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green@work : Magazine : Back Issues : March/April 2004 : Headlines

HEADLINES

Curing Our Ills
How design professionals can help solve some of the most pressing 21st-century health problems.


The drive from my office to my suburban Atlanta home is all too familiar: it begins with a scary seven-lane thoroughfare, infamous for its strip malls, lack of sidewalks and high pedestrian fatality rates; progresses to a jumble of connecting interstate highways packed with rush-hour traffic despite 12 or more roadway lanes; and ends with clusters of new, low-density, single-family residential developments lacking public parks, playgrounds, libraries, nearby stores or cafés, sidewalks, bicycle trails and public transit. Adults and children in my neighborhood travel by private automobile to virtually all of their destinations because they have no practical transportation alternatives.”

This daily routine will sound regrettably similar to many suburbanites, but for the senior advisor to the director of the Centers for Disease Control and Prevention (CDC) it’s particularly painful. Dr. Richard Jackson readily admits that he lives in Atlanta’s suburbs because of the city’s high crime rates and failing schools. However, unlike most who have simply resigned themselves to accepting life as it comes, his life’s work is, in his words, “to better understand the broad impact of our built environment on health and then to build future communities that promote physical and mental health.”

WHAT PROMPTED YOU AND OTHER PUBLIC HEALTH OFFICIALS TO BEGIN CONNECTING HEALTH PROBLEMS WITH THE WAYS IN WHICH WE DESIGN AND BUILD OUR ENVIRONMENTS?

JACKSON: The connection between the physical environment that we live in and our health was perfectly evident to Frederick Law Olmsted and to basically all the pioneers in urban design and urban planning throughout the 19th century. Many of the sanitary reforms that were put in place were led by docs working with business people and designers. It was perfectly obvious that sanitation influences people’s health, that people needed sunshine and fresh, clean water. Over time, we have become so reductionist that urban planners aren’t talking to architects who aren’t talking to health officials who aren’t talking to bankers, etc. The problem is that many of the problems with the 21st century are systems problems. They are not isolated, and pure reductionism impedes our ability to deal with them.

WHEN DID YOU BEGIN TO LOOK AT THESE ISSUES?

JACKSON:
I’ve studied environmental epidemiology for 25 years, investigating cancer and birth defect clusters, water contamination with pesticides and other chemicals, air pollution studies and on and on. When I became head of the Center for Environmental Health nine years ago we pushed very hard for bio-monitoring, which is the measurement of chemical body burdens in people.

About five years ago—and this is a true story—I was driving from my office to the CDC headquarters and I saw a woman who reminded me of my mom. She was thin, elderly, stooped over a bit, walking along in 100° heat next to Buford Highway, which is a street that’s seven lanes wide with no sidewalks. The poor woman had a plastic shopping bag in each hand. I wanted to stop, but I was late and she’d probably think I was a pervert if I offered a ride. But I got to thinking that I’m spending all my time worrying about parts per million and parts per billion and here is the most obvious health and environmental threat. We in healthcare have really not paid enough attention to the design of the environment. If that woman had collapsed from heat exhaustion, the cause of death would have been heat exhaustion. It wouldn’t have been lack of trees or the lack of sidewalks. If she was killed by a truck, it would be a motor vehicle trauma. It wouldn’t be blamed on bad urban design or negligent city management.

I began to work closely with a colleague of mine, Howard Frumkin, a professor of occupational and environmental health at Emory University. We started a livability work group at CDC and began working with the people in the injury center who were very interested in studying how to design environments that would be safer and healthier. We also began working with the folks in the obesity and nutrition program who were concerned that we’d engineered physical activity out of our environment. For example, only seven percent of our kids walk to school today versus 50 percent when I was a child. Across the CDC, we discovered a great deal of interest in this that hadn’t been crystallized.

HOW DO WE EDUCATE DESIGN PROFESSIONALS SO THAT WE CAN BEGIN TO MAKE SOME CHANGES?

JACKSON:
When I started talking about this four or five years ago, people thought I had lost my marbles because I didn’t know anything about urban planning and architecture. But I did know that people spend 95 percent of their time indoors—virtually all of that time in environments that have been designed and constructed by someone else. We can’t deal with the resulting health problems without reaching out and embracing these other professions.

There are multiple issues at work here. One is financing. Smart growth really requires that the financing community finds a home for multi-use development. Also, developers legitimately claim that their problem is building codes. We’ve been working with a number of groups, including Georgia Tech and Emory University, to make recommendations for re-writing building and planning codes that would reflect some of our concerns.

WHAT ARE THE BIGGEST OBSTACLES IN TERMS OF TURNING THIS AROUND-GOING FROM SPRAWL TO SMART GROWTH?

JACKSON:
I think it’s a mindset—people’s own perceptions that urban life or greater density is bad and unless we can create quality density that people want to be in, we’re never going to turn it around. We need leadership from the building design communities but a percentage of people are still going to want their isolated one-acre houses and all that goes with it.

ARE YOU OPTIMISTIC ABOUT THE FUTURE?

JACKSON:
After all is said and done, we don’t have any choice. We cannot have one-third of our adults diabetic. We cannot continue to be, on average, 20, 30, 40 pounds overweight with increased cancer, heart disease, blood pressure risks and all the rest. The environment is toxic from a nutritional standpoint, in terms of exercise and in terms of mental health. I mean, who feels good when they’re in environments that are lacking in green space? The financial part of the healthcare system will collapse at the rate we are going. We’re not going to spend 80 percent of the gross domestic product on healthcare. We have to turn it around.


This article was excerpted from “Curing Our Ills,” first published in the March 2004 issue of Interiors & Sources magazine.

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