The Impact of the Built Environment on Public Health

August 31, 2010 · by Betsy del Monte and Gary Lawrence

Americans are fatter than ever. How much can good design accomplish toward a slimming down of the population?

An individual’s general health is a function of several factors, including nutrition, environmental toxicity, exercise, and heredity. One of the major indicators of poor health is obesity. The Centers for Disease Control and Prevention has noted a dramatic increase in obesity in the United States in the past 20 years. In 2008, 32 states had a prevalence of obesity of 25 percent or more; six of these states had a prevalence of 30 percent or more. As a nation, we are increasingly fat and unhealthy.

The environments we build for ourselves cannot control all the factors that affect health, but they can have a huge impact on some of them. The A/E/C industry has worked hard the past several years to stop the incidence of sick buildings by putting an end to new structures that poison their occupants with toxic materials, mold, or poor air quality. The current emphasis on sustainability carefully measures volatile organic compounds and formaldehyde; carbon dioxide monitors are commonly installed, and air exchange rates are monitored.

But when it comes to assembling structures into a sustainable community, those efforts are only partly successful. Every new building from now on could conform to the LEED Platinum standard without necessarily addressing the real issues that affect community health. These issues are the focus of LEED ND, which is by no means widely used.

We bemoan the increase of American obesity but can’t seem to get at the root causes. The easy availability of nutrition-free food items along with their enhanced attractiveness due to branding and advertising is a major concern. But along with too many calories being consumed is the issue of too few being expended. Americans — children and adults alike — often have few opportunities to get physical exercise in an average day. How is our built environment contributing?

Issues at Every Scale

At the city scale. In most development projects in the United States, owners’ considerations focus on two issues: leasable area and available parking. Projects are often designed around car access. The infrastructure of roads is similarly designed to get vehicles as rapidly as possible from one discrete environment to another. The separated land uses and low density of typical sprawling development, often leapfrogging to distant green fields, offers no chance for connectivity between neighborhoods.
In only the densest U.S. cities can a resident live comfortably without owning a car; families often own one per driver. Few American cities beyond the largest 20 have any rapid rail, and not all of those do. Once a city’s residents are car-dependent, the concept of walkability tends to be forgotten. Acres of surface parking or stacks of structured parking are then deemed a necessary evil.

In the United States, the average commute time is more than an hour each day. The length of commuting time continues to grow: There has been a 250 percent increase in miles traveled in the past two decades. Without a change in this trend, our built environments will become less and less walkable.

At the neighborhood scale. Parking requirements teamed with setbacks put a field of asphalt at the street edge of most retail areas. A lack of sidewalks makes walking unsafe or uncomfortable. In residential areas, minimum lot sizes and deep setbacks keep neighbors separated and pulled away from the streets that connect them. In gated communities and cul-de-sac developments, connections to the city fabric are disrupted or outright prevented. The effect is the dissolution of any kind of pedestrian access.

Imagine a child whose grandparents live in the next gated community down the road. This situation necessitates that an adult drive the child out of the protected neighborhood onto a major traffic collector then into the secured community of the grandparents. This child cannot walk to visit grandparents (or friends) even in a safe neighborhood less than a quarter mile away.

At the project scale. In today’s projects, the basic issues of air quality, access to daylight and views, non-toxic materials, and accessibility for all users are more commonly well understood and are being emphasized. However, the more subtle issues of programmatic planning and shaping of built environments that have an impact on occupant health are not typically drivers of design change.

Seldom are the levels of non-residential buildings connected via visible, accessible, and attractive stairs, forcing occupants to use elevators for traveling even one or two floors. The only stairs, required for exiting, are likely to be tucked into the core and locked at the ground-level access point.

Buildings and their surrounding sites are planned and designed to favor car and service vehicle access, often to the extent of prohibiting pedestrian access. The required parking extends in an asphalt apron on all sides, discouraging a walkable connection to any neighboring sites and disallowing any real connection to outdoor areas.

Connections between buildings are also designed to maximize convenience, which often minimizes walking distance. Skybridges or tunnels are designed to connect building to garage or one building to another instead of to streets. Besides reducing the walking distance, this decreases the likelihood of walking to other destinations on the way in or out. This has the cumulative effect of making city streets less inviting by reducing the pedestrian count.

The Wrong Mold

In many cases the ideal walkable environment is illegal. It can be achieved only by violating zoning, setbacks, density and height limitations, street width requirements, and landscape and screening ordinances. To build the preferred design requires variances and special permits that take time and money to procure, often involving contentious public hearings.

How did we get to a point where our policies prevent a healthy environment? The impetus behind most land development policies was the encouragement of economic development and the facilitation of traffic flow. Few development policies from the past several decades have been written to favor a pedestrian environment; although there are places where that is now happening. (See the sidebar “The Transformation of Curitiba.)

The policies that states, regions, and cities have put into place, ostensibly to preserve the health, welfare, and economic stability of their residents, have locked development into the wrong mold. The intended and unintended consequences of these policies are numerous — and often detrimental.

Zoning policies typically restrict uses to separate areas, guaranteeing that even if two uses share an edge, the occupants of one use (say, housing) will not have a walkable connection to the other uses (jobs, shops) and must drive. It is often easier to get a permit for a wall that separates than a building that combines.

Even policies seemingly dictated by safety can end up endangering citizens. Each time fire trucks get larger and faster, a bigger turning radius is required. The resulting streets become too wide, fast, and dangerous for young pedestrians as well as older walkers. The unsafe streets cause a desire for separation, and walls or screens are constructed, furthering the disconnection. Schools, which used to be community centers and that could be reached by students on foot, are relegated to town edges where cars and school buses can easily drive. It is unsafe for children to walk to school.

Other policies, such as limits on density or minimums for lot size, mean that a growing community must consume greater areas of land, and infrastructure must be extended. These policies, typically implemented with the goal of preserving property values, may actually detract from neighborhood quality by creating unintended separateness.

More cities are beginning to understand that a walkable community is not just healthier for residents but for the city’s own economic health as well. A walkable city center is an economically viable one. If shops and services of all types are available, then local residents will spend their dollars there rather than driving to regional malls. An economically viable city must manage its growth to support the viability of different building types, scales, and densities.

Needed Change

If our environments are causing unhealthy residents, and if our policies are shaping those environments, what can we do? Policies for development will change only when pressure exists from users. It is commonly thought that residents of established neighborhoods resist efforts for change. While most residents would not say they favor sprawl, preconceived notions of what higher density would mean creates a hesitancy to pursue mixed-use or compact developments.

Does the design community have a responsibility to build the case to planners, clients, and society that healthier, more equitable, and more civil societies should be the new measure of success? How can we do this?

• Be selective of projects. It seems an absurd thought to architects (many of whom are currently un- or under-employed) that they would be able to choose which projects to work on when they are often glad to have work of any type. Even in good times, it’s hard for an architect to turn down work. But obviously, an architecture firm is not likely to be asked to work on a project that the firm does not seek, whether it is a hospital or a prison, a data center or a strip retail center, a hotel or a home. As architects seek and accept commissions for building types or specific projects, they must be aware of the greater effect on the environment and community that the building or project type will have. This is not to suggest that certain building types be boycotted but that the acceptance of the commission comes with responsibilities of awareness impact.

• Educate clients. Closely linked with the notion of project selection, the necessity of educating the client is a responsibility that must fall to the architect. Through the design approach they use, architects, planners, and site designers can maximize connection to a surrounding neighborhood, giving emphasis to pedestrians over vehicles.

By creating and presenting project designs within the framework of enhancing health, equity, and civility, architects can help clients understand the greater contribution that an individual project (their project) can make. Nearly every building is built for a purpose other than its own presence. It is built to house a process of some sort: educating students, healing patients, providing habitat. Through conversations and presentations, architects can allow clients to see that the ability to perform these processes may be enhanced by increased connection to the surrounding community, allowing for better health of the occupants within.

Activism and Advocacy

Architects and planners are uniquely educated, trained, and experienced to understand the linkages between the built environment and community health, equity, and civility; therefore, they are uniquely obligated to participate in designing a community that responds to those linkages. Such a community will be realized only through a combination of enlightened clients and inspired designers as well as through regulations that require — or at least do not prevent — such communities.

It is not necessary to become a politician to impact a city’s developmental policies. Savvy politicians know they cannot be experts in all the issues they must deal with; they rely on trusted experts. It’s all too seldom that architects and planners are placed in this role. Because of this, the financial and purely business aspects of decisions affecting the environment are often given disproportionate weight.

In his book Leadership by Design: Creating an Architecture of Trust, Richard N. Swett, writes, “It is important to remind our communities and the profession that it was the politics and relationships of many of the great architects that laid the foundations of their fantastic design accomplishments. It has always been the design leaders’ involvement in the community that has created and expanded the opportunity to build a better society.”

Architects must take a stand when such issues are discussed, whether at public hearings or behind the scenes. Policy makers need to understand the greater impact that the built environment has and the ripple effect of building non-walkable communities that discourage connections between residents. Architects need to work with the city’s planners and policy makers, and if possible, become the planners and policy makers.

Getting Results

What mechanisms work to redesign a city to enhance health? Mixing uses and increasing density can help create a safe walking environment, maintain economic growth, and address changing demographics. But for some residents, increasing density brings the fear of increased crime, traffic, noise, air pollution, water use, and trash.

While some of these impacts can be pinned to higher density urban environments, the increased resource use by a greater population is actually reduced when resources are more efficiently delivered to higher numbers in a smaller area. Compact areas mean fewer miles traveled, leading to fewer cars, less road construction, greater utilization of mass transit, and therefore less pollution from individual vehicles.

Smarter environments help maximize the community’s investment in infrastructure while reducing resource use and impact on the environment. Waste collection and recycling can be more efficient and effective. Besides allowing greater pedestrian access, preserving natural areas encourages outdoor exploration and recreational exercise.

In 2001, Richard J. Jackson, M.D., and Chris Kochtitzky of the Centers for Disease Control and Prevention published the report “Creating A Healthy Environment: The Impact of the Built Environment on Public Health.” They noted:

The challenge facing those with responsibility for assuring the health and quality of life of Americans is clear. We must integrate our concepts of “public health issues” with “urban planning issues.” Urban planners, engineers, and architects must begin to see that they have a critical role in public health. Similarly, public health professionals need to appreciate that the built environment influences public health as much as vaccines or water quality.

A study of comparative neighborhoods published in the American Journal of Public Health in 2003 showed that residents in a connected, walkable neighborhood averaged 70 minutes more physical activity per week than residents in a non-connected neighborhood. This exercise was primarily mid-level exertion (most likely walking) even though the residents of the non-connected neighborhood reported more recreational opportunities (such and hiking and biking trails). Importantly, the residents of the walkable community were much less likely to be overweight than those of the non-walkable community: 35 percent vs. 60 percent.

A 2006 study published in the Journal of the American Planning Association provided research into the level of improvement that could be demonstrated between neighborhoods. This study measured aspects of communities that contribute to walkability such as net residential density, street connectivity, land use mix, and retail floor area ratio.

The results showed that even small improvements helped. With a 5 percent increase in walkability, the average time spent in physically active travel increased by 32 percent. The additional effects were 6.5 percent fewer vehicle miles traveled, meaning 5.6 percent fewer grams of nitrous oxides and 5.5 percent fewer grams of emitted volatile organic compounds.

California’s Safe Routes to School legislation provided funds for construction projects such as sidewalks, traffic lights, pedestrian crossing improvements, and bicycle paths. An evaluation of the program’s effectiveness published in the American Journal of Preventive Medicine showed that 15 percent of children walked or biked to school more often where the projects were done, versus 4 percent where no projects were done. The results were deemed to support the effectiveness of these projects in increasing walking or bicycling to school for children.

Role of Architects

How do practicing professionals contribute to a community that is economically vibrant, connected, and healthy for inhabitants? As the economy recovers, some developer will purchase heavily treed land further out of town for a new corporate office building, which will require new roads, new utilities, and surface parking for the occupants who will have no choice but to drive to the building. Construction will provide jobs to the local community, and the company within will provide local employment. This could be a firm-saving commission for a struggling architect. Where does our responsibility lie?

The only answer is to strike a balance. We will continue to consume resources as our populations grow and relocate to desirable locations. We must accommodate growth and rehabilitate the areas left behind.

As design professionals, we are obligated to incorporate this understanding into each project we accept. Where development is beneficial, providing opportunities, we need to minimize the resources used and maximize the results. By collaborating with community leaders and helping establish workable, comprehensive plans for our own towns and cities, we can make a difference in how those communities are shaped. We must then educate clients about the importance of following these plans. We can contribute, project by project, to the goal of a walkable, human-scaled community that offers access to places to live, work, and play with safety and dignity for all residents.

It will take the highest design skills of our profession to be up to the challenge.

Related content

Intentional Collaboration in Asheville

Betsy del Monte is director of sustainability and a principal at Beck, an integrated architecture and construction firm. She serves as adjunct faculty at the Lyle School of Engineering at Southern Methodist University, where she teaches graduate courses in sustainability. She has spoken at national conferences on the subjects of green construction and sustainable building design. Del Monte received degrees in architecture from the University of Virginia and Rice University. She is a senior fellow of the Design Futures Council.

Gary Lawrence is vice president and chief sustainability officer, corporate division, at AECOM. He is an internationally recognized expert on urban strategies and sustainable development with more than 20 years’ experience assisting public-sector, private-sector and non-governmental organizations with research, analysis, strategic planning, and implementation toward the integration of sustainable development and risk management in urban development. He is a senior fellow of the Design Futures Council.

Post Comment

Building a Global Design Practice

Oct 15, 2014 · by Ken Sanders & Meredith Ludlow

How Gensler maintains quality, culture while expanding globally Read full »

What Clients Value: An Interview with David Crowell

Oct 2, 2014 · by Bob Fisher

The client perspective on design and what makes firms successful Read full »

Opening a New Office: A Case for Restraint

Sep 18, 2014 · by Riccardo Mascia

Weighing the risks and rewards of expanding into new markets Read full »

Richard Tomlinson: Career Retrospective

Sep 3, 2014 · by Richard F. Tomlinson II

A partner from SOM shares lessons from a storied and prolific career Read full »

The Owners Dilemma

Winning Work Isn't About Who You Know, But Who Knows You

The Transformation of Curitiba

Sometimes the simple, low-tech, low-cost solution is best. A good example is the impact of some unorthodox solutions offered by Jaime Lerner, mayor of Curitiba, Brazil. Like many cities, Curitiba is bordered by floodplain. Instead of building expensive and difficult-to-maintain levee systems, Lerner’s idea was for Curitiba to purchase the floodplain and create parks. The city now ranks among the world leaders in per capita park area.

Lerner also led Curitiba to great achievement in mass transit. The city received federal money to build a subway but then discovered it would cost 10 times the amount of light rail (trolleys), which in turn cost much more than buses. Although buses are the cheapest alternative, they require many more drivers per passenger and take longer to load and unload. By using high-capacity articulated buses, Curitiba could reduce the passenger-to-driver ratio. Transit stops were built with the look and utility of train platforms, allowing fast loading. Because the buses could travel on all city streets, cars were given only limited access, clearing the streets for the frequent bus routes and maintaining a more walkable downtown. In the end, Lerner convinced private firms to purchase and operate the buses, providing a profitable and efficient solution for the city.

Topics

DI.net RSS Feeds

DI.net on Twitter

Research Support