EXTRA CONTENT FEATURE:
Interview with Dr. Howard Frumkin, MD
Dr. Frumkin is Special Assistant to the Director for Climate Change and Health at the Centers for Disease Control & Prevention in Atlanta, Georgia. The following interview is an excerpt from our conversation with Dr. Frumkin during production for Episode #1 of American Makeover.
AM: What is the link between health and how cities and neighborhoods are designed?
FRUMKIN: More and more we're finding evidence that the way places are designed and built has a big impact on the health of people who live, work, play and study in those places. These are public health interventions that may one day rival vaccinations and medications in terms of promoting health. Let me give you some examples: if you design places with a certain amount of density and with mixed land use so that residential, commercial, recreational and other destinations are close to each other with good connectivity, then trip distances are shorter and it becomes practical for people to take those trips by foot or by bicycle rather than by car. That builds physical activity into daily lives and physical activity we know is a very strong attribute for health -- reducing cardiovascular disease, reducing the risk of cancer, reducing the risk of depression -- it has a whole range of positive health effects. Another example: if we build good pedestrian infrastructure -- bicycle paths, sidewalks, either along streets or off streets -- then people can travel by foot or by bicycle safely and that reduces the injury risk. Car crashes are now one of the major causes of death among young people in this country. Another example: if we site schools relatively far from busy roadways then the air quality in those schools is improved and we know that the air pollution from roadways challenges the respiratory health of children, so that’s a good design strategy, these are examples of design strategies that, taken together, both make places livable and make places healthy.
AM: Tell us about the resources that CDC provides for urban planners and designers.
FRUMKIN: Well here at CDC we have been very interested in recent years in the ways in which community design might improve and advance good health. We have a website called "Healthy Places" and it’s at CDC.gov/ healthyplaces and it’s the website of our healthy community design program. This is a program where we look at the built environment from the relatively small scale of buildings to the larger scale of entire metropolitan areas and ask where do we have good evidence -- we are a very evidence based agency -- where do we have good evidence that design decisions can contribute to better health? And we present that information so that members of the public and developers and builders and others can access that information. Our goal here is communities that are designed and built in ways that promote health across the country and across the world.
AM: What diseases should we be concerned about when choosing were to live, or when building new cities or places?
FRUMKIN: Well we have a lot of information about the health benefits of being physically active. After all we have become a relatively sedentary society and regrettably we have had a lot of opportunity to study what happens when people become sedentary, and in relation to sedentary, overweight. So we know that being sedentary and or being overweight increases the risk of a number of diseases. That includes cardiovascular disease, and a number of cancers; mental illness, including depression (physical activities are very good antidepressant); and then a range of other diseases from osteoporosis to gallbladder disease, to many others. So that’s the physical activity piece. Now, how about the links in the chain from knowing about the health benefits of physical activity to knowing about the health benefits of community design. Well, the link is this: if we design communities in ways that allow or encourage people to be more physically active...if we build routine physical activity into people’s daily lives, then we can expect that people will enjoy the health benefits that flow from physical activity. But that’s only part of the story. If people are driving less because they are walking or biking more or using transit, then air quality in a region is improved. We know more and more that both ozone and particulate matter are major hazards to respiratory and cardiovascular health. But that’s not all: we know that being in a car is one of the most dangerous micro-environments we've got. Car crashes are the major cause of death among young people in this country. So we know that getting people out of cars is an act of primary prevention. It helps to reduce the motor vehicle fatality rate. But that’s not all: we know that some community design features encourage people to interact with each other in social ways, such as the traditional plazas and sidewalks and promenades that many cities and towns have had for centuries. We also know that social connectedness is a very important promoter of good health. People live longer and recover from diseases more quickly and develop diseases less if they have good strong social networks of family and friends. So designing communities that allow that to happen is also a public health intervention. So in all of these ways mortality can be reduced, disease risk can be reduced, and good health can be promoted through community design.
AM: How does community design impact different age groups - the young, the elderly, etc.?
FRUMKIN: One of the special thing about community design is that not all of us are equally susceptible to the risks that we are looking to control and not all of us will benefit equally from the advantages that flow from community design; but across the lifespan almost all of us can benefit from good community design. Let’s look at the different groups and how they might respond to healthy community design. Children need the opportunity to be active and independent and safe. Good pedestrian infrastructure, good sidewalks and bicycle trails that are separated from traffic and that are easily navigated are an important asset for children. At the other end of the lifespan, are the elderly. Many elderly people can't drive or shouldn't drive and that means that they will benefit from destinations that are close to where they live and from good pedestrian infrastructure that will help them get from home to the doctor's office or to the library or to the church. People with disabilities may not be able to drive and certainly benefit from good well-markedl, safe pedestrian infrastructure. People who are poor and can't afford to buy cars need to rely on transit and need to rely on pedestrian infrastructure. Putting those attributes in place is an act of social justice because it helps people who are poor to be able to get where they need to go, find economic opportunities, seek healthcare and do the other things they need to do. So for all of these subpopulations in our society and more health community design offers very important benefits.
ABOUT AMERICAN MAKEOVER
American Makeover is a six-episode web series taking you to six cities across America in search of the antidote to suburban sprawl.
Click here to watch our pilot episode about Atlanta, Georgia and the Glenwood Park Neighborhood built by Charles Brewer.
