Dr. Richard Jackson, Professor and Chair of Environment Health Sciences, UCLA, said the built environment in the U.S. was designed in a way that is “fundamentally unhealthy” in a talk at the New America Foundation, a think tank in Washington, D.C. The environment is now making it difficult for people to achieve well-being. It’s getting so bad that this generation growing up may be the first in American history that has “a shorter life span than their parents.” Communities have to be redesigned to “make us all healthier – young or old.”
Host of the new four-hour PBS series Designing Healthy Communities, author of the series’ companion book, and co-author of a more in-depth text book, Dr. Jackson knows what he’s talking about. Primary care doctors, he said, are now inundated with young, overweight, depressed patients. These kids are sent to weight loss programs, told not to watch TV, and drink less soda, but they can’t really lose any weight because “they have no place to walk.” So, “two months later” they are loaded up medications to deal with their weight, anxiety, depression at a cost of about $400 a month. This is the part the medical community is missing: “These are environmentally-induced diseases. The environment is rigged against kids, doctors, communities.”
Now, 18 percent of the U.S. economy goes to healthcare, which is more than the country spends on defense. Among developed countries, the U.S. now ranks 47th in terms of average life span. Meanwhile, Costa Rica, whose population has about the same life span as the U.S., spends seven times less per person than the U.S. While the U.S. life span rates have improved (30 years has been added over the past 110 years), only “five years can be attributed to the work of doctors.” The rest of the gains come from immunizations and “infrastructure” that helped defeat diseases like tuberculosis.
These days, the challenge is chronic disease caused by our shared environment: asthma, obesity, diabetes, along with mental disorders like anxiety and depression. Jackson, who (amazingly) lives in Los Angeles without a car, said “people are now appendages to their cars” so it’s no wonder these diseases have skyrocketed. People are isolated and communities are broken, largely because people now have car-centric lifestyles and there are no longer any real community spaces in the average suburban subdivision. The result: “Antidepressants have increased 400 percent over 20 years.” Jackson thinks this number shows how the power of community to undo depression has itself been totally undone. “For thousands of years, community has gotten us through depression. Unfortunately, we’ve unravelled our communities.” Jackson also said what landscape architects have always known: getting out and walking in green spaces is about as effective as antidepressants (that is, if people can get to them).
Dealing with diabetes now takes up 2 percent of the GDP of the country given that in many states almost 10 percent of the population has the disease. By 2050, that number is expected to grow to more than 20 percent. Obesity is another, well, big problem: In comparison with past generations, the average American is now 25 pounds heavier and the average kid, 14 pounds heavier. In some states, 30 percent of the population is severely obese. The problem is particularly depressing with kids, but, again, one can point directly at the built environment as a primary cause of the weight gain. “One generation ago, 2/3 of kids walked or biked to school. Now, it’s 1 in 8.” On top of that, the country subsidizes soy and corn products to be used in highly processed foods, but doesn’t do the same for fruits and vegetables. “In fact, if everyone at the surgeon general’s daily recommended amount of fruits and vegetables, the country would run out in three days. We just don’t have the produce available. This is why it’s so expensive.”
Jackson believes that every school should have a garden and every community should have a farmer’s market. Walkable green spaces should be used to fight mental health issues. Kids should live in walkable, bikeable areas so they can further their own “autonomous development.” Moving up in scale, cities can create active design guidelines like New York City has, and states can even incorporate healthy community designs into their planning efforts.
These health arguments are more powerful than the wonkier ones related to transportation financing or economic development, said Christopher Leinberger, a professor at the University of Michigan, smart growth developer, and writer for The Atlantic. Still, he thought it was odd that “public health people and nurses get these ideas,” but doctors still don’t.
While many doctors need to be brought around, many communities may be realizing they can affect change on their own, and put pressure on elected officials and planners to do things differently. AARP certainly thinks so. The organization, said Amy Levner, who manages their mobility programs, is now focused on supporting local activists in improving quality of life for those over 50. Now active in the Complete Streets Coalition, AARP is financing “pedestrian audits” that help figure out the obstacles that prevent people from walking. For this group, one of the most powerful in D.C., it’s about improving quality of life for older people who are “past their driving years.” But what’s good for those older folks will be good for all.
Shannon Brownlee, Health program director, New America Foundation, said siloed policies have meant that policymakers haven’t realized all the end costs of their decisions. For example, subsidizing unhealthy foods just passes the costs onto people and the healthcare system. “We don’t think of the costs to health – on the other end.” Indeed, according to Leinberger, the problem just continues at the federal level. Few on Capitol Hill are thinking of the health or economic costs of the transportation bills now being considered, which simply push forward the same old model: 80 percent of funding for highways, and 20 percent for “alternative” transportation. Leinberger said that “alternative” financing, which sounds like something marginal, devious, actually covers “all transportation networks in cities,” things like pedestrian and bicycle infrastructure.
In the Senate, which is a “rural body” even though it’s run by Democrats, “most still refer to this as the highway bill.” Leinberger didn’t seem to be hoping for much, just that “transit-oriented development and mixed-use development is made legal. Currently, it’s illegal.” He also rang a hopeful tone by saying that the market will eventually succeed over dysfunctional Washington.
This is because there’s a 40-200 percent premium for walkable, well-designed communities. “The market desperately wants this. There’s 30 years of pent-up demand.” He said some 56 percent of the U.S. wants to live in these communities but maybe only 20 percent actually do. So even though the new transportation bill is actually “going the wrong way” by incentivizing more highways, the market will eventually “get what it wants,” overcoming any obstacles the federal government puts in the way.
See more of Dr. Jackson on PBS and check out his new books: Designing Healthy Communities and Making Healthy Places (also see a review of the 2nd book).
Also, see ASLA’s resources on healthy and livable community design, including an animation explaining how landscape architects help undo the damages of car-centric environments: Designing for Active Living: