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The concept of sustainability has been widely adopted in urban planning practice and theory. The social dimension of sustainability (SDS) remains the most underdeveloped and overlooked dimension of sustainability, both conceptually and practically, though social aspects of sustainability offer great potential to address urban social problems. This article reports on findings from research involving case studies of neighborhood-scale sustainability planning projects in Portland, Oregon; Copenhagen, Denmark; and Nagoya, Japan to describe the ways in which the SDS has been conceptualized and implemented in recent planning practice. The social determinants of health (SDH) framework is applied to these conceptualizations to identify the utility of this framework in further developing the SDS. Findings suggest commonalities across contexts and differences in their emphasis on structural and contextual determinants. This SDH framework contributes structure to theory on the SDS and provides a useful tool for planners to address complex urban social problems through neighborhood-scale sustainability planning practice.

Assisted living (AL) communities in the United States are home to a steadily growing population of over 900,000 individuals and provide assistance with daily activities, medical treatments, and social and recreational activities in a congregate residence. States license AL and oversee regulatory compliance. Studies have examined states’ regulations in terms of stringency and specificity, though they did not address survey processes, especially administrators’ perspective. We conducted semi-structured interviews with 37 AL administrators in Oregon to examine AL administrators’ experiences of the licensing and survey process. Using thematic analysis, we identified three major themes: emotional reactions, practical considerations, and relational assessments. First, administrators expressed feelings of high-level stress related to the survey process. Second, administrators discussed drawing on multiple practical approaches to become “survey ready,” including reviewing prior survey results, having support during a new administrator’s first survey process, and setting up other types of partner or mentor support systems for administrators. Third, administrators defined the survey process through their relationship with surveyors, in terms of tone (adversarial vs. collaborative), hierarchical/power structure (“negotiating the evidence”), and the extent of collaboration (“surveyor as mentor”). We interpret these findings using elements from the Resource Dependency Theory by situating “substantial compliance” as a vital resource for the successful operation of AL and regulatory authorities as key resource providers for AL administrators. These results also emphasize a potential mismatch between how AL administrators view their setting and how regulators do.

This study centers the voices and experiences of those working and living in assisted living, residential care, and memory care (AL/RC) settings in Oregon to understand how workplace diversity, equity, inclusion, accessibility, and belonging (DEIAB) can promote well-being. From January to April 2024, we conducted individual and focus group interviews with a total of 68 people, including 25 direct care staff, 9 former direct care staff, 9 administrators, 7 management representatives and 18 current residents from 23 AL/RC communities. We highlight six primary themes: 1) Care staff face discrimination, physical and verbal abuse from residents and colleagues; 2) those experiencing discrimination or not belonging were more likely to be from a minoritized group; 3) there is inconsistency in the existence, awareness, and currentness of diversity, equity, and inclusion policies, making implementation challenging; 4) company culture can support feelings of connection and belonging among staff; 5) care staff rely on peers and coworkers for support; and 6) workplaces need infrastructure that reflects language diversity of residents and care staff. Participants noted discrimination can happen overtly and subtly. In many instances, overt discrimination can be easier to address and handle, while subtle forms of discrimination happen daily and many times are invisible or look like unspoken norms. Recommendations include comprehensive DEIAB policies with clear implementation plans, DEIAB training programs for residents, investing in linguistic accessibility resources, and training administrators and managers in inclusive leadership practices.

Assisted living communities in the U.S. provide housing and care services to a sizable share of older adults and people with disabilities (over 900,000 individuals). The recent increase in climate-related emergencies has underscored the need for these communities to have preparedness measures in place to protect residents and staff. State agencies require preparedness plans, but these plans cannot anticipate all events. Oregon presents an important case study as a pioneer state in community-based care as well as with recent experience in various natural disasters. We interviewed administrators and management company operators (n=14), surveyed 140 direct care workers, and conducted focus groups with direct care workers (n=23) to learn about experiences during recent extreme heat events, wildfires, and ice storms. Thematic analysis revealed several themes related to the existing strengths and challenges in the current systems in place for responding to these emergencies. Strengths included an “all hands on deck” approach demonstrating teamwork among frontline workers, a commitment to show up for the residents in all conditions, and improved relationships with emergency management offices. Challenges included power and internet outage-related interruptions in technology for basic care delivery, insufficient plans for evacuation of residents with complex needs, increased staff injury, and lack of safe transportation. Our findings identify several opportunities and caution against pitfalls for regulators and policymakers in maintaining an acceptable level of emergency preparedness in AL settings.

Abstract Extreme heat is an environmental health equity concern disproportionately impacting low- income older adults and people of color. Exposure factors, such as living in rental housing and lack of air conditioning, and sensitivity factors, such as chronic disease and social isolation, increase mortality risk among older adults. Older persons face multiple barriers to adaptive heat mitigation, particularly for those living in historically temperate climates. This study measures two heat vulnerability indices to identify areas and individuals most vulnerable to extreme heat and discusses opportunities to mitigate vulnerability among older adults. We constructed two heat vulnerability indices for the Portland, Oregon metropolitan area: one using area scale proxy measures extracted from existing regional data and another at the individual scale using survey data collected following the 2021 Pacific Northwest Heat Dome event. These indices were analyzed using principal component analysis (PCA) and Geographic Information Systems (GIS). Results indicate that the spatial distribution of areas and individuals vulnerable to extreme heat are quite different. The only area found among the most vulnerable on both indices has the largest agglomeration of age- and income-restricted rental housing in the metropolitan area. Due to spatial variations in heat-related risk at the individual and area scales, measures addressing heat risk should not be spatially uniform. By focusing resources on older adult individuals and areas in particular need of assistance, heat risk management policies can be both highly efficient and cost-effective.

Abstract As climate change drives more frequent and intense weather events, older adults face disproportionate impacts, including having the highest mortality rates from storms, wildfires, flooding, and heat waves. State governments are critical in deploying local resources to help address climate change impacts. This policy study analyzes states’ climate adaptation plans to assess the methods through which they address the impact of climate change on older adults. This study uses content analysis to analyze available climate change adaptation plans for all U.S. states for strategies designed to increase resilience of older adults to impacts of climate change. Nineteen states have climate adaptation plans, of which 18 describe older adults as a population group with specific health impacts and risks factors. Four categories of adaptation strategies for older adults include communications, transportation, housing and emergency services. State plans vary in terms of the risk factors and adaptation strategies included. To varying degrees, states’ climate change adaptation planning address health, social and economic risks specific to older adults, as well as strategies for mitigating those risks. As global warming continues, collaborations between public and private sectors and across regions will be needed to prevent negative outcomes such as forced relocation and other social and economic disruptions as well as disparate morbidity and mortality.

This research explores the ways that professionals and the processes in which they engage for the redevelopment of the historic district of Old Havana, Cuba, consider social sustainability. As Cuba proceeds with ongoing market reforms, the country is faced with significant challenges in maintaining social equity, particularly within the urban region of Havana. Semi-structured interviews were conducted with urban planners, architects, economists, community activists, urban agronomists, medical professionals, housing specialists, and religious leaders in this unique sociocultural context in a time of economic transition. Literature on social sustainability in urban regeneration and the social determinants of health informed categories for framing and analyzing social implications of redevelopment and economic change. Our findings indicate that substantial measures are being taken to reinvest in housing and social infrastructure while restoring historic structures and promoting tourism. However, due to overwhelming challenges that planning professionals and health practitioners face, such as inadequate supply and crumbling housing infrastructure, difficulties remain in addressing health, safety, and security concerns. Despite the country’s legacy of community-focused values, changing conditions have increasingly given rise to two Havanas, exemplified by a dual economy, a generational split, and an unsettling of spiritual identity across lines of race and class. Cuba’s foundational social equity values, which prioritize access to health, education, and housing, seem to be at risk of unraveling as the country transitions toward a more open, market-oriented economic system.

In response to growing social inequality, environmental crises, and economic instability, sustainability discourse has become the dominant “master signifier” for many fields, particularly the field of urban planning. However, in practice many sustainability methods overemphasize technological and economic growth-oriented solutions while underemphasizing the social dimension. The social dimension of sustainability remains a “concept in chaos”, drawing little agreement on definitions, domains, and indicators for addressing the social challenges of urban life. In contrast, while the field of public health, with its emphasis on social justice principles, has made significant strides in framing and developing interventions to target the social determinants of health (SDH), this work has yet to be integrated into sustainability practice as a tool for framing the social dimension. Meanwhile, as municipalities move forward with these lopsided efforts at approaching sustainability practice, cities continue to experience gentrification, increasing homelessness, health disparities, and many other concerns related to social inequity, environmental injustice, and marginalization. This research involves multi-site, comparative case studies of neighborhood-scale sustainability planning projects in Portland, U.S.; Copenhagen, Denmark; and Nagoya, Japan to bring to light an understanding of how the social dimension is conceptualized and translated to practice in different contexts, as well as the challenges planners, citizen participants, and other stakeholders encounter in attempting to do so. These case studies find that these neighborhood-scale planning efforts are essentially framing the social dimension in terms of principles of SDH. Significant challenges encountered at the neighborhood-scale relate to political economic context and trade-offs between ideals of social sustainability, such as social inclusion and nurturing a sense of belonging when confronted with diverse neighborhood actors, such as sexually oriented businesses and recent immigrants. This research contributes to urban social sustainability literature and sustainability planning practice by interrogating these contested notions and beginning to create a pathway for integration of SDH principles into conceptualizations of social sustainability.