The potential utility of close relationships between urban and health
planners has been recognized, and interest in developing them is growing.
This paper describes and discusses aspects of these relationships, and
offers suggestions for accelerating their development.
URBAN-PLANNING/HEALTH-PLANNING
INTERRELATIONSHIPS
Donald B. Ardell, M.C.P.
Legislative and Social Bases for
Better Communications
AOST urban planners realize that seri-
IYv ous problems exist in the health
field. With respect to the distribution of
quality medical services, rising hospital
and other medical costs, facility inade-
quacies, manpower unavailability, and
so on, the crisis or near-crisis is as ably
perceived by urban planners as by na-
tional commissions.1
Concurrently, many of these same
urban planners sense that old linkages
between their profession and health plan-
ning (concern about air and water pollu-
tion, waste disposal, neighborhood blight,
access to health facilities, among others),
while still relevant, are of less immediate
priority than, for example, the avail-
ability and quality of medical care re-
ceived by black and other poor people
living in urban renewal and model city
neighborhoods; or by the effective place-
ment of state and treawide comprehen-
sive health-planning bodies, and the di-
rections taken by said governmental de-
cision-making bodies in defining prob-
lems and distributing resources.2
While urban planners might possess
less definable technical skills to rely upon
in these health-directed endeavors than
in the area of combating environmental
hazards, a number of urban planners
have nevertheless argued for such an
NOVEMBER. 1969
extension of professional commitment.3
The case for added involvement of the
urban-planning profession is strengthened
by legislative and social developments
affecting both health and urban plan-
'ning.
The most dramatic legislative initia-
tive furthering the possibility of colla-
boration between urban and health plan-
ners was the Comprehensive Health
Planning and Public Health Service
Amendments of 1966 (P.L. 89-749).
This program calls for a new breed of
"comprehensive" health planners who are
expected to prepare long-range as well as
short-term comprehensive plans. The pro-
gram has already brought about new
forms of health-planning structures at
state and areawide levels and has been
granted and/or assumed certain review
powers. The program has also empha-
sized a partnership with the private
sector, while it fostered a centralization
of control and placed high -priority on
the creation of a continuing planning
process within the health system.4
Other legislation that has or could
work to bring about new relations be-
tween the two types of planners are the
Model Neighborhood Program (P.L. 89.
754, the Demonstration Cities and Metro-
politan Development Act), Sections 204
(regional review) and 205 (supple-
mentary grants for regional facility de-
velopment programs) of the same act,
2051
and HUD's Neighborhood Facilities Pro-
gram. To a lesser, though still significant
extent, the Neighborhood Health Center
Program (OEO), the Mental Health
Centers Program (HEW), and the Com-
munity Renewal Program (HUD) could
also be employed by motivated and stra-
tegically placed urban and health plan-
ners to upgrade the dialogue between
the fields.
The social bases for drawing urban
and health planners together are even
more familiar than the problems con-
fronting the health system: racial unrest,
poverty, decaying cities, outmoded public
accommodations, archaic welfare, and
other services, an educational system too
slow to adapt, and so forth. Interestingly,
many of the same urban planners most
challenged by problems in the health
system are largely the ones who reject
what they feel are aged techniques and
irrelevant concerns of their discipline
(zoning, land use, development plans)5
in favor of new forms of social policy
planning."
These techniques and concerns are still
practiced and shared by the majority of
urban planners, but they are less often
unconscious ends in themselves as was
once the case. Urban planners attracted
toward these new directions are not ad-
verse to becoming involved in efforts to
alleviate health problems and better dis-
tribute services. This motivation, shared
by planners in the health system dissatis-
fied with what they consider the con-
tinued categorical, voluntary, fragmented,
and inefficient nature of health planning,
could constitute a persuasive basis for
closer relationships between at least a
subgroup of urban and health planners.7
Other social bases for collaboration
could be identified, all of which would in
varying ways be related to the prob-
lems of the cities and the nation's health
system. The entire issue of urban and
health planners - coming together to
learn about each other's germane tech-
niques and capabilities in order to im-
prove the utility of their respective im-
2052
pacts-seems likely a timely idea. There is
a desire for change in the health system.
In some areas, a "comprehensive" health
planning movement worthy of the name
has begun to emerge. Urban planners are
being challenged to "turn on" and move
beyond land and facility developments.8
New and sweeping legislation, combined
with a changing national mood to put
things right that had been too long neg-
lected-all these developments within
the past several years focus attention on
planning: on what it is and what it
might do to help make conditions better.
It is this climate that proscribes insular-
ity, and prescribes the kind of discipli-
nary extension that continued inquiry
into health-planning and urban-planning
interrelationships promises to bring
about. Therefore, it is not surprising
that several projects have been under-
taken in the past year or so to explore
this relationship.
Studies to Date on the Subject
Several studies germane to the ques-
tion of urban-planning/health-planning
interrelationships have been undertaken
which, in combination with pressures for
change in the two fields of planning
endeavor and other influences noted
above, augur well for both a fuller under-
standing and eventual acceptance of a
closer relationship between the profes-
sions. At the Massachusetts Institute of
Technology's Joint Center for Urban
Studies, an attempt was made in a series
of papers to identify links between urban
planning and the planning of health
services.9 The Department of Labor's
Bureau of Labor Statistics is trying to
identify the urban and regional planning
skills needed to disseminate new knowl-
edge and techniques to improve compre-
hensive planning.10 The American Re-
habilitation Foundation's Health Services
Research Center is conducting studies of
urban-and-health planner relationships,
with the idea of providing graduate plan-
ning schools substantive feedback on
skills and knowledge areas needed by
VOL. 59, NO. 11. A.J.P.H.

both types of planners in order to work
effectively together.1' The American So-
ciety of Planning Officials (ASPO) has
completed for the Public Health Service
an investigation of the urban planning
agency's involvement in fields of health
service and facility planning.12
In the last-mentioned endeavor, ASPO
researchers examined published informa-
tion, polled 204 planning agencies with
questionnaires, and interviewed urban
and health planners in five metropolitan
areas. The final report contains a general
summary of what urban-planning agen-
cies are doing in support of community
health service and facility planning,
analyzes problem areas and procedures
for potential coordination between these
two interests, and presents a series of
recommendations primarily directed to
urban planners. The concluding remarks
warrant consideration by urban and
health planners:
At present, the most urgent need is to
establish a system of communication between
the fields of urban planning and health plan-
ning; it is not to build individual empires.
Both the uirban planner and the health plan-
ner must explore opportunities for collabora-
tive efforts. Both must be willing to experi-
ment. If these collaborative efforts are to be
successful, the urban planner must recognize
his obligation to his constituents to press for
decisions he thinks are in their best interest.
To do otherwise-to leave health planning
entirely to the health planners-is to shirk a
professional responsibility.13
Other studies include surveys of plan-
ners working as staff in various hospital
complexes, "utilization research" projects
as to the applicability of selected urban-
planning techniques to problems of
health-facility planning, and several
HEW reports on the subject of shared
data banks for urban- and health-plan-
ning operations. In addition, a number
of urban-planning agencies have turned
out special health-oriented studies and
reports. the preparation of which re-
quired extensive collaborations with
health planners.14
NOVEMBER, 1969
URBAN PLANNING/HEALTH PLANNING
Conferences and conventions of urban
and health planners are increasingly
offering workshops and other special
sessions on the subject of interdiscipli-
nary relations between the two profes-
sions.15 Several university graduate
schools of urban planning have been
working under grants from the U. S.
Public Health Service to develop and
offer curricula in health planning'6;
others have initiated interdisciplinary
course work for students in the two fields
independent of HEW support. The Amer-
ican Institute of Planners recently re-
ceived from its national Comprehensive
Health Planning Committee a report ad-
dressed to the following charge:
1. Review Public Law 89-749 as amended,
together with other planning legislation such
as Public Law 89-239 and supplementary
Bureau of Budget Circulars A-80 and A-82.
Describe their pertinency to the Institute and
its members. Make recommendations as ap-
propriate for Institute action.
2. Spell ouit areas where the Institute and
its members can make contributions to the
process of comprehensive health planning. Give
examples and appropriate recommendations.
3. Identify and suggest where the Institute
should establish relations and coordinating
mechanisms wvith such groups as HEW, state
health-planning agencies (these may not be
the health departments), medical schools, and
professional associations such as AMA, AHA,
and the like (both national and state level).
4. Determine howv AIP can assist in formu-
lating plans and programs for better health
services and their delivery. Recognizing AIP's
concern for comprehensive planning of the
total community, determine ways in which
AIP members can relate comprehensive health
planning to other planning activities, including
Model Cities Program.*
* This "charge" was drafted before the
com-
mittee was formed by Jerome Lubin, chairman
of the group, and approved by the Institute.
It was considered a general statement of the
committee's area of responsibility: the final
report included analyses and recommendations
considerably beyond the scope of this state-
ment. Copies may be obtained by request to
the American Institute of Planners, 917
Fifteenth Street. N.W., Room 800, Washing-
ton. D. C. 20005.
2053
 Assessing its own lengthy report, sub-
mitted in June, 1969, the AIP Commit-
tee provided the following synthesis:
Planning for health services, facilities, and
manpower-and for environmental factors that
bear directly on personal health-must become
a vital input into the urban-planning process.
Toward this end, the Committee on Compre-
hensive Health Planning recommends that:
(1) urban-planning programs be broadened to
include such factors; (2) academic curricula
create a new combination of skills for health
planning drawn from the administrative, social,
engineering, and biological sciences; and (3)
AIP expand its role in alerting and inform-
ing its members, and others, concerning de-
velopments in the field of health planning.
Barriers to Improved Relationships
The list of barriers to closer, more
productive relationships between any two
disciplines could be lengthy; the history
and nature of urban and health planning
are such that seven barriers appear to
have been most formidable. These were
essentially different types of planning
(management v. cooperation) tendencies
toward exclusiveness by both professions,
resistance to the idea of planning itself
by some health professionals, varying
orientations (land use v. disease), prod-
uct-process conflicts, role limitations, and
knowledge gaps.
The nature and gravity of the prob-
lems both professions must face, the de-
sire of many within each field to broaden
the scope of concern, the impetus of new
legislation and programs, and the widen-
ing opportunity areas for urban and
health planners to participate in each
other's respective field-these and other
influences have eliminated or signifi-
cantly lowered the barriers that once
blocked collaborations between urban
and health planners. With the barriers
down or lowered, it remains for indi-
vidual urban and health planners, uneasy
about the direction, tools, pace and/or
impact of their own profession, to in-
vestigate what is happening and what
could be done in other increasingly re-
2054
lated professions. It seems to this writer
that the urban- and health-planning pro-
fessions could benefit from the fresh
perspectives and hard questions which
this collaborative approach might en-
gender.
REFERENCES
1. Report of the National Advisory Commis-
sion on Health Manpower I (Nov.), 1967.
2. See the "Policy Statement" of Planners
for Equal Opportunity (PEO), adopted
August 31, 1968. This organization of
urban planners, formed in 1964 at the
Newark Convention of the American In-
stitute of Planners (AIP), "is dedicated to
supporting the civil rights movement,
struggles for liberation, the elimination of
poverty, and equal opportunity for all
people." PEO members serve as "advo-
cate" planners to citizen organizations in
model city, urban renewal, and other
urban program-focused endeavors; im-
proved health services to the disadvan-
taged, paramedical job creations, and
other health-oriented endeavors form an
important part of the PEO-endorsed in-
itiatives sought by advocate planners. More
information can be obtained from PEO
headquarters at 76 Reade Street, New
York, N. Y. 10007.
3. For notable papers on this subject, see:
Frieden, Bernard J. Comment: Environ-
mental Planning and the Elimination
of Poverty. J. Am. Inst. Planners (May),
1967.
Webber, Melvin M. Comprehensive Plan-
ning and Social Responsibility. Ibid.
(Nov.), 1963.
Davidoff, Paul. Advocacy and Pluralism
in Planning. Ibid. (Nov.), 1965.
4. For an elaboration of developments in
the states, as a consequence of compre-
hensive health planning, cf. the American
Rehabilitation Foundation's (ARF) report
to the U. S. Public Health Service, en-
titled, Planning for Better Health: An
Experiment in Partnership. This report
summarizes ARF's year-long study of how,
and with what effect, P.L. 89-749 was
being implemented in the states. Copies
of this report are available from the Office
of Comprehensive Health Planning, U. S.
Public Health Service, HEW, Bethesda,
Md.
5. For an extensive discussion of the merit
of continued reliance upon development
plans ("master" planning), zoning, and
VOL. 59. NO. 11, A.J.P.H.

other land use orientations which charac-
terized the urban-planning profession's
historical focus, see:
Bolan, Richard S. Emerging Views of
Planning. J. Am. Inst. Planners (July),
1967;
Frieden, Bernard J. Toward Equality of
Urban Opportunity. Ibid. (Nov.), 1965;
Perloff, Harvey S. New Directions in So-
cial Planning. Ibid. (Nov.), 1965.
6. Brooks, Michael P., and Stegman, Michael
A. Urban Social Policy, Race, and the
Education of Planners. Ibid. XXXIV, 5:
275-286 (Sept.), 1968.
7. The intent here is not to suggest the
creation of an urban-planning/health-plan-
ning "underground," but rather to note
that participation in a PEO-type organ-
ization or discussion group would be one
potential forum for collaboration between
urban and health planners.
8. Graduate students in urban-planning
schools expressed their ". . . dissatisfac-
tion with the structured organization of
the American Institute of Planners, na-
tionally and locally . . ." and deplored
the ". . . lack of direction and responsive-
ness of AIP to the 'now' challenges. . ."
at the Institute's October Conference in
Pittsburgh, Pa.
9-12. Further information may be obtained
from: Joint Center for Urban Studies,
MIT and Harvard Universities (66 Church
St., Cambridge, Mass.), or the U. S.
Public Health Service, HEW (ref. 9);
Administrator, Bureau of Statistics, U. S.
Department of Labor, or HUD (ref. 10);
Institute for Interdisciplinary Studies,
American Rehabilitation Foundation (1800
Chicago Ave., Minneapolis, Minn.) (ref.
11); and the American Society of Plan-
ning Officials (1313 East 60th St., Chicago,
Ill.), or the U. S. Public Health Service
(ref. 12).
13. The Urban Planner in Health Planning:
Mr. Ardell is Director, Comprehensive Health Planning, Metropolitan Council
(Capitol Square Building, Cedar Street at 10th Street), St. Paul, Minn. 55101
This paper was submitted for publication in August, 1968.
NOVEMBER, 1969
URBAN PLANNING/HEALTH PLANNING
Problems and Possibilities. American So-
ciety of Planning Officials (Feb.), 1968,
p. 69.
14. Examples of health reports produced by
urban-planning agencies (reviewed by the
author in the course of a content-analysis
study) include:
Health and Welfare Facilities: An In-
ventory. Tri-County Regional Planning
Commission, Lansing, Mich., 1964;
Hospital Study for Prince George's
County. Maryland-National Capital Park
and Planning Commission, 1965;
Medical Center Hill: A District Plan for
the Growth and Development of "Pill
Hill." City Planning Dept., Oakland,
Calif., 1959;
The Medical Center District: Planning
Analysis and Recommendations. City
Planning Commission, Chicago, Ill.,
1956;
Pinellas County Health Center Site Eval-
uation. Pinellas County Planning &
Zoning Dept., Clearwater, Fla., 1965;
A Plan for the Hospital Complex: A Part
of the Avondale Corryville Urban Re-
newal Area. City Planning Commission,
Cincinnati, Ohio, 1964;
Responsibilities of the City and County
of Denver for Providing Hospital Treat-
ment. City Planning Office, Denver,
Colo., 1962.
15. The procedings of three recent AIP Con-
ferences contain highlights of workshop
sessions devoted to examining relation-
ships between urban and health planning.
The first was entitled Health Services
Planning and Comprehensive Planning
(St. Louis, Mo.), 1965; the second, Health
and City Planning (Houston, Tex.), 1967;
the third, Health Planning Techniques
(Pittsburgh, Pa.), 1968.
16. These include, but are not limited to, the
Universities of California at Berkeley,
North Carolina, Cincinnati, and Cornell.
2055