 Okay so thank you all for sticking around the whole day and thank you for participating. It's been a wonderful day and we're happy to say we had a strong role in it and show of hands how many people had the chance to get out front to the UTSA students and take a look at their work. Wonderful work right? How about a round of applause for them? So actually I want to read each of their names off and then we can give them another round of applause as a thank you. For the downtown group Sarah Esserly, Gilbert Morales, Nicholas Post, and Renee Zamora. Could you stand up? And for the five points group, Kristen Ramirez, Carla Burrell, Kristen Flores, and Ryan Kirby. And for the Gardendale group that was Kimberly Hopkins, Betsyta Paulette, and Nicole Thompson. And so you guys can keep standing because the conference has selected you as the winners. So if you if you want to if you want to come around and one of the gifts we'd like to give is a copy of Autograph copy of Chuck's book Thoughts on Building Strong Towns. Well good afternoon and wasn't that delightful? I am delighted to see students and young people really being in the right place for the future of San Antonio. My name is Bilal Oates and I'm delighted to be here this afternoon with you to share this wonderful wonderful panel. It's called the final panel but it's really the best panel so thank you for hanging around. We've heard so much today that's exciting and you know one of the questions that I heard David asked Mr. Bigelow Perry our last presenter was how do residents know about this? What can we do? Well guess what? Awareness. You know conferences like today make a difference and I really want to commend Metro Health for hosting this public health in the built environment and a special shout out to David Clear for an outstanding outstanding. Our panelists today require no introduction because they've been our keynote speakers, our focus group, our plenary speaker presenters, a moderator, our host Dr. Thomas Schlenker. The only one that has not been introduced is Dr. Richard Tangelman. I'd like to say a little bit about him. He's the director of the Center for Urban and Regional Planning Research at the University of Texas at San Antonio. He is a registered architect and urban and regional planner with more than 40 years extensive and varied experience at architecture, urban and regional planning, housing, urban design and economic development and we're very pleased to be here at UTSA for this conference. All of our speakers here have contributed so much but as a final discussion we'd like to frame this in a concept that's called the social determinants of health because that seems to weave and integrate silos into a way that we can understand and explain how health disparities, based on all the things that we've learned today. Robert Wood Johnson and in partnership with the Wisconsin School of Public Health has been really activating this model of social determinants of health because they weren't the ones that really started it. It was something that was developed for the World Health Organization in order to explain health disparities. But Robert Wood Johnson and the Wisconsin School of Public Health have done an excellent job of applying it to improve communities and community health. And they tell us something that we know intuitively and that we heard today from our presenters in many, many, many ways. For example, air quality, water quality and the built environment account for about 10% of the influence on health outcomes and socioeconomic factors such as education, income, social disruption account for about 40% of health outcomes. Good or bad. Human behaviors such as tobacco use, diet and exercise, alcohol use, high risk sexual behavior and violence account for between 30 and 40% of health outcomes and only 10 to 20% is attributed to healthcare, which we often think of as the one that we talk about when we talk about health outcomes and only about 10 to 20% is attributed to healthcare which the model identifies as access to care and the quality of care. So from a social determinant perspective, recently the Wisconsin School of Public Health with Robert Wood Johnson released the county health rankings and Bear County was ranked 69th out of 239 counties in the state of Texas. And that was an overall improvement from the 2010 rank of 78th. So that's very good for us in this last 2014 release. Bear County's score for the physical environment improved dramatically. And I think we know why. We've heard about what has gone on in San Antonio in these last couple of years. The clinical care ranking also improved as did our overall morbidity ranking. So given that we understand the social determinant model very naturally, because you know when Ivy Taylor started the afternoon proceedings, she hinted at saying that there was a difference between SIP codes and people's longevity actually was different if you lived in this SIP code or that SIP code. And why? Because of the framework that I just talked about. These things can make a difference. Where you live does make a difference. So given that information that I've shared with you on what factors play important roles in impacting health, along with the perspectives and ideas that we've heard today, I would like to ask you, the panelist, can you identify one significant way in which San Antonio can continue to improve its health outcomes through the built environment? And so let's begin with Dr. Thomas Schlinger. And you know, I'm going to ask you, each panelist will have about five minutes to respond to the question. And then we're going to have time to hear from you. But I'm going to ask if everyone will remain seated, because it'll take a long time for people to come back and forth to the podium. So if we begin with Dr. Schlinger, then we can go down the row and hear from everyone. Thank you, Pilar. Glad to begin the discussion. This has been a long day, but such an exciting and stimulating day. We've all been bombarded with great ideas and concepts and visuals and it's almost overwhelming, it's too much and but it helps to be in this kind of setting where we are. And I do want to thank UTSA for hosting this in their beautiful downtown campus, because just being here is so conducive to the project that we're all about. We have this beautiful indoor space that's open and conducive to talking and looking at posters and projects and works of art. We have the beautiful outdoor space where most of us had lunch today on the benches, talking with each other. I noticed walking down the hall that we have fabulous staircases in this building. They're the kind of staircases that invite you to walk up them and down them. They're not hidden in some corner. And so I did. I walked up to the library and walked through the library and the library looks out on the inner courtyard where we all had lunch. So it's an integrated kind of urban setting that is perfect for us. And I'm hoping this kind of relationship continues between various city departments and metro health, UTSA and then the designers and the builders and the architects that are creating our city, recreating our city as we speak about it. I think that one thing that I remember from today even though all the presentations were absolutely fabulous, some of the best things I got were between presentations out in the lobby talking to people. And one thing that John Dugan, the San Antonio City planner said to me is that he thinks it's all about connecting. Connecting the various great ideas that we all have that come from different disciplines. Connecting the concept of clean air, clean water, inviting physical space for physical activity, good nutrition, economic development and social justice. An all-inclusive kind of community. The challenge is not having a good idea because there are a million of them sitting in this auditorium. It's connecting them together in a way that creates the community that we all want to live in. And for me, a very good example and a great symbol of that here in San Antonio was presented by one of my favorite people who live here and his name is Dante Jones and you might have noticed him because he was dressed in orange as he always is because he leads a bicycle group called Dante's Roll Models that takes children and families on bicycle tours starting in their neighborhoods but then going anywhere and everywhere in San Antonio and opening up new vistas to them, new ways of thinking and new parts of town that they would have never seen any other way except in this terrific collective physical activity of riding their bikes together following this orange clad figure with the boom box playing great jazz and rhythm and blues and a little trailer behind his bike and to me that's sort of a physical connectivity that connects one neighborhood with another neighborhood and brings people into new areas where they can explore and get new ideas that symbolizes connectivity in general, the challenge that we all face to have our ideas converge and to result in connected development that will serve us all. Thank you so much Dr. Schenker and if I can answer for you as well, one of the things most significant things that you can do for next year's, please host this conference again I think it's been extraordinary. Can I ask John Simmerman to please give us his perspective on the most significant things San Antonio can do to move forward? Yes, thank you very much. One of the great things that I love to do when coming into a city is take a few extra days to explore and as you could probably tell I do it by bicycle. So I did have a couple of days to explore and really get a sense as to what's happening on the ground and I want to really commend and applaud all of you, the city of San Antonio, you're making inroads, you're making strides in addressing the challenges that you have. It's no big surprise. Your built environment is a challenge but you're not alone. You're right there with the rest of the United States. When you look at the social determinants of health and you look at the communities that are underserved and you've got issues and challenges there, the three P's that come out are the pathways, your proximity and programming. So starting with programming I'm so glad to hear the story of Dante's group and that aspect of integrating fun, integrating exploration and taking it to the level of the community and exploring in their neighborhoods and then expanding beyond the neighborhoods and making what could seem to be quite scary like riding your bike from the airport to downtown. It's a little less scary. Crazy. This was a piece of cake compared to Los Angeles to Long Beach but in all seriousness it should be fun. We should be able to laugh a little bit and have a good time and play the boombox as we're going through the neighborhoods and be able to see the potential that's there. So there's a fourth P, the potential and your potential is very very encouraging of what you have out there. So when I look at the pathways and the connectivity to these neighborhoods, again I had it up on one of my slides where I said accessibility equates to the equality that we're looking to create. So when I was heading on my trip down to the missions and I'm using the bike path down there I'm taking note of what are the neighborhoods like and so I'm going through neighborhoods that are clearly underserved. A couple of trailer parks and some other things. The fact that they now have an easy way to be able to get activity into their lives and very critical here, be able to use physical activity to get downtown. Absolutely amazing. And then the next, that second P that I mentioned was proximity and that's when we start taking note and taking accounting of the activity assets that you have in addition to the pathways and the connections to those pathways, what about access to other open space, other parks, other community programs, things of that nature and really starting to address with those three things, the connectivity through the pathways, the programming with the outreach, and then the proximity to the other assets in the built environment. That's really critical. I applaud the great strides that San Antonio is making and keep up the good work. Thank you. Thank you so much. What would you say is the most significant point that you can continue to improve? Well, I think, you know, to me, I think the conversation has to get down to the individual level and the block level. We can have great policies that are really embraced by people. They're not going to amount to as much. So to me, like for all of you in the room right now, I've got just a few things that I would recommend you do. First, go home and make it a point over the next week to meet your neighbors. I don't know how many of you know your neighbors well, how many of you have never met your neighbors, the people who live directly around you, the people on your block, the people in your neighborhood. I think that we all have a responsibility to meet and know our neighbors. And not just, you know, I'm not saying get up in their business or anything or invite them into your house, but I'm saying, you know, you should know their names, you should know a little bit about them. You should chat with them. These are the people that you need in your life. These are the passive people that can, you know, let the UPS guy in and, you know, watch your kid for the five minutes that you've got to run and do something. These are like the very base social bonds that we've kind of let go. It's so easy to, you know, get in the car, drive out the garage, hit the garage door opener, you know, do the reverse on the way home and just never meet your neighbors. And I think we all could benefit from doing that. Beyond that, there's just some certain base things that I think we can do to start to get in touch with the communities that we live in. And we can model this behavior as John said earlier for others. Go for a walk. Go for a bike ride. You know, I walked here from the hotel today, which is like two and a half blocks away. What a despotic environment. I can't imagine any of you walking that on a routine basis and being okay with it, right? I think we have to intentionally engage with the spaces around us. Because right now we passively engage with them from, you know, the back of the steering wheel. And if we want to know them and understand them intimately, we have to actively engage and we have to be present. And then the last thing that I would say, I've got a book recommendation for you. There's a book called The Lean Startup, a very popular book in the business world. But the principles that I think are most important apply really well to this because the central tenet of the book is to ask the question, what is the next smallest step we can take to get us moving towards success? What's the next smallest thing we can do to bring us closer to our goal? A lot of times we're paralyzed because we look at the problems that face us and they look just insurmountable. We have to change the ordinances. We have to change the streets. We need a new engineer. We need, you know, a different business community. We start to list off like all the things that are wrong and all the things that we think need change and they're so huge and they're so fundamental. Forget about it. Forget about it. If everybody in this room just concentrates on like what is the next smallest step I can take to make the place that I live and the place around me a little bit better, it would be game changing for this city. So The Lean Startup, I would read it, embrace the concepts and see what you can do to apply them in your place. We have a saying at Strong Towns which is keep doing what you can to build a strong town and the idea there is that not all of us will be president not all of us will be mayor. Not all of us want to be in positions of power but all of us have the capacity to do that next smallest thing to move the ball ahead and that's what you need to do. Thank you so much and that's really huge and it seems like the next small thing was to meet your neighbor. Wow. That seems like something that we really need to do. That's pretty easy to do. It's not a huge bar but we'd all benefit from it. We would all benefit from it. Don, how would you answer that question for San Antonio to move this community forward? Well, first I'd like to say I thought I was the eye candy in the group when you passed over me and so I'm glad that you came back around. No, actually I had you listed here in order of how I was following you so it was not discriminatory. Well, I'm the city's new chief sustainability officer and the link between sustainability and the built environments and healthy communities is very clear. I'm also since I'm the new guy in town I can still sort of play dumb a little that I'm still learning the ropes but the time that I've been here I definitely see it almost seems like there's multiple San Antonio's. There's at least two that I'd like to talk about. We have the inner core, we have inner city neighborhoods where there's high poverty, there's high crime, there's significant health problems and then we have the sprawling communities outside the loops which have different issues and they both require different interventions. I think with the inner city neighborhoods we really need to sort of take a look at policy how we implement infrastructure projects. We need to start creating places in those communities once again. We need to start revitalizing them using mixed income mixed use neighborhoods, better access to education and jobs and again it's really is about connections re-knitting those neighborhoods back in with the rest of the city. In terms of the suburban areas, there's a saying in the planning field it's the land use stupid. It's just how we're building these communities. They're single use pods. The land use stupid or the stupid land use? It's the stupid land use. It's the land use stupid. So we have your residential pod, your institutional pod. You can't go anywhere without a car and so there's two things I think we can do. One is really look at how we're growing going forward, taking a look at policies, zoning codes, build more complete neighborhoods and then for existing suburban neighborhoods really looking at things like sprawl repair. How can we start rebuilding communities within these existing sprawl neighborhoods to allow for town centers just to grow, to allow for safe trips by bike or car to shops, to schools and incrementally trying to repair what we built. Thank you, Doug. He reminds us that we have multiple communities here in San Antonio, multiple San Antonio's and we need to remit them and I like that word. Dr. Tangum, what do you propose would be the most significant thing we could do for San Antonio? Thank you. I'm the old guy. I was born in San Antonio and went to school here and so I bring a different kind of perspective having seen the city really being radically transformed and really in the last 60 years. And I think the most critical challenge that this city faces, then what most American cities are facing is how to deal with the rapid change that's coming. Demographically by 2060 the city, our state demographers telling us and others too that the population could double in size so we could go from over 1.3 million to 2 plus who knows how many people. Now the real impact is I look at San Antonio in an earlier point in time, back in 1940, right before 1940 the city limits were 36 square miles and you had a little over 250,000 people. And so the population density at that time is about 7,000 people per square mile. Now today we have, I have to write it down so I make sure I got my figures right, we have 473 square miles but John is annexing additional portions, I'm not sure if my figure is correct, but basically our density then has dropped to 2,923 people per square mile. Now this is telling in many ways. When I go back to San Antonio in 1940 I got a glimpse of it as a small boy. It was, we were looking at really walkable, complete neighborhoods at that time. Up until 1933 San Antonio had a great trolley system that had 90 miles of track that connected all sections of the city so you could easily get around anywhere. And if you lived in a neighborhood you really didn't need a car. You basically could walk to a market, all the school tour and walk to school. You could walk to a pharmacy. Food was grown in truck gardens around the city. There were fruit and vegetable vendors that passed through the neighborhoods that had circuits. So we were eating well, we were health here. And in that 60 years there's been a major transformation. We've lost our connectivity with each other. In fact if any of you have read the article by Richard Florida in Atlantic cities San Antonio now ranks number one in terms of being America's most income segregated large metro area in the United States. So we have a point I'm trying to make, I'm not trying to prick the balloon here, but we've got some major problems we need to tackle and if we don't basically start dealing with the kinds of development patterns we have today, by 2060 that land area that we're looking at if we continue the sprawl pattern could be over a thousand square miles essentially. So there's the challenge. If we want a healthy city we're going to have to really get serious about making the city more compact, more efficient and pay attention to our network and system of moving people about in a more humane way that's equitable to all age groups. Wow, that's a very provocative response. We're looking at rapid change, rapid growth, population density, but I think one thing to note is the discussion that where we were many years ago and what we've become and where we need to go sounds like a similar place. It's your turn now. What questions do you have of the panel? Can I make one quick comment just about in regards to growth I think it's interesting because one of the comments that I've heard today in chatting with people out in the hall etc. was we're going to have all this growth and it's almost like well the growth is our savior, right? We can make some mistakes and the growth will just cover it up. I mean we talked about the illusion of wealth beginning this morning. I think it's important to note the path that you're on does not seem to be Detroit's path where you had this huge population contraction in this large area with not enough people. But San Bernardino California went bankrupt shortly a little bit before true Detroit did. San Bernardino over the last two decades had a 420% population increase huge huge amounts of growth. The question is not about growth it's exactly as it was framed down there it's about how do we build this place productively. I also think that the challenge that you have demographically is that the growth that you're going to have is not the growth that San Bernardino had which tended to be slightly upper middle class, people who were moving to the city with some affluence. Your demographics are going to be, you know, have much broader range than the narrow band that they had there. I don't think that that's a bad thing. I think that that's actually a really good thing but it means that your policies and your approach have to change because segregating people into different pods by income is a really really destructive way to build the city. My question is about mass transit and the limits that we have in our ability to expand mass transit right now. San Antonio is growing and I don't know how we can possibly become a healthy city without expanding our mass transit options, our public transportation system and I'm distressed by the political opposition that's on the horizon. Some of it from groups that are not staked in San Antonio and they're for reasons that don't have anything to do with San Antonio's health and well-being as a city and I'm just wondering especially for those of you that have experience with other cities of how do you handle this? What are your thoughts about the role of mass transit in a sustainable and healthy city and what we can do with this tide that's coming and VIA has an argument to make and they've got, there's a lot at stake and I'm just curious what your take is on that. Oh, do you want to stay away from that one? I'm new here. We'll let the activity guy jump in on this one. So what I'm going to do is relate this back to a situation that I'm very familiar with because I use mass transit continuously when I'm in Boulder. I am car free in Boulder so if I'm not on my little folding bike or one of my other bicycles that I have, I am actually taking public transit so the bus system in Boulder is fantastic if you've not had a chance to study it or understand a little bit about what it's like to have a hip happening bus system, transit system, this is it. It serves all income levels and it's one of these vibrant, it's a really neat thing to be able to interface with a transit system where you are able to permeate into all the different income levels and the reason it's able to do so is because it is effective. They've got good routes, good timing schedules, they've really approached it scientifically so that it is convenient and guess what? I get an awful lot of walking in to be able to get to mass transit and be able to take advantage of that comprehensive route system that it has. When I was attending the conference for Smart Growth and New Partners conference down in Denver, yep. I was able to ride the RTD from Boulder all the way down to Denver on an express bus. So if you want to have an impact on being able to have transit work in a more suburbanized slash urban interface, you're going to have to be able to make it significant and it's got to be a program that works and the money's got to pencil out, but you can't just do, you know, kind of do transit. Another great system that I'm familiar with is in Honolulu that has one of the most vibrant bus systems. And yes, I can't forget about light rail and the fact that that's one of the things that in Denver, you know, they're being quite aggressive with trying to get the lines in place throughout Denver, but quite frankly, you know, light rail is extremely expensive so you may have an interface that takes place between the bus and any light rail lines that you have that are spurs. So that's, you know, from my perspective, Laura, I hope that helps a little bit. Really the key successes again are the number of stops, the routes, and the fact that it is considered cool to ride the bus. I'm frequently on the bus with high schoolers getting around throughout town. So that to me is significant that it's not something where just the poor people are riding. I thought you were going to say earlier that you rode your bike from the Denver airport into downtown Denver. That would have been incredible. I think that there's a couple things on transit that are really re-important. And I get the transit people upset with me sometimes because the same, you know, reaction to build it and they will come transit as I have to build it and they will come other things. There's a sense amongst many that transit is the solution, the magic bullet. And I'm not suggesting you were suggesting that, but I want to make it clear that especially here in San Antonio we need to walk before we run. And literally, I'm saying we need to be able to walk. I was out, you know, walking your streets and you've got bus stops all over the place that you can't even get to, right? Like, how do you get to the bus stop? What sense is there in putting in, you know, an expensive, expansive system when like literally you just need to paint some crosswalks and fix some curb radiuses and narrow up some lanes? I mean, we're talking about pennies instead of, you know, tens of dollars in comparison of what like needs to be done to get that first step. It's really hard to impose a transit culture on a community that doesn't have respect for, you know, the current systems that it has or, you know, a biking culture or a walking culture. To me, there's a certain progression that we need to start with. The other thing that I think is really important and this goes to how we finance transit and how we make it viable over time. If you want transit, you have to have a place. Remember when we talked about roads during a street great transit connects productive places. It functions like a road. It gets you from one productive place to another productive place. So if you want functional viable transit, build productive places and connect them. That's what like a really viable transit system looks like. A lot of what we do today for transit is we take the mentality of the highway engineer and transfer it over to the transit where we say, well, we're going to serve a corridor and what you wind up with is the same low productivity development pattern that doesn't pay for itself. And when we do it with transit, we actually do some type of accounting that we don't do with highways, build productive places and connect them. So if you're an advocate for transit by default, you're an advocate for great productive places and if you put your energies there, the transit will follow. Let me also say that... Thank you. I'm not running for office or anything. It hurts a little to hear someone from the outside come in and say, your bus stops are horrible. The walk from the hotel to the campus is really terrible. But in fact, it reminds us of the truth. And I was talking with a UTSA student this morning who put together the five points poster. And that's the way I come and go to work every day on my bike. And I ride past the bus stop at five points at the intersection of Flores and Fredericksburg. And it's got to be one of the bus stops in town. There's always about 20 people there. And it's just ugly and horrible and it could be beautiful because it's actually kind of a vacant corner. There's nothing there except for about three gigantic beautiful trees that are just being choked by this massive ugly nothing around it. And it wouldn't take much to make it a decent inviting place. The other comment I would make about mass transit in general and how do we get a better mass transit system in San Antonio is I was about 10 years ago the director of public health in Salt Lake City and we were having the same argument there and lots of opposition to mass transit in the Salt Lake City area from the usual suspects of people who sell cars and build highways, et cetera. And I went back there last year to go skiing at Alta and I noticed there is light rail from the airport and there's various other amenities that go up and down and that were very, very nice. Really beautiful done. Beautifully done. They had an advantage though in Salt Lake City. They have terrible air quality there because they're right up against the mountains and they have these horrible inversions. It's kind of like Mexico City so I think it was easier for them to make the case the last thing we need are more cars driving up and down the Wasatch Mountains because we're killing ourselves. We have better air quality here in San Antonio however and one of the last big cities in the United States to still be in attainment of air quality standards up until now but we will soon be falling out of attainment to those standards and especially with all the development going on south of us along the Eagle Ford Shale oil development and perhaps doubling of the growth of the population of San Antonio the writing is on the wall. Our air quality is going to be more and more challenged here and so I think maybe we can use that as sort of the wedge to get this done because we're going to have to or else we're going to have Mexico City quality that we are here in the future. Do we have time for more questions? Do I see anybody else? You know you can even take a stab at answering the question yourself. You know what single most important thing most significant way in which San Antonio can move forward to continue to improve its health outcomes through the built environment. Maybe you have an idea. Would you like to share it? Anybody out there? If you want to respond to Dr. Schlanker's comment about the five points bus stop I feel obligated to respond. Via actually has had a design for that site on the boards for no less than three to four years and part of the issue with bus stops around the city is getting easements from property owners and in that particular case having a willing seller for that property has been a difficult issue and it is actually on our agendas currently as we speak so we are trying very hard to get that because we do have a design to greatly improve that stop because it is one of our highest ridership stops in the city so you're absolutely right there. And along that line trying to improve what you asked, what could we do maybe for the next bond election which is probably going to be in 2017 that a grassroots effort to demand improvements in our pedestrian network and how each project is evaluated when it goes to scoping that communities, neighborhoods look to their political leaders to say that what good is a large scale project if nobody can walk. So I would suggest that you talk to your council people and look at the different types of projects that are being suggested in your districts for these bond projects and really demand that pedestrian network because we can't have just pockets. I look at it similar to what if we had just major intersection connections at our freeways but we didn't have the connection in between the intersections. Where would we be? It's the same thing with the pedestrian network. You know there's one thing that I like to do when we're done here and this just crossed my mind. When we're done I'm going to walk off the stage. I'm going to walk out the door. I'm going to walk out to the street and whoever wants to join me out there, we'll just talk for like 10 minutes about the street right in front of you. This is a university right? Where do you walk more than when you go to a university? You can't walk to the parking lot across the street right? And I just want to go out and just like show you because I think sometimes in an environment where really walking is not just an afterthought but it's a distant far far you know thing down the list of priorities. I think sometimes we just forget like all the simple things. And to me I think that even just in front of the school we could be leaders here in making this block and the block on the other side more walkable if we just like could visualize what a different thing would look like. So when we're done here I'm going to walk out the stage. I'm going to walk out the door. I'm going to walk out there and anybody that wants to come with will spend 5 minutes or 10 minutes just talking about basically urban design 101 on the one block out in front of this place. I lost my mic but we're out of time and I really want to thank this panel for such insightful responses to our question of participation today and all of you. And so there is no finale until we all do a standing applause for all of you and for this panel. Thank you for coming.