this period that, despite population decline throughout Chicago, West Ridge continued to gain residents ultimately leading to a need for multi-unit and apartment-style housing. This increased multifamily-style development throughout the 1930s.6 Post World War I is also where the now vibrant Devon Image Source: cinematreasures.org Avenue commercial district started to

flourish as a cultural and commercial center of the community.5 Having just experienced a population increase post-WWI, West Ridge saw another wave of growth following World War II (WWII) with a sizable population of Russian and Polish Jews moving into the neighborhood.5 Later, beginning in the 1960s the community witnessed an additional wave of population growth brought about by Indian, Pakistani, Bangladeshi, Assyrian, and Korean immigrants moving into the neighborhood, significantly altering the diversity of the resident Image source: Time Out base. The community is now home to people of a multiplicity of cultures, languages, ethnic identities, and businesses. 5 This language and cultural diversity defines the community and is important to consider when designing interventions for the built environment and assessing the health impacts of the Western Avenue Corridor Study. Today the community of West Ridge remains a vibrant, multicultural community, especially at the intersection of Devon and Western. However, along Western Avenue, both at the intersections of Pratt and Touhy and throughout the entire corridor, are a variety of issues that the City of Chicago, as well as the community, would like to address. These include several vacant storefronts, numerous car-oriented businesses, unsafe pedestrian and bicyclist infrastructure, and a perceived lack of neighborhood cohesion and social interaction.

Indicators for the Social Determinants of Health Among the issues identified within the community described above, the HIA team found it important to identify a series of socioeconomic indicators that inform the overall health of the West Ridge community. Although these indicators lie outside of traditional health metrics, the context within which people live such as housing conditions, income levels, and feelings of neighborhood safety can significantly influence the health of residents. 7 The following indicators provide a brief snapshot of the social determinants of health present in West Ridge that are 15

most relevant to this HIA’s topics of interest. West Ridge is compared to the neighborhoods of Lincoln Square and North Center, two communities south of West Ridge that are encompassed in the Western Avenue Corridor Study but not further analyzed in this HIA.

Demographics Figure 3 depicts the racial and ethnic makeup of the West Ridge community and compares it to that of Lincoln Square and North Center. West Ridge is a much more diverse neighborhood compared to Lincoln Square and North Center with less than half of the population identifying as Non-Hispanic White, and over three times the population of individuals identifying as NonHispanic Black. Finally, compared to both Lincoln Square and North Center, there is a much greater population of those who identify as Asian in West Ridge, many of whom are refugees as mentioned previously. The demographic makeup of West Ridge is important to note as neighborhoods that do not identify primarily as non-Hispanic White have a history of being marginalized throughout the country, but specifically in Chicago throughout its history. 8 Although historically this has been much more prominent on the City’s South and West Sides, the experiences of Figure 3: Neighborhood Demographics diverse Lincoln Square North Center communities such as West Ridge should not be minimized for reasons that will be identified in the following sections.

West Ridge

Source: U.S. Census Bureau 2015-2019 American Community Survey 5-Year Estimates

Figure 4 and Table 1 provide a visual representation of 30000 both the total 25020 25000 22749 population of West Ridge compared to 20000 18084 Lincoln Square and 14379 15000 North Center, as 12327 12829 10952 10056 well as a 10000 breakdown of that 6568 6225 population by age. 4038 3693 5000 3129 3453 2721 Overall, the 0 population of the Infants (0-4 Juveniles (5- Young Adults Middle-Aged Seniors (65 West Ridge years) 17 years) (18-39 years) Adults (40-64 and older) community is much years) larger than the two West Ridge Lincoln Square North Center other communities and has a greater Source: U.S. Census Bureau 2020 Decennial Census number of individuals in every age group. However, the difference in population between the age groups is largest for juveniles (5-17 years) and seniors (65 and older) when comparing West Ridge to Lincoln Square and North Center. This has implications, especially when considering development proposals Table 1: Population Totals aiming to make Chicago Neighborhood Population Total communities more West Ridge 78772 transit-friendly, walkable, and safer for Lincoln Square 41271 pedestrians. North Center 36180

# of Residents

Figure 4: Population Breakdown by Age and Community Area

Source: U.S. Census Bureau 2020 Decennial Census

Median and Per-Capita Income Income level, in general, is increasingly being understood as a key driver for health disparities, especially in the U.S. In fact, those with lower incomes have seen stagnation in life expectancy rates, while those with higher incomes have seen a rise in their life expectancy. This is exacerbated when looking at racial minority groups who are disproportionately more likely to have lower incomes than whites.9 Table 2 highlights the stark disparities in income between residents and households in West Ridge compared to Lincoln Square and North Center. For example, the median household income in West Ridge is half that of North Center and disparities are even more pronounced in terms of per-capita income.

Table 2: Median and Per-Capita Income

Indicator West Ridge

Lincoln Square

North Center

Median Household Income

65,003

90,457

$ 130,550

Per Capita Income

29,917

51,806

77,989

Source: U.S. Census Bureau American Community Survey 2015-2019

Housing

PERCENT

Housing costs in relation to household income can provide insight into the impact of rising rents on financial stability and the overall health of a community. A 2018 report by the PEW research center states that “rent-burdened households have higher eviction rates, increased financial fragility, and wider use of social safety net programs, compared with other renters and homeowners.”10 In addition, the lack of availability of affordable housing decreases the likelihood of having access to reliable medical care and reduces available funds for healthimproving activities Figure 5: Housing Indicators such as gym memberships, 100 education, and 90 purchasing 80 11 70 medications. Figure 5 60 highlights the 50 disparities between 51.15 40 West Ridge, Lincoln 37.75 30 28.46 Square, and North 20 26.89 10 Center with respect to 7.91 2.43 15.49 1.13 11.09 0 the percentage of West Ridge Lincoln Square North Center households that Crowded Housing Severely Rent Burdened Rent Burdened experience crowded housing, those who are Source: U.S. Census Bureau American Community Survey 2015-2019 rent-burdened, and those who are severely rent-burdened. Compared to the other communities, West Ridge has over double the number of households that experience crowded housing. Compared to North Center, West Ridge has almost double the number of households that are rent burdened, meaning that they spend over a third of their income on housing.

Neighborhood Safety Studies have shown that lower perceptions of neighborhood safety decrease an individual’s likelihood of leaving their home and engaging in physical activity, which can affect physical and mental health. In addition, higher rates of crime in a community can affect long-term adolescent mental health through immediate and long-term exposure to traumas.12 Figure 6 provides a visual depiction of the percent of adults who report that they feel safe in their neighborhood “all

Pedestrian Traffic Fatalities Over the past decade, pedestrian traffic fatalities have increased across the country. These fatalities are not distributed equally, with communities of color Figure 7: Pedestrian Fatalities

Figure 6: Neighborhood Safety Rate 100

90.1

95.3

75.6

PERCENT

of the time” or “most of the time.”13 West Ridge, while higher than many disinvested and segregated neighborhoods in Chicago, has a neighborhood safety rating significantly lower than Lincoln Square and North Center, highlighting the need for more safety- and neighborhood trustpromoting interventions.13

60 50 40 30 20 10 0

West Ridge

Lincoln Square North Center

Source: CDPH Health Chicago Survey, 2016-2018

experiencing higher rates of pedestrian traffic fatalities than predominantly white communities.14 According to Vision Zero Chicago (VZC) data, since July 2020, West Ridge has had five pedestrian traffic fatalities, four of which occurred in 2021 (see Figure 7). During this same time span, North Center and Lincoln Square, which have a larger population of white residents, experienced no pedestrian traffic fatalities. Additionally, West Ridge saw two automobile passenger fatalities and one cyclist fatality, while North Center and Lincoln Square saw one automobile passenger fatality in North Center and zero cyclist fatalities in the two community areas.

Zoning Zoning has recently been understood to play a role in the health of communities, specifically as it relates to physical activity.15 Establishing areas in which pedestrian activity is encouraged through the walkability of a neighborhood can greatly improve resident health and the cohesiveness of a community.15 Zoning can also play a major role in the promotion of housing density in addition to housing affordability. Page 21 provides a map of the City of Chicago zoning districts that make up each focus area and Table 2A in Appendix A defines each of the zoning districts in more detail. The following highlights key aspects of each focus area’s zoning that the HIA team found to be the most relevant within the context of this HIA. Focus Area 4 In Focus Area 4, the primary commercial and business zoning classifications are B3 and B1 along Devon Avenue and then C2 along Western Avenue. Both zoning classifications allow for residential use above the ground floor, but not on the ground floor itself. The designation of the C2 zoning district along Western Avenue, on the north and south sides of Devon, creates autooriented spaces that operate very close to a dense retail and shopping corridor along Devon Avenue. However, the B3 district also encourages a destination-oriented environment, thereby requiring more off-street parking than B2 or B1 districts, further promoting automobile usage. With respect to residential zoning, the area has a mix of both RS and RT zoning classifications. Specifically, the RT zoning designation allows for multi-unit housing greater than 3 units. This contributes to the residential density of the community, especially given that each of the districts abuts the major business and retail corridor along Devon Avenue. Focus Area 5 Focus Area 5 is much different from Focus Area 4 in that the predominant zoning districts are RS districts, aside from Warren Park which is designated as a POS District. Therefore, much of this area is made up of varying sizes of single-family homes and very few townhome or multifamily uses. In addition, the only pedestrian-oriented commercial and business districts are relegated to California Avenue and Western Avenue, leaving Western Avenue north and south of Pratt Blvd to be primarily auto-oriented. Also, as stated previously, this zoning does not allow for ground floor residential, only above ground. It is worth noting that the planned development PD 1388 is a development that includes the North Branch Chicago Public Library with affordable housing above the ground floor. Focus Area 6 Focus Area 6 has a diverse set of zoning districts and, similar to Focus Area 4, has a designated business district corridor that runs east to west along Touhy Avenue. It also has business districts running north and south across Touhy Avenue along Western Avenue. However, all these districts limit residential units on the ground floor and the majority of the district regulations are designed to be destinations for automobile traffic as opposed to pedestrian (i.e., B3 districts). The only exceptions are the B1 districts, just east of Touhy Avenue and Western Avenue and further west towards California Avenue on Touhy Avenue, which are designed to be more pedestrian-oriented. Similar to Focus Area 4 and different from Focus Area 5, Focus Area 6 has a much more diverse range of residential districts that encompass singlefamily districts along with townhomes and multi-unit. 20

Focus Area 4: Devon Ave and Western Ave

City of Chicago Focus Area Zoning Maps LEGEND Devon Ave

Business

Commercial

Manufacturing

Western Ave

Residential

Focus Area 5: Pratt Blvd and Western Ave

Planned Development

Park and Open Space Pratt Blvd Intersection

Western Ave

Focus Area 6: Touhy Ave and Western Ave

Touhy Ave

Western Ave

Source: City of Chicago Department of Planning and Development

Health Indicators Rates of Chronic Disease Morbidity and Mortality Chronic disease is one of the greatest threats to health in the United States. Millions die each year from preventable diseases and trillions of dollars are spent on medical care for those suffering from chronic diseases.16 Table 3 outlines the disparities in the rates of chronic disease morbidity such as the rates of asthma, diabetes, and hypertension between West Ridge, Lincoln Square, and North Center. Table 4 outlines the rates of chronic disease mortality for chronic diseases such as cancer, coronary heart disease, diabetes, heart disease, and stroke in the same communities. A focus on health in the West Ridge community is vitally important to help alleviate the burden of disease that has led to a disparity in mortality among West Ridge residents. This highlights the need for chronic disease prevention to continue to be at the forefront of decision-making.

Table 3: Chronic Disease Morbidity

Indicator (% of adults) West Ridge Lincoln Square North Center Adult Asthma Rate 9.1 6.3 5.6 Adult Diabetes Rate Hypertension Rate

11.3 29.7

7 27.7

5.9 20.1

Source: Chicago Department of Public Health, Healthy Chicago Survey

Table 4: Chronic Disease Mortality

Indicator (per 100,000 population) West Ridge Lincoln Square North Center Cancer Mortality Rate 158.4 158.8 144.3 Coronary Heart Disease Mortality Rate Diabetes Mortality Rate Heart Disease Mortality Rate Stroke Mortality Rate

104.7 29.7 185.6 43.1

97.1 31.0 165.8 45.4

67.8 20.2 129.3 37.0

Source: Illinois Department of Public Health, Death Certificate Data Files 2015-2019

Diet and Exercise

Figure 9: Easy Access to Fruits and Vegetables (% of Adults)

Adult physical inactivity rate and the percent of adults who report eating five or more daily servings of fruits and vegetables are two health behaviors that are important for understanding the ability of West Ridge residents to pursue activities that can improve their physical and mental health. Many of the chronic health conditions previously described can be mitigated or even eliminated with adequate fruit and vegetable intake and with regular physical activity.17,18 There are many determinants that play a role in whether individuals are able to engage in these health-promoting behaviors. But any interventions that make it easier to do so will likely improve the health of residents and reduce the disparities between West Ridge, Lincoln Square, and North Center displayed in Figures 9 & 10. Figure 8: Adult Physical Inactivity Rate (% of Adults)

Source: CDPH Healthy Chicago Survey 2016-2018

Figure 1

Community Assets While the West Ridge community and the Focus Areas of interest for this HIA bring with them a host of health concerns and socioeconomic struggles, the community is not devoid of its assets and strengths. The scope of this study did not allow the HIA team to engage in qualitative discussions with community members, which often results in missed opportunities to discover assets such as cultural resilience, community-based empowerment, and the strengths of social networks. Given the willingness of residents to participate in focus groups with the city, there is at least a part of the community that is dedicated to letting itself be heard. Despite this, the HIA team composed a map of physical community assets, such as grocery stores, schools, community centers, banks, restaurants, and pharmacies that portray the community from a positive, asset-based perspective.

Western Avenue Corridor Study HIA 2022

STAKEHOLDER ENGAGEMENT executive summary introduction screening and scoping community health assessment -stakeholder engagementassessment of health impacts strategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 25

Stakeholder Engagement Planning for engagement with community stakeholders is a vital step in the HIA process. It can promote equity within the process, ensure stakeholder input is considered, build community resilience, ground the process in lived experiences of residents, rally support for recommendations, and foster methods of dissemination and future engagement. 19 However, stakeholder engagement is difficult to approach in a standardized way. Each situation and community require different strategies, and the COVID-19 related adjustments to public engagement have required a change in flexibility on behalf of planners, officials, and the public. One of the most important and simultaneously difficult aspects of successful stakeholder engagement is reaching the most vulnerable populations when attempting to communicate and request input. Because the most vulnerable populations are also the groups which stand to benefit the most from policy changes resulting from an HIA process, it is most effective to have a clear picture of the needs of these most vulnerable groups. A diversity of stakeholders can increase the likelihood of achieving end results which deliver helpful and positive health outcomes for the widest range of stakeholders. Due to the short-term nature of this HIA, stakeholder engagement during the HIA process was handled primarily by the Chicago Department of Transportation (CDOT) and the Chicago Department of Planning and Development (CDPD). The HIA team was notified of opportunities to attend virtual community focus groups with selected stakeholders. Each focus group consisted of representatives from CDOT, CDPD, various design and planning agencies involved in the project, and selected community members who, for example, might live in or near the Focus Area or own a business or property within the specific Focus Area. From the perspective of the HIA team, the purpose of the focus groups was to provide a voice to a guaranteed group of representatives from each Focus Area during presentations on the proposed development strategies embedded within the Western Ave Corridor Study. Below is a list of the total focus group meetings attended by the HIA team.

March 2022 Community Engagement: Focus Group Meetings Date: 3/10/22 Time: 11:00 am Name: Addison to Byron Segment Focus Area: 1

Date: 3/15/22 Time: 2:00 pm Name: Rosemont to Albion Segment Focus Area: 4

Date: 3/15/22 Time: 11:00 am Name: Bryn Mawr to Glenlake Segment Focus Area: 3

Date: 3/23/22 Time: 2:00 pm Name: Pratt to Birchwood Focus Area: 5 & 6

Additional stakeholder engagement used to conduct this HIA, not observed by our team but completed by the CDOT and CDPD project leads, includes the following: ● A community survey, with Focus Area Concepts responses from more than 1,500 residents ● Western Avenue Corridor Youth Council, in partnership with youth group Territory ● March 2021, six focus groups Image Source: Chicago Department of Planning and Development divided by topic ● January 2021 virtual community kick-off meeting

Summary of Observations The HIA research phase involved observation and data comparison on trends observed during these meetings with stakeholders. The HIA team was able to draw limited conclusions about similar trends and different needs between Focus Areas. Below is a compilation of observations meant to provide a record of the community engagement observed during selected Spring 2022 community meetings. ●

● ● ● ● ● ●

●

Generally, community residents did not understand the role of the multiple organizations and considerations involved (ex. zoning) in the Western Avenue Corridor Study process. As a result, a large amount of time was spent discussing corridor changes that are either not feasible or not currently on the table. The community residents in attendance did not represent the full diversity of the neighborhood. Residents need additional guidance on the feasibility of the addition of biking infrastructure in the community. Residents largely requested more design and effort from CDPD to address pedestrian and biking travel needs. Residents were largely concerned with how to cross streets safely. Overall neighborhood safety was also a top concern amongst stakeholders. A traffic study of Western Avenue could help illuminate first-hand resident accounts of difficult street crossings and pedestrian injuries and fatalities. Pedestrian islands as a traffic calming option were both supported and dismissed in meetings. In some instances, community members had interest in the benefits that pedestrian islands could provide. However, there were also times when community members voiced concerns over the danger of having residents stuck in the middle of the street at the same time as fast car and truck traffic. There are a variety of opinions on the need for more parking at different points along the corridor. 27

Conclusion This collection of observations is meant to represent a portion of what was communicated by the stakeholders at focus groups meetings. A summary of these observations was used by the HIA team to form a basic understanding of how members of the focus groups perceived and responded to the information shared about the Western Avenue Corridor Study. The HIA team realizes that these observations do not represent the entirety of the stakeholder engagement throughout the Western Avenue Corridor Study process. However, in the interest of community input, the HIA team utilized the available engagement options to supplement the literature review with qualitative data.

Western Avenue Corridor Study HIA 2022

ASSESSMENT OF HEALTH IMPACTS executive summary introduction screening and scoping community health assessment stakeholder engagement -assessment of health impactsstrategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 29

Assessment of Health Impacts Figure 11: Pathway Diagram

Pathway Diagram Figure 11 above shows the relationship between CDPD’s proposed strategies for improving the Western Avenue Corridor according to the principles of the 15-minute city and the health outcomes associated with these improvements. The various strategies would lead to specific proximal impacts such as reductions in crime, safer intersections, and improved housing quality. These impacts affect intermediate outcomes such as increased physical activity, reduced travel times, and greater neighborhood satisfaction. The intermediate outcomes then lead to improved health outcomes such as reduced stress, anxiety, and depression, cardiovascular health, traffic fatalities and injuries, and mental health.

Literature Review Once the study area and focus of the HIA was identified, the next step was to assess the potential health impacts of the various planning strategies involved in implementing the 15minute city concept. First, the HIA team reviewed a variety of literature sources to predict how CDPD’s proposed strategies for the study area might impact the community’s primary health challenges and needs. The literature review aims to address the following three overarching questions: 1. How will neighborhood development strategies and increased housing opportunities impact health? 2. How will better access to neighborhood amenities impact health? 3. How will public realm improvement strategies impact health?

Impact Table The following table summarizes the impacts of the proposed strategies developed by CDPD and CDOT, which will be discussed in further detail in the next section. Health Determinant

Direction of Impact

Likelihood of Impact

Magnitude of Impact

Severity of Impact

Distribution

Strength of Evidence

Strategy #1: Activate and Develop Underutilized Sites Gentrification/ Displacement

Possible

Medium

High

Narrow (Costburden)

Moderate

Vacant Property Redevelopment

Likely

Low

Narrow (related to only a few buildings)

Moderate

Health Determinant

Direction of Impact

Likelihood of Impact

Magnitude of Impact

Severity of Impact

Distribution

Strength of Evidence

Increased Housing Density

+/-

Possible

Low

Medium

Broad (block level impacts)

Moderate

Increased Mixed-Use Development and Ground Floor Activation

Possible

Medium

Broad

Moderate

Strategy #2: Update and Improve the Public Realm and Transportation Gentrification/ Displacement

Possible

Medium

High

Narrow (Costburden)

Moderate

Improvements to pedestrian/bicycle infrastructure

Likely

Low

High

Narrow (limited to users of the corridor)

Moderate

Improvements to bus infrastructure

Possible

Medium

High

Broad

Moderate

Public Realm Improvements

Likely

High

Broad

High

Street redesign: painted streets

Likely

Medium

Broad

High

Strategy #3: Increase Access to and Diversity of Neighborhood Amenities Gentrification/ Displacement

Possible

Medium

High

Narrow (Costburden)

Moderate

(continued) Increased Social Connection

Possible

Medium

Low

Broad

Moderate

Increased Access to Neighborhood Amenities

Likely

Medium

Low

Narrow (limited to immediate community)

Moderate

Presence of Arts in the Public Realm

Possible

Medium

Low

Broad

Low

Western Avenue Corridor Study HIA 2022

STRATEGY 1 ACTIVATE AND DEVELOP UNDERUTILIZED SITES executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts -strategy 1strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 33

Strategy: Activate and Develop Underutilized Sites The City of Chicago’s Department of Planning and Development’s (CDPD) strategy for improving both the public realm as well as economic and community development throughout Focus Areas 4, 5, and 6 is predicated on the following development goals.

Focus Area 4: Rosemont to Albion ● ● ● ●

Encourage mixed-use activity prioritizing service, retail, and hospitality at Devon and Western Activate ground floors to attract users and support an attractive pedestrian realm Encourage residential development between mixed-use hubs Prioritize and emphasize residential development at opportunity sites near Warren Park

Focus Areas 5 & 6: Pratt to Birchwood ● ● ●

Activate ground floors to attract users and support an attractive pedestrian realm Encourage ground floor residential uses where appropriate Consider pop-up or temporary opportunities for strategic locations

The success of these goals will ultimately create a series of impacts on the community that will have repercussions on physical and mental health and are assessed in the Impacts section.

Methods To research the following impacts, the HIA team engaged in site visits where pictures and notes were taken on location-specific details that were easily observable. The team conducted a literature review of case studies and relevant research done on the subject and attended focus group meetings held by CDPD. The literature review performed incorporated the use of search terms related to the topic as well as its connection to health which have been compiled and provided in Appendix A.

Impacts Increased Housing Density Background As a community facing some of Chicago’s highest levels of overcrowded housing, especially compared to Lincoln Square and North Center (See Figure 5), West Ridge residents could potentially benefit from added housing density along the Western Avenue Corridor. The Western Avenue Corridor Study has identified added housing stock along the corridor as one avenue for revitalization which would also serve to support future commercial/retail development at specified nodes within each Focus Area. Residents who participated in focus groups did not push back against the idea of new housing development within the corridor.

Assessment of Health Impacts Research indicates that the impact of increased housing density can vary depending on the context and type of added housing. As part of a location with many amenities, in-line with the 15-minute city concept, added housing density can provide a residential population that can benefit from, and enhance the positive health impacts of existing community resources. Increases in residential density that result from denser housing development, such as two or three flats, provide an ideal environment for intergenerational interactions and increased walking. These activities are associated with improvements in mental and cardiovascular health.20, 21 More densely populated areas can better support healthpromoting social and recreational activities among youth, particularly in communities with existing parks and green spaces such as West Ridge.22 There is also evidence to suggest that real and self-perceived community safety is promoted in areas with higher housing density. This results in an “eyes on the street” effect and increased avenues for social support.23,24 Image source: POAH Communities While cardiovascular health, mental health, and stress levels for residents could all potentially improve as a result of added housing density, there is some evidence to the contrary. Noise pollution from increased residential density has been linked to higher stress levels.25 There is evidence to suggest that high-density apartments are connected to poor mental health and high stress. However, this does not correspond to the types of additional housing that would be considered along Western Avenue.26,27 Three flats and other low-rise buildings in RS and RT zoning would likely form the basis of new apartment units in Focus Areas 4, 5, and 6, matching the existing character of the neighborhood. Finally, improvements to mental health are highly dependent on existing resources, as low amenity areas could be poorly situated to provide health-promoting resources for residents to walk to.28 The level of the positive impact that increased housing density has on residents is thus dependent on complementary resources and investments in the community.

Increased Mixed-Use Development and Ground Floor Activation Background Small businesses in and around the Western Avenue Corridor Study area have struggled to produce an attractive pedestrian environment that encourages residents to walk along the corridor and support commercial/retail uses. To improve the vitality of community-facing businesses, CDPD seeks to promote the development of 3-4 story mixed-use developments near high pedestrian volume intersections. The developments are to include multi-family residential units as well as neighborhood-serving commercial uses. These mixed-use hubs are 35

meant to be complemented by increased housing density in between high pedestrian intersections.

Assessment of Health Impacts Mixed-use development that allows for different land uses near each other in one area is strongly linked to improvements in increased physical activity and improved cardiovascular health.29,30,31 Providing a built environment with nearby amenities, in contrast to more sprawled and segregated land uses, allows residents to walk in their neighborhoods to meet their daily needs. This type of community design Image source: ADPRO/James Steinkamp has the potential to increase physical activity among all age groups regardless of sexual identification However, to encourage more walking and community interaction there may be a need for commercial, retail, or institutional development that is population specific. For example, older adults can benefit from mixed-use developments that meet their retail needs such as pharmacies.32 In locations with a mix of available amenities and high residential density, interactions between neighbors can increase social capital. As a social determinant that can affect mental and physical health, social capital can take on a variety of forms. Increased political participation and trust in neighbors are both forms of social capital that can increase with the levels of familiarity that someone can develop from interacting with others in their community. 33 As a form of pedestrian-oriented design, mixed land uses provide more amenable situations (walking and cycling) for social capital building among residents in comparison to automobile-oriented communities.34 While there is ample evidence to suggest that mixed-use development can have positive health impacts, the level of these impacts may be stratified by other factors. Historically disadvantaged groups may face additional barriers to health that mitigate the positive impacts of having access to mixed land uses in their communities. Studies of Hispanic and African American communities have found small or nonexistent relationships between mixed land uses and improved physical activity.35 For West Ridge, a diverse community with residents who may face a multitude of barriers to health, the impact of mixed land uses that are culturally and socially accessible may still be more context-dependent than can be estimated from the literature.

Reduction in Vacant or Underutilized Properties/Storefronts Background Vacant buildings/storefronts have been highlighted as a concern by the Chicago Department of Planning and Development (CDPD) within the scope of their Western Avenue Corridor Study. Specifically, Focus Areas 5 & 6 have four vacant or underutilized buildings/storefronts that CDPD identified and would like to see reused and repurposed to increase the available tax base primarily through the introduction of residential use on the ground floor. The first is located at 6840 N Western Avenue, the second on the 6900 Block of N Western Avenue and Lunt Avenue, the third on the 7100 block of N Western Avenue, and the final at the 7400 block of N Western Avenue. A focus group session with community members located in Focus Areas 5 & 6 did not identify any specific Image Source: City of Chicago Department of Planning and Development concerns related to vacant buildings in the neighborhood, however, residents did express a desire to see more mixed-use residential community spaces in the identified areas.

Assessment of Health Impacts Vacant storefronts present a concern for any neighborhood for several reasons. These include the fact that they have been shown to reduce or suppress property values within a community, and they contribute to elevated crime rates, trash accumulation, negative neighborhood perception, and reduced foot traffic.36 Vacant storefronts are also a drain on community resources given that they provide little tax revenue but negatively impact surrounding properties.37 Strategies to reduce the number of vacant properties within a community either through re-use or redevelopment can have a positive impact on community health and wellbeing. This can ultimately impact individual physical and mental health. The presence of vacant or underutilized storefronts/buildings in a community can be loosely tied to what scholars would define as neighborhood disorder which brings with it both physical and social disorder.38 While the community of West Ridge is not impacted nearly to the degree of other neighborhoods in the City of Chicago in terms of vacant properties and buildings, the presence of vacant storefronts still accompanies a degree of neighborhood disorder. This 37

disorder can lead to a lower likelihood of engaging in physical activity such as walking. Physical activity has been linked to improved cardiovascular health, reduced anxiety, and reduced blood pressure.39 From a social perspective, the prevalence of any vacant storefront or underutilized land can give the impression of weak social control and neighborhood safety due to less public presence on the streets.38,40 Social connection is important because it can lead to feelings of stress, anxiety, or fear, all of which impact mental and physical health. 41 Therefore, the reduction of vacant or underutilized properties along Western Avenue represents an important way that new development can improve existing and future residents’ overall health.

Recommendations 1. 2.

3. 4. 5. 6.

Encourage the re-use or redevelopment of the vacant or underutilized buildings and/or storefronts along Western Avenue. Encourage the rezoning of properties that remain vacant to allow for ground floor residential space to bring in additional residents that can support existing and future commercial or retail developments. Encourage temporary pop-up activation in vacant buildings to build the economic vitality of the community and provide support to property owners to find long-term tenants.42 Prioritize added housing density near community green spaces to maximize physical activity and social capital benefits. Maximize opportunities for added housing density along the Western Avenue corridor, with priority on 3 to 5-story buildings. Encourage mixed-use development of commercial and institutional spaces that are accessible to a range of community members (youth, older adults, low-income, minority groups).

Western Avenue Corridor Study HIA 2022

STRATEGY 2 UPDATE AND IMPROVE PUBLIC REALM AND TRANSPORTATION executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 -strategy 2strategy 3 recommendations monitoring, evaluation, and limitations conclusion references 39

Strategy: Public Realm and Pedestrian Transportation The City of Chicago’s Department of Planning and Development’s (CDPD) strategy for improving both the public realm as well as multi-modal transportation development throughout Focus Areas 4, 5, and 6 is predicated on the following development goals.

Focus Area 4: Rosemont to Albion ● ● ●

Emphasize the positive traits of a 15-minute neighborhood concept, attempt to recreate these same positive traits within this section of Western Avenue Emphasize the corner of Devon and Western through gateways, streetscape improvements, and placemaking interventions Extend the Devon Avenue streetscape east to west

Focus Area 5: Pratt to Lundt ● ● ● ● ● ● ●

Strengthen connection to Warren and Indian Boundary parks Enhance east-west bikeway connections across Western at Pratt Modify the cross-section at Lundt and Western Prioritize Pratt and Lunt intersections for pedestrian crosswalks and implement safety measures Expand interior building programs into the public realm through placemaking interventions Prioritize new street trees along the corridor Activate residential streets through placemaking interventions

Focus Area 6: Fitch to Birchwood ● Modify the cross-section at Chase and Western ● Enhance East-West bikeway connections across Western at Touhy ● Activate Western and adjacent streets through temporary and permanent placemaking interventions ● Establish unique public art and identity opportunities, including pop-ups, at highly visible locations within the streetscape ● Enhance pedestrian crosswalks and implement safety measures The success of these goals will ultimately create a series of impacts on the community that will have repercussions on physical and mental health and are assessed in the Impacts section.

Impacts Background The Chicago Department of Transportation (CDOT) utilizes various tools to address traffic calming, with the implementation process based on site and neighborhood characteristics. The tools include street speed humps, alley speed humps, curb bump-outs, traffic circles, and cul-du sacs.43 Proposals for street redevelopment and redesign to encourage the creation of a beneficial public realm and pedestrian transportation environment can have many short- and long-term health benefits. During focus groups and multiple community meetings, residents, community guests, and survey participants voiced specific concerns about the traffic and street patterns on Western Avenue. Residents voiced an interest in bike lanes and safer crossing paths both alongside Western and running perpendicular to Western. They also expressed concerns about heavy truck Image Source: OHM Advancing Communities congestion along the northern portion of Western Avenue and the resulting pollution that is created. CDPD has suggested and developed several interventions to address these voiced needs, each of which will be discussed to clarify the utility and potential health impact of each intervention. The interventions include curb cuts, painted medians, and increased street signage; gateway, public art, and placemaking interventions; pedestrian connectivity improvements; and an elevated focus on pedestrian safety and multimodal transportation planning. In addition, to understand each of the proposed interventions, the HIA team researched how public realm studies have been approached, paying specific attention to the challenges that come with studying spaces that are changing both demographically and spatially.44

Assessment of Health Impacts Improvements to Public Realm for Pedestrians Walkability is a frequently used term to describe the need for design improvements to both streets and sidewalks, with the understanding that pedestrians participate in both environments; an improvement in one environment should be reflected in the other. Previous research has established a link between the creation of an active public realm, high neighborhood walkability, and increased neighborhood health.44 The research also points to the importance of residents’ ability to choose a walking option, noting increases in physical activity and reduced reliance on 41

motorized vehicles. In areas where there is already a heavy presence of transit activity, such as on Western Avenue, research has shown that there is a positive correlation between physical activity and health when reliance on motorized transit is reduced and walking is encouraged through urban.46 Creating a safer environment for pedestrians has the potential to increase the number of pedestrians using the street, ultimately increasing physical activity for residents. 47 There are numerous health benefits to increases in physical activity. Studies suggest physical activity positively correlated with improved cardiovascular health, diabetes, mental health, and an increase in life expectancy.48,49,50 Studies have also shown that increases in active transportation, in general, have led to improved mental health. Finally, having a more walkable neighborhood has been related to reduced depression symptoms in older men and lower rates of dementia in both men and women.51

Improvements to Pedestrian and Bicycle Infrastructure In addition to increasing walkability, CDPD has a goal of improving safety at various intersections along Western Avenue, with the hopes of decreasing traffic crashes, injuries, and fatalities. One pedestrian infrastructure improvement CDPD has proposed are pedestrian refuge islands. A refuge island offers a break between traffic for pedestrians. Various studies suggest that refuge islands can decrease pedestrian crashes anywhere from 32 percent to 56 percent.52 Additionally, refuge islands can be made safer with proper lighting and made accessible for pedestrians with disabilities. It is also recommended that Image Source: Virginia Department of Transportation they be at least eight feet wide.52 Another measure that has been proposed by CDPD is Leading Pedestrian Intervals (LPIs). LPIs allow pedestrians to start using the crosswalk before vehicles heading in the same direction are allowed to travel. Studies have shown that LPIs help reduce traffic crashes and pedestrian injuries by a significant amount.53,54 Additional measures that can be taken to improve safety at signalized crosswalks are audible crosswalk signals, which are beneficial to pedestrians with visual impairments, and increasing the amount of time allotted for pedestrians to cross. 55,56,57 Some pedestrians, including older pedestrians, typically travel at a slower speed. Evidence has

been provided that increasing the amount of time a pedestrian has at a crosswalk can increase safety for some pedestrians.58 In addition to safety interventions at intersections, CDPD has also proposed to expand the cycling network on eastwest routes that cross over Western Avenue. Expanding cycling infrastructure is another way to encourage increased physical activity and decreased cyclist traffic fatalities.59 Additionally, when it comes to building out a cycling network, more protection is better. One study found that on major roads, more conventional bike lanes were associated Image Source: AustinTexas.gov with lower levels of crashes. The more protection a bike lane had (i.e. the heavier the separation from vehicle traffic) the lower the risk of traffic crashes.60

Street Redesign: Painted Streets Painted streets are another public realm improvement option suggested by CDPD. The concept of introducing public art to create transit improvements is endorsed by the National Association of City Transportation Officials (NACTO), of which the City of Image Source: Chapel Hill Community Arts & Culture Chicago and the Chicago Transit Authority (CTA) are members. NACTO’s 2021 Annual Report details a 2021 grant opportunity in which several cities took part, in which one of the three possible project categories was ‘traffic calming and wayfinding’.61 The uniting factor for projects in this category were design changes that altered the street in order to slow traffic and increase resident safety, including projects from Seattle and Fort Collins that were centered on public art and painted streets. This connection between transportation design, public art, and public safety is not always prioritized in urban spaces, which is why this practice by a leading transportation group to increase safety through funding public art is notable. It is also supported by a recent study on painted streets, with findings showing a 17 percent decrease in total crashes and a decrease in the severity of the crashes that did occur, 37 percent fewer crashes that resulted in injury, and 43

50 percent fewer crashes that involved pedestrians or cyclists. 62 Overall, an association has been established between an increase in safety for those who use various types of transit and painted streets.

Bus Infrastructure

Image Source: National Association of City Transportation Officials

CDPD is also looking to improve bus service along the corridor by making improvements to the existing bus infrastructure. One proposed strategy is bus bulbs. Bus bulbs extend the curb further into the street, allowing buses to pull right up to the curb without having to leave the lane.63 Studies have shown bus bulbs increase a bus's speed and travel times.64 Other vehicles that are traveling behind the bus may experience some delays, however, one study found these delays to be minimal.65,66 Importantly, having a faster commute can have positive effects on a person’s mental health, including depression.67 While bus bulbs can be an effective way of improving bus speeds, a more effective way to increase bus speeds is by implementing dedicated bus lanes. Dedicated bus lanes can double or even triple bus speeds on congested streets.68

Recommendations 1. Pedestrian refuge islands should be implemented at proper locations with proper lighting and be made accessible for pedestrians with disabilities. Additionally, it is recommended that refuge islands be at least 8 feet wide. Potential sites include the intersection of Touhy and Western, which is located near a nursing home, and the intersection of Pratt and Western, which is located near a public library and a playground in Warren Park. 2. LPIs should be implemented at signalized intersections. Additionally, crosswalk signals should be both audible, for pedestrians with visual impairments, and allow a proper amount of time for pedestrians who travel slower, including elderly pedestrians, children, and pedestrians with disabilities. Potential sites include the intersection of Touhy and Western, which is located near a nursing home, and the intersection of Pratt and Western, which is located near a public library and a playground in Warren Park. 3. Bike lanes on east-west routes should be fully protected with barriers. 4. To allow for faster travel times, bus bulbs should be coupled with bus-only lanes. 5. Utilize painted medians, streets, and sidewalks as a design approach which will also increase safety for pedestrians, cyclists, and drivers.

Western Avenue Corridor Study HIA 2022

STRATEGY 3 INCREASE ACCESS TO AND DIVERSITY OF NEIGHBORHOOD AMMENITIES executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 -strategy 3recommendations monitoring, evaluation, and limitations conclusion references 45

Strategy: Increase Access to and Diversity of Neighborhood Amenities The City of Chicago’s Department of Planning and Development’s (CDPD) strategy for improving the connections between Western Avenue corridor community assets and nearby neighborhoods throughout Focus Areas 4, 5, and 6 is predicated on the following development goals:

Focus Area 4: Rosemont to Albion ● ●

Emphasize and embrace the Devon Avenue cultural identity Extend the energy and success of West Devon to Western Avenue

Focus Area 5: Pratt to Lundt ● ●

Emphasize existing and new civic amenities Strengthen connections between assets/destinations and nearby neighborhoods

Focus Area 6: Fitch to Birchwood ●

Establish a distinct sense of arrival into the City of Chicago

The success of these goals will ultimately create a series of impacts on the community that will have repercussions on residents’ physical and mental health, which are assessed in the Impacts section below.

Methods To research the following impacts, the HIA team engaged in site visits where pictures and notes were taken on location-specific details that were easily observable. Additionally, the team conducted a literature review of case studies and relevant research done on the subject and attended focus groups meetings held by the Chicago Department of Planning and Development (CDPD). The literature review performed incorporated the use of search terms related to the topic as well as its connection to health which have been compiled and provided in Appendix A.

Impacts Background The 15-minute city concept aims to ensure that residents can fulfill six essential functions within a short walk or bike from their home: living, working, commerce, healthcare, education, and entertainment.68 Important neighborhood amenities and services within these functions might include, but are not limited to, parks and playgrounds; libraries; schools; grocery stores; pharmacies; hardware stores; coffee shops; and medical and dental offices.69

Neighborhood amenities accessible within a short walk or bike from home not only allows residents to conveniently meet their daily needs but also helps with coping with both health problems (ex. social capital in the neighborhood) and undesirable neighborhood characteristics (ex. crime). Because one of the aims of the Chicago DPD’s Western Avenue Corridor Study is to improve how development along the corridor relates to the surrounding, lower-scaled residential areas, ensuring that the neighborhood amenities and services available to residents who live along the corridor are optimal for health is an important objective of this HIA. A majority of the neighborhood amenities and services located along the Western Avenue corridor are restaurants/cafes, with schools representing the second largest category (see Community Asset Map in Community Health Assessment). Because the 15-minute city concept relies upon a mix of neighborhood amenities and services, the objective of this portion of the literature review is two-fold: ● To understand how access to neighborhood amenities and services impacts health ● To understand the role that neighborhood amenities and services play in the neighborhood social environment

Assessment of Health Impacts Social Connection Having a mix of neighborhood amenities promotes social connection between residents by providing opportunities for informal interaction as well as providing spaces for social gathering and community activities.70 This is especially important for older adults who are at the greatest risk of social isolation and rely more on social networks in their neighborhood; when living in less walkable neighborhoods with few amenities, older adults are more likely to stay at home, be less physically active, and have worse overall health. 70, 71 For example, a study conducted to better understand the associations between neighborhood composition and amenities with the health and well-being of older urban residents found that access to public transport and social support show the largest associations with health and well-being.71 Particularly, older residents with access to public transportation were diagnosed with a lower number of comorbidities. 71 Another study looking at the role of lifestyle activities on the relationship between neighborhood amenities and cognitive function in older adults found that amenities that promote an active lifestyle contributes to the prevention of cognitive decline.72 While neighborhood amenities alone were not associated with cognitive function, the study demonstrates that increased lifestyle activity in Image Source: Chicago Park District combination with 47

neighborhood amenities contribute to the prevention of cognitive decline. 72 Similarly, researchers Clarke et al. found that an increased density of institutional resources like schools, libraries, and communication centers that promote cognitively beneficial activities (ex. physical activity) affects cognitive function.72 They also found that urban environments with increased density promote cognitive reserve in older adults.72 In sum, the literature suggests that removing barriers to mobility in neighborhoods with high shares of older adults in addition to supporting the presence of neighborhood amenities that help build up social networks by increasing neighborliness, feelings of safety, and social trust have positive health impacts. The role of neighborhood amenities and services in fostering social connection among residents is also important for neighborhood mobilization. Residents of disadvantaged neighborhoods have a higher risk of coronary heart disease and higher rates of mortality than residents of advantaged neighborhoods.73 Additionally, researchers have found that the richness of neighborhood amenities such as recreational sites and proximity to grocery stores, residents’ perceptions of local problems, and the neighborhood’s reputation impact health behaviors and the mental health status of residents.73 For example, one study found that in lower income neighborhoods, residents utilized social capital to procure the services, resources, and amenities that they are unable to purchase with financial capital. Becoming involved in one’s community and organizing for its improvement involves the development of ties with others in the neighborhood, resulting in more involved residents who feel supported by their neighbors. In conclusion, by using collective neighborhood social resources to improve their neighborhoods, residents effectively impact health outcomes and health disparities. Overall, living in an amenity rich neighborhood not only promotes health through physical activity and a more walkable street network design, but also through social goods such as trust and community satisfaction. Residents who live in close proximity to community parks, libraries, restaurants, and theaters are more content with their neighborhood, more trusting of others, and less lonely regardless of whether they live in large cities, suburbs, or small cities or towns. 74 Also, residents of amenity-packed neighborhoods are more likely to say their community is an excellent place to live, to feel safer walking around their neighborhood at night, and to report greater interest in neighborhood goings-on.74

Placemaking and the Arts

Image Source: Choose Chicago

Placemaking, the creation of quality public spaces that contribute to residents’ health, happiness, and well-being through a community-based participatory process, is important for promoting both economic vitality and community health through two different pathways. First, placemaking strategies that encourage mixed land uses and pedestrian-friendly development can improve housing quality and increase employment opportunities and physical 48

activity.75 Second, placemaking encourages neighborhood-based community contact, social interaction, engagement, and trust through pedestrian-friendly strategies like adding new neighborhood retail outlets that residents can walk to. 75 Related to CDPD’s strategies for emphasizing existing and new civic amenities, expanding interior building programs into the public realm and activating residential streets through placemaking interventions, and establishing a distinct sense of arrival into the City of Chicago when traveling along the Western Avenue corridor, the HIA team focused on the potential impacts of the arts on community health. Studies of redeveloping urban communities have shown that the arts can nurture local identities and ethnicities, guiding future development in more economically equitable ways.76 Further, the arts can serve as neighborhood resources by creating public spaces and opportunities for diverse residents to interact and connect with one another, increasing civic engagement, dialogue, and social capital. 76 Neighborhood distinction spurs income and industry diversification, therefore attracting a wider range of households and industries to the community.76 In sum, art spaces, like a signature gateway that CDPD is proposing as part of the Western Avenue Corridor Study, not only provide opportunities to create, perform, and experience the arts, but they often serve as quasi-public spaces enabling different kinds of social interactions, the building of community identity, and the strengthening of social cohesion. 9 All of these buffer the negative health impacts associated with neighborhood disadvantage, especially chronic disease, and stress.38

Recommendations 1. Increase opportunities for residents to engage in face-to-face socializing through the conversion of vacant building lots and/or parking lots to park space or retail overflow space (ex. Pop-up parks, parklets, and outdoor cafes). 2. Enhance the intergenerational friendliness of the Western Avenue corridor by prioritizing access to health-promoting amenities that allow residents to meet their shopping, entertainment, healthcare, employment, and physical activity needs within close proximity to their homes, especially for aging and senior residents (ex. grocery stores, pharmacies, primary care services). 3. Partner with a local arts organization for the creation of the gateway art piece that will represent the mark of entry into the City of Chicago to ensure that Western Avenue residents have ownership over the project. 4. Strategically locate the gateway art piece that will represent the mark of entry into the City of Chicago next to or nearby a park or other public open space to create an opportunity for residents to interact and connect with one another. Potential sites include the intersection of Touhy and Western Avenue or Lunt and Western Avenue (near Indian Boundary Park), Pratt and Western Avenue (next to Warren Park), and Peterson and Western Avenue (next to West Ridge Nature Park).

Western Avenue Corridor Study HIA 2022

RECOMMEND ATIONS executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 -recommendationsmonitoring, evaluation, and limitations conclusion references 50

Summary of Recommendations

Key Considerations Potential for Gentrification All the previously proposed strategies concerning the activation and development of underutilized sites, public realm improvements, and increasing access to and diversity of neighborhood amenities carry with them the risk for gentrification and the displacement of longterm, low-income residents of West Ridge, many of whom are residents of color. The resulting negative health effects could severely reduce or negate the positive health gains made by the proposed strategies and recommendations for Western Avenue as outlined in this HIA. This is especially true for lowincome, minority, and/or older adult Image source: American Planning Association populations.77,78 A primary consideration for CDPD as they seek to establish mixed-use hubs and greater neighborhood connectivity along the Western Avenue corridor through placemaking and development strategies is to protect, preserve, and foster the diverse resident base. When neighborhoods experience an influx of investment and changes to the built environment, there is often a rise in home values, family incomes, and educational levels of residents. 79 Additionally, cultural displacement is likely to occur, which refers to the occurrence of affluent, white gentrifiers replacing the incumbent minority residents. 79 As described in the community profile, there is a large refugee population along the Western Avenue corridor. From a health perspective, displacement can eliminate the positive health effects of community investment by preventing residents from experiencing the health benefits discussed at length in this assessment. This directly impacts long-term residents of lower socioeconomic status, many of whom stand to benefit the most from neighborhood improvements due to existing chronic health conditions that persist because of underlying systemic and structural factors.80 In addition, there are common health concerns associated with gentrification including anxiety and depression which can be brought on by increased financial strain due to rising housing costs, the fracturing of social bonds and infrastructure caused by the displacement of long-time residents, and stigmatization and discrimination by new developers or incoming, more affluent neighbors.80,81 Given these potential negative health impacts that could occur due to seemingly

positive community improvements, it is imperative that strategies are developed and policies put in place to mitigate the displacement of residents of lower socioeconomic status. As CDPD plans to reinvigorate the corridor through strategies that aim to increase access to a variety of neighborhood services and amenities, it will be important to provide adequate affordable housing and a variety of employment opportunities to guarantee residents of all income levels can enjoy the improvements. Ensuring all residents have the opportunity to stay in their neighborhoods increases social capital and neighborhood-level social power, enabling the Western Avenue corridor community to continue to advocate for needed changes. 76 Below is a list of recommendations the HIA team has identified, and strongly encourages CDPD along with local aldermen and community members to consider, when engaging in the proposed strategies of the Western Avenue Corridor Study. This list, while not exhaustive, draws references from several ordinances and actions both from within the City of Chicago and from other cities.

Western Avenue Corridor Study HIA 2022

MONITORING, EVALUATION, AND LIMITATIONS executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations -monitoring, evaluation, and limitationsconclusion references 54

Monitoring and Evaluation To maximize positive health outcomes of the strategies discussed in this HIA, there is a need for monitoring and evaluation of community and health outcomes after the implementation of the strategies assessed in this HIA. This monitoring and evaluation should be completed by stakeholders who have a hand in the development along the West Ridge portion of the Western Avenue Corridor, including the Chicago Department of Planning and Development and the local alderperson’s office. The following are community and health outcomes to monitor and evaluate to assess changes during and after implementation of the assessed strategies:

Community and Health Outcomes

Tool/Indicator of Evaluation & Monitoring

Community and Health Indicators

Chicago Health Atlas can be utilized to track community socio-economic data along with health indicators. For access to non-aggregated original sources refer to Table A3 (see Appendix A).

Indicators of Gentrification

Monitor the impacts of gentrification utilizing resources such as the Urban Displacement Project or the Natalie P. Voorhees Center Gentrification Index. Additional impacts should include housing indicators such as resident rent burden, demographic shifts within the community, and dramatic changes in median household income without substantial employment gains.

Community Assets

Utilize resources such as NowPow and google maps to survey the community to assess whether the proposed strategies make a positive or negative impact on the number of restaurants, retail, and grocery stores.

Implementation of Recommendations Zoning Changes

Assess whether zoning changes have been made in the community through communication with local aldermen.

Reduction in Vacant Storefronts

Regular visits to the community should be conducted to identify whether existing vacant storefronts have been revitalized or repurposed and whether other properties have become vacant.

Changes in Housing Density

Number of new Public Realm and Transportation Improvements

Number of new outdoor areas for socialization (ex. pop-up parks, parklets, and outdoor cafes)

Number of new health-promoting amenities (ex. grocery stores, pharmacies, primary care services)

Construction of new community gateway arch

Track the distribution and number of new housing units in Focus Areas 4, 5, and 6 along the corridor. Housing density can be calculated by census tract or block group by dividing the total number of housing units (American Community Survey) by acreage within a census tract/block group (Census Bureau Reference Files). Assess whether the public realm and transportation improvements have been made. Conduct a crash and traffic analysis, in partnership with CDOT, in order to keep track of the number of traffic crashes that occur with pedestrians or cyclists along the corridor with the Chicago Data Portal. Track bus times and delays with CTA data. Continue stakeholder engagement to assess community feedback as design changes to the public realm are implemented. A minimum of 10% of vacant lots will be used for public outdoor space. Track both the distribution and number of these spaces to ensure equal access to community members using NowPow, Google Maps, or another mapping tool. Track both the distribution and number of new amenities in the following categories to ensure equal access to community members using NowPow, Google Maps, or another mapping tool: education, healthcare, essential retail, recreation, and working spaces. Hire a minority artist or minority-owned art organization to design the gateway arch.

For monitoring and evaluation of community and health indicators utilized in this HIA’s Community Health Assessment, Table A3 (see Appendix A) lists key indicators with their sources. Data for these indicators are available at the community area level, but more localized data (census tract, block group level) can also be accessed to measure Focus Area-specific impacts. Special consideration should be given to monitoring and evaluating impacts among groups who may face inequitable impacts of implemented strategies. Populations of interest include youth, older adults, low-income residents, and minority populations. Monitoring of health impacts should allow for adaptations to strategy implementation if inequitable or minimal impacts are measured. A final evaluation of the Western Avenue Corridor Study’s immediate and long-term health impacts will provide a more detailed understanding of its overall success than this HIA’s literature review alone can provide. Therefore, CDPD along with CDOT should prioritize a robust evaluation process that engages community stakeholders and residents with the goal of establishing where the study was successful and where it fell short, especially with respect to resident health and well-being.

Limitations There are several limitations in this HIA that merit highlighting. The rapid 16-week semester timeline of the HIA dictated limitations of what was possible in the scope and assessment of health impacts. Due to the specific focus on the West Ridge community, consideration of health impacts in Lincoln Square and North Center were not factored into the scope of this HIA. As well, the usage of West Ridge community area-level data to represent Focus Areas 4, 5, and 6 of the Western Avenue Corridor Study may not account for highly localized impacts at the block level. Further research of health impacts related to the Western Avenue Corridor Study could measure impacts at the block group or census tract level to get a more detailed look at how different areas of the community experience improvements and changes in the corridor. The usage of a literature review to assess health impacts allowed for rapid assessment but did not allow for a more detailed analysis of how each Focus Area might experience health impacts. Another major limitation of this HIA was the opportunity for community engagement. Community engagement was primarily limited to stakeholder engagement as part of attending focus groups led by CDPD. While this was informative and helpful in crafting the scope of this HIA, no followup questions were asked by HIA team members, and no further input from community members or organizations was collected as part of the HIA process. Additional conversations with individuals from some of the many racial/ethnic groups in West Ridge would have been beneficial in considering possible disproportionate health impacts for some groups.

Western Avenue Corridor Study HIA 2022

CONCLUSION executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations -conclusionreferences 58

Conclusion Throughout the process of this HIA, the HIA team investigated the potential health impacts of strategies proposed by CDPD that seek to foster elements of the 15-minute city concept within three Focus Areas along the Western Avenue Corridor. Based on the findings, the majority of the interventions have the ability to produce positive health outcomes. Literature discussing the potential impacts related to the activation and development of underutilized sites, improvements to public realm and transportation, and increased access to and the diversity of neighborhood amenities demonstrated the potential for positive impacts on mental and physical health for residents. These include positive mitigating effects on stress, anxiety, depression, cardiovascular disease, diabetes, and traffic fatalities and injuries. Based on these findings, the HIA team made recommendations that would best promote these positive health outcomes. While the 15-minute city offers many health benefits, the risk of gentrification and resulting displacement is possible. Specifically, the risk of gentrification and displacement is highest for low-income residents of color. With West Ridge having a high number of refugees, this risk cannot be ignored. Gentrification and displacement can negatively affect a person's mental and physical health, including anxiety, depression, and chronic disease. To best mitigate against gentrification and displacement, it is important that CDPD adheres to this HIA’s recommendations to make sure there is an adequate amount of affordable housing and jobs within the community for residents. Additional policies, such as deconversion ordinances, should also be implemented. The Western Avenue Corridor Study offers the West Ridge community an opportunity to further evolve into a neighborhood that is healthy, equitable, and safe, where all residents are able to thrive. Considering the impact of this report, the HIA team encourages CDPD to consider the proposed recommendations and continue to engage with all residents of the West Ridge community to ensure that development occurs on their terms and with their engagement.

Image Source: City of Chicago Department of Planning and Development

Western Avenue Corridor Study HIA 2022

REFERENCES executive summary introduction screening and scoping community health assessment stakeholder engagement assessment of health impacts strategy 1 strategy 2 strategy 3 recommendations monitoring, evaluation, and limitations conclusion -references60

References 1.

4. 5.

6. 7. 8.

9. 10.

11. 12.

13. 14. 15.

16.

17. 18. 19.

Argerious NB. Study Ranks U.S. Cities by 15-Minute City Potential. The Urbanist. Published August 16, 2021. Accessed March 28, 2022. https://www.theurbanist.org/2021/08/16/study-ranks-u-s-cities-by-15-minute-citypotential/ C40 Cities Climate Leadership Group, C40 Knowledge Hub. How to build back better with a 15-minute city. C40 Knowledge. Published July 2020. Accessed March 28, 2022. https://www.c40knowledgehub.org/s/article/How-tobuild-back-better-with-a-15-minute-city?language=en_US Ramos M. Refugees drive West Ridge’s growing Asian population. Chicago Sun-Times. Published February 1, 2022. Accessed March 28, 2022. https://chicago.suntimes.com/news/2022/1/30/22904372/refugee-immigrantswest-ridge-growing-asian-population Society of Practitioners of Health Impact Assessment. What is HIA? Accessed April 17, 2022. https://hiasociety.org/What-is-HIA Sofianos J. West Ridge (West Rogers Park). The City of Neighborhoods. http://www.thecityofneighborhoodsproject.com/blog/2016/12/27/west-ridge-west-rogers-park. Published June 2, 2020. Accessed April 1, 2022. Mooney-Melvin P. West Ridge. http://www.encyclopedia.chicagohistory.org/pages/1341.html. Published 2005. Accessed April 1, 2022. Social Determinants of Health. Social Determinants of Health - Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/social-determinants-health. Accessed April 2, 2022. Racial wealth divide in Chicago. Racial Wealth Divide in Chicago | Prosperity Now. https://prosperitynow.org/resources/racial-wealth-divide-chicago. Published January 1, 2017. Accessed April 2, 2022. “Health, Income, & Poverty: Where We Are & What Could Help, " Health Affairs Health Policy Brief, October 4, 2018. DOI: 10.1377/hpb20180817.901935 American families face a growing rent burden. The Pew Charitable Trusts. https://www.pewtrusts.org/en/research-and-analysis/reports/2018/04/american-families-face-a-growing-rentburden. Accessed April 2, 2022. “Housing And Health: An Overview Of The Literature, " Health Affairs Health Policy Brief, June 7, 2018. DOI: 10.1377/hpb20180313.396577 Crime and violence. Crime and Violence | Healthy People 2020. https://www.healthypeople.gov/2020/topicsobjectives/topic/social-determinants-health/interventions-resources/crime-and-violence#6. Accessed April 2, 2022. West Ridge: Neighborhood Safety. Chicago health atlas. https://chicagohealthatlas.org/indicators/HCSNSP. Accessed April 2, 2022. Dangerous by design 2021. Smart Growth America. https://smartgrowthamerica.org/dangerous-by-design/. Published September 13, 2021. Accessed April 10, 2022. Chriqui JF, Nicholson LM, Thrun E, Leider J, Slater SJ. More Active Living–Oriented County and Municipal Zoning Is Associated With Increased Adult Leisure Time Physical Activity—United States, 2011. Environment and behavior. 2016;48(1):111-130. doi:10.1177/0013916515611175 Chronic diseases in America. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm. Published January 24, 2022. Accessed April 3, 2022. Boeing H, Bechthold A, Bub A, et al. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr. 2012;51(6):637-663. doi:10.1007/s00394-012-0380-y Marques A, Santos T, Martins J, Matos MG, Valeiro MG. The association between physical activity and chronic diseases in European adults. Eur J Sport Sci. 2018;18(1):140-149. doi:10.1080/17461391.2017.1400109 Stakeholder Participation Working Group of the 2010 HIA of the Americas Workshop. Guidance and Best Practices for Stakeholder Participation in Health Impact Assessments. SOPHIA - HIA Guidance and Tools. https://hiasociety.org/HIA-Guidance-and-Tools. Published October 2011.

20. Zhong S, Lee C, Lee H. Community Environments That Promote Intergenerational Interactions vs. Walking Among Older Adults. Front Public Health. 2020;8:587363. Published 2020 Dec 3. doi:10.3389/fpubh.2020.587363 21. Shams-White MM, D'Angelo H, Perez LG, Dwyer LA, Stinchcomb DG, Oh AY. A national examination of neighborhood socio-economic disparities in built environment correlates of youth physical activity. Prev Med Rep. 2021;22:101358. Published 2021 Mar 12. doi:10.1016/j.pmedr.2021.101358 22. Nordbø ECA, Raanaas RK, Nordh H, Aamodt G. Neighborhood green spaces, facilities and population density as predictors of activity participation among 8-year-olds: a cross-sectional GIS study based on the Norwegian mother and child cohort study. BMC Public Health. 2019;19(1):1426. Published 2019 Oct 30. doi:10.1186/s12889-019-7795-9 23. Badland H, Foster S, Bentley R, et al. Examining associations between area-level spatial measures of housing with selected health and wellbeing behaviours and outcomes in an urban context. Health Place. 2017;43:17-24. doi:10.1016/j.healthplace.2016.11.003 24. Haas BM, Berg KA, Schmidt-Sane MM, Korbin JE, Spilsbury JC. How might neighborhood built environment influence child maltreatment? Caregiver perceptions. Soc Sci Med. 2018;214:171-178. doi:10.1016/j.socscimed.2018.08.033 25. Tamura K, Elbel B, Chaix B, et al. Residential and GPS-Defined Activity Space Neighborhood Noise Complaints, Body Mass Index and Blood Pressure Among Low-Income Housing Residents in New York City. J Community Health. 2017;42(5):974-982. doi:10.1007/s10900-017-0344-5 26. Sarkar C, Lai KY, Kumari S, Leung GM, Webster C, Ni MY. Characteristics of the Residential Environment and Their Association With Depression in Hong Kong. JAMA Netw Open. 2021;4(10):e2130777. Published 2021 Oct 1. doi:10.1001/jamanetworkopen.2021.30777 27. Chan SM, Wong H, Chung RY, Au-Yeung TC. Association of living density with anxiety and stress: A crosssectional population study in Hong Kong. Health Soc Care Community. 2021;29(4):1019-1029. doi:10.1111/hsc.13136 28. Saarloos, D. and Alfonso, H. and Giles-Corti, B. and Middleton, N. and Almeida, O. 2011. The built environment and depression in later life: The health in men study. American Journal of Geriatric Psychiatry. 19 (5): pp. 461470. 29. Nieuwenhuijsen, M.J. Influence of urban and transport planning and the city environment on cardiovascular disease. Nat Rev Cardiol 15, 432–438 (2018). https://doi-org.proxy.cc.uic.edu/10.1038/s41569-018-0003-2 30. Kärmeniemi M, Lankila T, Ikäheimo T, et al. Residential relocation trajectories and neighborhood density, mixed land use and access networks as predictors of walking and bicycling in the Northern Finland Birth Cohort 1966. The international journal of behavioral nutrition and physical activity. 2019;16(1):88-88. doi:10.1186/s12966-0190856-8 31. Pinter-Wollman N, Jelić A, Wells NM. The impact of the built environment on health behaviours and disease transmission in social systems. Philosophical Transactions of the Royal Society B: Biological Sciences. 2018;373(1753):20170245-. doi:10.1098/rstb.2017.0245 32. Richardson AS, Troxel WM, Ghosh-Dastidar MB, et al. One size doesn't fit all: cross-sectional associations between neighborhood walkability, crime and physical activity depends on age and sex of residents. BMC Public Health. 2017;17(1):97. Published 2017 Jan 19. doi:10.1186/s12889-016-3959-z 33. Leyden KM. Social Capital and the Built Environment: The Importance of Walkable Neighborhoods. American journal of public health (1971). 2003;93(9):1546-1551. doi:10.2105/AJPH.93.9.1546 34. Iravani H, & Rao V. The effects of New Urbanism on public health. Journal of Urban Design. 2020;25(2), 218235, DOI: 10.1080/13574809.2018.1554997 35. Lovasi GS, Neckerman KM, Quinn JW, Weiss CC, Rundle A. Effect of Individual or Neighborhood Disadvantage on the Association Between Neighborhood Walkability and Body Mass Index. American journal of public health (1971). 2009;99(2):279-284. doi:10.2105/AJPH.2008.138230 36. Gonzalez-Hermoso J, Park J. Local policies can protect commercial corridors as the pandemic continues. Urban Institute. https://www.urban.org/urban-wire/local-policies-can-protect-commercial-corridors-pandemiccontinues#:~:text=Vacant%20storefronts%20have%20negative%20social,trash%2C%20and%20attraction%20of %20rodents. Published November 19, 2020. Accessed April 16, 2022. 37. Vacant and abandoned properties: Turning liabilities into assets: HUD USER. Vacant and Abandoned Properties: Turning Liabilities Into Assets | HUD USER.

38.

39. 40. 41. 42. 43. 44. 45.

46.

47.

48. 49.

50. 51.

52.

53.

54.

55.

56.

https://www.huduser.gov/portal/periodicals/em/winter14/highlight1.html. Published 2014. Accessed April 16, 2022. Ross CE, Mirowsky J. Neighborhood disadvantage, disorder, and health. J Health Soc Behav. 2001;42(3):258276. https://www.cdc.gov/physicalactivity/basics/adults/health-benefits-of-physical-activity-for-adults.html. Published November 1, 2021. Accessed April 16, 2022. Warr DJ, Tacticos T, Kelaher M, Klein H. “Money, stress, jobs”: Residents’ perceptions of health-impairing factors in “poor” neighbourhoods. Health & place. 2007;13(3):743-756. doi:10.1016/j.healthplace.2006.12.001 Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057-1072. Published 2017 Jul 21. doi:10.17179/excli2017-480 CultureHouse. From vacant to vibrant. Medium. https://culturehouse.medium.com/from-vacant-to-vibrantbac095189463. Published September 15, 2019. Accessed April 16, 2022. Traffic calming. City of Chicago: Traffic Calming. https://www.chicago.gov/city/en/depts/cdot/supp_info/traffic_calming.html. Accessed April 19, 2022. Jones A. Public realm ethnography: (Non-)Participation, co-presence and the challenge of situated multiplicity. Urban studies (Edinburgh, Scotland). 2021;58(2):425-440. doi:10.1177/0042098020904261 Harvey C, Rodriguez DA. What makes an active public realm? Opportunities and challenges for research. Preventive medicine. 2017;103:S5-S6. doi:10.1016/j.ypmed.2017.06.017 Li J. Neighborhood characteristics and transport walking: Exploring multiple pathways of influence using a structural equation modeling approach. Journal of Transport Geography. 2020;85. doi:10.1016/j.jtrangeo.2012.09.006 Morrison DS, Thomson H, Petticrew M. Evaluation of the health effects of a neighbourhood traffic calming scheme. Journal of Epidemiology & Community Health. https://jech.bmj.com/content/58/10/837. Published October 1, 2004. Accessed April 22, 2022. Davison KK, Werder JL, Lawson CT. Children's active commuting to school: Current knowledge and future directions. Preventing chronic disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483568/. Published July 2008. Accessed April 24, 2022. Hamer M, Chida Y. Active commuting and cardiovascular risk: A Meta-Analytic Review. Preventive Medicine. 2008;46(1):9-13. doi:10.1016/j.ypmed.2007.03.006 Lee I-M, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Impact of physical inactivity on major noncommunicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet (London, England). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/. Published July 21, 2012. Accessed April 24, 2022. Litman T. Transportation and Public Health. Annual Review of Public Health. 2013;34(1):217-233. doi:10.1146/annurev-publhealth-031912-114502 Pedestrian Refuge Island: Safe Transportation for Every Pedestrian Countermeasure Tech Sheet. https://safety.fhwa.dot.gov/ped_bike/step/docs/techSheet_RRFB_2018.pdf. Published June 2018. Accessed April 22, 2022. Sze J. An evaluation of the impact of leading pedestrian interval signals in NYC. CUNY Academic Works. May 2019. https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1488&context=hc_sas_etds. Accessed April 22, 2022 Fayish AC, Gross F. Safety effectiveness of leading pedestrian intervals evaluated by a before–after study with comparison groups. Transportation Research Record: Journal of the Transportation Research Board. 2010;2198(1):15-22. doi:10.3141/2198-03 Barlow JM, Scott AC, Bentzen BL, Guth D, Graham J. Effectiveness of audible and tactile heading cues at complex intersections for pedestrians who are blind. Transportation Research Record: Journal of the Transportation Research Board. 2013;2393(1):147-154. doi:10.3141/2393-17 Barlow JM, Scott AC, Bentzen BL. Audible beaconing with accessible pedestrian signals. AER journal : research and practice in visual impairment and blindness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901122/. Published 2009. Accessed April 24, 2022. Guth DA, Long RG, Kim DS, et al. Beaconing signalization substantially reduces blind pedestrians’ veer on snow-covered pavement. Transportation Research Record: Journal of the Transportation Research Board. 2017;2661(1):43-50. doi:10.3141/2661-05

57. Duim E, Lebrão ML, Antunes JLF. Walking speed of older people and pedestrian crossing time. Journal of Transport & Health. https://www.sciencedirect.com/science/article/abs/pii/S2214140516302250. Published February 9, 2017. Accessed April 24, 2022. 58. Mueller N, Rojas-Rueda D, Salmon M, et al. Health Impact Assessment of cycling network expansions in European cities. Preventive Medicine. 2018;109:62-70. doi:10.1016/j.jth.2017.05.287 59. Cicchino JB, McCarthy ML, Newgard CD, et al. Not all protected bike lanes are the same: Infrastructure and risk of cyclist collisions and falls leading to emergency department visits in three U.S. cities. Accident Analysis & Prevention. 2020;141. doi:10.1016/j.aap.2020.105490 60. CITIES TAKING THE LEAD: NACTO Annual Report 2021. NACTO. https://nacto.org/wpcontent/uploads/2022/03/NACTO-ANNUAL-REPORT-2021.pdf. Published 2021. Accessed May 4, 2022. 61. Velie E. Public Art Decreases Traffic Accidents by 17%, Report Finds. Asphalt Art. https://asphaltart.bloomberg.org/news/. Published April 19, 2022. Accessed May 4, 2022. 62. Bus bulbs. National Association of City Transportation Officials. https://nacto.org/publication/urban-street-designguide/street-design-elements/curb-extensions/bus-bulbs/. Published July 24, 2015. Accessed April 24, 2022. 63. Fitzpatrick K, Hall K, Finley M, Farnsworth S. Alternative bus stop configuration: An analysis of the effects of bus bulbs. Journal of Public Transportation. 2002;5(1):19-38. doi:10.5038/2375-0901.5.1.2 64. Daniel J, Konon W. Effectiveness of bus bulbs for bus stops . New Jersey Department of Transportation. https://www.nj.gov/transportation/business/research/reports/FHWA-NJ-2003-015.pdf. Published January 2005. Accessed April 24, 2022. 65. Fitzpatrick K, Hall K, Farnsworth S, Finley MD. An evaluation of bus bulbs on transit, traffic, and Pedestrian Operations. National Association of City Transportation Officials. https://nacto.org/docs/usdg/bus_bulbs_and_transit_traffic_ped_operations_fitzpatrick.pdf. Published August 2000. Accessed April 24, 2022. 66. Wang X, Rodríguez DA, Sarmiento OL, Guaje O. Commute patterns and depression: Evidence from eleven Latin American cities. Journal of Transport & Health. 2019;14. doi:10.1016/j.jth.2019.100607 67. Litman T. When are bus lanes warranted? . Victoria Transportation Policy Institute. https://www.vtpi.org/blw.pdf. Published November 25, 2016. Accessed April 24, 2022. 68. Moreno C, Allam Z, Chabaud D, Gall C, Pratlong F. Introducing the “15-Minute City”: Sustainability, Resilience and Place Identity in Future Post-Pandemic Cities. Smart Cities. 2021;4(1). doi:10.3390/smartcities4010006 69. Butler S. What Is a 15-Minute City? (And Why You Should Care). MRSC. Published October 25, 2021. Accessed April 17, 2022. https://mrsc.org/Home/Stay-Informed/MRSC-Insight/October-2021/What-is-a-15-Minute-City.aspx 70. Community Amenities. HealthyDesign.City. Accessed April 17, 2022. https://healthydesign.city/communityamenities/ 71. Eibich P, Krekel C, Demuth I, Wagner GG. Associations between Neighborhood Characteristics, Well-Being and Health Vary over the Life Course. Gerontology. 2016;62(3):362-370. doi:10.1159/000438700 72. Katayama O, Lee S, Makino K, et al. The Association between Neighborhood Amenities and Cognitive Function: Role of Lifestyle Activities. J Clin Med. 2020;9(7):2109. Published 2020 Jul 4. doi:10.3390/jcm9072109 73. Altschuler A, Somkin CP, Adler NE. Local services and amenities, neighborhood social capital, and health. Soc Sci Med. 2004;59(6):1219-1229. doi:10.1016/j.socscimed.2004.01.008 74. Cox D, Streeter R. The Importance of Place: Neighborhood Amenities as a Source of Social Connection and Trust. American Enterprise Institute; 2019. Accessed April 18, 2022. https://www.aei.org/wpcontent/uploads/2019/05/The-Importance-of-Place.pdf?x91208 75. Pastor M, Morello-Frosch R. Integrating Public Health And Community Development To Tackle Neighborhood Distress And Promote Well-Being. Health Affairs. 2014;33(11):1890-1896. doi:10.1377/hlthaff.2014.0640 76. Foster N, Grodach C, Murdoch J. Neighborhood Diversity, Economic Health, and The Role of the Arts. null. 2016;38(5):623-642. doi:10.1111/juaf.12278 77. Smith GS, Breakstone H, Dean LT, Thorpe RJ Jr. Impacts of Gentrification on Health in the US: a Systematic Review of the Literature. J Urban Health. 2020;97(6):845-856. doi:10.1007/s11524-020-00448-4 78. Smith RJ, Lehning AJ, Kim K. Aging in Place in Gentrifying Neighborhoods: Implications for Physical and Mental Health. The Gerontologist. 2018;58(1):26-35. doi:10.1093/geront/gnx105 79. Richardson J, Mitchell PhD. B, Franco J. Shifting Neighborhoods: Gentrification and Cultural Displacement in American Cities. National Community Reinvestment Coalition; 2019. Accessed April 25, 2022. https://ncrc.org/gentrification/

80. Iyanda AE, Lu Y. “Gentrification is not improving my health”: a mixed-method investigation of chronic health conditions in rapidly changing urban neighborhoods in Austin, Texas. Journal of housing and the built environment. 2021;37(1):77-100. doi:10.1007/s10901-021-09847-8 81. Mehdipanah R, Marra G, Melis G, Gelormino E. Urban renewal, gentrification and health equity: a realist perspective. European journal of public health. 2018;28(2):243-248. doi:10.1093/eurpub/ckx202 82. Von Hoffman A. Single-family zoning: Can history be reversed? Single-family Zoning: Can History be Reversed? | Joint Center for Housing Studies. https://www.jchs.harvard.edu/blog/single-family-zoning-can-history-bereversed. Published October 5, 2021. Accessed May 4, 2022. 83. VPT vacant property tax. City of Oakland. https://www.oaklandca.gov/topics/vacantpropertytax. Accessed May 4, 2022. 84. Pilsen develops new tools to fight gentrification. WTTW Chicago. https://interactive.wttw.com/myneighborhood/pilsen/gentrification. Published March 22, 2019. Accessed May 4, 2022.

Appendix A Literature Review Methods The literature review for the HIA was divided into three sections corresponding to strategy areas. Different HIA team members took the lead on their corresponding sections to compile relevant literature related to each strategy area and health. The variety of search terms and search engines are detailed in Table A1. Table A1. Literature Review Methods by Strategy Area Strategy

Search Term(s)

Search Engine(s)

Activate and develop underutilized sites

“housing density AND health”

PubMed

“mixed land use AND health”

Google Scholar

“mixed use development AND health”

UIC Library

“vacant property AND health” “vacant storefront AND health” Update and Improve Public Realm and Transportation

“public realm AND health”

Google Scholar

“transportation AND health”

UIC Library

“pedestrian infrastructure AND health” “bicycle infrastructure AND health” “painted streets AND health” “bus infrastructure AND health” Increase access to and diversity of neighborhood amenities

"neighborhood amenities AND health"

Google Scholar

"neighborhood institutions AND health" "neighborhood resources AND health"

Relevant Zoning Districts Table A2: Relevant Zoning Districts Abbreviation

Name

Description

Residential Single-Unit (Detached House) Districts

The primary purpose of the RS districts is to accommodate the development of detached houses on individual lots. It is intended that RS zoning be applied in areas where the land-use pattern is characterized predominately by detached houses on individual lots or where such a land use pattern is desired in the future. The Zoning Ordinance includes three RS districts – RS1, RS2 and RS3 – which are differentiated primarily on the basis of minimum lot area requirements and floor area ratios.

Residential Two-Flat, Townhouse and Multi-Unit Districts

The primary purpose of the RT districts is to accommodate detached houses, two- flats, townhouses and low-density, multi-unit residential buildings at a density and building scale that is compatible with RS districts. The districts are intended to be applied in area characterized by a mix of housing types. The districts are also intended to provide a gradual transition between RS districts and higher density RM districts. The RT districts are differentiated primarily on the basis of allowed density (minimum lot area per unit) and floor area ratios. The RT4A designation is intended to accommodate and promote multi-unit buildings containing accessible dwelling units. See also Sec. 17-2-0105.

Residential Multi-Unit Districts

The primary purpose of the RM districts is to accommodate detached houses, two-flats, townhouses and multi-unit residential buildings. Although the districts accommodate a wide range of housing types, they are primarily intended to accommodate moderate- to high-density, multi-unit residential buildings in areas where such development already exists or where it is desired in the future. The Zoning Ordinance includes 5 RM districts – RM4.5, RM5, RM5.5, RM6 and RM6.5. These districts are differentiated primarily based on allowed density (minimum lot area per unit), floor area ratio and allowed building heights.

Table A2: Relevant Zoning Districts Abbreviation

Name

Description

Neighborhood Shopping District

The B1, Neighborhood Shopping district is intended to accommodate a broad range of small-scale retail and service uses. B1 zoning is intended to be applied in compact nodes at the intersection of two or more major streets or in a cohesive linear fashion along relatively narrow streets that have low traffic speeds and volumes (compared to multi-lane, major streets). The B1 district is intended to exhibit the physical characteristics of storefront-style shopping streets that are oriented to pedestrians. The B1 district permits residential dwelling units above the ground floor. The B1 district can be combined with the dash 1, dash 1.5, dash 2, dash 3 or dash 5 bulk and density designations (see Sec. 17-3-0401).

Neighborhood Mixed-Use District

The purpose of the B2, Neighborhood Mixed-Use district is the same as the B1 district, but with the added objective of providing a greater range of development options for those streets where the market demand for retail and service uses is relatively low. By allowing ground-floor residential uses by-right, the B2 district is intended to help stimulate development along under-developed streets. The B2 district permits residential dwelling units on or above the ground floor. B2 zoning is intended to be applied in compact nodes at the intersection of two or more major streets or in a cohesive linear fashion along relatively narrow streets that have low traffic speeds and volumes (compared to multi-lane, major streets). The B2 district can be combined with the dash 1, dash 1.5, dash 2, dash 3 or dash 5 bulk and density designations (see Sec. 17-3-0401).

Table A2: Relevant Zoning Districts Abbreviation

Name

Description

Community Shopping District

The primary purpose of the B3, Community Shopping district is to accommodate a very broad range of retail and service uses, often in the physical form of shopping centers or larger buildings than found in the B1 and B2 districts. In addition to accommodating development with a different physical form than found in B1 and B2 districts, the B3 district is also intended to accommodate some types of uses that are not allowed in B1 and B2 districts. Development in B3 districts will generally be destination-oriented, with a large percentage of customers arriving by automobile. Therefore, the supply of off-street parking will tend to be higher in B3 districts than in B1 and B2 districts. The B3 district permits residential dwelling units above the ground floor. The B3 district is intended to be applied to large sites that have primary access to major streets. It may also be used along streets to accommodate retail and service use types that are not allowed in B1 and B2 districts. The B3 district can be combined with the dash 1, dash 1.5, dash 2, dash 3 or dash 5 bulk and density designations (see Sec. 17-30401).

Neighborhood Commercial District

The primary purpose of the C1, Neighborhood Commercial district is to accommodate a very broad range of small-scale, business, service and commercial uses. C1 zoning is distinguished from B1 zoning by the range of use types allowed: C1 permits more intensive, more auto-oriented commercial use types than does B1. The C1 district also allows taverns and liquor stores by-right. The C1 district permits residential dwelling units above the ground floor. C1 zoning is generally intended to be applied in compact nodes, at the intersection of two or more major streets, or in a cohesive linear fashion along streets. The C1 district can be combined with the dash 1, dash 1.5, dash 2, dash 3 or dash 5 bulk and density designations (see Sec. 17-3-0401).

Table A2: Relevant Zoning Districts Abbreviation

Name

Description

Motor-Vehicle-Related Commercial District

The primary purpose of the C2, Motor Vehicle-Related Commercial district is to accommodate a very broad range of business, service and commercial uses. In terms of allowed uses, C2 represents the highest intensity business or commercial zoning district. It allows nearly any type of business, service or commercial use, including those involving outdoor operations and storage. Like the B3 district, the C2 district, development will generally be destinationoriented; a very large percentage of customers will arrive by automobile. The C2 district permits residential dwelling units above the ground floor. The C2 district is intended to be applied to large sites that have primary access to major streets. The C2 district can be combined with the dash 1, dash 1.5, dash 2, dash 3 or dash 5 bulk and density designations (see Sec. 17-3-0401).

POS

Parks and Open Space District

The “POS”, Parks and Open Space zoning district is intended to preserve, protect and enhance lands set aside for public open space, public parks and public beaches. Such areas and facilities provide many benefits to city residents and visitors. They provide cultural and recreation opportunities; preserve natural and scenic areas; protect sensitive natural resource areas; and offer refuge from the built, urban environment. The POS district is also intended to be applied to cemetery lands. Other than cemeteries, the POS district is intended to be applied exclusively to public-owned lands. Regional or Community Park (POS-1); Neighborhood Park, Mini-Park or Playlot (POS-2).

Planned Development

See Ch. 17-8 Planned Developments of the City of Chicago Zoning Code

Source: Chicago Department of Planning and Development, Chicago Zoning Ordinance

Monitoring and Evaluation Table A3: Monitoring and Evaluation Indicators Community and Health Indicators

Source

Median and Per-Capita Income

US Census Bureau, American Community Survey

Crowded Housing

US Census Bureau, American Community Survey

Rent Burdened

US Census Bureau, American Community Survey

Severely Rent Burdened

US Census Bureau, American Community Survey

Adults Who Report They Feel Safe in their Neighborhood “most” or “all of the time”

Chicago Department of Public Health, Healthy Chicago Survey

Pedestrian Traffic Fatalities

Chicago Department of Transportation, Vision Zero Chicago

Adult Asthma Rate

Chicago Department of Public Health, Healthy Chicago Survey

Adult Diabetes Rate

Chicago Department of Public Health, Healthy Chicago Survey

Hypertension Rate

Chicago Department of Public Health, Healthy Chicago Survey

Cancer Mortality Rate

Illinois Department of Public Health, Death Certificate Data Files

Coronary Heart Disease Mortality Rate

Illinois Department of Public Health, Death Certificate Data Files

Diabetes Mortality Rate

Illinois Department of Public Health, Death Certificate Data Files

Heart Disease Mortality Rate

Illinois Department of Public Health, Death Certificate Data Files

Stroke Mortality Rate

Illinois Department of Public Health, Death Certificate Data Files

Easy Access to Fruits and Vegetables

Chicago Department of Public Health, Healthy Chicago Survey

Adult Physical Inactivity Rate

Chicago Department of Public Health, Healthy Chicago Survey