Health and Community Design
The Impact of the Built Environment on Physical Activity
Lawrence D. Frank, Peter O. Engelke, Thomas L. Schmid, Health and Community Design: The Impact of the Built Environment on Physical Activity, Island Press, Washington, 2003, 253 pp.
Health and Community Design lays some of the essential groundwork for the growing field of health and the built environment. Increasingly, Americans live in urban and suburban areas that are not natural environments in the sense usually associated with wilderness, John Muir and the Sierra Club, or Aldo Leopold's land ethic.
When we think environment, we tend to think of rivers, forests, mountains, mega fauna like grizzlies and wolves, or perhaps, at least, rolling, rural countryside with a few foxes. Forget it. With a US population that shifted from mostly rural to mostly urban during the twentieth century and that about doubled in my lifetime, most Americans, especially younger ones, take as given huge interstate highways, vast urban sprawl, and daily life that centers on commuting and driving for the simplest of daily routines -- at the mall, the movies, munching or making a meal. The result? A landscape designed for cars (more properly SUVs and vans), declining physical activity, and burgeoning obesity, beltlines as well as beltways.
Frank, Engelke, and Schmid provide a useful corrective to the idea that diminished landscapes, rotting core cities, and interminable traffic jams just happened and are here to stay. Or that obesity results from a lack of willpower or wayward parenting. Instead, in a classic public health interdisciplinary approach based on CDC funded research and other scholarly sources, they dissect just how our current "environment" came to be through a series of policy, design, economic, public health and social choices. They then document the enormous health consequences associated with auto-centered design, inactivity and obesity, and what steps will be needed to begin the vast redesign and rebuilding project that is sure to occupy much of this and the next generation's resources, imagination, and political will.
One of the key points in this short book is that recent authoritative health studies now indicate that Americans can be fit and lead healthier, happier, longer lives simply by keeping at sustained, moderate physical activity like walking or bicycling and building it into their daily routine. Sure, runners, rowers, rappelers and rippling specimens of rigorous and vigorous exercise will still be with us and win gold medals and glamour. But such feats are beyond most modern urbanites. Simply setting out by foot or bike (been passed by cyclists or walkers when you're in the morning commute as I have?) is often enough. This paradigm shift, announced by the Surgeon General in the1996 report Physical Activity and Health, should be reducing guilt for millions of Americans whose Nordic tracks and gym memberships are gathering dust. It also means that the establishment of bike and pedestrian trails and routes, of redesigned, interesting, livable urban areas more like those in Europe, and other changes in urban and suburban design can have a significant positive effect on the health of Americans.
These points are established with a nice opening section that traces how early public health reforms and ideas designed to combat tuberculosis and other contagious diseases a century ago led ultimately to the American ideal of the leafy suburb, and finally to exurban sprawl. Next comes an important section that reviews and explains the literature of what design elements deter or promote walking and cycling and how and why these things are good for you.
One of the most interesting sections focuses on research on how and why children, the poor, and the elderly - important vulnerable groups in need of greater physical activity - are especially deterred from activity in their daily lives. They often share common characteristics: entrapment in areas hemmed in by huge roads or highways; dependency upon transit that is limited in scope, does not access jobs, recreational facilities or greenways; and higher rates of pedestrian accidents and fatalities.
The authors then review road design, land use, and other features of the built environment to show how certain patterns actually promote physical activity while others like the now familiar outer suburban subdivisions with cul de sacs and no nearby amenities, reduce it. Throughout these sections there are often useful contrasts to European patterns, especially in the Netherlands and Germany, that show marked improvement in exercise and health with redesigned bike and pedestrian routes, easily connected and useful transit systems and neighborhoods that integrate residences, stores, and shops with interesting building features, street designs and sight lines.
There is, overall, a strong case made here for renewed urban and suburban design, including interesting pedestrian friendly streets, bikeways, and connected communities where people actually go outside and get around on their own power without burning up fossil fuels.
Unfortunately, Health and Community Design suffers too often from dulling scholarly, sociological and public health prose for such an exciting subject. There is a lack of affective, compelling anecdote or narrative, too few real people, and insufficient attention to how citizens already have and can continue to influence and create the necessary policy changes. There are brief references to groups like the Rails-to-Trails Conservancy and to the environmental enhancements fought for and made possible by political struggle over transportation policy such as ISTEA and, more recently, successful bi-partisan Congressional battles to beat back efforts by the Bush Administration to gut appropriations for environmental enhancements before final reauthorization of the Transportation Equity Act for the 21st Century known as TEA-21.
That said, Health and Community Design still deserves an important place on your bookshelf and frequent reference to its concepts, charts, graphs, data, and footnotes as well. It is a groundbreaking and essential baseline text for what undoubtedly will be an increasingly important and popular field for scholars and activists alike.
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