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.