Thanks to anthrax, our new national hobgoblin, the federal
Centers for Disease Control have been in the news a lot these
days. Yet a report released by the CDC late in 2001 on a very
different public health menace—urban sprawl—has gone largely
According to the striking findings of the report, “Creating
a Healthy Environment: The Impact of the Built Environment on
Public Health,” unless you are U.S. Senate Majority Leader Tom
Daschle, sprawl almost certainly poses a far greater threat
to your health than bioterrorism. To wit:
* Tailpipe emissions cause or exacerbate respiratory problems,
* Long distances and poor civic design virtually mandate driving
rather than walking or biking, thereby contributing to obesity.
* Runoff from paved areas, especially parking lots, threatens
our water quality.
* Multilane roads, high speed limits and lack of sidewalks
result in pedestrian and cyclist fatalities.
* Long commutes and traffic snarls induce that popular Everyman’s
At first glance, these conclusions are so self-evident as
to be almost frustrating. Why spend time and money to establish
what is intuitive to anyone who stops to think about it? So
walking and biking, clean air and clean water are good for our
health. This is news?
But if the report’s conclusions are sometimes obvious, the
statistics behind them are arresting. In Europe, up to 129,000
adults die each year from long-term exposure to vehicle-generated
pollution. The annual health-related cost of such pollution
is roughly $23.8 billion for Austria, France and Switzerland
Back in this country, smog was responsible for more than 6
million asthma attacks in 1997, including 159,000 emergency
room visits and 53,000 hospitalizations. Meanwhile, as many
as 300,000 people die from obesity-related illnesses each year,
and the health care costs of obesity and low physical activity
were estimated at $100 billion in 1995. Oddly, although Americans
make fewer than 6 percent of their trips on foot, 13 percent
of all traffic fatalities are pedestrians. It is one thing to
acknowledge that sprawl is bad for our health. It is quite another
to realize that it is costing billions of dollars and claiming
drastically more lives than all the incidents of terrorism in
modern history combined.
So why do we live this way? The CDC report suggests one plausible
answer: Urban planners have strayed increasingly far from the
public-health roots of their field. “It is time,” the authors
write, “for the planning community to remember that in the beginning,
many, if not most, land-use decisions were made to separate
people from land uses and industrial processes that posed a
threat to their health or safety.”
Our sanitation systems, our street patterns, our building codes
and materials have all been shaped by health threats: cholera,
yellow fever, industrial waste, fire, earthquakes. But some
of the most pressing contemporary health concerns in the United
States—heart disease, cancer, diabetes, obesity, asthma, depression—are
all too often dismissed by planners as irrelevant. To correct
the problem, the CDC report calls for “coalitions between doctors,
nurses and public health professionals and others such as architects,
builders, planners, and transportation officials.” A great idea.
But what about the rest of us?
Any massive shift in urban design will, by definition, involve
millions of people making different kinds of choices about how
and where they live. As a nation, we have shown time and again
that we are capable of doing just that. In the last half-century
alone, vast numbers of Americans have grasped the health risks
of smoking and stopped doing so, creating a nonsmoking culture
in the process. We have learned to use seatbelts almost reflexively.
We have dramatically reduced incidents of drinking and driving.
In what may be the most apt analogy, we have learned to recycle
and agreed that the time it takes to sort our trash is a worthwhile
investment in our planet.
Anyone who thinks these innovations are insignificant should
visit a country where they do not yet exist and propose implementing
them. The initial resistance will be massive, as it was here.
Likewise, any effort to redefine the urban American landscape
will be difficult—but it will not be impossible. Our cities
and towns are the stronghold of democracy. They change when
Right now—with our nation at war, our way of life under scrutiny,
and part of one of our greatest cities lying in ruin—is precisely
the right time to redesign our national landscape. The tragedies
of Sept. 11 sparked quick action in the public and private sectors,
an unusual capacity to think big and a neighborliness that spans
thousands of miles. We need to capitalize on all of those forces
as we try to imagine how America will rebuild in the aftermath
of the attacks. We need to remember that problems are not more
grave because they are more novel; that crises we inflict on
ourselves are not more threatening than those that originate
outside our borders; that needless sickness and death are not
any less heartbreaking when they are less newsworthy; that public
works are not less appropriate when they are directed less toward
long-term planning than immediate emergencies.
If what we are really after is “homeland security,” then we
need to begin exactly there: with our homes, with our land.
Printed in the February/March 2002 Newsletter