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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Designing Healthy Communities, the companion book to the acclaimed public television documentary, highlights how we design the built environment and its potential for addressing and preventing many of the nation's devastating childhood and adult health concerns. Dr. Richard Jackson looks at the root causes of our malaise and highlights healthy community designs achieved by planners, designers, and community leaders working together. Ultimately, Dr. Jackson encourages all of us to make the kinds of positive changes highlighted in this book. 2012 Nautilus Silver Award Winning Title in category of “Social Change”
"In this book Dr. Jackson inhabits the frontier between public health and urban planning, offering us hopeful examples of innovative transformation, and ends with a prescription for individual action. This book is a must read for anyone who cares about how we shape the communities and the world that shapes us." —Will Rogers, president and CEO, The Trust for Public Land
"While debates continue over how to design cities to promote public health, this book highlights the profound health challenges that face urban residents and the ways in which certain aspects of the built environment are implicated in their etiology. Jackson then offers up a set of compelling cases showing how local activists are working to fight obesity, limit pollution exposure, reduce auto-dependence, rebuild economies, and promote community and sustainability. Every city planner and urban designer should read these cases and use them to inform their everyday practice."
—Jennifer Wolch, dean, College of Environmental Design, William W. Wurster Professor, City and Regional Planning, UC Berkeley
"Dr. Jackson has written a thoughtful text that illustrates how and why building healthy communities is the right prescription for America."
—Georges C. Benjamin, MD, executive director, American Public Health Association
Publisher Companion Web site: www.josseybass.com/go/jackson
Additional media and content: http://dhc.mediapolicycenter.org/
Das E-Book können Sie in Legimi-Apps oder einer beliebigen App lesen, die das folgende Format unterstützen:
Veröffentlichungsjahr: 2011
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Table of Contents
Cover
Title
Copyright
Foreword
Preface
The Author
Dedication
Prologue
Part One: Health and the Built Environment: An Introduction
Chapter 1: What Does Love, or Caritas, Have to Do with the Built Environment?
We Love Our Families and Our Country, But do we Really Love Ourselves?
For Love of Family
For Love of Community
For Love of our Nation and the World
Chapter 2: What Is Health, and How Do We Measure It?
Personal Health
Public Health Policy
Environmental Health
Mental and Social Health
Chapter 3: Can the Built Environment Build Community?
Organic Places are Healthy Places
Urban Centers
State and Nation
Part Two: Examples of Change
Chapter 4: From Monoculture to Human Culture
Symptoms
Diagnosis
Cure
Prevention
Chapter 5: Using New Urbanism Principles to Build Community
Symptoms
Diagnosis
Cure
Prevention
Chapter 6: Saving America’s Downtowns and Local History Through the Political Process
Symptoms
Diagnosis
Cure
Prevention
Chapter 7: Reinventing a Healthy City Through Community Leadership for Sustainability
Symptoms
Diagnosis
Cure
Prevention
Chapter 8: Ending Car Captivity
Symptoms
Diagnosis
Cure
Prevention
Chapter 9: Ports as Partners in Health
Symptoms
Diagnosis
Cure
Prevention
Chapter 10: The City That Won’t Give Up
Symptoms
Diagnosis
Cure (or at Least Treatment)
Prevention
Part Three: Be the Change you Want to See in the World
Chapter 11: What’s Happening in Your Community?
Determining the Health of Your Community
Conducting an Audit of Your Built Environment
Chapter 12: Who Are the Players?
Finding Your Stakeholders
Social Networking
Getting Everyone to Pull Together
Chapter 13: Create an Action Plan
Analyze the Symptoms
Determine the Diagnosis
Implement the Cure
Protect Through Prevention
Epilogue
Index
Portfolio
End User License Agreement
List of Illustrations
Prologue
Figure P.1
Robert “Bobby” Jackson and his P-51 Mustang in Iwo Jima, September 1945.
Figure P.2
Olmsted realized his idea of a public park as a green space accessible to all citizens in his design of Central Park.
Figure P.3
Patient and doctor talk about changing habits.
Figure P.4
A poster to encourage taking the stairs.
Chapter 1: What Does Love, or Caritas, Have to Do with the Built Environment?
Figure 1.1
Fast-food choices.
Figure 1.2
Obesity trends among children and adolescents: United States, 1963–2008.
Figure 1.3
Leonardo da Vinci’s
Vitruvian Man
.
Figure 1.4
Street scene in Greenwich Village in New York City.
Figure 1.5
Income and happiness in the United States.
Figure 1.6
Means of transportation for U.S. workers aged 16 years and older.
Figure 1.7
Travel time to work for U.S. workers aged 16 years and older.
Chapter 2: What Is Health, and How Do We Measure It?
Figure 2.1
The ten leading causes of death as a percentage of all deaths—United States, 1900.
Figure 2.2
The ten leading causes of death as a percentage of all deaths—United States, 2006.
Figure 2.3
Asbestos fibers.
Figure 2.4
Obesity and physical inactivity in the United States, 2005.
Figure 2.5
California and United States minus California adult per capita cigarette pack consumption, 1986/1987–2005/2006.
Figure 2.6
The dangers faced in crossing Buford Highway point to upstream issues.
Figure 2.7
Communities can be segregated by pricing as well as location.
Chapter 3: Can the Built Environment Build Community?
Figure 3.1
Traditional roofing tiles on a California mission.
Figure 3.2
Strolling in a public square in Italy.
Figure 3.3
Children lost the opportunity to roam in only four generations.
Figure 3.4
The purpose of public health is to reduce the effort required from an individual to overcome health burdens.
Figure 3.5
Runoff is directly proportional to surface material porosity.
Chapter 4: From Monoculture to Human Culture
Figure 4.1
One of the structures in the Belmar district of Lakewood, Colorado.
Figure 4.2
Bird’s-eye view of a suburban neighborhood with cul de sacs.
Figure 4.3
Wide sidewalks, recessed parking, landscaping, single-lane traffic, and bicycle parking support Belmar’s focus on the pedestrian.
Chapter 5: Using New Urbanism Principles to Build Community
Figure 5.1
Suburban sprawl.
Figure 5.2
A New Urbanism community.
Figure 5.3
Homes at Prairie Crossing reflect both residents’ new interests and their ancestral architecture.
Chapter 6: Saving America’s Downtowns and Local History Through the Political Process
Figure 6.1
Population growth in the Charleston Metropolitan Statistical Area (MSA), 2000–2009.
Figure 6.2
Two-way streets allow involvement with the life of the city.
Figure 6.3
A parking structure that pedestrians may not immediately recognize as a car park.
Chapter 7: Reinventing a Healthy City Through Community Leadership for Sustainability
Figure 7.1
Weight gain is a national problem.
Figure 7.2
The home of the Elgin National Watch Company in the 1950s.
Figure 7.3
The three-legged stool: the pillars of sustainability must remain in balance.
Figure 7.4
Diabetes hospitalization 2002–2008: rate per 100,000 population.
Figure 7.5
Adult overweight and obesity 2002–2008: percentage of adult population.
Chapter 8: Ending Car Captivity
Figure 8.1
Walking is one way to reduce child and adult obesity.
Figure 8.2
Cyclists in Boulder use a combination of on- and off-street routes.
Figure 8.3
Marni Ratzel at the 13th Street bike lane.
Figure 8.4
The Boulder Creek Path is a major bicycling artery.
Chapter 9: Ports as Partners in Health
Figure 9.1
The Port of Oakland is one of the busiest gateways for goods in the northern hemisphere.
Figure 9.2
Death from all causes: selected counties and California: age-adjusted rates, 1998–2000 average.
Figure 9.3
Life expectancy at birth: Oakland Flats and Hills, 2001–2005.
Figure 9.4
Average diesel particulate emissions per person, by region.
Figure 9.5
Asthma and race in Oakland.
Figure 9.6
Adult cigarette consumption: California versus the rest of the United States, 1984–2004.
Figure 9.7
Lung cancer incidence: California versus the rest of the United States, 1988–2003.
Chapter 10: The City That Won’t Give Up
Figure 10.1
Sheps Barber & Beauty Shop is a shining beacon on an otherwise blighted street.
Figure 10.2
Eastern Market grows some food locally and sells it in a thriving farmers’ market.
Figure 10.3
Campus Martius Park has transformed its part of the city.
Chapter 11: What’s Happening in Your Community?
Figure 11.1
The change from natural land to urban core happens across a continuum of density. Where is your community on this continuum?
Figure 11.2
Huge roads don’t work well for the number of cars we have and don’t work at all for nondrivers, so what are we doing building more of them?
Chapter 12: Who Are the Players?
Figure 12.1
Richard Jackson leading a class discussion at UCLA.
Figure 12.2
Counties oversee permits for zoning and road construction.
Chapter 13: Create an Action Plan
Figure 13.1
Installing electric cranes and reducing diesel truck emissions has improved the health of Port of Oakland employees.
Figure 13.2
Small local restaurants are often healthy options and can foster a dynamic and active local social life.
Figure 13.3
Approximate weekly mortality and SO
2
concentrations for Greater London, 1952–1953.
Figure 13.4
The worst traffic jam in the history of the world happened in China in August of 2010.
Figure 13.5
Events like Earth Day are excellent opportunities to get your message out and increase your visibility.
Figure 13.6
Evaluation in PACE-EH—13-Task Process.
Epilogue
Figure E.1
A Walk Score is one of the tools for determining the desirability of a location.
Portfolio
Plate 1 The United States
Since 1985, the fastest moving and most pervasive chronic disease infiltrating America is obesity. From 15 to 30 percent of the people in each of our states suffer from overweight, and our nation as a whole pays the health care cost burdens.
Plate 2 The Belmar district in Lakewood, CO
Healthy communities create places like Belmar Plaza, where people meet, relax, and enjoy the beauty that surrounds them.
Plate 3 Englewood, CO
Connecting Englewood with the established communities of Denver to the north and Littleton to the south, light rail gives people a public transportation choice and reduces traffic on the main north-south roads.
Plate 4 The Belmar district in Lakewood, CO
When they live in proximity to where they work and play, people interact more, building community.
Plate 5 Prairie Crossing, IL
When people work together and learn from each other, friendships as well as food grow.
Plate 6
Prairie Crossing, IL
Through specific choices, Prairie Crossing was designed to maintain 60 percent of its land protected from development.
Plate 7 Prairie Crossing, IL
A learning farm associated with the Prairie Crossing school was incorporated into the community design to keep people connected to the land.
Plate 8 Charleston, SC
Housing built by the government, like this Rainbow Row development, can be attractive and should fit in with the surrounding architecture so residents feel they are a welcome part of the community.
Plate 9
Charleston, SC
Access to the waterfront is a gift Mayor Joseph Riley gave the people of Charleston. This unique decision in redeveloping the city encourages people to walk and to enjoy the beauty that surrounds them.
Plate 10 Charleston, SC
Parks that provide shade and places to walk, sit, and gather become places for people to take exercise and to connect with their neighbors.
Plate 11 Elgin, IL
Walton Island, in the middle of the rejuvenated Fox River, is a popular site for events.
Plate 12 Elgin, IL
In rejuvenating its community, Elgin chose to protect and restore its historical architecture.
Plate 13 Elgin, IL
The fountain in Elgin’s new Festival Park attracts children, who play in the water for hours. Once a superfund site, the park is a destination where families gather to enjoy music and picnics.
Plate 14 Boulder, CO
Pedestrian-only streets, with shade and places for people to relax, encourage healthy choices and build community.
Plate 15 Boulder, CO
Boulder uses a combination of on- and off-street bike paths to encourage bicycling as a safe transportation choice.
Plate 16 Oakland, CA
One of the busiest ports in the United States, Oakland is making efforts to minimize emissions that affect the air quality and the health of the surrounding community.
Plate 17 Oakland, CA
Multiple freeways have bifurcated Oakland and increased traffic in West Oakland; vehicle emissions are affecting the air quality and the overall health of those who live in proximity to these roads.
Plate 18 Oakland, CA
This new development was built in proximity to the West Oakland BART (Bay Area Rapid Transit) station to give residents easy access to public transportation.
Plate 19 Detroit, MI
An unfixed broken window can encourage further vandalism, leading to an abandoned building, and eventually a blighted community as people leave in search of work and welfare.
Plate 20 Detroit, MI
Urban gardening repurposes blighted land into a source of healthy eating, and the bonds that grow between neighbors as they garden together are even more valuable.
Plate 21 Detroit, MI
The Eastern Market, once a rail terminus for transporting goods through Detroit, has become a hub of local economic growth and a destination for local small businesses.
Plate 22 Atlanta, GA
Planned communities, once thought to be a haven from urban strife, isolate both the young and the old because they cannot drive themselves and so have limited access to markets, school facilities, and friends.
Plate 23 Atlanta, GA
Once a symbol of industrialization, the Beltline now links communities through walking and bicycle paths, connecting people and encouraging healthy choices.
Plate 24 Atlanta, GA
When the anchor store of a mall closes due to changes in the economy or population decline, communities must decide how they will repurpose the land.
Plate 25 Los Angeles, CA
The neighborhood coffee shop is an integral part of a community; people can meet for conversation and take a break from the pace of their day to enjoy the local surroundings.
Plate 26 Los Angeles, CA
The automobile has become a symbol of Los Angeles. The highways act as arteries, moving cars throughout the city, but now they routinely become clogged, as they were never designed to handle the number of people who have flocked to this sunny, seaside community.
Plate 27 New York City, N
Frederick Law Olmsted knew that for a city to be healthy, its people needed places where they could walk and enjoy fresh air. The best of such places, such as Central Park in New York City, have become iconic to their communities.
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DESIGNING HEALTHY COMMUNITIES
RICHARD J. JACKSON
WITH STACY SINCLAIR
FOREWORD BY ANTHONY ITON
Copyright © 2012 by John Wiley & Sons, Inc. All rights reserved.
Published by Jossey-Bass
A Wiley Imprint
989 Market Street, San Francisco, CA 94103-1741—www.josseybass.com
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at www.wiley.com/go/permissions.
Readers should be aware that Internet Web sites offered as citations and/or sources for further information may have changed or disappeared between the time this was written and when it is read.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Jossey-Bass books and products are available through most bookstores. To contact Jossey-Bass directly call our Customer Care Department within the U.S. at 800-956-7739, outside the U.S. at 317-572-3986, or fax 317-572-4002.
Jossey-Bass also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Library of Congress Cataloging-in-Publication Data
Jackson, Richard J., 1945–
Designing healthy communities/Richard J. Jackson with Stacy Sinclair.—1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-118-03366-1 (cloth); ISBN 978-1-118-12981-4 (ebk.); ISBN 978-1-118-12982-1 (ebk.); ISBN 978-1-118-12983-8 (ebk.)
1. Sustainable urban development—United States. 2. City planning—Environmental aspects—United States. 3. Distributive justice—United States. I. Sinclair, Stacy. II. Title.
HC110.E5J33 2012
307.1’20973—dc23
2011025367
FOREWORD
In a startling article in the New England Journal of Medicine in 2005, researchers predicted that life expectancy in the United States would decline early in this century, primarily due to the obesity epidemic. In 2007, researchers attributed a regional stagnation and decline in life expectancy in the Southeastern United States to obesity and related chronic disease risk factors. And now, just last week, for the first time in twenty-five years, the Centers for Disease Control and Prevention reported an actual decline in overall U.S. life expectancy. Although this decline may or may not represent the beginning of a new downward trend, one thing is for sure . . . Dr. Dick Jackson warned us.
Thirty years ago many of us thought nothing of frying up a half pound of bacon for the family breakfast. Today most of us wouldn’t even think of doing that, given what we now know about risk factors for cardiovascular disease. However, most Americans live in cities and suburbs designed decades ago, before we knew the potential health consequences of these designs. Our car-focused community design has facilitated a burgeoning obesity epidemic. In their seminal book, Urban Sprawl and Public Health, Dick Jackson and his coauthors remind us that the “modern America of obesity, inactivity, depression, and loss of community has not ‘happened’ to us. We legislated, subsidized, and planned it this way.” Dick Jackson has become a public health evangelist, traveling the countryside, imploring us to look at the profound correlations between obesity and urban design and how our “vehicle miles traveled” have escalated exponentially just in order to navigate our pedestrian unfriendly, obesogenic (obesity-producing) neighborhoods. He highlights how our children are particularly vulnerable to these new environments. Like a true public health detective, Dick Jackson has been putting the puzzle together for us. We ignore his message at our peril.
Dick Jackson is unusual for a scientist. He is accessible. While his research is rigorously methodical, analytical, and detailed, his presentation is inspiring, humorous, philosophical, and often poetic. He leaves us hopeful and motivated to rise to the challenge of reimagining and redesigning our communities. He is also courageous, and at many points in his career Dick has chosen the difficult route of speaking truth to power, despite clear personal and professional consequences. For that he has earned enormous respect in the rank-and-file public health community and has received accolades and awards culminating in the Presidential Distinguished Service Award, awarded to individuals by the president of the United States for achievements “so outstanding” that the individual “is deserving of greater public recognition than that which can be accorded by the head of the department or agency in which he is employed.”
At The California Endowment we seek to promote fundamental improvements in the health status of all Californians. We recognize that the twenty-first-century public health challenges of obesity, chronic disease, and profound health inequity are not simple medical challenges but implicate community design, public policy, and the very political process itself. Given this understanding, we have embarked on a ten-year, fourteen-community initiative called Building Healthy Communities (BHC). This name is in part a tribute to the insights of public health visionaries like Dick Jackson, who have shown us that we have to literally rebuild and redesign our communities in order to achieve the kinds of environments that will allow us to live in harmony with our human health needs.
Anthony Iton, MD, MPH, JD
Senior Vice President, Building Healthy Communities
The California Endowment
PREFACE
THE PERFECT STORM
The United States is confronting a “perfect storm,” one where three powerful threats are converging to create near-catastrophic conditions. The first threat is social: an aging population and a hurricane of chronic diseases. The second threat is environmental, with challenges ranging from the microscopic to the global, including resource depletion and global heating. And the third is economic, particularly the struggles of middle-class and working people in a stagnant and staggered economic system.
The health and social storm is formidable. Sixty-eight percent of Americans over age twenty are overweight or obese, and obesity in U.S. children and adolescents has tripled in just over a generation. One in three American children is overweight. These changes raise the risks of heart disease, stroke, and many other illnesses, and especially, an epidemic of diabetes. Becoming severely obese (body mass index greater than 35) increases the risk of diabetes 40-fold for a man and nearly 100-fold for a woman. Developing diabetes before the age of forty shortens life expectancy by nearly fifteen years, and diminishes the quality of life by twenty years. If current trends are not reversed, this could be the first generation of American children to have shorter life spans than their parents.
Not only is the obesity epidemic prematurely aging our population but we also seem to be enjoying our lives less. In the last ten years, antidepressants have become the second most prescribed medication in the United States, and the percentage of the population, including children, receiving them has doubled. And we, especially our children, are becoming increasingly unfit. Nearly three-quarters of our high school students are unable to pass simple fitness exams. Regular physical activity in natural settings is beneficial for children, yet more and more children confront environments generally hostile to walking, bicycling, and independent play. Many young teens live in isolated housing developments and, being unable to drive, have no access to shops, community centers, and public transportation—their community. This isolation puts them (and also adults who cannot drive) at increased risk of boredom and depression.
Of all the interventions that could counter these epidemics, none works as well as increased physical activity, particularly when carried out in contact with nature. Yet if we continue to design and build America in ways that are hostile to walkers and bicyclists—creating an America without parks and without safe routes for walking or biking to destinations such as schools and workplaces—we are unlikely to see better physical and mental health.
The environmental storm is equally formidable. In 1950, the greenhouse gas carbon dioxide was at a level of 305 parts per million; by 2011, this number had increased to 391 parts per million. This change has been accompanied by increasing acidity in the oceans, glacial melting, sea level rise, and global heating. About one-seventh of the carbon dioxide retention in our atmosphere is due to loss of trees and vegetation; the remainder is due to the burning of fossil fuels. Doctors know that a patient who retains too much carbon dioxide is in trouble. All signs tell us it is also bad for our planet globally. At the same time, resource extraction has become more difficult, expensive, and destructive. For example, a century ago a small team of men could drill an oil well. Today oil wells require a huge infrastructure and investment. And in that same span of time the global population has grown from 2 billion to 7 billion.
The economic storm is the third tempest making up our perfect storm. Americans’ real income doubled between 1950 and 1980, but since that time, real income has “flat-lined” for all but the top 20 percent of the population. After-tax income for the top 20 percent has improved and for the top 1 percent it has doubled. The income gap grows ever wider. Millions of the jobs Americans once relied on are no longer available, and trillions of U.S. dollars are now being held by other nations. Although tax and other strategies seek to end this dolorous situation, little change can be expected when close to $200 billion a year is being used to buy foreign oil. At the same time, Americans spend proportionally more of their income on transportation than any other population in the world. How and where we build our dwellings drastically affects what we spend and how we live. We remain servants of the automobile.
BUILDING HEALTHY COMMUNITIES
I have come to realize that those of us who work in environmental health have focused too much on“parts per million” and “parts per billion” and on remote places, and have neglected the origin of environmental health—namely, that people’s health is profoundly shaped by their immediate environments, the places and things we as communities build, and where we house people. How and what we now build is being determined by financial and social policies, outmoded housing codes, and car-loving design principles that have long undervalued the needs of the poor, the young, and those who do not or cannot drive, and that, as is now becoming apparent, are also failing to produce an environment that meets the needs of everyone else as well.
We as a species are very adaptable to the environment in which we find ourselves. In the United States, we have designed and constructed a car-centric environment and adapted our lives to it. In making this adaptation we have often overlooked the dangerous health, social, environmental, and economic consequences that come with it. But as human beings we are also able to shape our environment. We need to start thinking about communities that work for all of us, young and old; communities that support those who walk, bike, or drive; communities that don’t demand that we own a car or burn large amounts of fossil fuels; communities that create good, local, and meaningful jobs, for example, in artisanal production, high-quality construction, urban farming, solar power adaptation, teaching, and service.
Our urban design, especially the buildings and roads we make and maintain, can give people access to the places that help them fill their life needs, including food, shelter, work, and health care—or take it away. This human-made environment, or built environment, is at the core of environmental health. This idea was obvious to everyone in the nineteenth century, a time when nearly everyone knew someone with tuberculosis and nearly every family had lost a child to a diarrheal illness.
Public health has traditionally associated the built environment with systems that address such issues as sanitation, water and air quality, pest control, lead paint poisoning in children, workplace safety, fire codes, toxic sites, and access for persons with disabilities. These issues are important, but they do not tell the whole story. We now realize that how we design the built environment may hold tremendous potential for addressing—and it is to be hoped, preventing—many of the nation’s current public health concerns. And, as an urgently needed by-product, better design may reduce health care costs, allowing us to divert those savings to redressing the equally challenging imbalances in the quality of education in our country.
Our environment is everything around us. If an embryo makes it to birth, the environment influences that person’s health even more than his or her genetic makeup. That environment is physical, social, nutritional, economic, and behavioral. The built environment, the physical one that we humans make, comprises our houses and workplaces, streets and water systems, parks and play areas. Even on the water we are in human-made craft. Most of us spend 99 percent of our time in the built environment and only rarely can we experience wilderness. How we design, and what we then build, create, and destroy, has profound impacts on our health. This is obvious when we think about drinking water or sewer systems or strong, stable buildings and safe roadways, but the built environment is shaping our health in equally profound though less apparent ways. It determines where we can live, work, visit, walk, run, shop, worship, and play.
Health is defined as a state of complete physical and mental well-being. We cannot have physical well-being in dark, damp buildings or on dangerous streets. Most of us cannot have mental well-being without human and nature contact and supportive environments. I often think that a healthy community is not unlike a computer: it must have highly functional software and hardware, the operating system as well as the computer chips. A highly functional community must have its software—systems for education, justice, an economy, and human support—as well as its hardware—homes, workplaces, roads, and more. No community can function long if it lacks either a social or a built environment. The best communities offer both. In the words of Charleston mayor Joseph Riley, “what you need to do is make sure that the place in which you live, and your people live, is as nice as the places they would dream about visiting.”
For a community to be healthy, it must have both functional social systems and functional built environments. In fact, the built environment becomes social policy in concrete, literally. A city that provides good transit in its poorer areas is enacting a social policy (a good one in my opinion). A contrasting social policy is made concrete when a city demolishes low-income housing to build a sports stadium with forty acres of parking that is to be used ten times a year, mostly by wealthier suburbanites. A city that fails to build complete streets—streets that accommodate all users, including walkers and bicyclists—is enacting a policy that fails to serve the third of the population that does not drive. Cities that create quality urban centers that nurture culture, diversity, exercise, and farmers’ markets are exerting a social policy as well, a healthy one. What we build is not enough in itself to create a healthy environment, but it is an essential and critical element of that environment.
ABOUT THIS BOOK
This book is intended for those of us who are concerned about our communities and the world we are giving our children. As I explain more fully later, it is a companion to the public television series Designing Healthy Communities, but it can also be used alone. It is not a textbook for a course on the built environment and health but is intended instead to help community members with understanding their current built environment and recognizing a range of possibilities for changing it. Specialists in public health, architecture, and urban planning increasingly recognize the links between health and built environment, and the public and its leaders are now beginning to catch on as well, but they need to effectively push for the healthy changes we all need.
Part One of this book is devoted to the software of a healthy built environment. The chapters in this part describe the characteristics of healthy communities and look at why caring, love, and caritas are important elements in these communities. Our caring—for ourselves and our community and for future generations—must shape what we build. We need to put not only social policy into concrete; we also need to put our caring into concrete. Our current nonsustainable way of building and of depleting resources and our profligate use of energy are a form of generational child abuse. It is remarkable to me that people who would not dream of taking a loaf of bread away from a hungry child seem unaware of the generational abuse inherent in paving over fine farmland, leveling forests, and destroying the planet’s thin atmospheric cover. So in the first part of this book, we will think about the linking of caring to health in our communities.
Part Two examines communities that are working to transform themselves into healthful physical environments. In Belmar, a development near Denver, Colorado, a dead shopping mall has been retrofitted to create a lively downtown with housing, retail, and recreation, and that area is linked via transit to Denver itself. In Prairie Crossing, Illinois, a subdivision has been created with a view toward sustaining maximum green space, local organic agriculture, and a strong social network for the people living there. An old city that has revitalized itself, Charleston, South Carolina, was fortunate enough to escape the post–World War II destruction other cities experienced from “urban renewal” centered on automobile driving, and has redeveloped a lively, charming, diverse, and economically viable downtown. I reflect on the importance of political leadership in bringing about this creation. In discussing Boulder, Colorado, I talk about the vision of this city that values physical activity and has committed itself to active transportation, particularly walking and biking. In Elgin, Illinois, a drive toward sustainability is revitalizing this former one-industry town that came on hard times; this effort is coming both from city leaders and from the base, namely high school students led by a charismatic teacher named Deb Perryman. In Oakland, California, a port city that faces the world as a point of international trade, residents have suffered degraded air quality and disease increases and have not shared in the benefits of the port. And the last chapter in Part Two looks at Detroit (Motor City), the home of automobile-dependent America, which is confronting twenty-first-century realities of loss of industry, depopulation, and poverty, and asks what we can learn from urban homesteaders and local agriculture.
Part Three of this book investigates ways in which the average citizen can have a voice and can help to take charge of the future of his or her community and the world we all are giving to our children.
In preparing this book and the public television series, several colleagues and I conducted many interviews, mostly in the communities discussed in Part Two. Unless otherwise indicated, comments quoted here made by individuals who live in these communities and a few others are taken from these interviews, carried out by me and by Harry Wiland, Dale Bell, and Stacy Sinclair, in 2009 and 2010. These interviews provide an essential element of both the book and series.
Throughout, I provide photographs and figures to illustrate and supplement the discussion. In the Portfolio, in the center of the book, you will find a number of color photographs from the locations my team and I visited during the filming of the public television series. The plates show both scenes of desolation delineating the pathology of the built environment gone wrong and best practice examples of what is possible with proper planning and execution. At the end of the book, you will find the notes and an index.
THE TELEVISION SERIES
As I have mentioned, this book is a companion to the upcoming special public television series Designing Healthy Communities. Produced and directed by the Media Policy Center in Santa Monica, California, the series describes, in depth, how the design of the built environment affects our health, with an additional emphasis on inequities related to that design and on the need for social and environmental justice. In this series I explore how the built environment has contributed to the fact that two-thirds of Americans are overweight; seventy million are obese, including many of our most vulnerable children; and many individuals suffer from an array of other chronic but preventable diseases, including type 2 diabetes, high blood pressure, asthma, heart disease, and depression. These diseases cost billions of dollars annually as we try to treat them. The series looks upstream at the root causes of our malaise and highlights best practices that can be put into action and are based on the efforts of real people with compelling solutions.1
The television series offers insights on our challenges and examines how our focus on building our country to meet the needs of cars and not of people, and especially not of our children, has undermined our health, wealth, and communities. At the same time, this project seeks to identify hope and options in the face of these challenges. Just as we must be mindful of the world we are giving our children, so too should we be alert to the gifts our children are offering to us. Over and over again in making this series and in my teaching, I have been struck by the resilience, optimism, and energy of young people. The revitalization of our communities and our nation can come from our children, if we are wise enough to listen.
Many people and organizations now recognize how the existing built environment is harming public health and needs to be redesigned or retrofitted to reflect new information: for example, that toxic, contaminated air is a factor in asthma; that having insufficient sidewalks, bike paths, and parks is a factor in obesity; that a lack of access to fresh food and farmers’ markets is a factor in diabetes; and so forth. I am convinced that the struggles and triumphs of concerned community activists, politicians, socially responsible businesses, and ordinary citizens presented in this book will engage, encourage, and inspire you to action, wherever you live, work, study, or play.
It is possible to weather a perfect storm, but not in poorly built structures, whether social or physical. A good solution solves multiple problems. A good solution to our social, health, environmental, and economic challenges is to design and build places that allow us to meet our life needs well, and to be with the people we love as much as we can, and to spend only as much time in cars as we really want to. We need to focus on this now, because even with the best will in the world, it won’t happen overnight. Moreover, it won’t happen at all unless we decide we want to give our children a better and more health-giving world.
ACKNOWLEDGMENTS
This book, along with the accompanying public television series, was instigated by the many people who have told me that its message—that the environments we build can greatly help, or profoundly harm, our health and happiness—needed to be more widely heard.
I need to first acknowledge the creativity, social awareness, support, and provocation of Harry Wiland and Dale Bell, who have been powerful tugs pulling and pushing this work along; the patience and diligence of the brilliant film editor, producer, and writer Beverly Baroff; and the research, diligence, camera work, and artistry of Jonathan Bell, Charla Barker, Teresa Chang, Scott Izen, Aaron Kemp, Adil Khanna, Alan Mabry, Troy Mathews, Karen Ng, Ruben Rajkowski, David Rosenstein, Sari Thayer, Brianna Tyson, and all the energetic staff of the Media Policy Center. I also most profoundly thank Stacy Sinclair for working with me on this book. She was superb in taking a mass of facts, insights, places, people, and stories, and organizing them into a logical and provocative structure. Her diligence and discipline, humor, and knowledge, especially in the area of education, educated and assisted me enormously. I now also see why she skippers a large sailboat in heavy seas so well.
My intellectual mates in the built environment and health voyage have been led by public health physicians Howard Frumkin, now of the University of Washington, and Andrew Dannenberg, both formerly of the Centers for Disease Control and Prevention (CDC) and both remarkable leaders—brilliant, disciplined, and patient. I am grateful for the work of so many in the planning field, especially Lawrence Frank at the University of British Columbia, as well as my health and planning colleagues at the University of California, Los Angeles, and the University of California, Berkeley.
The reviewers and editors who reviewed my manuscript and provided me with valuable suggestions and constructive criticism were Parris Glendening, Leslie Meehan, Preston Schiller, and R. K. Stewart. I thank them for both their time and their feedback.
This work was first launched thanks to a seed grant from the board of directors of the American Institute of Architects. Essential to the provisioning of this voyage have been the Kresge Foundation, the California Endowment, the Kellogg Foundation, the Gifford Foundation, the Marisla Foundation, Kaiser Permanente, and the Robert Wood Johnson Foundation.
My colleagues at the CDC, the California Department of Public Health, UC Berkeley, and UCLA have been a huge help and an inspiration, and I thank them. I am especially grateful to my wonderful students. There are too many to name, but I must especially acknowledge Rachel Cushing, Heather Kuiper, Lisa Martin, Marlon Maus, Kyra Naumoff, Mathew Palmer, Tamanna Rahman, June Tester, and Andrew Tsiu.
My wife, Joan, and sons, Devin, Galen, and Brendan and his bride, Cheryl, are the anchors and tell-tales in my life, as are my six brothers and sisters and their families, and of course our patiently strong, red-haired mother, who gave me the gift of life, of insight, and of gratitude.
Los Angeles, California Richard J. Jackson
July 2011
1
For more information about designing healthy communities and the public television series, please visit the Media Policy Center’s Web sites
http://www.designinghealthycommunities.org
and
http://www.mediapolicycenter.org
.
THE AUTHOR
Richard J. Jackson is professor and chair of the Department of Environmental Health Sciences at the School of Public Health at the University of California, Los Angeles. He has also served in many leadership medical positions with the California Department of Public Health, including the highest, state health officer. For nine years he was director of the Centers for Disease Control and Prevention’s National Center for Environmental Health, in Atlanta.
His work in California led to the establishment of the California Birth Defects Monitoring Program and state and national laws that reduced risks, especially to farmworkers and children, from pesticides. At the Centers for Disease Control and Prevention (CDC) he established the national asthma epidemiology and control program, the environmental health tracking program, and built environment and health activities, and advanced the Childhood Lead Poisoning Prevention Program. He instituted the current federal effort to biomonitor chemical levels in the U.S. population. Jackson was the U.S. lead for government efforts around health and the environment in Russia under the Gore-Chernomyrdin efforts, including radiation threats. In the late 1990s, he was the CDC leader in establishing the U.S. National Pharmaceutical Stockpile to prepare for terrorism and other disasters—which was activated on September 11, 2001. He has received numerous awards, including the Breast Cancer Fund’s Hero Award and the UC Berkeley School of Public Health’s Distinguished Teacher and Mentor of the Year award. He has received lifetime achievement awards from New Partners for Smart Growth, Making Cities Livable, and the Public Health Law Association.
Jackson is a coauthor of Urban Sprawl and Public Health (with Howard Frumkin and Lawrence Frank, 2004) and is the host of an upcoming public television special on public spaces and public health, and coeditor of the follow-up textbook. He has testified before the U.S. Congress and the California legislature. He has served on many health and environment boards, numerous Institute of Medicine efforts, and the board of directors of the American Institute of Architects. He received his MD degree from the University of California, San Francisco, and did his pediatric training there as well, and his master of public health (MPH) degree, in epidemiology, at the University of California, Berkeley. He is board certified in pediatrics and in preventive medicine.
He is married to Joan Guilford, and they have three sons—the oldest recently became a physician epidemiologist at the CDC, the second is in public service work, and the third is in the arts, especially film, in Northern California.
To Robert Jackson, whose short life took me to public health; to Dorothy, whose humanity took me to medicine; to Joan, who gives me love and insight; and to Brendan, Devin, and Galen, who inspire me
PROLOGUEWHY I CARE ABOUT THE BUILT ENVIRONMENT
A few years ago I was on a morning radio talk show and the host challenged me. “You work for the government? You must be lazy or stupid or corrupt,” he said. I responded, “No, I am none of those. I am a physician, a pediatrician, and I picked the career of public health to make a difference, to embrace life’s challenges, not to control people’s lives, but to assure conditions where people can be healthy.”
As a public health officer, I use every tool I have learned in my training—medicine, pediatrics, epidemiology, statistics, toxicology, and psychiatry—but the most important tool I use is communication, in order to share information that is technically competent but also compassionate and honest. How we use our words, our lexicon, is important. Doctors call the tracking of disease surveillance, though that word has a very different meaning to the FBI. Development means child fulfillment to pediatricians, but to the State Department it means nation building. So in this book I am communicating ideas, and I hope the words I use are tools of health.
This book is intended to communicate some of the public health challenges that arise from our built environment, to help others see what I see, so we can all play a part in designing healthier communities for our children and grandchildren.
The built environment is everything we have made in order to live our lives. It is our homes, places of business, public spaces, and parks and recreational areas—or the lack thereof. It extends to electric transmission lines, waste disposal facilities, and transit pathways that keep us moving, communicating, and functioning. Every building and designed space we see was at one time a sketch in someone’s imagination, and at some point a decision was made to build solely a functional structure or one that functions while it inspires.
The Golden Gate Bridge, in my opinion the most beautiful large bridge in the United States, was built at about the same time as the Empire State Building in New York City. The Grand Coulee Dam on the Columbia River was open by the beginning of World War II, irrigating the Northwest and bringing water and electrical power to war efforts. The theme here is capturing our culture in concrete. These iconic structures were created during an economic downturn, when labor and materials, including concrete, were less expensive and people needed work. The government put people to work creating not only functional structures but also magnificent gifts to our grandchildren and future generations.
The United States and other civilizations must work not just for the economy but also for people in communities that are stressed and in need of support. If we are going to make changes, we ought to be creating spaces that work for our health, the economy, and the planet—places that are of the heart. When we look around our communities, what we see are the choices people made in the past manifested as the communities in which we live now. We can choose to keep the parts that work for us and to change what does not.
We have paved over 60,000 square miles of the United States, an area the size of Georgia. We have gotten rid of trees and we have created impervious surfaces, with the result that rainwater and melting snow run off the streets and into concrete sluices rather than percolating into the soil to nourish and cool the planet. Then we buy bottled water because we are made to think that we do not like our local drinking water. We have more cars in the United States than we do licensed drivers. No wonder the parking lots and streets feel so congested—and we build this landscape at a cost.
I believe that how and where we build affects people’s health. To build communities that are good for people will require new partnerships and new thinking. Children have value intrinsic to the gift that they are. Today’s children deserve a planet at least as healthy, beautiful, and biodiverse as the one we received from our parents and grandparents.
In nature, everything is fascinating. Ecosystems are remarkably biodiverse yet stable and produce little waste. In an ecosystem, something is always consuming something else. There is a balance of old and young, big and small, with immense functional variety. A forest can sit on a patch of land for 80,000 years and the land will be richer for it, unlike what Western civilization has done to the land. Biological systems can digest sugars and proteins—all kinds of natural products. It was not until we began bonding large amounts of organic molecules to elements like chorine, fluorine, and bromine that molecules that could not be readily degraded in natural systems became pervasive in the biosphere, that is, in all the living things around us. These molecules, which have health effects, concentrate in the bodies of animals and humans, with the human infant at the top of a bioconcentrating food chain. Through our habits and practices, we humans are creating the next great mass extinction of species, comparable to the earth being hit by an asteroid. Nature does not tolerate dysfunctional systems for very long. Thanks to the astonishing molecule DNA, biological systems change and do so much faster than we once thought; indeed, evolutionists have been stunned to realize how quickly change happens. We are learning that our current exposures affect our own DNA and, in turn, these changes will affect not only us but also the generations who follow. As we look at our own communities, we must ask whether we are leaving the next generation a gift or a staggering burden.
GROWING UP
Children learn about the world around them through experience, and the primary providers of that experience are their parents and the other adults in the community. When I was little and lived in Portland, Maine, my father was an air traffic controller. When he took me for a walk he would say, “Stay close to me. There are bears in these woods.” I remember picking blueberries and bringing back a bucketful. Maybe that is where I began to make the connection between love and belonging with the natural world and the connection between food and joy.
My father flew P-40 and P-51 fighter planes in the South Pacific during World War II (Figure P.1). He crashed at least once and survived a massacre while at Iwo Jima. He married the love of his life at twenty-two, my mother. After the war they had three sons in three years. I was the oldest son, named after my father’s brother, a landing ship tank (LST) skipper stationed in the South Pacific.
Figure P.1 Robert “Bobby” Jackson and his P-51 Mustang in Iwo Jima, September 1945.
Source: Photograph from the Jackson Family.
On August 19, 1949, when I was three, polio stopped my father’s breathing after two days of illness. After the funeral, when I still had no idea what death was, my grandmother told me, “You’re the man of the family now. You have to take care of your mother and your brothers.” That message has been a gift and burden.
Growing up I was a good reader, and I studied yearbooks, magazines, and pictures, especially pictures of my father. These images had a profound impression on me, and I stored the insights, memorable comments, and Irish family jokes of the people around me. I still remember when I was six, after my grandmother died, my mother saying, “the veil over the future is held by the angel of mercy.” She tried to help me worry less about the future so I could focus on fulfilling the present.
My widowed mother remarried when I was eight years old, and then had four more children. The nine of us lived in a three-bedroom, one-bathroom house in Nutley, New Jersey. My stepdad struggled with poor health and was intermittently out of work. There just never seemed to be enough food in the house, especially with five boys, and we would go and get USDA surplus milk powder, macaroni, and other foods to help stretch our family’s food budget. Dinner was a verbal free-for-all. There were many meals we barely could finish because we were laughing so much at the stories our youngest sister, Kathleen, would tell.
I joined the Jesuit seminary Saint Andrew-on-Hudson, in Poughkeepsie, New York, at age eighteen. I planned to be a priest. When I entered the seminary I weighed 132 pounds, and I must have gained a dozen pounds in the first two weeks I was there. I was delighted to eat whatever was put in front of me, and I did not mind that we ate in silence for many of the meals. My young Jesuit friends stunned me. No subject would come up, not a year in history, a thought leader, or a political event, on which someone at our table did not have a remarkably deep knowledge and the ability to provide commentary.
For two years I prayed five hours a day, lived mostly in silence, spoke in Latin, and learned the Jesuit life and the insights of Greek, Roman, Catholic, and modern philosophers. I also learned about Henry David Thoreau and read his book Walden about five times in two years. He spoke right to my core as he observed the beauty of the natural world. The Jesuits used to say age quod agis—“do what you are doing”—but I became restless. The seminary was intellectually stimulating, but it certainly did not meet all my needs as a young man. I left the seminary, completed a range of college science courses compressed into two years, and ended up in medical school in San Francisco.
PRACTICING MEDICINE
I loved the Bay Area, Yosemite, and Point Reyes. The city, the mountains, hiking, music, the bay, and the wonderful quality of life in San Francisco transfixed me. I married a beautiful woman, and I became a pediatrician. I graduated medical school in 1973 and completed my internship (I used to call it my internment as the hours were so long) and residency at the University of California, San Francisco, and San Francisco General Hospital.
During my residency I soon realized that to doctors a patient is defined by data—the statistics and lab results. To me the data are only a part of the picture. When I was working at the San Francisco VA Hospital, I got to know and like an old veteran who talked a lot about World War I. I had grown up with stories about WWII and had not heard these earlier stories. Sixty years after the war, he would still have nightmares about being gassed, and his stories moved me. One day I had to present his case to the attending internist, and of course no one wanted to know his fascinating stories. He was a case to be solved, not a person to know. He died after I had known him for a few weeks, and being an ex-seminarian, I wanted to go to his funeral. I was told, “doctors don’t do that,” with the clear message that I was not going to amount to much of one.
When I was in my third month of internship in pediatrics, a delightful fifteen-year-old girl came in for chemotherapy for leukemia. She was a very lively and bright girl, who had taught herself American Sign Language so she and her friends could gossip at school soundlessly during class. I was glad to see her on morning and evening rounds. She seemed to be in stable health when I left on Saturday, but when I returned on Monday, I learned she had died. I was instructed to go to the morgue in the basement to observe the autopsy. Though I had known all along that she would eventually die of leukemia, I learned that she had died more directly from the chemotherapy we gave her.
I remember going home feeling very low and realizing that there are no safety nets for emotions in medicine. There is an ugly saying in medicine that “you learn the most from the patients you kill.” No one makes mistakes on purpose, but as horrible as it sounds, doctors do learn from each case. I was doing what I was told and administering the medications according to protocol, but this experience taught me about myself, and my limits. I stuck with my residency but surprised myself at the end when I told my favorite and most supportive cardiology professor, “Dr. S., I am not going to do an infectious disease fellowship. I’m going to do public health.” He sat back in his chair and sighed. “Where did we fail?” he asked. I loved medicine, but I was also very intuitive, social minded, and political. I realized I could do more good in public health than I could seeing one patient after another. I also think that my medical school professors did not fail.
LEAVING TRADITIONAL MEDICINE
There is a long tradition of service to our country in my family. My great-great-grandfather served in the Union Army throughout the Civil War. His father was an officer in the War of 1812 and his uncles had served during the American Revolutionary War. My father and uncle served in World War II. My brother Jim became a Marine and served sixteen months near the Ho Chi Minh Trail in Vietnam during some of the worst fighting. At the same time, my brother Bill served in the Air Force. I was deferred from service until 1975, when I served in the U.S. Public Health Service, as does my son Brendan now.
I went to the Center for Disease Control (CDC), as the agency was then known, and was assigned as an epidemiologist to the State of New York. It was an amazing experience. I was working at least one epidemic per week, with terrific staff, and I never knew what was going to happen next. The most remarkable case was a cluster of hundreds of school children with severe bellyaches and fevers leading to sixteen appendectomies. We discovered that the cause of illness was the production procedure used by the dairy supplying the school. The dairy was adding chocolate syrup to already pasteurized milk under unsanitary conditions. When we stopped the chocolate milk supply to the school, the epidemic stopped. The bacteria that caused the illness, Yersinia enterocolitica, grew beautifully in sugary, alkaline, cold solutions, such as refrigerated chocolate milk.
