Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities

By Howard Frumkin, Lawrence Frank, and Richard Jackson Island Press, 2004, 338 pp., hardcover $60, paperback $30

The past couple of years have produced a series of reports linking sprawl to obesity and suggesting that Americans would be healthier if they lived in more walkable communities. Now Howard Frumkin of the Rollins School of Public Health at Emory University, Lawrence Frank of the School of Community and Regional Planning at the University of British Columbia, and Richard Jackson of the California Department of Health Services have elaborated on those arguments in an immensely readable book.

“Urban health — a field that has until very recently focused on the diseases of poverty in the inner city — needs to be broadened to consider health on a systems basis, across the entire metropolis,” they declare. Urban Sprawl and Public Health assesses what’s currently known about the effects of community design on physical fitness, mental health, air and water pollution, traffic deaths and injuries, and social capital, among others. It is an impressive, one-stop sourcebook that doesn’t read at all like a ponderous academic volume.

Though the authors use the term “Smart Growth” more often than “New Urbanism,” they find a wide range of benefits in the aims and techniques associated with New Urbanism. They conclude: “Mixed land use, a balance of density and reserved greenspace, a balance of automobile transportation with walking, bicycling, and transit, the provision of attractive and functional public spaces, the mingling of different styles and price levels of housing — these and other strategies offer the potential to increase physical activity, decrease air pollution, protect source water, control injuries, and improve mental health and social capital.”

Examining the love affair

Should planners encourage what is often benignly called “the American love affair with the automobile?” Only if they’re willing to accept the fact that “automobile crashes are the leading cause of death among people from one year to twenty-four years old, cause about 3.4 million nonfatal injuries each year, and cost an estimated $200 billion annually.”

But isn’t driving a car something that makes people happy? The authors report that according to the best available analysis, “Automobile commuting is more stressful, for more people, than train and bus commuting.” An investigation of road rage found that “an individual encased in an automobile seems to have a lower threshold for hostility.”

A German study of patients with coronary artery disease discovered that “approximately half the patients showed pathological EKG changes while driving.” The authors rhetorically ask, “Why is the term ‘road rage’ familiar, while there is no such thing as ‘sidewalk rage?’ ” Clearly, walking is better for people’s health, and walking is more common in the kinds of settings that new urbanists propose.

In San Diego, a study found that people in a walkable neighborhood — one featuring “higher density, land-use mix, connectivity, aesthetics, and safety” — engaged in moderate physical activity nearly 50 percent more than those in a neighborhood that ranked poorly on walkability. Frumkin, Frank, and Jackson report that “35 percent of people in the high-walkability neighborhood were overweight, as compared to 60 percent in the low-walkability neighborhood.”

The authors declare, “At a time when the nation faces epidemics of inactivity, obesity, and related disorders such as diabetes, this is a compelling public health issue.” The book gracefully weaves stories, statistics, and scientific studies into a coherent whole. A special virtue is the authors’ ability to start a chapter with a fiery quotation — such as James Howard Kunstler’s assertion that “isolated, disaggregated, and neurologically punishing” suburban habitats make people “succumb to the kind of despair and anomie that we have labeled ‘depression’ ” — and proceed into a careful, balanced discussion of the evidence.

Community design does affect people’s ability to meet others, and that’s one reason why it influences their state of mind. “Social connectedness is clearly good for mental health,” the authors affirm. “People with strong social networks live longer.” Readers may find errors. I noticed that in citing my own writing, the authors misspelled my first name and identified me as an architect, which I’m not.

Overall, however, this seems a reliable publication, with strong conclusions. On the final page, the authors write, “At its best, Smart Growth is like a medicine that treats a multitude of diseases — protecting respiratory health, improving cardiovascular health, preventing cancer, avoiding traumatic injuries and fatalities, controlling depression and anxiety, improving well-being.”