Good Design Keeps the Doctor Away

Are our cities making us sick? Will children born today die fatter, more sugar-saturated and at a younger age than their parents?

Cities were sickly places 150 years ago. Dysentery, typhoid, measles, influenza and other diseases thrived in overcrowded and unsanitary conditions. It took heroic and creative leadership by city planners, architects and health advocates to create healthier cities.

Political will and professional expertise helped drive improvements in housing codes, sanitation ordinances and work-site conditions. Locating cemeteries on the outskirts of cities and placing green space in the center minimized pollution and encouraged outdoor physical activity. Such changes fueled the health advances in the first half of the 20th century. Life expectancy rose from 39 years in 1850 to 50 years in 1900 and to 68 years in 1950.

Today’s cities are plagued with traffic, violence and overcrowding. People are isolated from each other, spending too much time indoors and bombarded with unhealthy food, cigarettes, alcohol and drugs. Homicide and fatal car crashes may be the swiftest urban killers, but bad living conditions and unhealthy choices contribute to obesity, diabetes, heart disease, cancer, asthma, depression and violence-related injuries.

Sound urban design and smart architecture create bustling streets and people-filled parks where young and old safely walk and talk, see old friends and feel confident they will not be attacked. Well-planned cities create communities where neighbors can meet in the local cafe, talk about their concerns, say hi to the other patrons and feel connected to the shared public spaces filled with old and new friends.

Homes close to businesses allow people to shuttle back and forth easily, running out to get what they need, while still having leisure time to mow the lawn or read a book.

Neighborhoods where services are located close to each other make it easier for a mother with four children to see the doctor, the teacher and the counselor and still have time to go grocery shopping to get nutritious, fresh food for her family. Communities where residents are actively involved create spaces where a group of seniors can play cards, where grandmothers can walk their grandchildren to the store, and where fathers can teach their children to ride a bike or throw a ball.

When health-oriented approaches to planning and design are embraced -- such as the Health Impact Assessment used in Europe, Australia and Canada -- health planners can guide development by predicting and measuring the health effects of a policy or a proposed construction project. When developers, builders and school boards guided by appropriate zoning regulations, building codes and performance standards work with residents, they create vibrant and health-promoting neighborhoods. When we cluster a useful mix of schools, parks, libraries, mixed-income housing, healthcare, adult education and social services, neighborhoods become more vital, people more healthy and fit. That’s good for waistlines and the civic bottom line.