Coming together: Strategic collaboration between environmental health and public health departments for health-promoting built environments

Increased recognition of the built environment as an important determinant of chronic disease, health disparity, and degraded environmental conditions comes at a time when the two agencies best-suited for addressing these challenges through built environment interventions – environmental health (EH) and public health (PH) – have grown apart. The present study evaluated the strategic value and feasibility of augmenting collaboration between environmental and public health for establishing health-promoting built environments and identified opportunities and challenges for doing so. It used mixed methods including a survey of 159 (89% participation) health officers, health directors, and environmental health directors from 100% of California's local jurisdictions and 30 qualitative interviews with health officers and environmental health directors. Multivariate linear and logistic regression, and content analysis assessed convergence of environmental and public health leaders built environment-related opinions and practices. Leaders from both fields reported compatible views on built environment-related state legislation, policy vision, and the value of built environment-related health strategies, with small variation on positive attitude toward it (scoring 35 (PH) and 31 (EH) on a 40-point scale, p<.05). Leaders viewed land use and transportation interventions as a shared responsibility, scoring 5.7 on a 1-10 scale with 1 holding all responsibility in EH and 10 in PH. An inventory of built environment-related activities and resources disclosed that the two fields have little overlap but are highly complementary. PH reported EH colleagues providing access to land use processes, and EH more frequently reported constructive relationships with a full spectrum of land use professionals (95% versus 50%, p<.05). Conceptual, cultural, procedural, and territorial challenges were identified and characterized, but many felt these were surmountable. Environmental health and public health have complementary roles, resources, and relationships that, if aligned, can increase both fields' health-related impacts on the built environment.