Part 2 on Urban Sprawl and Public Health looks at potential interventions and theories that can help reduce the impact of sprawl (read part 1 here). For authors Howard Frumkin, Lawrence Frank, and Richard Jackson, hope lies in the new strategies being put forth under the terms Smart Growth and New Urbanism, arguing for Smart Growth at least as a public health strategy. I have a lot of issues with New Urbanism and Smart Growth as they are so often removed from issues of equity and spatial justice, but it’s interesting to think of how to rebuild and rework our cities as part of a plan around improving health.
They trace a lineage of people working on the connections between health and cities — Dr. John Henry Rauch (1828-1894) in Chicago arguing for land use policies to improve public health, cemeteries at a remove from dense neighborhoods being one of them. Frederick Law Olmstead, and garden cities. Edwin Chadwick working sanitary regulations, housing standards, public water and sewage systems in the UK, Thomas McKeown at Birmingham, who
showed that many of the health advances of the nineteenth and twentieth centuries resulted not from better medical care, but from ‘upstream’ improvements such as better urban infrastructure–better housing, neighborhoods, water, food, and transport. (203)
They also name psychiatrist Leonard Duhl, who has looked at connecting mental health with urban design and community involvement. His ideas have been broadened by physician Trevor Hancock. In 1987, the World Health Organization jumped on the bandwagon, initiating a Healthy Cities Network, which I confess I had never heard of.
There are of course many who could be added to this list, and in the UK at least you have the Marmot Review among others, trying to move health care providers to think more broadly about wellness and how it connects to social and environmental factors.
So…to return to the strategies they promote, we start with Smart Growth. The Environmental Protection Agency itself formed the Smart Growth Network in 1996 together with a number of other nonprofits and governmental organizations. The Networks’ ten Smart growth principles (the whole document ‘Getting to Smart Growth: 100 Policies for Implementation’ can be found here):
1. Mix land uses
2. Take advantage of compact building design
3. Create a range of housing opportunities and choices
4. Create walkable neighborhoods
5. Foster distinctive, attractive communities with a strong sense of place
6. Preserve open space, farmland, natural beauty, and critical environmental areas
7. Strengthen and direct development towards existing communities
8. Provide a variety of transportation choices
9. Make development decisions predictable, fair and cost effective
10. Encourage community and stakeholder collaboration in development decisions
The book goes on to give a more elaborate set of principles in full…they’re interesting, so I do the same — the full text can be found here:
All planning should be in the form of complete and integrated communities containing housing, shops, work places, schools, parks and civic facilities essential to the daily life of the residents.
Community size should be designed so that housing, jobs, daily needs and other activities are within easy walking distance of each other.
As many activities as possible should be located within easy walking distance of transit stops.
A community should contain a diversity of housing types to enable citizens from a wide range of economic levels and age groups to live within its boundaries.
Businesses within the community should provide a range of job types for the community’s residents.
The location and character of the community should be consistent with a larger transit network.
The community should have a center focus that combines commercial, civic, cultural and recreational uses.
The community should contain an ample supply of specialized open space in the form of squares, greens and parks whose frequent use is encouraged through placement and design.
Public spaces should be designed to encourage the attention and presence of people at all hours of the day and night.
Each community or cluster of communities should have a well defined edge, such as agricultural greenbelts or wildlife corridors, permanently protected from development.
Streets, pedestrian paths and bike paths should contribute to a system of fully connected and interesting routes to all destinations. Their design should encourage pedestrian and bicycle use by being small and spatially defined by buildings, trees and lighting; and by discouraging high-speed traffic.
Wherever possible, the natural terrain, drainage, and vegetation of the community should be preserved with superior examples contained within parks or greenbelts.
The community design should help conserve resources and minimize waste.
Communities should provide for the efficient use of water through the use of natural drainage, drought tolerant landscaping and recycling.
The street orientation, the placement of buildings and the use of shading should contribute to the energy efficiency of the community.
The regional land use planning structure should be integrated within a larger transportation network built around transit rather than freeways.
Regions should be bounded by and provide a continuous system of greenbelt/wildlife corridors to be determined by natural conditions.
Regional institutions and services (government, stadiums, museums, etc.) should be located in the urban core.
Materials and methods of construction should be specific to the region, exhibiting continuity of history and culture and compatibility with the climate to encourage the development of local character and community identity.
The general plan should be updated to incorporate the above principles.
Rather than allowing developer-initiated, piecemeal development, local governments should take charge of the planning process. General plans should designate where new growth, infill or redevelopment will be allowed to occur.
Prior to any development, a specific plan should be prepared based on the planning principles. With the adoption of specific plans, complying projects could proceed with minimal delay.
Plans should be developed through an open process and participants in the process should be provided visual models of all planning proposals.
Of course, in years of community work around development, I have never seen anything actually work like this.
walkable neighborhoods, a range of housing choices, a mix of land uses, participatory planning, revitalization of urban neighborhoods (206)
They talk about some of the critiques. They come from wildly different directions…
the public doesn’t want it
it limits consumer choice — it’s a form of coercive social engineering
can exacerbate traffic congestion by creating greater density
smart growth projects are isolated enclaves, not integrated
encourage gentrification (213)
Then go on to look at a public health approach to Smart Growth. It’s a very different perspective though concerned with all of the same things. They begin with constructing a community health assessment — paralleling the medical assessment. One method they believe has great promise is the Health impact Assessment, as a way to measure the health benefits from a Smart Growth approach. Nor is it surprising that many of the potential indicators would be the same as for sustainability — transit ridership, percentage of population living within ten minutes of a park, incidence of asthma, extent of recycling. (217) A few useful checklists exist already that could serve, one is the Built Environment Site Survey Checklist in London (this is news to me, this BESSC).(218)
I like how numerous things are coming together — concerns for the health of individuals and communities and neighbourhoods, issues of sustainability and the health of the land and environment. I think, again, there’s a lot more to think about in terms of equity. People’s own power in the process is always the first thing to go — if it ever was on the table. The cold hard facts of development and politics are not amenable to such things, so progress has been made where it helps certain kinds of development become more marketable. But criticism to come…
Urban Sprawl and Public Health — a great book! It was amazing to see urban planning and public health brought together in this way — a solid primer on both for each, along with a plea for professionals to start working together to fix this. Because sprawl is killing us.
I myself would throw in a soupçon of sociologists and geographers and community organizers to the health and planning mix as well, because what was missing? More analysis on the nature of development and how the drive for profit drives this urban form, more analysis on the struggle of everyday people to fight for and against some of these dynamics, and the ways in which race and land have long been linked (but there is more of this second aspect than in many another book). Still, despite these critiques, I confess that few things get me going the way that talking about the city and health in the same book do.
Health & Sprawl facts:
In the last 15 years, the US has developed 25% of all the land developed in the past 225 years of its official existence. (xii)
Between 1960 and 2000, average American’s yearly driving more than doubled — 4,000 to nearly 10,000 miles per years. “rush hour” spread over seven, not 4 and a half, average driver’s time spent stuck in traffic each year: 6 to 36 hours in Dallas, 1 to 28 hours in Minneapolis, 6 to 34 in Atlanta. (xiii)
Sprawl — a term from William H. Whyte! Did I know that? He wrote an article for Fortune in January 1958, titled ‘Urban Sprawl’. There are a variety of definitions and measurements of sprawl, here they follow those that incorporate both land use and transportation as intrinsic. They focus on four main aspects — density, land use mix, automobile dependence and connectivity (or how destinations are linked through transportation systems (7). (5)
I particularly like how much they use illustrations, this is a good one:
I also liked the ‘transect’ — a look at the continuum between sprawl and compact neighbourhoods (16)
Chapter 2 looks at the origins of sprawl, and it is based almost in its entirety on Kenneth Jackson’s Crabgrass Frontier. So it summarizes the multiple factors that have lead to spraw, and it is a very long list. He heads it with the pull of the suburbs and the (European) cultural values Jackson believed underlay that pull — domesticity, privacy and isolation (28). In addition you have land ownership as a mark of wealth and status, alongside (partly driving perhaps, but I’m a cynic that this drove development rather than sales) a love of land itself and antipathy toward cities. (29) The Garden City movement feeds into this, embodied by Frederick Law Olmstead, along with the new technologies and construction methods and lots of cheap land (no mention of conquest here of course). There is a little here on the willingness of cities to spend taxes on providing infrastructure like roads and sewers — directly subsidising this kind of development as opposed to improving older neighbourhoods or public housing. The rise of the automobile and destruction of public transportation. The rise of zoning. The HOLC and the FHA, federal policy and money going towards new housing for whites (I do wish, though, that they had read Freund).
Still, I like the simplicity of their conclusions though:
Sprawl, as we know it today, appears deceptively chaotic. In fact, it is a highly ordered and predictable form of development. An edifice of public and private instruments erected over the past three-quaters of a century reinforces and extends sprawl. (42)
There is a little on financing here, and that real estate financing now works on an expectation of profits within 5-7 years — more built-in obsoleteness. I wish they had connected this to Harvey’s ‘spatial fix’ but that’s complex I guess. This is my field though, and this is a good summary.
Urban health is not my field, though I have a good deal of practical organising experience on the subject.
Frumkin et al compare the evolution of urban health with public health through ‘epidemiologic transition’ — and these titles really do inspire the SF writer side of my brain: The Age of Pestilence and Famine, The Age of Receding Pandemics, and where we are now: The Age of Degenerative and Man-Made Diseases. In cities, infectious diseases once dominated, but sanitary infrastructure ended that to a great extent. But industrialisation introduced pollution, and mental health and violence are not forgotten here, with growth in poverty, social dislocation and crime. (45)
From a public health perspective, the critical problems that grew as cities did were: garbage, commercial activity (tanning and other nasty things), sewage, water, air, and housing. (46)
An interesting aside:
In New York, Assemblyman Aaron Burr [founding father and profiteer] obtained a charter for the Manhattan Company, a private firm that was to hold a monopoly on piped water for the next quarter of a century. (51)
Privatised water is nothing new. Nor are the images from Jacob Riis in How the Other Half Lives. My family for example, hanging out with the other half in Pittsburgh, probably looked much like this, though they were never in this particular alley.
The Results: A Plethora of Infections
Their heading, not mine. I had not read of the yellow fever epidemics that swept through Washington D.C. — as President Washington fled in 1793 leaving over 5,000 dead, or over ten percent of the city’s population. (55)
The book quotes a citizen group in Philly writing:
if the fever shall become an annual visitant, our cities must be abandoned, commerce will desert our coasts, and we, the citizens of this great metropolis, shall all of us, suffer much distress, and a great proportion of us be reduced to absolute ruin. (56)
Cholera, Typhoid…Cities in these early days were ‘incubators of infectious disease’ (57)
Now this is Pittsburgh just as my great-grandparents were arriving:
But slowly this would change…
During the nineteenth and twentieth centuries, as sanitary challenges were met and as industrial pollution was managed, the toxicity of cities–the factors that most threatened residents’ health and well-being and even helped drive migration out of the cities–came overwhelmingly to revolve around social circumstances. (61)
The heading for this section is ‘The Social Pathology of City Life’. (61)
during the nineteenth and twentieth centuries, as sanitary challenges were met and as industrial pollution was managed, the toxicity of cities–the factors that most threatened residents’ health and well-being and even helped drive migration out of the cities–came overwhelmingly to revolve around social circumstances. (61)
The urban crisis — it is interesting, perhaps a little troubling how the social is here linked with the epidemiological, but I am often troubled by the public health gaze at poverty. Foucault was too, so I’m in good company. The book here notes the riots of the Red Summer of 1919 — yet it doesn’t distinguish these horrifying white killing sprees where literally hundreds of people were murdered with ‘riots’, what inhabitants themselves described as ‘uprisings’ in protest of police brutality and living condition in Watts in 1965, LA again in 1992 and etc (62).
It is interesting to consider the ‘urban health penalty’, however:
a complex of environmental conditions such as deteriorating housing, inadequate access to nutritional food, and scant medical care, and health consequences such as untreated hypertension, cardiocasvualr disease, intentionala dn unintentional injuries, and infectious diseases. (63)
Interesting to read of a 1990 article in New England Journal of Medicine showing that men in Harlem had lower life expectencies than in Bangladesh.* They write:
A literature of urban health arose, focusing on these conditions and how to provide health care to the victims. (63)
From here on to the nitty gritty.
I like this chart:
‘As the model illustrates, land use patterns affect each category of athropogenic emmissions–their location, their quantity, their dispersion in the air, and how people are exposed. (66)
And a summary of what air quality means for health:
Air pollution threatens human health in four principal ways. The two most important are by increasing mortality and by threatening respiratory health. In addition, air pollution can damage cardiovascular function and increase cancer risk. There is evidence for some other health effects as well. (80)
The ‘epidemic’ of obesity must be well known to anyone doing community work, or even who just reads the paper.
Being overweight is itself a well-established risk factor for a number of diseases. people who are overweight die at as much as 2.5 times the rate of non-obese people, and an estimated 300,000 Americans die preventable deaths each year as the result of being obese. (96)
So sprawl obviously has some share of this, creating environments where no one walks. Where it is dangerous to walk even if you wanted to, and there were somewhere to go. What features of the environment help people become more active?
Frank, Engelke and Schmid** identify three dimensions of the built environment…. land use patterns, design characteristics and transportation systems. (99)
Pikora et al*** expand on this, primarily in area of design — functional factors, safety factors, aesthetic factors and destination factors. So — a mix of different land uses, availability of sidewalks and footpaths, enjoyable scenery, the presence of other people in the space being physically active, safety.
Fucking rocket science, this is.
Injuries and Deaths from Traffic
Holy Jesus, this will make you never want to get in a car again. Over 40,000 people a year die by automobile. (110)
Water Quantity and Quality
So, you got your microbial contamination of water, your chemical contamination. You have your water scarcity. Sprawl affects all of these — thus the section titled ‘The Hydrology of Sprawl’. The rain falls, it percolates through foliage, roots and soil — cleansing itself as it does — to recharge groundwater and the water table. About half of us drink water from surface sources, and the other half from groundwater. My family drank from groundwater once, now we’re on a list, because it was contaminated. But that’s a longer story.
Forested areas are best at capturing and cleaning water, paved streets and rooftops, as you can imagine, fail completely. It all becomes chemical and pollutant-rich run-off. They give a view of what development’s effect is on this process:
The stormwater runoff from suburban development contributes to microbial contamination as it ‘includes large loads of waste from pets and wildlife and nutrients from such sources as fertilizers’. Heavy runoff also carries sediment, these can protect dangerous bacteria like giardia as they sit in filters and drains. And then you have your further suburbs using wells and their own septic systems. The final way is unexpected — the continued growth of suburbs means the focus is on building new infrastructure, not repairing and cleaning out the old, which desperately need it. So our own pipes and things are poisoning us.
The chemical contamination is more obvious I think, all the toxic things we uses every day as well as those deposited by cars and exuded by factories all get swept into the water supply as well.
this is good to see here, I think it is left off of such analyses far too often. They remind us that sprawl is partly caused by a desire to get away from the city, into nature, into all that is good for mental health. Yet this is only one aspect of the suburbs — possibly offset by highways, sameness, box stores, speed, large scales, and just the amount of time people spend driving.
There is a whole of information on just how bad for us driving is. How it increases stress, makes us angrier. Studies on road rage. All of these things could, most likely do, contribute to morbidity.
This comes from community. They define such a sense of community as a
“feeling that members have of belonging, a feeling that members matter to one another and to the group, and a shared faith that members’ needs will be met through their commitment to be together.”**** There are four aspects of this sense of community: membership, influence, integration and fulfillment of needs, and shared emotional connection. (161)
They look at the many ways community psychologists, human ecologists, and sociologists have talked about community and social capital, but much of it is based on Robert Putnam’s Bowling Alone, so I won’t go on too much more here except for the ways it affects health. I’ll be dealing with Putnam too. Everyone quotes him.
Research has focused on two broad aspects of the social environment: structural features and social support. Structurally, people look at the density of relationships and extent of social networks. Social support is described as the the amount of emotional support (and other kinds?) in times of need (166. In a nutshell: People with strong social networks live longer. Lots of studies confirm it (you can see the Marmot Review on the UK). (166) The same correlations hold true for social capital.
Sprawl, on the other hand, tends to to diminish both networks and capital in several ways:
Cars have much to do with this, the amount of time people spend driving restricts free time for civic engagement.
sprawl ‘reduces opportunities for spontaneous, informal social interactions’ (173)
‘sprawl privatizes the public realm’, people who spend all their time at home don’t value public space, green space, suburban voters almost always vote to limit government programs with social goals or for public transportation
sprawl divides people into homogenous communities.
sprawl disrupts continuity of life as people age — can’t move into smaller house in the same neighbourhood (173)
1998 report from the Transit cooperative Research program found that ‘sprawl weakens households’ connection both to their immediate neighbors and to the larger metropolitan community. (174)
But it turns out that some sprawl better than others — the built environment and design can affects this, so there is some hope. But this first post is on all that is wrong, the second on what can be made right…
Health Concerns of Special Populations
I do like that there is focused attention on how sprawl impacts different groups, acknowledging that the costs of it are not even. There is a long list…Given that women are usually doing most of daily chores and chauffeuring of kids, the burden falls disproportionately upon them.
Children breath more rapidly, have narrower airways — thus pollution has much more impact on them than on adults. The lack of physical activity affects them more — and yet when they are physically active in polluted areas, it is more dangerous for them. Part of childhood is exploration of the world and the self away from parents — yet we have built spaces where that is not safe, impacting the mental health and development of kids. They are isolated, and don’t have the wealth of networks and adults watching out for them that a health community might have.
The elderly, too, are severely impacted. Communities that aren’t walkable require cars — so people drive long past the time they should not. Elders are isolated, unable to exercise, unable to have meaningful connections that improve their health and quality of life. This is often also true for those who are disabled. How dare we create cities without sidewalks.
Then, of course, there are the poor and people of colour. A reprise here for HOLC and FHA regulations, the racism that confined people into inner cities (I don’t think they quite realise how prevalent this continues to be). The steady concentration of poverty and its related health impacts in areas of higher pollution. The disparities of race in class so visible in health and morbidity statistics.
The connections are multiple and strongly evidenced. Enraging really. I like that they don’t stop there, but include a final chapter on possibilities for changing our cities and our future. That will follow in the next post.
*McCord C., Freeman, H. Excess mortality in Harlem. New England Journal of Medicine 1990; 322: 173-179.
**Frank, Engelke and Schmid (2003) Health and Community Design: How Urban Form Impacts Physical Activity, Washington D.C.: Island Press.
*** Pikora, T et al (2003) Developing a framework for assessment of the environmental determinants of walking and cycling. Social Science and Medicine 56: 1693-1703
**** McMilland and Chavis Save
Just communities. Just cities. Just connections between country and city. Also, the weird and wonderful.