What does the epidemic of obesity in the U.S. have to do with how communities are designed and built? That was the question at a panel at the ULI Fall Meeting in Denver. In short, panelists said the way we design and build communities can have a big effect on residents’ physical and mental health.
The causes of obesity are clear: people consume to much unhealthy food and don’t exercise enough. Because obesity and other health problems, including asthma, diabetes, and depression, have all been linked to poor neighborhood design, public health professionals have recently turned their attention to issues that have typically been the domain of developers, architects, and planners.Richard Jackson – a physician and chair of Environmental Health Science at the University of California at Los Angeles School of Public Health – said health care expenditures in 2007 represented 16.7 percent of domestic GDP, and are projected to grow to 19 percent of GDP by 2017. In 2010, more than one-third of adults in the U.S. adults (35.7 percent) and almost 17 percent of youths were obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and other health problems.
In 2008, medical costs associated with obesity were estimated at $147 billion. On average, annual medical costs for people who are obese were $1,429 higher than individuals of normal weight. According to Dr. Jackson, the average American has gained 26 pounds in the last 25 years. Jackson and other leading public health officials say that the best antidote to obesity is to build physical activity into one’s daily life, but given the fact that we are a society in which most people have to drive everywhere for everything this is not easy to accomplish.
Dr. Jackson suggested that the path to healthier communities should begin with a health impact assessment (HIA). Doctors routinely advise their patients on ways they can stay healthy. An HIA provides similar advice to communities, which could help local leaders make informed choices about improving public health through community design.
The National Research Council defines an HIA as a ”systematic process that uses an array of data sources and analytic methods as well as input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population.” Health impact assessments also provide recommendations on monitoring and managing these effects. For example, imagine that a city school board proposed consolidating two neighborhood schools into a new, larger school on the edge of town. A health impact assessment could help the school board to understand that by closing the neighborhood schools, fewer children would be able to walk to school. However, an HIA might also make recommendations for minimizing the negative health effects of the new consolidated school, such as constructing new sidewalks or bike trails that would connect to the new school to existing neighborhoods.
Khanh Nguyen, portfolio director for healthy living at the Colorado Health Foundation, told the group that lifestyle has a bigger impact on health than either a person’s biology or environment. This realization led the nonprofit Colorado Health Foundation to create a “Healthy Communities Program” which works with local governments to incorporate health and wellness into local comprehensive plans.
“Your address can play an important role in how long you live and how healthy you are,” Nguyen said. She urged people in the land use field to help make the healthy choice the easy choice by building communities that provide sidewalks, bike paths, parks, trails, open spaces, and fitness facilities.
The panelists also recommended better access to public transportation. In fact, Dr. Jackson said that a study of transit-oriented neighborhoods in Charlotte, North Carolina, found that light rail users weighed on average six pounds less than those who do not use light rail. Transit users typically walk to and from the transit station. “Fitness can add six to eight years to an individual’s lifespan,” he said.
Kimball Crangle, a senior developer with the Denver Housing Authority, described how the organization is using a health impact assessment to help redesign public housing projects in Denver. The goals of this process were to increase physical activity, reduce crime, to provide better access to health care. These goals have manifested themselves in new buildings and redesigned neighborhoods that include such features as daylighted stairwells, pedestrian and bicycle links to nearby parks and transit stations, outdoor play areas for children, indoor bike storage, and bicycle repair stations.
Small changes like these can lead to big changes in health. Citing the American Journal of Preventive Medicine, Crangle said that people who live in neighborhoods with parks, trails, and greenways are twice as healthy as people who live in neighborhoods without such facilities.
Developers, architects, and city planners have a role to play in preventive medicine, according to the panelists. These healthier communities can lead to more profitable real estate developments.
Edward T. McMahon is the Charles Fraser Chair for Sustainable Development and Environmental Policy and a senior resident fellow at ULI.