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The Impact of the Built Environment on Health

Will power, genetics and meds affect our weight, fitness and health, but profoundly do the urban, suburban, park, school, nutritional, commercial, transportation and social environments we live in. The outdated 20th century American life‐style adds pounds, reduces vitality, and burns fuel rather than fat.

Published January 15, 2010 in Opinion      16 Comments    Open printer friendly version of this article Print Article

The drive from my office to my suburban Atlanta home is all too familiar: it begins with a scary 7-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.

We humans often assume that what is, had to be that way. In reality, virtually everything in our built environment is the way it is because someone designed it that way. Central Park is beautiful and appears "natural" precisely because Frederick Law Olmsted designed and built it that way. Roadside signs advertising fast food restaurants strike the eye because they are designed to catch the attention of someone rushing by at high speed. Because children cannot buy homes or vote for parks, bicycle trails, small local schools, or nearby ball fields, many new residential areas in America are built without such community assets.

Despite the fact that many humans accept the world as it is, we have a remarkable capacity to plan ahead, shape the future, and adapt to new settings. This capacity serves us well when we are trying to build new societies or solve public health dilemmas. Our parents and grandparents helped extend our life expectancy and build great cities such as New York and San Francisco that became hubs for culture and diversity. Our predecessors left us an economically strong and well-educated nation with a high standard of living seen as a model for many around the world.

The current generation now faces its own challenges. One challenge is to better understand the broad impact of our built environment on health and then to build future communities that promote physical and mental health. Public health has traditionally addressed the built environment to tackle specific health issues such as sanitation, lead paint, workplace safety, fire codes, and access for persons with disabilities. We now realize that how we design the built environment may hold tremendous potential for addressing many of the nation’s greatest current public health concerns, including obesity, cardiovascular disease, diabetes, asthma, injury, depression, violence, and social inequities.

Some of our current zoning laws that block high-density, live–work–play developments derive from interventions that helped prevent the spread of tuberculosis and other infectious diseases in the 19th century. Public health–based zoning laws were also instrumental in separating homes and schools from the odors and toxic emissions of abattoirs and tanneries. In the 20th century, the automobile and accompanying highway construction enabled the growth of suburbs and the vast expansion of metropolitan areas. Rail and trolley lines declined, and by the late 1960s, the cores of most major cities were sapped of economic vitality and left with failing schools and rising crime rates. Government incentives that subsidized mortgages and highways encouraged home-building further out from urban areas. As the US population grew and density dropped, vast stretches of forests and farmland were lost in the creation of roadways, megamalls, megaschools, and megasubdivisions.

Even our environmental policies exacerbated the flow. In urban areas with extensive preexisting infrastructure, the past contamination of land presents future investors with real or potential liability risks, so many of these urban "brownfields" go unsalvaged. Despite the availability of over 10,000 vacant land parcels in New York City, some city workers there have chosen to face commutes of 4 or more hours per day to subdivisions that replaced forests in northern Pennsylvania. This commuting pattern has led to the paving of vast quantities of landscape for roadways, cloverleaf intersections, and parking lots. At this point, the United States has paved a land area equivalent in size to the state of Georgia.

Typical American families earn in real dollars roughly what they earned in the 1970s, but we spend much more now on motorized transportation. From 1969 to 1995, the number of private vehicles per household rose more than 50% to roughly one vehicle per licensed driver. Cars are such a necessity for work and other daily activities in American life that most adults manage to find the $7000 or more per year to own, maintain, insure, and drive a car, even if faced with choosing between health insurance and a car. Since 1970, the US population has increased 37%, but the distance traveled by the nation’s fleet of cars, motorcycles, sport-utility vehicles, and small trucks increased 143%. From 1982 to 2000, the annual hours of highway traffic delay per person in urban areas increased from 16 hours to 62 hours per year. And Americans now work more hours than people in any other major industrial nation in the world. With rising private vehicle costs, long commutes, increasing traffic delays, and long work hours, it is easy to understand why parents may feel overwhelmed by time and financial demands.

Private motor vehicle transportation made necessary by extensive low-density land use has important implications for health: people are less active because they walk less, vehicle exhaust degrades air quality, motor vehicle injuries increase, and mental health and social capital are adversely affected. Decreased opportunities for children to incorporate physical activity into their daily lives, such as the inability to walk to school because of hazardous streets and long distances, have contributed to a threefold increase in the prevalence of overweight children over the last 3 decades.

America’s aging population faces its own challenges. In this country, the number of people aged older than 65 will double by the year 2020. Communities that are adequately designed for a young adult with fast reflexes can be unnavigable for an elderly person. As chronic diseases such as arthritis, obesity, and diabetes increase in prevalence, the need becomes paramount for communities where elderly and disabled persons (and young persons with few resources) can function well and contribute to society without needing to own an automobile.

As Hippocrates, the Romans, and Jung knew, our physical environment affects our physical and mental health. We physicians focus well on our patients as individuals with health problems, but when so many of our patients have the same problems, such as cardiovascular disease, diabetes, and depression, we must realize that their poor health is not caused only by a lack of discipline but may be the result of the built environments in which we live.

It is time for a shift to communities intentionally designed to facilitate physical and mental well-being. To effect this change, we need to draw upon the unique ability of humans to plan creatively for healthy communities. The first step is to understand better the elements of the built environment that promote health. From the limited research to date, the public health community knows that some environments encourage walking, biking, and social interaction more than others do; that many traffic injuries can be prevented; that increasing motor vehicle exhaust exacerbates pulmonary disease; and that the presence of neighborhood liquor stores increases alcohol consumption and associated adverse health consequences. But overall, there is still much to learn about the effects of the built environment on health. To address the multitude of questions, public health professionals must work closely with experts in other fields: architects, planners, policymakers, social scientists, traffic engineers, developers, law enforcement officers, economists, social marketers, and others.

Many aspects of the built environment will resist rapid change, even when research has adequately revealed key aspects of healthy communities. Efforts to improve pedestrian facilities, preserve green space, and upgrade public transportation are under way in many communities. Whereas our generation may reap some benefits from the new field of the built environment and health, with a little vision and a lot of good science and hard work, our children and grandchildren will be able to walk or bicycle home from their workplaces through attractive communities designed to promote the physical and mental health of all people.

Richard J. Jackson, MD, MPH, Guest Editor

At the time of original publication, the author was the director of the National Center of Environmental Health at the Centers for Disease Control and Prevention, Atlanta, Ga.



January 15, 2010, 11:21:17 AM
Wow.  That really makes you think.

Very well stated.

Captain Zissou

January 15, 2010, 01:20:15 PM
A really great and well written article.  A great contribution to metrojax.


January 16, 2010, 11:48:51 AM
How interesting that the Springfield gossip posts generate dozens of comments and sometimes pages, yet an article like this can't even get a handful.  It makes me wonder if all of the motivated individuals on this forum are losing spirit for changing this city.  Are our current city leaders really taking all of the fight out of us?  We have to find a way around them.  They are worthless in my opinion and incapable of change.

Jacksonville is a perfect example of what's wrong with current growth patterns in most large cities in the US.  We live in a warm climate, yet have high obesity rates.  Children continue to be diagnosed with diabetes at alarming rates.  Parents complain about how unsafe their neighborhoods are.  Downtown is desolate after 5pm.  We have enough apathy for the entire US in one city (I'm probably adding to it right now)....and the list goes on.  It is my generation that must wake up and demand change!  I'm not sure what the next 50 years hold but I think if we continue down the path we are on as a society we are going to implode mentally and probably die young.  I'm not sure what all of the answers are, but we can't be afraid of having the discussion.  Don't lose heart.  Let's get back to healthy discussion about what we must do to make this city a better place for all of us.  After all that's how I first found metrojacksonville.  We must broaden the conversation and scope of thought to include not just next month, but five, ten and 25 years from now.


January 16, 2010, 12:12:34 PM
We could change it in two years, brainstormer.

With the research that weve done over the past four years, I think we have the answers that could radically transform the life of the city and in the process make our taxpayer financed national system sustainable again.


January 16, 2010, 01:42:27 PM
I think this article highlights a point:  The true costs of our current "planning" and "development" protocols are far more than the up front dollars initially invested.  At some point, to be truly "efficient", which includes providing us the highest quality of life for the least overall costs to society, we need to start assigning value to intangibles such as impacts on environment, health, safety, people's time, sustainability, our social and educational fabric, surrounding aesthetics, etc.  And, we need to stop distorting the economic process with unquantified or underreported subsidies for projects that lead to urban sprawl while underplaying the benefits of mass transit and good high-density urban design.

Perhaps, the study of feng shui should be required for urban planners, developers, and public officials who approve and enable their projects.  ;D  (See Wikipedia article for more at: )


January 16, 2010, 02:53:04 PM
Regarding Nocatee, it is a shame that the design is nothing more that a sprawling collection of subdivisions. A much smaller footprint coupled with a form of municiple transit, such as a trolley or two, could have produced a very enjoyable, convenient community. Driving to walk the dog? Driving to the amenities? Driving to the nature trails?

Did GM have a hand in designing this community?

Perhaps people desire driving for the sake of seclusion and quiet? If density was selling it seems we'd see more of it.


January 16, 2010, 09:16:10 PM
Great article indeed.  It really makes you think.  Jacksonville, we have some work to do.


January 17, 2010, 02:32:52 PM
This is an interesting article. He makes a good point that we seem to have won the battle against infectious diseases like tuberculosis and small pox, only to have replaced them with cardiovascular disease, diabetes, and depression.

Burning fuel instead of fat is another good quote.

CS Foltz

January 17, 2010, 03:42:25 PM
Kids.....we have our work cut out for us! Just thinking where we could be 10 years from now gives me a chill!


January 18, 2010, 09:33:44 AM
I think Jacksonville really needs to develop a two-fold approach.  We first need to create a development plan that encourages infill, high density, mixed use, and rehab investment.  Continuing to fill in swamp land at the outer edges is irresponsible.

The second thing to address would be asking ourselves, "How can we make current development better?  What investments can we make to give people neighborhoods that encourage live, work, play and healthier lives?"  

A perfect example of this is the Touchton, Southside, Gate Pkwy area.  Thousands of people live within a few square miles here and if one includes the SJTC there are dozens of restaurants and about all the retail one needs.  There are also large businesses located here including BCBS.  However, not a bike lane or hardly even a sidewalk to connect everything!  Wouldn't it be great to have a wide bike lane/walking path down each side of Southside?  There aren't even safe places or crosswalks crossing Southside!  On a daily basis I see runners, bikers, moms with strollers trying to cross Southside and then when they do they are running in the grass along side the road.  On Touchton you really have to bike/run in the road and Gate Parkway has a sidewalk here or there.  

How hard would it be to have a looping electric bus or trolley that connected these areas easily to one another?  Would BCBS employees take a trolley to get to the SJTC for lunch?  It worked in the downtown-Riverside experiment.  Would residents of Tapestry Park take it to get to a movie at Tinseltown?

To really think out of the box, let's put Southside from Touchton to Gate underground and create a green central park on top.  That would really connect the two sides!  The naysayers will always claim that there isn't money.  But if we stopped the planned widening of just one road in Jacksonville we would have money to get started.  This will all take an attitude adjustment, one I'm not sure this city is ready for.  We need to discuss ways we can make failures of the past into healthy communities of the future.


January 18, 2010, 10:18:30 AM
All I can say at this point is that 2010 will be an interesting year.  A lot of the things you just mentioned will at least be put on the public table for discussion.  It will be up to the community to push for them when the time comes.


March 16, 2010, 06:27:25 PM
This is a great piece. Worth reading again.

Miss Fixit

March 16, 2010, 08:21:07 PM
Walkability is where it's at!


March 27, 2011, 10:32:43 PM
To really think out of the box, let's put Southside from Touchton to Gate underground and create a green central park on top.  That would really connect the two sides!  The naysayers will always claim that there isn't money.  But if we stopped the planned widening of just one road in Jacksonville we would have money to get started.  This will all take an attitude adjustment, one I'm not sure this city is ready for.  We need to discuss ways we can make failures of the past into healthy communities of the future.

You truly are a brainstormer, brainstormer. That idea sounds awesome. I am curious if this has been done anywhere else before?


March 27, 2011, 10:42:08 PM
Fantastic article!!!! More Please!


November 08, 2013, 10:56:30 AM
Seems like our built environment really is a threat to public safety. 

Pedestrian crashes spike in Jacksonville

Florida has the title no state wants -- the most dangerous place for pedestrians.

The organization Transportation for America ranked the top cities across the country, and Jacksonville claimed the No. 3 spot, only behind Orlando and Tampa.

There have been more than 30,000 car crashes on Duval County roads so far this year. FHP said 104 have been fatal.

Crashes involving pedestrians make up a large number. Troopers say 399 people have been hit so far in 2013, compared to 456 for all of last year, and 397 in 2011.

There have been 28 fatal crashes so far this year. There were 31 all of last year and 21 in 2011.

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