Looking Forward: Community Engagement & Long-Term Planning

Alexander is working to develop a tree-based health intervention with local nonprofit Trees Durham

In my prior blog posts, I have outlined the intimate connection between the environment and human health, demonstrated the association of low tree canopy and historical racist policies in Durham, and described the process of cultivating a multi-sector community partnership to plant trees. The goal of this work can be distilled down to investing in Durham’s marginalized communities, working against climate change, and improving the health of our community.

The simplicity of this project in many ways makes it appear as a simple win-win. However, as I have come to realize through my research and work, every intervention requires (1) community member engagement and (2) short-term and long-term planning.

  • Community Member Engagement

The partnership with Trees Durham is the foundation of our community engagement efforts. The organization upholds a robust community-building philosophy by partnering with local projects with missions that extend beyond environmental justice, including Black Mama’s Bailout Campaign, which raises money to bail black mothers and caretakers out of Durham’s pretrial detention facility, and Project Build, which seeks to prevent gang violence by engaging vulnerable youth communities. Further, Trees Durham leadership has experience working with community members specifically in our target areas.

In Hayti, one of the target sites, community members have already shaped the vision for this project. Last fall, Trees Durham held a focus group at the Hayti Heritage Center for participants, who largely identified as Black or multiracial, on the benefits of trees and what matters most to their community. Residents identified extreme heat reduction, lowering crime, and lowering air pollution as benefits they valued most. Surveys administered by Trees Durham have also identified that residents around Durham (n=670) rank street trees as the highest priority for future tree planting followed by commercial sites, parking lots, and finally, around homes.

Figure 1 from Angeulovski et al. 2019

We will lean on the expertise of our community member stakeholders to determine final target sites and continue to develop a deeper understanding of the space in which their families live, work, and play. A simple strategy to start is to provide flyers to distribute to residences that explain the purpose of planting new saplings. Previously, the City of Durham has posted tree planting information on door hangers around neighborhoods and we hope to partner with youth in the community (specifically at the elementary schools in the target areas) to help design these flyers.

  • Short-term and Long-term planning

Looking to the future, our team has begun to investigate the long-term effects of our work, both positive and negative. With this in mind, I want to introduce the concept of green gentrification. This term refers to the process in which urban planning initiatives to create more green space attract wealthier residents and displace low-income residents. This potential creates a terrible scenario where the green infrastructure improvement targeting marginalized communities may cause these people to lose their neighborhoods entirely. This concept is summarized in Figure 1 from Anguelovski et al. 2019. Historical examples of this phenomenon include the creation of the U.S. National Park System as a means of stealing land from Indigenous tribes and the creation of Central Park in New York, which required the demolition of Seneca Village, one of the only neighborhoods where Black residents could own property in the first half of the 19th century (Figure 2—the link to the Vox YouTube video is worth checking out!).

Figure 2 from Vox.com “The lost neighborhood under New York’s Central Park” Link

Acknowledging the risk of green gentrification, Connolly and Anguelovski (2021) write, “We can start recognizing how the history of greening—a seemingly apolitical “urban project” sold as a win-win, universal benefit with ample health, economic, and environmental qualities—has deep links to the exclusionary and racist roots of urbanization that manifest at different points in time and space across and within cities.” Given these risks, environmental interventions need to incorporate affordable housing protections in addition to the urban green space and infrastructure. Specific anti-displacement tools could include rental subsidies, rent-control schemes, and community land trusts. Regarding our work in Durham, we will advocate for affordable housing and equitable green infrastructure together as they are closely related with one another.

Urban greening and green spaces are vital to mitigating the impact of climate change and promoting the health and wellbeing of residents. To achieve an equitable future, we need to question the pattern of green infrastructure and whiteness, purposefully abolish the racist systems that created the current inequities and invest specifically in affordable housing and green infrastructure of marginalized communities.

Works Cited

Anguelovski I, Connolly JJT, Pearsall H, et al. Why green “climate gentrification” threatens poor and vulnerable populations [Internet]. Proc. Natl. Acad. Sci. U. S. A.116(52), 26139–26143 (2019). Available from: www.pnas.org/cgi/doi/10.1073/pnas.1920490117.

Connolly JJT, Anguelovski I, Campbell LK. Three Histories of Greening and Whiteness in American Cities. Front. Ecol. Evol. [Internet]. 9(March), 101 (2021). Available from: https://www.frontiersin.org/articles/10.3389/fevo.2021.621783/full.

Cultivating Partnership: A Plan to Get Trees Planted

Alexander is working to develop a tree-based health intervention with local nonprofit Trees Durham.

Figure 1. High-resolution landcover data showing tree canopy cover in Durham in 2015.

In my previous blog post, I outlined the intimate link between climate, environment, and human health. Further, I made the argument that an evidence-driven and community-based intervention is needed to purposefully plant trees in Durham communities who would benefit the most. This goal has added emphasis with the recent cold snap that devastated many areas in the central and southern United States. Climate change will lead to more extreme weather events and we need to invest now in infrastructure to prevent unnecessary deaths and disease. With this renewed significance, let’s jump into the planning of our work in Durham.

The project is a novel partnership between Trees Durham (a community-based organization that aims to create a sustainable tree canopy), the City of Durham Division of Urban Forestry, and the U.S. Environmental Protection Agency that aims to increase tree canopy coverage in historically red-lined areas of Durham in order to combat structural racism while promoting cardiovascular outcomes and environmental justice.

The first step of this project is to operationalize the available data from these partnerships to identify the communities in Durham that (1) do not currently have adequate tree coverage; (2) have been historically red-lined and excluded from city planning processes; and (3) suffer from poor cardiovascular outcomes as shown in the included figure. Durham’s Division of Urban Forestry and Trees Durham have provided maps of Durham County’s tree canopy coverage that were created using LiDAR with resolution up to two feet (Figure 1). In collaboration with the EPA, we will use information on cardiovascular disease within Durham County with resolution up to the neighborhood-level (pre-liminary analysis in Figure 2). From our preliminary analysisthe areas of focus will likely be in the Rolling Hills/ Southside Neighborhood, including streets around Hillside Park, Shepard Middle School, NCCU, and the Hayti District.

Figure 2. Incidence of Heart Attack in the Adult Population in Durham in 2017 (Adapted from Durham Neighborhood Compass)

Importantly, we aim to prioritize community engagement and advocacy throughout this initiative. In addition to leveraging Trees Durham’s existing relationships with several community-based organizations, we are building a stakeholder board comprised of community members who reside in the target areas. Additionally, this project adds a health equity lens into Urban Forestry planning in Durham with the potential to be an example for other city planning policies.

Looking to the future, we will ask volunteers and community members to complete a four hour training by Trees Durham to become certified Tree Keepers. This training provides information on tree planting, maintenance, and sustainability. All equipment needed for the planting of trees will be provided by the Division of Urban Forestry and Keep Durham Beautiful, Inc. Trees will be planted in the green space along the identified streets, which is owned by the City of Durham. Volunteers will be asked to participate in the maintenance and sustainability of the planted trees. Additionally, the City of Durham will be responsible for ongoing maintenance including watering, mulching, staking, and pruning.

This work capitalizes on recent research unveiling the positive health effects of tree canopy coverage and leverages data to create a targeted tree-based intervention. This comes in the context of historical maldistribution of trees along social and economic strata and in the growing recognition of the responsibility of physicians in global climate change. In short, this project has a remarkably simple goal: we will invest in Durham’s marginalized communities, work against climate change, and improve the health of our community.


Linking the Environment and Human Health

Alexander is working to develop a tree-based health intervention with local nonprofit Trees Durham.

Growing recognition of the relationship between global climate change and human health has led to a greater emphasis on the responsibility of clinicians and health systems to incorporate a climate lens into their practice. The intimate link between the environment and human health has many dynamic mechanisms affecting both health outcomes and health disparities. This lens adds emphasis to the vital work of Trees Durham, a local nonprofit organization. Trees Durham is an environmental justice group that is dedicated to combating climate change and creating environmental equality across Durham. The goals of the organization are to take direct action to (1) plant & preserve trees, (2) combat climate change, and (3) create environmental equity.

Recent research has supported the positive effects of urban green space and tree canopy coverage on patient-level health outcomes such as cardiovascular and respiratory disease, immune function, and mental health. In addition, epidemiological analyses have demonstrated that populations are at lower risk of mortality when they reside in areas with more green space. Beyond direct health implications, tree canopy coverage has an added benefit of increasing residents’ sense of community connectedness and reducing crime rates. Finally, trees are among the most effective tools for taking care of our global community, capturing carbon from the atmosphere, and limiting the rise of CO2 emissions.

In urban areas across the United States, tree canopy coverage is not equally distributed and often aligns with well-known health disparities. In Durham County, where tree canopy coverage is 52% (Figure 1A), lowest coverage is found in districts historically red-lined in the 1930s (Figures 1B and 2), according to an analysis done by Duke’s Nicholas School of the Environment. Policies like redlining perpetuate a pattern of inequity across social, economic, and health strata, ultimately manifesting as structural racism. Durham residents in these districts are disproportionately non-white, have lower median household income, are more likely to be renters, and suffer from worse health outcomes. Cardiovascular is of particular interest as the incidence of heart attack is four times higher in areas affected by these historical discriminatory policies. This is important in light of the 2017 Durham Community Needs Assessment, which identified cardiovascular disease as the second leading cause of death in the county, affecting more than 35% of residents and making it one of the “most widespread and costly health problems facing Durham County.”

The goal of our project is to develop an evidence-driven and community-based intervention to purposefully plant trees in Durham communities that would benefit the most. An additional ambitious goal of our work is to directly combat historical racist policies that dictate the health and wellbeing of our city’s most marginalized communities and to provide an example for how to implement city planning interventions with a health equity framework.

Finally, this work has tremendous meaning for my vocation as a medical student and as a future physician. The essential reflection is that the health of the patients I work with now and my future patients is shaped by many factors outside the clinic, such as the environment in which they live. Moreover, their health outcomes are affected by historical context, including discriminatory policies from nearly 100 years ago. Together, these reflections expand what needs to be considered in the clinical interaction beyond counseling on what diagnostic tests or prescription medicines are needed to include more robust context of the patient.

Figure 1.

A – Durham County tree canopy coverage map, summarized by 1000-foot grid cells. Derived from LiDAR by City of Durham.

 B – Street tree sites in Durham. The green dots represent sites with trees and the purple dots represent sites that are available. The red designates preliminary target sites. (Adapted from City of Durham and Trees Durham)

Figure 2.

Comparison of tree canopy coverage in 2015 among Durham risk class zones delineated by the Homeowners Loan Corporation in the 1930’s. (Adapted from Swenson et al. 2020)