Healthy PAGE


Healthy PAGE (Policies and Actions Guided by Evidence) Project

Project Synopsis: The Healthy PAGE project led a health impact assessment (HIA) of the Page Avenue redevelopment in Pagedale, Missouri in St. Louis County. The Page Avenue HIA was carried out to (1) examine how the redevelopment will affect community health by modifying economic, environmental, and social determinants; and (2) develop recommendations to decision-makers about project plan priorities and changes that maximize the comprehensive health of residents. To make its recommendations for improved health effects in the Pagedale redevelopment, the HIA used information from scientific studies, local data, design expertise, and community input. HIA recommendations and findings will be broadly disseminated.

Project Goals:

The primary aim of this project is to influence project plans to improve safety, walkability, and access to recreational facilities and healthy foods for families and youth in the City of Pagedale and surrounding communities.

Secondary aims:

  • Increase citizens' awareness and involvement in planning decisions that impact the health of families in the community
  • Increase awareness about the health impacts of neighborhood revitalization projects among decision-makers and developers in the St. Louis region
  • Build partnerships for HIAs in the St. Louis region
  • Increase visibility for HIAs in the St. Louis region

Project Timeline: April 2009 to September 2010

Target Audience: Decision-makers in the Page Avenue redevelopment process and the surrounding area, community stakeholders, and researchers and practitioners who are interested in healthy policy-making and health impact assessment.

Project Description: Creating environments that promote health can play a significant role in reducing rates of chronic disease, the leading cause of death and disability in the United States. Evidence supports a relationship between the economic, physical, and social environments of neighborhoods and health outcomes such as chronic diseases and behavioral risk factors. Planning, transportation, economic development, and housing sectors all need to be engaged in public health decision-making in order to improve community health and health determinants. HIA is a tool to support evidence-based public health among non-health sectors.

In 2009-2010, the Healthy PAGE project team led an HIA of a redevelopment project along Page Avenue in Pagedale, a low-income, inner-ring suburb of St. Louis County, Missouri. The project plans include: a grocery store, bank, improved pedestrian connectivity, mixed-income residential development, and commercial development. The improvements are being partially funded through tax increment financing with the non-profit organization Beyond Housing as the lead developer. Along with community stakeholders, the HIA team used information from scientific studies, local data, design expertise, and community input to identify the priority impacts of the redevelopment and make recommendations to decision-makers about how to improve the health effects of the redevelopment. The seven priority impacts of interest included employment; access to good, services, and recreation; access to healthy foods; pedestrian safety; community safety; community identity; and housing.  The top five cross-cutting recommendations represented evidence-based approaches for modifying current plans and supplementing with programs and policies to maximize the health benefits in the target population:

1.    Replace symbols of disinvestment and improve pedestrian infrastructure in the short term;

2.    Implement orchards and gardens;

3.    Supplement physical improvements with education and programming;

4.    Prioritize spaces and programs for youth recreation; and

5.    Foster stakeholder engagement.

The recommendations and findings will be broadly disseminated in the form of in-person meetings with decision-makers, a community newsletter, full report, executive summary, conference presentations, and scientific papers.  The process and impacts of the HIA will be evaluated.

Implications for Research and Practice: The Healthy PAGE project has the potential to make health a priority for decisions about the Page Avenue redevelopment, as well as future projects and policies in the St. Louis metropolitan area. It also advances the practice of HIA in the United States.

Project Leaders:
Christine Hoehner, PhD, MSPH, Washington University, School of Medicine: Project Co-Leader
Jodi Rios, MArch, Washington University, Sam Fox School of Design and Visual Arts: Project Co-Leader
Cristina Garmendia, BA, Washington University, School of Medicine: Project Manager

University Partners:
Washington University, George Warren Brown School of Social Work and Center for Social Development, Brown School of Social Work
Carolyn Lesorogol, PhD, Co-Investigator
Gena Gunn, Facilitator
Donna-Mae Knights, MA-SID, Doctoral student
Michael Sherraden, PhD, Advisor

Saint Louis University School of Public Health
Cheryl Kelly, PhD, MPH, MS, Evaluation expert
Ellen Barnidge, PhD, MPH, Focus group expert
Michael Elliott, PhD, Data manager

Community Partners: 
Beyond Housing
Regional Housing and Community Development Alliance
City of Pagedale

HIA Advisors:
Candace Rutt, PhD, Centers for Disease Control and Prevention
Brian Cole, DrPH, University of California in Los Angeles, Health Impact Assessment Project

Research Assistants
Peg Allen, Emily Augsburger, Lauren Carothers, Bennett Gale, Elaine Grimm, Ali Leipsiger, Christine Marx, Takahiro Nakamura, Kimberly Newcomer, Ethan Park, Lisa Pollack, Eric Ryszkiewicz, Megan Roy, Stephanie Spence

Washington University (Center for Social Development, Alvin J. Siteman Cancer Center Prevention and Control Program, and Institute for Public Health) and the Active Living Research program of the Robert Wood Johnson Foundation

Logic Model: Healthy PAGE HIA Logic Model  Download PDF 

Study Area Resource Map:

HIA Report 
• Full report
• Executive summary
• Impact table

HIA Assessment Instruments
• Household survey instrument
• Active Neighborhood Checklist    Tool       Protocol
 Key informant interview guide
• Steering committee surveys         Baseline      Evaluation

Community Engagement and Dissemination
 Notification letter
• Open house summary
• Community newsletters  #1,  #2  and #3
• Summary of dissemination to decision-makers