In cities and towns across the United States, life expectancy varies from neighborhood to neighborhood by as much as 28 years for men and 25 years for women. San Francisco is no exception. Residents in low-income areas live far fewer years in comparison to higher-income areas and to the city overall. These "place-based" disparities extend to other health outcomes as well, including asthma hospitalizations, heart disease, diabetes, and low birth weight births.

Historically, health inequities were associated with differences in health behaviors and health care access and utilization. Today, however, many believe that these inequities result from differences in access to the social, economic and environmental resources necessary for health. To reduce these inequities requires a strategic focus on improving these resources that are necessary for health and well-being. Changes in societal conditions can affect many individuals simultaneously, and have broad and diverse impacts on multiple health outcomes.

The value of this Tool is that it focuses on broadening the range of social, economic, and environmental resources needed for health on a population level. It does so by recognizing a range of resources needed for optimal health at the societal level and identifying measurable and actionable ways to meet those needs through urban development. It combines quantitative analysis of health indicators with a qualitative assessment of whether plans and projects meet Tool development targets.

The avoidable economic costs of acute and long-term illness are significant. The Tool identifies a range of actions that could also reduce the costs associated with problems such as vehicle injuries, obesity, asthma, diabetes. For example:

• Fatal and nonfatal vehicle injuries in California resulted in over $3.9 billion in direct and indirect costs ($692,000 per injury).¹
• Overweight, obesity and physical inactivity in California in the year 2000 resulted in over $21.6 billion in health care, lost productivity and workers compensation costs.²

A number of population health indicators serve to assess the overall health of City residents and how health varies at the neighborhood level. San Francisco data on the following population health indicators are available as part of the Healthy Development Measurement Tool.

• Leading causes of premature mortality
• Ranking of top 10 causes of death by neighborhood
• Age-adjusted mortality rates
• Infant mortality rates
• Low birth weight births
• Ambulatory care sensitive conditions

Where possible data is disaggregated spatially to illustrate place based differences in health. Achieving Tool development targets through policy or implementation of land use design strategies will result in the advancement of community health objectives, improvement in associated health outcomes, and reduced social and economic costs.

The Tool represents an innovative approach to public health practice in that it provides tools and methods to assess health in land use planning. As we apply the HDMT to development, we see this work as an attempt to create a social, physical, and economic environment that protects and promotes health.