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Working Together for Healthy People and Sustainable Communities: A Commentary on How the Alignment of Public Health Standards and Sustainable Communities Certification Can Lead to Improvements in Quality of Life for All

Varnadore, Hilari, B., MA, BSc

Journal of Public Health Management and Practice: May/June 2018 - Volume 24 - Issue - p S44–S46
doi: 10.1097/PHH.0000000000000701

STAR Communities, Washington, District of Columbia.

Correspondence: Hilari B. Varnadore, MA, BSc, STAR Communities, 777 North Capitol St, NE Ste 500, Washington, DC 20002 (

The author declares no conflicts of interest.

Sustainability managers and public health professionals share the same goal of improving the quality of life for all people, now and in the future. Yet local leaders often operate in departmental silos, which impacts the opportunities to leverage one another's resources and collaborate cross-agency on shared goals. In this commentary, we explore how the STAR Community Rating System1 is guiding local leaders to more effective, inclusive decision making, resulting in more livable, resilient, and just communities. The parallel goals of public health accreditation and sustainable communities certification—to equip local leaders with consistent national standards and strategies—are also highlighted.

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A Common Framework for Sustainability

The Brundtland Commission's 1987 report2 defined sustainable development as meeting the needs of the present without compromising the well-being of future generations. Striking a balance between a healthy environment, a strong economy, and the well-being of the people living in a community has been referred to as the 3 pillars of sustainability or the 3 “e's”—environment, economy, and equity. Like a 3-legged stool, when one leg is missing, the stool is out of balance and falls over. These analogies and definitions shaped the sustainability movement well into the early 2000s.

By the mid-2000s, climate change had emerged as the leading sustainability issue; growing scientific evidence, public awareness, and political change in the United States contributed to an understanding that greenhouse gas emission reductions were critical to mitigation and adaption strategies. The federal government, under the leadership of President Barack Obama, invested in the Recovery Act, and programs such as the Energy Efficiency & Conservation Block Grant program instigated the creation of municipal sustainability programs and initiatives around the country.

Rather than reinvent the wheel, sustainability managers called for a common framework for sustainability—national standards and strategies to guide local efforts that would also catalyze leadership and innovation. As a result, the STAR Community Rating System was developed to serve as the nation's framework and certification program for measuring the social, economic, and environmental performance of US cities and counties. Built by and for local governments, STAR serves as the “operations manual” for sustainable communities; it provides the national standards to which we aspire and the local actions that help us innovate and collectively impact our communities in a positive way.

Released in pilot in 2012, nearly 70 US cities and counties have achieved a STAR Community Rating and hundreds are actively using STAR to set goals, measure progress, and improve their communities. More than 121 million people live in a community that has participated in STAR programs.

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Developing National Standards

When released, STAR represented a milestone in the national movement to create more livable communities for all. The rating system's evaluation measures collectively define community-scale sustainability and present a vision of how communities can become more healthy, inclusive, and prosperous across 7 goal areas. The system's goals and objectives provide a much-needed vocabulary that local governments and their communities can use to more effectively strategize and define their sustainability planning efforts.

STAR is holistic and comprehensive and goes well beyond measuring the “green lens” of sustainability. The STAR framework3 equally balances social, economic, and environmental sustainability (Figure). There are 7 goal areas: Built Environment; Climate & Energy; Economy & Jobs; Education, Arts, & Community; Equity & Empowerment; Health & Safety; and Natural Systems. Each goal area has 5 to 7 objectives, ranging from topics such as Aging in the Community; Compact & Complete Communities; Workforce Readiness; Food Access & Nutrition; and Green Infrastructure.



These diverse, yet synergistic, topics require expertise from technical advisors across many disciplines. Local government leaders, the US Centers for Disease Control and Prevention (CDC), Federal Emergency Management Administration, Public Health Accreditation Board (PHAB), Prevention Institute, American Planning Association, and Atlanta Regional Commission contributed to the development of the Health & Safety goal area. Advisors reviewed guidance from the National Prevention Strategy, the Surgeon General, Healthy People 2020, and CDC's research building the evidence base for healthy, active, and safe places and communities to develop the framework for public health in STAR.

Public health accreditation is one example of external standards that are incorporated and referenced in STAR. Communities receive credit in HS-5: Health Systems for demonstrating that the local health department is PHAB accredited. Community health assessments and community health improvement plans included in accreditation receive credit in HS-2: Community Health. Examples of other national standards integrated within STAR include EPA water quality standards,4 the ISO fire protection classification,5 and the Center for Neighborhood Technology's transportation affordability calculator.6

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Coordinating Health and Sustainability Practice

From the Health & Safety goal area, Objective HS-2 Community Health:

The health of people is fundamental to livability, yet the quality of health is profoundly influenced by factors outside the traditional health care system. The social, economic, and physical conditions in which people live, otherwise known as the social determinants of health, affect choices regarding behaviors that ultimately affect health outcomes. The knowledge and means to avoid toxic exposure and to access healthy food, physical activity opportunities, and safe housing all contribute to an individual's overall health.

To address the social determinants of health, Healthy People 2020 stresses the importance of “creating social and physical environments that promote good health for all.”7 STAR offers a path forward, encouraging cross-agency coordination and collaboration on complex community issues such as air quality, transportation, active living, safe communities, and poverty prevention. With public health standards integrated in STAR, health care professionals are at the table with economic development, planning, public works, and other agencies to address gaps and present creative solutions. Working collaboratively and across departments, managers can have a powerful, positive effect on the quality of life and future of a community.

Just like health care professionals are expanding their approach to public health, local leaders are evolving their approach to sustainability to be more holistic and comprehensive than the “greening” initiatives of the past 5 to 10 years. Residents and businesses are asking for safe, walkable neighborhoods, access to good schools, quality jobs, living wages, and affordable housing and health care. Managers will be called upon to make decisions and investments that balance those needs for all.

Local leaders, regardless of what department they operate out of, should be thinking about how to embed sustainability principles into their organization's DNA. A sustainable organization collaborates across departments, is innovative, efficient, and resourceful, and approaches decision making and investment with social, economic, and environmental conditions in mind.

Organizations such as PHAB and STAR Communities are leading with sustainability principles as well. Through technical and governance committee collaboration, alignment of standards, and coordination on research and best practice, we are equipping local leaders with the tools they need to be successful. From methodologies to measure equitable access to services to standards for adapting to a changing climate, we are helping cities and counties lead by example and continuously improve. Improving the quality of life for all people, now and in the future, is no small task. Let's all roll up our sleeves and get to work ... together!

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1. STAR Communities. STAR Community Rating System. Version 2.0. Washington, DC: STAR Communities; 2016.
2. World Commission on Environment and Development. Our Common Future. New York, NY: Oxford University Press; 1987.
3. STAR Communities. Our framework. Accessed October 11, 2017.
4. Environmental Protection Agency. Drinking water requirements for states and public water systems. Drinking water regulations. Accessed October 11, 2017.
6. Center for Neighborhood Technology. Total driving costs. Accessed October 11, 2017.
7. Social determinants of health. Accessed October 11, 2017.
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