Designing Healthy Communities E-Book

Richard J. Jackson

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 566

Veröffentlichungsjahr: 2011

Beschreibung

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/

Leseprobe

Contents

Foreword

Preface

The Author

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

Copyright © 2012 by John Wiley & Sons, Inc. All rights reserved.

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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

PROLOGUE

WHY 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.