Moving in the City: A Promise For Better Health

Written by Sven Eberlein

The current healthcare debate has highlighted many problems with the U.S. healthcare system, such as escalating costs, insurance industry profits, denial of coverage for pre-existing conditions, and the fact that almost 50 million Americans are uninsured. While a private for-profit health insurance system that has run amok needs to be addressed in the form of a public insurance option, or better yet, universal health care, our long-term healthcare debate must also include some of the underlying causes of a society that finds itself in worse overall health with each passing year.

When we talk about healthcare we usually think of the interaction between patient and doctor when the patient is sick. However, we often fail to acknowledge that healthcare starts long before this meeting. According to a recent report in Archives of Internal Medicine, four healthy lifestyle factors—never smoking, maintaining a healthy weight, exercising regularly and following a healthy diet—together appear to be associated with as much as an 80% reduction in the risk of developing the most common and deadly chronic diseases.

What’s truly stunning about this number is that, smoking habits aside, these factors are heavily dependent on collective structural decisions we have made about how to live together and move around. It is true that a person can choose to join a health club and work off the extra pounds from sitting idle in their office and car all day. But how did we ever arrive at a situation where little to none of our daily activities involve that most basic of human functions, moving our bodies?

We’ve become accustomed to quick fixes and simple explanations for everything in our sound bite driven modern world. If you’re hurting, here’s a pill; if your arteries are clogged, we’ll give you a bypass. The wonders of technology have enabled us to treat the symptom but ignore the cause. Connecting urban sprawl and city design with public health and the escalating costs of our healthcare system may not be obvious at first sight, but it has become a popular topic among public health officials for good reason.

Several recent studies show just what a toll car-centric lifestyles have taken on the American population.

A study entitled Relationship Between Urban Sprawl and Physical Activity, Obesity, and Morbidity published in the American Journal of Health Promotion found this: “People living in counties marked by sprawling development are likely to walk less and weigh more than people who live in less sprawling counties. In addition, people in more sprawling counties are more likely to suffer from hypertension (high blood pressure). Physical inactivity and being overweight are factors in over 200,000 premature deaths each year. Meanwhile, rising health care costs are threatening state budgets. Getting decision makers to consider how the billions spent on transportation and development can make communities more walkable and bikeable is one avenue to improving the health and quality of life of millions of Americans.”

Another study of nearly 11,000 people in the Atlanta area found that people living in highly residential areas tend to weigh significantly more than those in places where homes and businesses are close together. The effect appeared to be largely the result of the amount of time people spend driving or walking. Each hour spent in a car was associated with a 6 percent increase in the likelihood of obesity and each half-mile walked per day reduced those odds by nearly 5 percent, the researchers found.

“The kind of neighborhood where a person lives clearly has an effect on their health,” said Lawrence D. Frank, an associate professor of community and regional planning at the University of British Columbia, who led the study.

The CDC’s statement on climate change and public health states that “walking and bike riding are more than alternate forms of transportation; they are steps to healthier lives. Automobile traffic contributes to air pollution, which in turn means more illnesses related to breathing problems such as asthma. Furthermore, every additional car on the road can lead to increases in the numbers of injuries and deaths from vehicle crashes, which already kill more than 40,000 people each year die.”

Clearly, the way we have sprawled across the landscape is at the core of the imbalance in both our human and the planet’s ecosystem. It connects all the big problems we face, from climate change to peak oil, from loss of biodiversity to public health. High-density cities that connect housing, commerce, urban parks and farms using public transit, bike paths and pedestrian walkways hold promise for vastly improving our public health. Such an approach addresses the cause instead of treating the symptoms of our healthcare woes.


Several city planning and policy experts will be addressing the issue of public health in cities at the upcoming EcoCity World Summit in Istanbul this December. Presenters will include Richard Register of EcoCity Builders, Walter Hood (urbanist, landscape architect), Ken Yeang (bioclimatic design), David Hall (New Vista Ecocity), the World Bank Eco2Cities program, Global Footprint Network, Janet Larsen of Earth Policy Institute (representing Lester Brown’s Plan B), and Brent Toderian, head of City Planning for City of Vancouver, Canada and author of the EcoDensity Initiative.

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Sven Eberlein

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