RWJ Funded Gehl Institute Report: Building Inclusive Healthy Places

Place is integral to health. Our everyday environments play a fundamental role in shaping how healthy we are, as individuals and as communities. Where we live, work, and play has a lot to do with why some people are healthier than others, and can have a key role in determining why some people are not as healthy as they otherwise could be. A wealth of research demonstrates that place matters when it comes to health.

In practice, our most important shared places—our public spaces—continue to be planned and designed without considering all users or an entire range of well-being. There’s no common framework; it’s almost as though people in the fields of public health and urban planning and design speak different languages.

To bridge these gaps, Gehl Institute and the Robert Wood Johnson Foundation, with a group of global advisors, have developed the Inclusive Healthy Places Framework as a tool for evaluating and creating healthy, inclusive public places that support health equity.

The Framework and supporting analysis presented in this report represent a synthesis of research and expertise in public health and urban planning and design, focusing on those social determinants of health that can be viewed clearly through the lens of public space.

Public Space, Health Equity, & Inclusion

This work looks primarily at public spaces as those publicly accessible outdoor spaces that we encounter in our everyday lives and that offer distinct physical and mental health and well-being benefits to individuals and communities. These include streets, sidewalks, parks, plazas, parts of our transportation networks, and more. These are the spaces that support recreational physical activity, play, and active transportation; give us opportunities to meet and see others in our communities; provide us with access to nature and greenery; and more. Everyone has access or exposure to some form of public space.

However, not all public spaces are created equally or equitably—nor are the neighborhoods, towns, or cities that surround them. Indeed, the health disparities and inequities that this work is concerned with often track with such factors as access to and quality of available public spaces and degree of representation and participation in the process of shaping and maintaining public spaces. The Guiding Principles of Inclusive Healthy Places introduced in this report and in the Framework describe four distinct but interrelated areas in which public space intersects with health equity and inclusion. Inclusion itself is a complex concept that is challenging to define; it is not just the opposite of exclusion.

We present a working definition of inclusion as an outcome and a process—and as a tool for change.

Inclusion is an outcome: All people who use a public space feel welcome, respected, safe, and accommodated, regardless of who they are, where they come from, their abilities, how old they are, or how they use the space. Inclusion is a process: Inclusionary public space processes recognize and respect the needs and values of people using the space and the assets present in a place, actively engaging and cultivating trust among participants, ultimately allowing all members of the community to shape, achieve, and sustain a common vision. This is a deliberate process that requires understanding of context and lived experience, among other factors. 

Inclusion is a tool: As a tool, inclusion can help practitioners and communities reduce and ultimately eliminate health inequities stemming from long-term systemic discrimination and other barriers. Inclusion has the power to create real change—in practice, in process, and in people’s lives. Over time, with greater experience and implementation, we will expand our understanding and improve our tools for fostering inclusion as a means toward increasing health equity through public space.

Healthy inclusive public places can support health equity in many ways, including:

• Being both accessible and welcoming to all
• Reflecting shared social values such as dignity and respect
• Demonstrating the value of processes that promote trust and participation, particularly among marginalized groups
• Promoting vibrant and diverse social interaction
• Offering everyone opportunities to enjoy and use public space in diverse ways, such as for physical activity or relaxation
• Helping communities overcome barriers to better physical and mental health
• Supporting and sustaining the natural assets and strengths of a place and its people

Inclusion efforts at the intersection of public space and public health should focus on populations and neighborhoods that have experienced disenfranchisement and disinvestment or that have access challenges.