All policy is local: Public health professionals' experience with shaping the built environment

The built environment significantly impacts physical activity. At the local level, policies related to the built environment are often determined by municipal decision-makers. Local public health officials are charged with addressing the obesity epidemic and increasing physical activity, yet their experience in shaping local built environment policy is unclear. The goal of this study was to describe US public health officials' experiences with built environment-related policy and compare their involvement to other municipal officials (planning, transportation, development, parks and recreation, mayors/city managers, and municipal legislators). A web-based survey was conducted among 453 local elected and appointed officials representing 8 states and 53 municipalities. Respondents were asked whether they had ever participated in development, adoption, or implementation of policy affecting community design and layout in three domains: land use, transportation, and parks and recreation. Involvement in five policy types (ordinance, plan, design standards, funding reallocation, new funding) was assessed for each domain. Among all respondents, 74% indicated past experience with land use policy, 75% with transportation policy, and 64% with parks and recreation policy. Among public health officials, however, only 29%, 42%, and 26% had worked on such policies, respectively (p-value <0.0001 for each). For each domain, public health officials had greatest involvement with plan development and least involvement with funding decisions. Findings illustrate a gap between public health officials' experiences and evolving expectations about their role in built environment policy. Research is needed to understand best practices for integrating public health into the built environment decision-making process.