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Better Health Through Community Design

The case for building better places to walk and bike

At 6:10 every weekday morning, Jean O’Callaghan, 69, and her friend Donna Johnson, 63, leave their condo building in downtown Decatur, Ga., and head out for a walk. They stop after a block to pick up Bob Biebel, 59, and his Labrador retriever, Duncan, then wind their way through downtown and a nearby neighborhood before finishing up at the local Chick-fil-A. There, they’re joined for coffee by two other women, now in their 80s, who have walked four blocks to meet them.

For O’Callaghan, whose husband’s health is failing, this chance to get out on foot has become a cherished ritual. It has made all members of the group “happier people—we’re not sitting home by ourselves,” O’Callaghan says. “And Decatur is such a pedestrian-friendly city that you get to know people right up and down the street. Your mental health and your physical health are so much better when you’re out exercising.”

Decatur is not a big place—just four square miles perched on Atlanta’s eastern flank—but even so, it did not always invite people to get outside and move around. With a dying downtown and—typical of metropolitan Atlanta—streets given over entirely to cars, “it was not pedestrian-friendly 20 years ago,” says O’Callaghan.

The city has changed dramatically. Its transformation began in 1982 when Decatur pegged its economic revitalization to selling itself as a community where you can easily move between home and work or leisure activities by foot and public transit. The city improved its sidewalks, lined streets with trees, installed brick crosswalks—and enforced the state stop-for-pedestrians laws. Restaurants, stores, offices and condos began filling downtown, making it a popular destination for walkers.

In 2005, the city pushed further. Nudged by a city commissioner and planning director, Decatur embraced the notion that it should promote “active living,” making it as easy as possible for residents to weave bicycling, walking and other physical activity into their daily lives. The city created a transportation plan that explicitly put residents’ health at the forefront. Among other things, it mandated a “complete streets” policy that called for incorporating features for pedestrians and bicyclists, even at the inconvenience of cars. And it used a health impact assessment, much like an environmental impact statement, to gauge the public-health consequences of the policies and projects it was considering.

Going national

This community appeal to pedestrians and bicyclists is precisely what the U.S. Centers for Disease Control and Prevention had in mind in a recent report urging those responsible for shaping cities and towns to “expand awareness of the health impact of community design decisions.” The report summarizes a workshop for 20 architects, planners, builders, health officials and others convened last September by the Healthy Community Design Initiative of the CDC, which is based in Atlanta.

The CDC might seem an odd federal agency to be concerned about how communities design their streets and sidewalks. But about a decade ago, three physicians—Richard Jackson, M.D., who at the time ran its National Center for Environmental Health; Howard Frumkin, M.D., who was then at Emory University and is now at the CDC; and Andrew Dannenberg, M.D., now the associate director for science at the National Center for Environmental Health—began sharing notes on their belief that toxins and microbes were not the only threats to human health.

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.”

Two-way street

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.

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