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
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) its particularly painful. Dr.
Richard Jackson readily admits that he lives in Atlantas suburbs
because of the citys high crime rates and failing schools.
However, unlike most who have simply resigned themselves to accepting
life as it comes, his lifes 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
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
peoples health, that people needed sunshine and fresh, clean
water. Over time, we have become so reductionist that urban planners
arent talking to architects who arent talking to health
officials who arent 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: Ive 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 agoand this is a true storyI 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
thats 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 shed probably think I was a pervert if I offered
a ride. But I got to thinking that Im 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 wouldnt 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 wouldnt 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 wed 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 hadnt
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 didnt
know anything about urban planning and architecture. But I did know
that people spend 95 percent of their time indoorsvirtually
all of that time in environments that have been designed and constructed
by someone else. We cant 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. Weve 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 its a mindsetpeoples own
perceptions that urban life or greater density is bad and unless
we can create quality density that people want to be in, were
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 dont 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
theyre in environments that are lacking in green space? The
financial part of the healthcare system will collapse at the rate
we are going. Were 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.