Leveraging Neighborhood-Scale Change for Policy and Program Reform in Buffalo, New York Samina Raja, PhD, Michael Ball, MUP, AICP, Justin Booth, MS, Philip Haberstro, BS, Katherine Veith, BS 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 collabora- tion 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. (Am J Prev Med 2009;37(6S2):S352–S360) © 2009 American Journal of Preventive Medicine Introduction T he noted landscape architect, Frederick L. Olm- sted, once described Buffalo, New York, as the “best planned city” because of its street infra- structure, public spaces, and park system. 1 The city’s plan, originally devised by Joseph Ellicott in 1804, was modified in the late 1800s by Olmsted through the introduction of a system of parks and parkways de- signed to both link neighborhoods and be a haven from the congestion and rapid pace of urbanization. Despite its green infrastructure and architectural leg- acy, Buffalo faces considerable demographic and eco- nomic challenges. Although it is the second largest city in New York, by 2007, Buffalo’s population had shrunk to 264,292, nearly half of its peak population (580,132) in 1950. Recent estimates indicate that 28.7% of its population lives in poverty, compared to only 13% nationwide. 2 The condition of younger Buffalonians is even more sobering: 41% of the population aged 18 years lives in poverty, compared to 18% nationwide. Within this socioeconomic context, particular neigh- borhoods, such as the city’s East Side, have been especially hard hit. This paper describes the experience of the Healthy Communities Initiative (HCI) community partnership to promote active living in one of the especially vulner- able, albeit unique, areas of Buffalo. The initiative was launched in 2003 by the Buffalo Niagara Medical Campus, Inc. (BNMC, Inc.) with the aid of a 5-year, $200,000 grant from the Active Living by Design (ALbD) program of the Robert Wood Johnson Foun- dation. A nonprofit organization, BNMC, Inc., is re- From the Department of Urban and Regional Planning (Raja, Veith), and the Department of Health Behavior (Raja), University at Buffalo, State University of New York; Buffalo Niagara Medical Campus, Inc. (Ball); Green Options Buffalo (Booth); and the Wellness Institute of Greater Buffalo (Haberstro), Buffalo, New York Address correspondence and reprint requests to: Samina Raja, PhD, University at Buffalo, State University of New York, 3235 Main Street, 201 D Hayes Hall, Building 1, Buffalo NY 14214. E-mail: sraja@buffalo.edu. S352 Am J Prev Med 2009;37(6S2) 0749-3797/09/$–see front matter © 2009 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2009.09.001