The walking cure

As Director of Environmental Health at the Centers for Disease Control in Atlanta, Dr. Richard Jackson did groundbreaking work identifying the public health problems with sprawl. Jackson and his colleague Dr. Howard Frumkin of the Rollins School of Public Health at Emory University collected a body of research showing environments designed around the needs of automobiles are as unhealthy as they are unsightly. This work brought Dr. Jackson’s views in close alignment with new urbanists and brought him to CNU XI in Washington DC to deliver a memorable plenary address. In his new book Urban Sprawl and Public Health, co-authored with Frumkin and landscape architect Lawrence Frank, Dr. Jackson promotes New Urbanism as an essential strategy for solving a health crisis marked by rising obesity, increased asthma, and widespread depression. Now back in his native California, where he is State Public Health Officer, Dr. Jackson spoke with CNU’s Stephen Filmanowicz for this article. CNU: Early public health efforts focused on physical conditions such as overcrowding in tenements. There was a feeling that we’d fixed a lot of problems. How did health officials begin to think that the design of places had become a problem again? RJ: What struck me over my first few years at the CDC was how often the issues I was dealing with turned out to have a design component. For instance, as air quality gets worse, asthma gets worse. And our air quality depends on the fossil fuels we burn, which depends enormously on the design of communities and whether they accommodate transit and walking or require everyone to drive. I began to speak at great length with my colleague Dr. Howard Frumkin, the lead author of the book. We were both concerned that environmental public health was so concerned with remote and obscure matters. We weren’t applying nearly enough attention to fundamental issues of quality of life. Besides working on sanitation and hygiene issues, early public health leaders spent a lot of time on the design of the built environment. We kind of declared victory in the middle of the 20th century and walked away from it. It became clear to Howie and me, there were major impacts from the modern environment that we’d created, which is frankly designed more around the needs of automobiles than those of people. CNU: In making the link between sprawl and disease, which issues jumped out at you first — obesity, asthma from air pollution? RJ: Early on, I sent an email to Howie in which I described an experience I had driving to work on a very hot day in Atlanta. I saw a woman in her 70s walking alongside the road. There was no public transportation, no sidewalk, just a worn path next to the road. She had a shopping bag in each hand. I wanted to offer her a ride but didn’t and I thought about it all day. I wrote that if this woman had died in the heat, in our medical system, the cause of death would have been listed as heat stroke. It wouldn’t have been lousy urban planning, an inadequate transit system or removal of tree cover. We in health had focused on small things and hadn’t focused enough on larger issues. That was almost the “Eureka” or “aha” experience that I had. More recently the thing that has struck me is how much the mental health issues are operative. The most chronic disease in America and worldwide is depression. The cures for depression are social connectedness, medicine, and physical exercise. Exercise is the best treatment, yet our physical environments are set up to make it virtually impossible for many Americans to incorporate walking and physical activity into their daily lives. CNU: The book makes some striking points about mental health, including the anger and frustration associated with long automobile commutes. RJ: One of the things we’re seeing is that housing in the Bay Area has become so stunningly expensive. They have not created quality density in Silicon Valley and other parts of the area with lots of jobs. People are dropping off kids at 6 a.m. near Modesto and commuting two hours to Silicon Valley. They’re working a hard day and then spending another two hours driving back to pick up the kids, oftentimes coordinating with another spouse who’s commuting long distances. You can imagine what they’re eating for dinner. It’s fast food or frozen pizzas. We’re seeing the erosion of family life and quality of life for a lot of people. A lot comes back to housing policy – how do you create quality density and better transportation systems, since you can’t support density without good transit service? Density scares people. People don’t want to be in an environment that feels unsafe or that doesn’t offer quality schools. Unfortunately, we’ve allowed our cities and urban areas to deteriorate. We’ve also seen a deterioration of people’s assessment of their own well- being. In CDC’s annual surveys, people report that they spend more days of the year feeling unwell. There will have to be multiple fixes. One will be creating communities that nurture and reward community connectedness and the activity that our grandparents took for granted. That’s how I got to know new urbanists. CNU: Have you been able to observe new urbanist places to see which ones are encouraging the most physical activity? RJ: That research is still going on. One I’ve heard good things about … is the transformation of Pasadena. I’ve heard they’ve done very well in creating urban spaces that are inviting, that encourage socialization We all know anecdotal stories of people who move to a Smart Growth community. You ask them how they like it and they say, “I love it, I wish I’d lived here my whole life.” But does their blood pressure go down? Do they lose weight? We need more of that kind of research. CNU: What have you learned from your collaborations with new urbanists? RJ: Public health is very much community focused. One of the things that impressed me is the charrette process and the use of computer modeling as part of that process, where a community meets and you can extract from them their favored design styles. The community can come to consensus using these systems and visualize what needs to happen. From developers, I’ve learned how hard it is to do infill development. It’s far easier to take down a forest and put up big box than claim urban land that may be a brownfield. If there is a movement toward Smart Growth and New Urbanism, it’ll have to involve developers. It turns out there are plenty of benefits of density for homebuilders. They get to build more units per acre, for instance. We in public health ought to be a new set of partners for them. u