At the CDC, Jackson was “getting all these things across his desk on toxicology,” recalls Dannenberg, “and then he drives down Atlanta’s highways and says, ‘This is really what’s killing people: roads hostile to bikes and pedestrians, car crashes all over, the fact that we engineer physical activity out of people’s lives by not making it possible to be active—all of these things impact health, and no one’s looking at it!’ ”
Since then, the initiative has served as a seedbed within the federal health establishment for research and ideas on subjects such as how to reverse declines in walking and biking to school, developing model zoning codes that emphasize walking, and creating a primer for local health officials on community planning. Designing communities for bikers and walkers encourages people to leave their cars at home and be more active.
“We know physical activity is good for health,” says Dannenberg. “People who are more active have less heart disease and diabetes. One of the factors in this is giving people places to be active.”
Getting the CDC’s ideas to take a firmer hold among transportation and planning officials and other professionals is a challenge. The consensus at last fall’s workshop held that public health concerns are rarely included in discussions about community design, and when they are, they’re narrowly defined. As one state transportation official put it, “Public health means hazardous materials abatement, worker safety, and dust-dirt management during construction.” It’s notable that members of a new federal Partnership for Sustainable Communities include the departments of Housing and Urban Development and Transportation, along with the Environmental Protection Agency, but not the CDC or its parent Health and Human Services Department.
Still, there are tentative signs of collaboration among people concerned about public health and those involved with community design. The Congress for the New Urbanism, meeting this week in Atlanta, is focusing on “healthy places” with a full cohort of speakers from the CDC. And the Robert Wood Johnson Foundation has just put $7.2 million into a joint effort with the Pew Charitable Trusts to promote community use of health impact assessments.
The road ahead
Back in Decatur, city Commissioner Fred Boykin, who also owns a bicycle shop in town, sees plenty of room for improvement, several years after the city approved its transportation plan. “I commute [by bicycle] on some of the nastiest, busiest streets in the city of Decatur. My daughter, who’s 12, I would never let her get on them,” he says.
He compares the CDC’s efforts to improve health through community design to its efforts to combat infectious disease by constructing municipal sewers and public water systems 100 years ago. “If we fought infectious disease in the 1900s, I don’t see why we shouldn’t be fighting chronic diseases now, especially since they’re a direct result of how communities have been built,” he says. “The health community needs to be involved in that.”
As for the impact of places that promote activity, says Gina Lundberg, M.D., you need look no further than Jean O’Callaghan. Lundberg runs the Heart Center for Women at St. Joseph’s Hospital in Atlanta—and she happens to be Jean O’Callaghan’s daughter. Before O’Callaghan moved downtown nine years ago, Lundberg says, her mom “didn’t do near as much walking as she does now.” O’Callaghan’s father and brother both died in their 40s of heart attacks, a daunting family history that Lundberg believes her mother has counterbalanced with her move downtown. “Her arteries are wide open and clear and wonderful,” says Lundberg. “She’s a lot healthier for her walking.”
Rob Gurwitt lives in Norwich, Vt.