Designing Healthy Communities

Q&A with the Authors of Designing Healthy Communities

Is there a connection between the built environment of our communities and our health?
Where we live affects how we live. The houses and communities in which we live are very much the product of the safe water, food, transport, education, medical, and public health systems our grandparents created. People of wealth find places to live that are safe, with good air quality and water, affordable transportation, recreation and park amenities, lively culture, and healthful food.

The poor deserve these benefits as well; there is no reason for these fundamental needs to go unmet. Providing these benefits need not be costly, but it does require good design and collaborative planning.

Why the emphasis on communities? Isn't design about commercial and residential viability, access, and traffic flow?
There are many, many facets to community design, but promoting health is rarely one of them. Just as the core tenet of medicine is “First, do no harm,” so should this be the first rule of design. If our food, clothing, workplaces, and cars should all be designed with our health in mind, so should our communities. Thousands of years ago the progenitors of architecture understood this—buildings needed to be strong, useful, and have beauty.

Doing no harm today means constructing buildings that give us security, daylight, clean air, energy efficiency, places to walk, and stairs to climb. And it means designing streets that welcome people, all of us, in safety—not just users of motor vehicles, but walkers and bicyclists, old and young, agile or disabled, wealthy or poor. Design is about life and vitality, happiness and connection—one element is commerce, but commerce is not enough.

All of this seems kind of self-evident: of course people should walk, socialize, and have beautiful environments, but how can we afford the kinds of changes you’re suggesting?
A sedentary lifestyle increases the risk of cardiovascular disease, stroke, and mortality, whereas physical activity prolongs life. So how can we afford not to make these changes? And yet, we fail to build such places. When we focus on short term outcomes, quick returns on investment, we discount the future. When we build for the long term, when we build for well-being, we would build good communities. . . this is a fine investment, and one that pays off. For health we require community and beauty as much as we require rest and food. It is what earlier generations did.

Children need to grow up in safe and loving places with healthful food, physical activity, good education, and increasing socialization and autonomy. They should be afforded environments that require them to grow not just physically, and certainly not to grow fat or unhealthy, but to grow to be independent and intellectually incisive.

Yet for more than the last fifty years, we have increasingly diminished the life range of our children and the security of working families. We legislated, subsidized, and embraced a culture that has encouraged only financial capital and neglected natural, social, cultural, and intellectual capital. Our trajectory is ruinous, but reversible, if we are smart.

Aren't you just arguing for gentrification? What happens to poor people if we make places more desirable for higher income people?
Warehousing and isolating poor people in one place leads to dismal services and cultural failure, as does isolating the wealthy in enclaves. Children need to grow with challenges and amid diversity. We can get comfort from familiar surroundings and friends, but too constant a diet breeds deviance and inflexibility. We all need to learn to get along with each other.

Is there proof that making walkable, bikable, and socially-connected communities makes people healthier and happier?
There’s considerable proof. People in highly walkable neighborhoods record more walking trips per week, especially for errands and going to work, which translates into a higher total amount of physical activity with its associated health benefits.

The same is true for those who use rail transit. We know that people who exercise, walk, or bike in green spaces are less depressed. Drivers in traffic jams frown and have higher blood pressure and heart attack risks. Bicyclists on safe routes seem to smile more and are certainly healthier.

You seem to be arguing for a return to old-fashioned towns that went out with the horse and buggy.
I’m not arguing for a blindly nostalgic return to the past, but I am arguing for vigilance against a way of life that promotes pollution, heart disease, cancer, injury, and social isolation. I am arguing for living in places where we meet our life needs wasting little fossil fuel, for being with our family and friends, being physically vital—walking, running, and playing— and eating local, healthful food, without being owned by our cars and our staggering mortgages and college costs. Yes, that is exactly what I am arguing for. And the market place validates this: our young people have looked at their parents’ stressed car-dependent life styles and are saying, “This is wasteful . . . this is boring . . . I don’t want that.” They are opting for the America their great-grandparents told them was great.