Social Change and Public Health

Gender mainstreaming, a strategy used in European countries since the 1990s that identifies how policy decisions impact people based on gender, is gaining ground in the U.S. The recognition of nonbinary genders, as well as the needed inclusion of transgender people in these conversations, gives U.S. planners an opportunity to leverage their slow adoption of gender mainstreaming to develop an even more inclusive version of this approach.

The number of U.S. adults aged 65 and over is expected to grow to about 90 million by 2050. Few cities have the physical and social infrastructure to support aging in community. An aging population is also associated with high population dependency rates and slower economic growth. For more on how an aging population is already affecting planning and communities, check out the February 2021 Planning Magazine article, "Planning for the Needs of an Aging Population," and learn how to prepare in PAS Report 597, Planning Aging-Supportive Communities, and PAS Report 602, Intergenerational Community Planning.

A growing share of childless adults in the U.S. do not expect to ever have children, according to the Pew Research Center. Birth rates have dropped during the pandemic, contributing to the existing downward trend in U.S. fertility rates. As current young generations are already facing social, economic, and environmental crises, there are implications for the demand in daycare and school infrastructure in communities, as well as the balance between childless and child-friendly amenities.

Even before the impacts of the COVID-19 pandemic, the U.S. life expectancy was declining due to socioeconomic inequalities and inequitable access to health care services. Planners play an important role when it comes to improving quality of life for all communities, healthy conditions of the built environment, and equitable distribution of and access to healthcare services.

Diversity awareness has been increasing based on the experiences of groups that have been underrepresented and underserved by institutional and governmental response during the COVID-19 pandemic. Planning efforts need to meaningfully address growing diversity across communities and regions. Planners may need to pay closer attention to those being left out from programs they design or other governmental responses. Planners should play the role of advocate for groups that have been historically underserved by the profession. For more on this topic, check out APA's recent Planning for Equity Policy Guide, along with APA's curated Equity, Diversity, and Inclusion resources at Planning.org/Equity.

Discussions about gender, particularly those beyond the traditional gender binary, are becoming more common in major media outlets. As a result, the public is becoming more aware and vocal on these topics. Gender expansiveness, which is shifting from a fringe worldview, pushes us to imagine life outside the gender binary — but not without backlash. Gender neutrality is an attempt to avoid assuming roles or preferences based on gender stereotypes, or to not reinforce the gender binary, which is the traditional system of gender classification that defines every individual as either male or female. It is often conflated with nonbinary genders, which are genders that exist outside the gender binary. In recent years, regular reporting on nonbinary and transgender experiences and the tense negotiation of civil rights through federal and state legislation has proven the larger relevance of this topic. As discussions around gender continue to mature, planners need to balance addressing real-world implications of gender on public space use, behavior, and daily activities while also avoiding reaffirming the systems that lead to exclusionary and limited understandings of gender.

It is becoming more common for people to identify with complex identities at the intersection of multiple social characteristics instead of single characteristic, homogenous population groups. There are signals that indicate that we should consider life at the individual level, rather than using existing population groups as the default. More dynamic solutions are necessary, especially ones that planners can adapt or tailor based on the needs of complex individuals, especially those who have been traditionally underrepresented, underserved, or harmed by policies.

The planning profession, planning academics, and related professions increasingly focus on one social characteristic when recruiting the next generation of planners (e.g., race or gender). The profession needs to prepare to do a better job of reaching out to people with lived experiences at the intersection of multiple social identities (e.g., disability and class, in addition to race and gender). Ideally, the recognition of these complex identities will improve the range of perspectives represented in the planning profession.

By 2045, the majority of the U.S. population will be minorities. While greater cultural diversity is associated with wage growth and innovation, cities and communities must continue to adapt, both physically and socially, to meet the needs of a more diverse population. For more on effectively and equitably meeting the needs of a more diverse population, check out PAS Report 593, Planning With Diverse Communities. Furthermore, the planning profession is significantly less diverse than the U.S. population and must, itself, adapt to represent the communities it makes plans for. The need for the planning profession to diversify is further explored in the May/June 2019 PAS Memo, "More and Better: Increasing Diversity, Equity, and Inclusion in Planning."

The U.S. Supreme Court's decision to overturn Roe v. Wade has a far-reaching impact on pregnant people's health. Two years ago, about 250,000 people had abortions in the places where now it is banned or severely restricted, or probably will be soon. There may be a need for more healthcare facilities in states that allow abortions due to increased demand. Clinics in states such as Colorado, Illinois, and New York are already seeing more patients as pregnant people travel from other states for abortions. Planners should be prepared for changes in land use and zoning to respond to this additional demand. If places where abortion is banned begin to see higher birthrates, planners may need to consider whether their communities have adequate social services, facilities, and housing to support the needs of growing families, especially parents and children in more vulnerable or marginalized populations.

Planning for aging in community and planning for people with disabilities go hand in hand. Disabilities are more common among older populations, and the long-term effects of COVID-19 may increase the number of people affected by cognitive disabilities as they age. The tech sector has increasingly shown an interest in helping people with impairments or disabilities navigate the world. Not only are Big Tech's major players improving the accessibility of their own products, but a separate market for assistive tech is emerging. Products such as sensory aids and mobility aids are lucrative, as is the potential to 3D print prosthetics. Wearable AI is also an emerging field. The ubiquity of assistive tech may facilitate some solutions to aging in community.

Planning for aging in place and dementia are more important than ever. The national median age saw its largest single-year gain according to the U.S. Census Bureau's 2021 Population Estimates. The number of people with dementia and Alzheimer's disease is expected to more than double by 2060, with these cognitive diseases expected to most affect Hispanic and Black populations. Planners can contribute to the policies that can minimize disparities in dementia risk, namely equitable access to resources and environments that contribute to healthy cognitive function, such as aging-supportive communities, dementia-friendly communities, and communities that support intergenerational living.

There is a growing market for digital health technologies geared towards women, or FemTech. Popular examples of FemTech include menstruation tracking apps and newer innovations like biodegradable and flushable at-home pregnancy tests. Funding for the FemTech industry, which began in the 2010s, was slowly on the rise until the pandemic hit in 2020, and by January 2022 investments had skyrocketed. Privacy and surveillance concerns — especially after the U.S. Supreme Court's overturning of Roe v. Wade, which prompted warnings to women in pro-life states to stop using menstruation tracking apps, could be a disruptor to this burgeoning market. But FemTech's growth shows that gender considerations in health care are becoming a social priority.

According to the CDC and the American Public Health Association (APHA), gun violence is a public health issue. It includes homicide, violent crime, attempted suicide, and unintentional death and injury. In 2020, 45,222 people died from gun-related injuries. Gun violence can be reduced through a comprehensive approach that involves various programs, policies, and strategies. In schools and other public spaces, planners can use landscape features, such as safety gardens, to help create attractive, yet functional, safe places. And vacant lot remediation and renovating abandoned houses has reduced gun violence in various communities, including Philadelphia. Additionally, multiple studies show that an increased exposure to nature can reduce mental fatigue and related violence and crime in communities. PAS Report 602, Planning for Biophilic Cities, describes how elements of nature can improve a community's overall well-being and reduce violence.

Inclusive design is an emerging trend across industries. Inclusive design considerations are also being integrated into urban design, the built environment, and products. This evolving market and movement in design professions is leading to changes in public spaces, buildings and infrastructure, as well as product design. Planners can encourage developers, property owners, and service providers to enact inclusive design principles in their spaces and products. One notable instance of this is the growing awareness of the need for gender-neutral spaces. For more information about inclusive and universal design, check out the May 2021 Planning article "Why Planning Education Should Embrace Universal Design."

Public space and inclusive design are also directly related to the maturing conversation around gender. One recent trend is the disappearance of bathrooms as a public amenity. This disproportionately affects women because more of their daily activities (like childcare) or biological needs typically require more frequent bathroom access. Private companies controlling access to bathrooms can also lead to discriminatory practices against marginalized genders. Inclusive design often still focuses on biological differences rather than the overall diversity of body types. Sometimes, for instance, age and (dis)ability can be more relevant to design than gender identity.

The use of telemedicine, doctorless exams (where sensors and artificial intelligence capture health data to provide a direct diagnosis to the patient), at-home medical laboratory tests, and direct-to-consumer health-care models is increasing. The use of telehealth is 38 times higher than before the pandemic. Although at-home lab tests have been available for decades, over-the-counter COVID-19 rapid tests have now made at-home medical testing commonplace. According to a February 2022 report, the at-home test industry is projected to be worth over $2 billion by 2025. There has also been a rise in subscription-based health-care providers, such as Forward and Ro Health. As more consumers seek out convenient, on-demand health care, tech-enabled services may threaten traditional primary-care models and push health-care providers to adopt technological changes. For planners, this will impact the siting of health-care facilities, including clinics, urgent care facilities, and health centers. More research is needed to understand the real impact of these trends on brick-and-mortar health-care facilities. "Zoning for Eds and Meds," the November 2021 issue of Zoning Practice, outlines the challenges posed by technological change to local health-care anchor institutions such as hospitals.

Deaths involving fentanyl, an opioid that is often mixed with other drugs, are contributing to a declining life expectancy in the U.S. After a catastrophic increase in 2020, deaths from drug overdoses rose again in 2021 to record-breaking levels, nearing 108,000. Widespread social isolation and economic dislocation caused relapses in drug use and could have contributed to rising overdoses. Planners can help with isolation by creating socially connected communities. By designing public spaces that encourage gatherings and creating built environments that support social interactions, planners can help improve social connections among community members.

The number of people screening with moderate to severe symptoms of depression and anxiety has continued to increase in recent years. The COVID-19 pandemic has also resulted in a widespread reluctance to return to workplaces, classrooms, or other places where interactions with people are necessary, a phenomenon called pandemic cave syndrome. Where someone lives impacts their mental health. The quality of the built environment — noise, access to nature and services, perception of safety — is a determining factor for mental health. To get people out of their caves, planners can design places that encourage chance encounters and provide a feeling of safety.

Police, immigration officials, banks, universities, and even religious institutions are increasingly using scoring systems to inform decisions despite major issues with bias. COVID-19 travel restrictions based on residence and vaccine requirements, while necessary, may further popularize the "scoring" of individuals. Planners need to consider the risks of using scoring systems in their work, such as when attempting to measure neighborhood success.

More and more communities, as well as private residents within these communities, have access to video surveillance and facial recognition tools. Facial recognition and other software attempts to identify people's race, age, gender, and ethnicity. There is growing wariness of these privately and publicly used surveillance tools, particularly regarding the negative impacts they may have on vulnerable populations. Planners need to consider the impact of surveillance tools on equity, diversity, and inclusion in public spaces, as well as their impact on commercial districts and residential areas. For more on how to avoid using smart tech in ways that makes people feel surveilled, check out the March 2019 Planning article "Smart Cities or Surveillance Cities?"

Most influencers are real-life people, but social media bots are becoming more prevalent and better at mimicking human behavior on social media platforms. Bots are an example of applied artificial intelligence that uses data on human social media users to replicate their actions and communicate with people. Bots are not exclusively negative; for example, a bot can be helpful in local government website navigation by popping up to chat with website visitors. Planners need to adequately consider the impacts of these bots. Manipulation of public conversations on social media is especially relevant to community engagement processes.

Cities in the U.S. are adopting the attention-grabbing tactics of social media influencers. Whereas housing, job opportunities, and amenities traditionally determine how attractive a community is to residents, now more than ever communities and cities compete with one another to be seen as an authentic brand. In other words, communities themselves are becoming influencers. This can have consequences for community development. In the U.S., New York City and Los Angeles are examples of how cities use social media buzz to regenerate cultural and economic interest in a neighborhood. But what's potentially more impactful is how small and mid-sized cities are mimicking this tactic. Communities are advertising and curating content on social media as a means of retaining or growing their population and popularity among other communities.

Place-based social networking platforms, a form of civic technology that encourages neighbors to communicate virtually, are growing in popularity. This technology is reproducing racial profiling and surveillance of visible minorities in homogenous or gentrifying neighborhoods. The public-private nature of these platforms indicates that both virtual and physical approaches to placemaking, belonging, and inclusion are necessary to ensure public safety and combat exclusionary practices in urban spaces.

Cities and communities are now at the mercy of the rapidly growing social media influencer industry. An influencer is a type of social media user who uses a social media platform to market themselves, their lifestyle, or specific products to an audience of followers. Influencers have flourished under evolving social media platforms, sharing short-form content (e.g., TikToks, Instagram reels, or YouTube shorts). They can access or create niche or special interest online communities that are either geographically connected (like Nextdoor) or based on a shared topic (like Reddit). Travel-based influencers impact the tourism industry, with potentially positive impacts on the local economy and negative impacts on local ecology. City-living influencers can generate housing demand or revitalize shopping centers. And urban influencers have been advocating for transit, discussing the reality of suburban life, or inviting young people to participate in the planning process. For planners, it is important to understand the different social media influencers in their communities and how they can be leveraged for more equitable and inclusive community development.

Social media toxicity and accountability

The negative effects of constant social media use, such as exacerbating mental health issues like anxiety, depression, body image, and social comparison, should not be ignored as one factor influencing the social cohesion and well-being of community members. The trend of a toxic social media environment has impacts on how planners work. This emphasizes even more the importance of planners becoming social media-savvy. Planning departments may need to consider developing social media strategies and staff protection programs. Planners can't change the world of social media and its toxicity, but they can change the ways they approach and deal with it.

Special-interest online communities

In our increasingly digital society, special-interest online communities are influencing public dialogues and encouraging public participation in specific topics. Members of these digital spaces can either live near each other or far apart. Some of these online communities offer an opportunity to introduce topics and advance new ideas in geographically isolated communities. Planners can keep an eye on place-based social networking for insight on political ideologies in the geographically defined communities they serve and how this may affect local community engagement or project implementation.

APA's foresight research is made possible in part through our partnership with the Lincoln Institute of Land Policy.