with separate and distinct areas of education, work and commerce. Sprawl communities, which mushroomed beginning in the 1970s, often display “leapfrog” development and a lack of centralized planning and assume de- The Built Environment: Is There a pendency on auto travel. The typical subur- ban home sits on a cul-de-sac that feeds into Connection Between Sprawl & Health? a high-volume road separating schools, homes and shopping malls by large distances. The one-car garage is a relic of the past. The tale is in the taillights. Drive around tices, builders and developers blasted the re- Despite the long-held assumption that almost any American city of size at almost any port. The Southern California Building In- suburban living is healthier than urban, those hour of any day and you’ll see ahead of you dustry Association, for example, labeled it “a who study the issue of community design tie an unending string of lights on the cars, SUVs ludicrous sham,” suggesting that it has no sprawl to the nation’s increasingly sedentary and trucks heading to and from work, school scientific merit and that CDC should stick to living habits. Today’s neighborhoods, for ex- and shopping malls. Stressful, no doubt, but its mission of “fighting physical diseases, not ample, often lack sidewalks or bike paths, in addition, a growing number of public defending political ones.” making driving a necessity for even the short- health and urban planning experts are making But Chris Kochtitsky, the center’s asso- est trips. Safety is also a concern. Many par- a connection between suburban design and ciate director for policy planning and a coau- ents feel it’s dangerous for their children to myriad other health hazards, from obesity and thor of the report, said that while there isn’t play outside or walk or bike unsupervised to respiratory diseases like asthma to automobile- yet enough evidence to draw hard conclu- the school, store or playground. The result: related pedestrian deaths. sions, “there is evidence that our built envi- kids engage in less-active indoor pastimes, like A report issued in November by the Na- ronment affects our health.” The report, he watching TV or playing video games. tional Center for Environmental Health at continued, “was not intended to attack any “The logic is that built and natural en- the Centers for Disease Control and Preven- type of development but to provide infor- vironments affect our health and behavior in tion (CDC) highlights the dangers. The lack mation on how various urban design and a variety of ways,” observed Rich of sidewalks and bike paths in many cities land use decisions impact human health.” Killingsworth, director of active living by contributes to overweight and obesity and, design at the University of North Carolina in turn, to conditions like diabetes and heart WHAT IS SPRAWL? School of Public Health. One simple solu- disease, the authors of Creating A Healthy Once upon a time, neighborhoods were tion, he suggested, “is providing choice. Ev- Environment: The Impact of the Built Envi- designed to allow an integrated mixture of eryone should have the choice to be physi- ronment on Public Health say, and the “bad work, education, entertainment and shop- cally active and there should be close-to-home air” generated by vehicle emissions “makes ping that catered to pedestrians. Kids walked opportunities, but the way we are using our lung diseases, especially asthma, worse.” De- or rode their bikes to school—research com- land and designing our communities is not cisions about land use, they say, “are just as paring older to newer neighborhoods found accommodating that choice.” much public health decisions as are decisions that students are four times more likely to about food preparations… We must be alert walk to schools that were constructed before HEALTH HAZARDS to the health benefits, including less stress, 1983, for example—and adults tended to In its November report, CDC spotlighted lower blood pressure and overall improved reserve the automobile for work and for er- several major health hazards it said were physical and mental health, that can result rands outside of ambulatory range. connected to suburban design. when people live and work in accessible, safe, Then came “sprawl”—a relatively recent Obesity: Part of the impetus for study- well-designed, thoughtful structures and (post-World War II) phenomenon fostered by ing the connection between health and the landscapes.” greater automobile ownership and govern- built environment grew out of the U.S. Sur- Noting that the research was financed ment road-building subsidies and marked by geon General’s landmark 1996 report on by the Sprawl Watch Clearinghouse, a non- a number of easily recognizable characteris- physical activity and obesity. The report, profit group dedicated to best land use prac- tics, most notably low-density development which synthesized data from thousands of studies, documents the tremendous toll that rising rates of overweight and obesity take CONTRIBUTING STAFF on the public’s health. The report attrib- is produced by staff from the Environment, Energy and Glen Andersen, Janis Borton, Carla Curran, Ann Dietrich, Jo uted more than 200,000 deaths each year to Transportation Programs and the Health Care and Donlin, Doug Farquhar, Kristine Goodwin, Tracey Hooker, Prevention Projects Programs, located at the Martha King, Leslie Teach Robbins, Cheryl Runyon, Lisa sedentary lifestyles, and CDC pegs the direct National Conference of State Legislatures Speissegger, Laura Tobler, Stephanie Wasserman headquarters in Denver. 1560 Broadway, Suite 700 and indirect annual cost of inactivity, obe- Denver, CO 80202 sity and its related illnesses (heart disease, For more information about the programs, visit: Fax: 303-863-8003 http://www.ncsl.org or call (303) 830-2200. email: [email protected] or [email protected] diabetes, hypertension, osteoarthritis) at more than $100 billion. This insert is supported in part by grants from the Centers for Disease Control and Prevention and the Health Resources and Services Administration, U.S. Department of Health and Human Services [Sprawl, p.6]
STATE HEALTH NOTES - MAY 6, 2002 3 Sprawl, from p. 3 By reducing opportunities to exercise Atlanta, Georgia, one of the fastest grow- table. In Santa Rosa, for instance, officials are safely, the CDC report suggested, sprawl is ing cities in the country and also one of the taking steps to make sure the teen fatality contributing to the obesity epidemic—six in most notorious for urban sprawl, illustrates tragedy isn’t repeated, providing $5 million ten adults are overweight and four in ten are the problem. Huge increases in the number to build new sidewalks and requiring schools obese, and childhood obesity has doubled, of vehicles on the road and the number of to have safe, walkable routes. to nearly 25 percent, since the mid-70s. (See miles traveled have created very poor air qual- Other steps suggested in the CDC re- SHN #370, 4/22/02.) Americans consume ity, despite threats by the government to cut port: setting and enforcing lower speed lim- at least as many calories as they did a decade off federal highway funds for air quality vio- its in urban areas (pedestrians hit by a car ago, for example, yet over the past 20 years, lations unless the city takes steps to reduce traveling 40 mph have a 15 percent chance the average adult took 42 percent fewer trips health-threatening air pollution. of survival; at 20 mph, the odds leap to 95 on foot, and the frequency with which kids One dramatic example of the effects of percent) or using “traffic-calming” measures walked or biked to school dropped 40 per- air pollution on health occurred during the like speed bumps; using traffic signals to pro- cent. As many as 70 percent of adults do not 1996 summer Olympics, when Atlanta re- tect pedestrians in crosswalks; and providing achieve the Surgeon General’s recommenda- stricted traffic in an effort to provide cleaner over- or underpasses or tunnels for walkers tion for 30 minutes of moderate physical ac- air for the athletes. According to a CDC analy- and bikers to bypass particularly dangerous tivity at least 5 days a week. sis, smog levels fell 28 percent and emergency roads or intersections. “Parking lots are built as close as possible room visits for asthma attacks fell nearly 42 On a more global level, the agency out- to final destinations in order to increase con- percent. Even so, the city reverted to its old lined other ways for the public health sector venience and safety for motorists,” the report habits once the games concluded. to create healthier, more-livable communities, noted, and “the design of most new residen- Pedestrian Fatalities: In 1999 a Santa encouraging providers to join urban plan- tial areas reflects the supposition that people Rosa, California high school student was ners, architects, politicians and traffic engi- will drive to most destinations.” It may not struck and killed by a car while walking home neers in the planning process and making seem that taking a few more trips on foot from school on a busy street with no side- developments more people-friendly by turn- each day will have a meaningful impact on walks. As it turns out, the story isn’t uncom- ing to mixed land use patterns that allow obesity, Killingsworth added, but such rou- mon. According to the Surface Transportation people to work, shop and recreate within tine activities afford a great opportunity for Policy Project, walking is 36 times more dan- walking distance of their homes. daily exercise. gerous per mile covered than driving. Con- Because they control much of the money Respiratory Disease: Sprawl isn’t just bad sider this: Americans took about 1 out of 20 for transportation and land use, states can also for physiques; the lungs suffer too. Longer trips on foot, but 1 in 7 of all vehicle-related influence the process. “The perspective we commutes—CDC cited Sierra Club statistics deaths are pedestrians. In a study comparing have is to promote livable neighborhoods suggesting that the average American driver pedestrian fatalities in the U.S. and Europe, where people can walk or bike to the grocery spends 443 hours a year behind the wheel, moreover, researchers found that the death store, to the library, to school,” Maine Sen. or the equivalent of 11 work weeks—and rate per mile walked is 14 times higher in the Sharon Treat commented. “That’s why we’ve more auto dependence result in “an increase U.S. than in Germany and the Netherlands. worked on promoting downtown redevelop- in air pollution and in the incidence of respi- The way in which many newer commu- ment and renovation [instead of] decentral- ratory disease.” In fact, a broad body of re- nities are designed, however, means the only ized development.” search has demonstrated significant health way to visit a neighbor or get to the store on One approach being tested, for example, effects from breathing polluted air, includ- foot is to walk in the street. In sunbelt growth is targeted school siting, a major community ing decreased lung function, a greater inci- cities like Atlanta, Dallas and Miami, for ex- design component. Under a 2000 law, Maine dence of asthma and increased mortality rates. ample, pedestrian fatalities are far more com- school districts must work not only with the (According to the Environmental Protection mon than in rustbelt cities like Milwaukee Department of Education but with state plan- Agency, transportation-related air pollution and Pittsburgh, which have a more walking- ners during the siting process and assess causes 40,000 premature deaths a year in the friendly infrastructure. whether it is possible to locate schools near U. S.) Particularly in warmer months, vehicle community centers or downtown areas. “We exhaust creates a sun-induced chemical reac- SEARCH FOR SOLUTIONS are trying to build in a preference for tion that generates ground-level ozone and While the health problems associated with walkability,” Treat said. GA smog, causing shortness of breath, coughing, growth seem to be intractable by-products of (To download a copy of the CDC report, go to wheezing, headaches and eye irritations. modern society, potential solutions are on the http://www.sprawlwatch.org)
RESEARCH & EDITORIAL STAFF ADVISORY BOARD HEALTH POLICY TRACKING SERVICE Dick Merritt Forum Director Rep. Charlie Brown, Indiana M. Lee Dixon HPTS Director Linda Demkovich Editor Rep. Dianne White Delisi, Texas Staff: Allison Colker, James Cox, Eileen Crean, Anna C. Spencer Assistant Editor Kurt DeWeese, Speaker’s staff, Illinois Elizabeth Devore, Teresa Floridi, Patrick Johnson, Published biweekly (24 issues/yr.) by Contributors: Donna Folkemer, Wendy Fox-Grage, Rep. Susan Gerard, Arizona Lillian MacEachern, Rachel Morgan, Stephanie Norris, the FORUM FOR STATE HEALTH Shelly Gehshan,Tim Henderson, Kala Ladenheim, Rep. Peter Ginaitt, Rhode Island Carla Plaza POLICY LEADERSHIP, an Greg Martin, Anna B. Scanlon, Tara Straw Del. Marilyn Goldwater, Maryland information and research center at the John Kasprak, Senior Attorney, National Conference of State Legislatures Connecticut Legislature in Washington, D.C. EDITORIAL INQUIRIES Sen. William Martin, North Carolina For more information about Forum Linda Demkovich, Managing Editor Sen. Sandy Praeger, Kansas CUSTOMER SERVICE & SUBSCRIPTIONS projects, visit our Web site at: Tel: 202-624-5400 • Fax: 202-737-1069 John J.H. Schwarz, Michigan NCSL, 1560 Broadway, #700, Denver, CO 80202 www.ncsl.org/programs/health/forum email: [email protected] Tel: 303-830-2200 • Fax: 303-863-8003
6 STATE HEALTH NOTES - MAY 6, 2002 Howard Frumkin, M.D., chairman of the hoods, will people walk more and lose weight Environmental and Occupational Health and have less chance of getting diabetes? Department at the Rollins School of Public At heart, all of us want the same thing: Health at Emory University in Atlanta, has a pleasant, livable, healthy, affordable, safe special interest in the public health aspects of FRUMKIN: A DIALOGUE neighborhoods. The way to design those, es- urban sprawl. In addition to his post at Emory, ON SPRAWL AND HEALTH pecially at the beginning of a century in which Frumkin, who has a doctorate in public health hours on the road. But of course, most people the U.S. population is projected to double, is from Harvard University, sits on the board of don’t commit acts of road rage so that may be extremely important. I’m delighted we’re the Environment Committee of Physicians for just the tip of the iceberg. There must be a opening a dialogue [between] the public Social Responsibility and is directing a Centers larger reservoir of frustration and tension, and health community and planners, for Disease Control and Prevention-funded we don’t know much about how that mani- homebuilders, developers and mortgage lend- project on “Communities of Excellence in fests itself. Then, there has been discussion ers so that we can figure out the best way to Environmental Health.” In an interview, he about the connectedness among us, so-called achieve widely shared social goals. discussed the health problems posed by sprawl. social capital, trust and reciprocity. There’s a Q: What are examples of good design? Q: Why the sudden interest about possible case to be made for the idea that those things A: A lot of solutions go under the um- connections between urban and suburban decline in sprawling neighborhoods. If it’s brella of smart growth, which involves both design and public health? true those things are good, that’s another way land use and transportation decisions. It also A: The real question is why it didn’t happen in which land use and transportation deci- involves density—not a la New York City or sooner. For several decades, our country has sions affect our health. Hong Kong but the scale of three- or four- grown in a pattern that includes heavy reli- Q: What are the costs of the failure to plan story buildings or single-family houses bal- ance on cars and on single uses of lands, and without the pedestrian in mind? anced by preservation of green spaces, so that it’s surprising that with such a thorough A: Monetary costs? I can’t [answer] that. park land is available for everybody. It in- change in the form of the built environment, Obesity is an example. Sprawl isn’t the whole volves mixed land use so that residential, com- we haven’t asked earlier what the health con- explanation for it. There are [diet] and activ- mercial, educational, recreational and retail sequences of this are. The recent trigger may ity issues, so you want to be cautious about facilities are close to each other, obviating the be recognition of [the twin epidemics] of assigning cost entirely to sprawl. There is a need to drive everywhere. And it involves obesity and diabetes. financial issue that’s interesting, though. In transportation alternatives—not that we stop Q: What do you see as the main health Atlanta—and it is only one of many cities building roads but that we also construct side- problems that might be connected with modern that demonstrates this pattern—land values walks and bike paths, integrate different sys- community design? are rising much more rapidly in town than in tems, so you can take your bike on a bus, take A: There is a whole set of health prob- the suburbs, which suggests walkable neigh- it off at the other end and continue biking. lems, and they are linked. Some relate to the borhoods are becoming more appealing to There’s an agenda here that historical pres- way we use land, the fact that we build our buyers. For decades, the main option for most ervation people like, and it has to happen with buildings far apart from each other and seg- American homebuyers, especially those wor- community involvement to make it an open regate different uses. Some have to do with ried about affordability, was a house in the process. The bottom line is that smart growth transportation, the fact that we drive every- suburbs. Now that older neighborhoods are may well be a public health intervention. If where. And some have to do with the social being restored, there’s huge interest in them, that’s true, it’s not new; it’s simply rediscover- aspects of all of that, among them decreased as demonstrated by the prices they command. ing something that was standard wisdom a physical activity, which results from replac- So it may well be that we haven’t had a good century ago when urban planners were very ing walking and bicycling with automobile view of what Americans want because the much public health people. travel. Air pollution in rapidly growing sun options haven’t been there. Q: What is the role for state legislators? belt cities like Atlanta, Los Angeles and oth- Q: Some dispute the idea that sprawl affects A: The challenge for us in public health ers has also become a major problem and a lot public health, saying there’s no scientific evidence is the same challenge that presents itself to of that relates to motor vehicle traffic. Pedes- to that effect and labeling the work of researchers state legislators, and that is cutting across dis- trian fatalities [are an issue] because we are like yourself ‘junk science.’ How do you respond? ciplines. If you’re on a public works commit- increasingly building roads that are pedes- A: There is science indicating a connec- tee and not a transportation committee, or if trian-hostile and automobile-friendly. Then tion. Nobody can deny that if you move to- you’re on a health committee and not a hous- there’s the change in hydrology when we ward more automobile dependence, air pol- ing committee, work across the boundaries. build, putting down lots of impermeable lution problems are aggravated. Nobody can Like every big institution, state legislatures surface and removing tree cover, which has deny that if you build pedestrian-hostile have tended to build up silos, but people on effects on both water quantity and water qual- roads, there’s a higher risk of pedestrian fa- health committees ought to understand that ity, which in turn can have health effects. talities. On the other hand, there are many policy initiatives in transportation and land The mental health consequences of our questions we need answers to. For example, use are very much health initiatives. Also, put transportation and land use decisions are also what are the links between physical activity incentives in place. Much of this happens at important. Road rage may be an indicator— and the density and design of the built envi- the local level, and states can support creative, the frustration and tension that go with long ronment? If you build walkable neighbor- promising experiments at that level. GA
4 STATE HEALTH NOTES - MAY 6, 2002 A Couch Potato Society?
Trips < 1 Mile by Mode of Transporation Fast Facts
76 * Since 1982, the U.S. population has increased 80 20%, but the time Americans spend in traffic has 70 jumped an amazing 236%. 60 * The average American driver spends 443 hours 50 each year behind the wheel – the equivalent of 55 40 nine-hour days or 11 work weeks. 30 19 * The number of trips the average American adult
Percent of Trips of Percent 20 takes on foot each year dropped by 42 percent 10 2 2 between 1975 and 1995. 0 * Between 1986 and 1998, obesity among children Auto Walk Bicycle Other has doubled. Fourteen million children—24 *Source: Nationwide Personal Transportation Survey, 1995. percent—between the ages of 2 and 17 are obese. * In 1997, smog pollution was responsible for more than 6 million ashtma attacks, 159,000 vists to emergency rooms for the treatment of asthma attacks and 53,000 hospitalizations.
Obesity Trends Among U.S. Adults
(BMI > 30, or~ 30 lbs overweight for 5’4” woman)
1991 2000
No Data < 10% 10%-14% 15%-19% >20% *Source: CDC, 2001.
STATE HEALTH NOTES - MAY 6, 2002 5