Better Health Through Community Design

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.