A Call to Action to Address the Social Determinants of Health.

Rapid growth in metropolitan areas is associated with urban development and revitalization. However, neighborhood gentrification has negatively affected low income and communities of color by displacement and compounding structural and systemic inequities. Black/African American, Hispanic/Latino, and immigrants/refugee communities are burdened with negative health outcomes from adverse circumstances illustrated by disparities in the social determinants of health and health indicators, that is, chronic disease and COVID-19. To remediate the situation and restore health, the multisector response needs to be reframed and emphasize systemic, integrated, and aligned efforts. These include policy, systems and environmental change approaches, community involvement, improvement of data systems, and workforce development.

Increasing tidal inundation corresponds to rising porewater nutrient concentrations in a southeastern U.S. salt marsh.

Salt marshes are ecologically and economically important features of coastal environments that are vulnerable to sea level rise, the rate of which has accelerated in recent decades along the southeastern US Atlantic coast. Increased flooding frequency and duration across the marsh platform is predicted to impact vegetation community structure and overall marsh persistence, but the effect of changing inundation patterns on biogeochemical processes in marsh sediments remains largely unexplored. As part of a long-term monitoring effort to assess how marshes are responding to sea level rise in North Inlet estuary (South Carolina, USA), we collected data on porewater nutrient concentrations from a series of permanent monitoring plots across multiple transects spanning the marsh elevation gradient during the growing season from 2009 to 2019. Additionally, we calculated time inundated for each plot using local water level data and high-resolution elevation measurements to assess the change in time flooded at each plot. Our results indicate that both NH4 and PO4 nutrient concentrations have increased in most permanent plots over the 11-year study period and that nutrient concentrations are higher with increasing proximity to the creek. Spatial patterns in nutrient increases through time are coincident with considerable increases in tidal inundation observed over the marsh platform. Across plots located in the low marsh, porewater NH4 and PO4 concentrations have risen at average rates of 8.96 µM/year and 0.86 µM/year, respectively, and have reached rates as high as 27.25 µM/year and 3.13 µM/year. We suggest that increased inundation time due to rising sea level has altered biogeochemical conditions influencing nutrient availability in marsh porewater, resulting in increases that likely have relevance for larger scale nutrient cycles as well as marsh ecosystem stability and function.

Development of a community-sensitive strategy to increase availability of fresh fruits and vegetables in Nashville's urban food deserts, 2010-2012.

BACKGROUND: Food deserts, areas that lack full-service grocery stores, may contribute to rising rates of obesity and chronic diseases among low-income and racial/ethnic minority residents. Our corner store project, part of the Centers for Disease Control and Prevention's Communities Putting Prevention to Work initiative, aimed to increase availability of healthful foods in food deserts in Nashville, Tennessee. COMMUNITY CONTEXT: We identified 4 food deserts in which most residents are low-income and racially and ethnically diverse. Our objectives were to develop an approach to increase availability of fresh fruits and vegetables, low-fat or nonfat milk, and 100% whole-wheat bread in Nashville's food deserts and to engage community members to inform our strategy. METHODS: Five corner stores located in food deserts met inclusion criteria for our intervention. We then conducted community listening sessions, proprietor surveys, store audits, and customer-intercept surveys to identify needs, challenges to retailing the products, and potential intervention strategies. OUTCOME: Few stores offered fresh fruits, fresh vegetables, low-fat or nonfat milk, or 100% whole-wheat bread, and none stocked items from all 4 categories. Major barriers to retailing healthful options identified by community members are mistrust of store owners, history of poor-quality produce, and limited familiarity with healthful options. Store owners identified neighborhood crime as the major barrier. We used community input to develop strategies. INTERPRETATION: Engaging community residents and understanding neighborhood context is critical to developing strategies that increase access to healthful foods in corner stores.

Achieving built-environment and active living goals through Music City Moves.

BACKGROUND: Nashville, Tennessee, formed Music City Moves (MCM), an interdisciplinary, countywide partnership to implement its vision for the community: a metropolitan region where routine physical activity is a fundamental part of daily life for all residents. INTERVENTION: Music City Moves' main focus was the pursuit of changes in community planning policies to help shape Nashville's built environment and facilitate walking and bicycling. To complement this focus, MCM developed a suite of health programs to support physical activity in high-risk populations and a countywide promotional campaign designed to increase awareness and get people active through event participation. RESULTS: Nashville made considerable strides in improving policies and regulations related to building and site design to improve the built environment for pedestrians and cyclists, including passage of (1) specific plan zoning; (2) revised subdivision regulations that introduced a "walkable subdivision" option for developers; and (3) a community-character manual that will guide future land-use planning. Programs and promotions have increased awareness and participation, and the Tour de Nash bike/walk event showcases yearly changes in the built environment. LESSONS LEARNED: Political leadership has been critical to MCM's success. Leadership of the partnership by the planning department facilitated regulatory changes in planning policies. CONCLUSIONS: Music City Moves has accelerated Nashville's movement to improve the built environment and encourage active living. The beneficial impact of policy changes will continue to be manifested in coming years; however, ongoing political support and education of stakeholders in the planning process will be necessary to ensure that planning policies are fully implemented.