Leveraging neighborhood-scale change for policy and program reform in Buffalo, New York

Background: The Healthy Communities Initiative (HCI) affects 8500 employees working in the Buffalo Niagara Medical Campus and 8925 residents of adjacent neighborhoods, where 37% of people live below the poverty line, and a majority (68.7%) identify themselves as African-American. Intervention: The HCI partnership, which includes multi-sectoral and multi-disciplinary organizations and neighborhood residents, implemented the Active Living by Design community action model with greatest emphasis on achieving policy and planning changes to support active living behaviors. Results: The master plan of the campus now incorporates active living as a guiding principle. Physical improvements to support walking and bicycling in the target area have been planned and implemented through a $14 million federal transportation grant. The partnership facilitated the creation of a citywide Bicycle and Pedestrian Advisory Board and the passage and implementation of an ordinance to enhance bicycling infrastructure within the city. Lessons learned: Buffalo's experience suggests that to achieve lasting environmental change in the context of a medical campus and its surrounding neighborhoods, it is critical to: (1) engage neighborhood residents from the outset to build social capital; (2) cultivate a diverse partnership; (3) use a comprehensive approach; (4) balance long-term goals with short-term accomplishments; (5) integrate active living concerns within existing policy and planning mandates; and (6) make sustainability a priority. Conclusions: Environmental changes in the public domain that support active living require collaboration among public, nonprofit, and private sectors; citizen engagement; and the presence of a legal and structural framework provided by government policies and plans to direct future development.