Designing Healthy Communities

Richard J. Jackson, Stacy Sinclair

• Publisher: Jossey-Bass
• Year: 2011
• ISBN:
  9781118129838
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Designing Healthy Communities, the companion book to the acclaimed public television documentary, highlights how we design the built environment and its potential for addressing and preventing many of the nation's devastating childhood and adult health concerns. Dr. Richard Jackson looks at the root causes of our malaise and highlights healthy community designs achieved by planners, designers, and community leaders working together. Ultimately, Dr. Jackson encourages all of us to make the kinds of positive changes highlighted in this book. 2012 Nautilus Silver Award Winning Title in category of "Social Change"

"In this book Dr. Jackson inhabits the frontier between public health and urban planning, offering us hopeful examples of innovative transformation, and ends with a prescription for individual action. This book is a must read for anyone who cares about how we shape the communities and the world that shapes us." —Will Rogers, president and CEO, The Trust for Public Land

"While debates continue over how to design cities to promote public health, this book highlights the profound health challenges that face urban residents and the ways in which certain aspects of the built environment are implicated in their etiology. Jackson then offers up a set of compelling cases showing how local activists are working to fight obesity, limit pollution exposure, reduce auto-dependence, rebuild economies, and promote community and sustainability. Every city planner and urban designer should read these cases and use them to inform their everyday practice."
— Jennifer Wolch, dean, College of Environmental Design, William W. Wurster Professor, City and Regional Planning, UC Berkeley

"Dr. Jackson has written a thoughtful text that illustrates how and why building healthy communities is the right prescription for America."
— Georges C. Benjamin, MD, executive director, American Public Health Association

Publisher Companion Web site: www.josseybass.com/go/jackson

Additional media and content: http://dhc.mediapolicycenter.org/

PART ONE
HEALTH AND THE BUILT ENVIRONMENT: AN INTRODUCTION

From the beginning, we have built environments to support or hinder our way of life. What we build, what those buildings are made of, and how they are designed and situated in space all reflect some of our most basic ideas about humanity in general and our specific relationships to each other. To understand what it means to design healthy communities, we must understand that each of us has a unique lens through which we see the world and interpret our surroundings.

When I travel I take great pleasure in looking at the buildings in the communities I visit. I marvel at the strength, beauty, and meaning that specific structures and combinations of buildings and open space in communities hold. I choose to visit communities because of how they feel. There are places that feel important, romantic, or beautiful because of what they are as well as because of the historical events that occurred there.

Part One of Designing Healthy Communities explores each word in the title of the book. The first chapter deconstructs what I mean by the built environment and the impetus for and the importance of the choices we make when we construct spaces. Our connections to place are strong, and they come from a feeling of love (or its absence). When we make design choices, these decisions are based on values and beliefs. When we look at existing environments, we can view them through this lens to understand what was important to those who last envisioned the space. Acting on our beliefs, we can choose to preserve important spaces or redesign them into a new vision for our future. Both preservation and redesign send messages about the impermanence of buildings and the changing nature of humanity.

Chapter Two examines what I mean when I talk about health. I began as a pediatrician, but I learned through a variety of experiences that our health is more than the absence of disease. Health is the result of a complex series of choices. Our surroundings and the resources available to us influence these choices. When we look at the leading causes of death now versus those a hundred years ago, we can understand the importance of personal choice and the outcomes that result.

Chapter Three reflects on the idea of community and the complexity of being a part of many communities simultaneously. There are some communities we are born into and others we strive to access. Communities are the people we interact with, yet groups of people live, work, and recreate in spaces, and the spaces take on a personality reflecting group interactions and challenges.

What if we looked at our lives through the lenses of love, our health, and the communities we engage in? What could we learn about ourselves and the choices we make for our built environment? I invite you to take this journey with me—to discover how each filter we use to look at our world can color our perceptions of it and how this can lead to new ideas for making our built environment a more desirable place to live in.

Chapter 1
What Does Love, or Caritas, Have to Do with the Built Environment?

Love—for all the use this word gets, it is still a word that gets lost in our roiling culture. Ubi caritas et amor Deus ibi est. This is a classic hymn sung in Latin, written nearly two millennia ago. It translates to, “where charity and love prevail, there is God.” The absence of charity and love is the absence of God—a lonely place in any religion. Without God, one must struggle with existential loneliness. The Greeks had specific words for different kinds of love: éros for sexual love, desire, and the creative urge; philia for loyalty between friends and family, or enjoyment of an activity; and storge for natural affection, as between parents and children. There are many different kinds of love, but the word that matters in this book is agape in Greek, or in Latin caritas, the origin of our word charity—and this kind of love resides in our will, not in our emotions.

For goodness sake, what is this discussion doing in the story of built environment and health? Because, I think, the built environment is the embodiment of what we love, our imagination, and our will. It is what we value and reflects what and whom we care about. When it comes to love, talk is cheap—every adult has learned this lesson. It is what someone does, not what he or she says. And the built environment is very much what we do—in concrete.

When we meet a genuinely giving person, and we comment about the nature of her relationship with others, she invariably answers, “Oh no, I get more than I give.” So too, I think, do we from really great built environments—Chartres Cathedral with a beauty that has astonished for a thousand years; the Golden Gate Bridge with both its profound utility and its elegant, simple beauty that is, amazingly, an improvement on a land form of breathtaking vistas; or a simple seacoast cabin in Maine without a single knickknack or unneeded ornamentation. I think that when we design and construct environments that give joy and comfort, safety and beauty, we get places that reflect the best of ourselves in which to live our lives.

I grew up in Newark, New Jersey, near the Passaic River, one of the largest toxic waste sites in the United States. About once a week my mom would bring my brothers and me across the Jersey meadows to see her sister and her sister’s family. The ride through the swamps amazed me. We shut the car windows as we saw piles of yellow powder burning or smelled the stench of rotting garbage in the landfill.

When I went to study in the seminary, I found that even though the Greek, German, and modern philosophers had remarkable insights, the philosopher who really made sense was a peculiar and tubercular New Englander named Thoreau. The seminary was a place of high intellectual stimulation, but the sensual and physical worlds were marginalized, which was very difficult for me as a young, curious man of eighteen. I discovered that Thoreau spoke right to my core as he observed the beauty of the natural world—Walden Pond, the land, weather, and time. Oddly, once I better understood the natural world, I could better understand the textures and fragrances of the human world.

I went to medical school because I wanted a life of service and believed I would get meaning in my life out of that service. We were saturated in medical school with negatives, things to worry about—bad news and diseases. I learned a lot of pathology, and a lot about medicines. We were taught virtually nothing about health. I guess my teachers thought we would get that elsewhere. I became an epidemiologist and chased diseases. Epidemics of infectious diseases, pesticide poisonings, cancer, and birth defects became my life’s work. I soon realized I had to begin to learn less about disease and a whole lot more about the embedded health in the world around me if I was to make an impact.

I worry that in a larger way we are training our children the way we train doctors—lots of pathology, too little health—and too little time for independence and time with nature. I fear our children lose a lot when trash-culture, machines, and electronics dominate their lives. Realizing that well-built environments enhance and protect the natural environment, not erode it, and then providing those environments is an important way of revitalizing our children and their childhoods.

WE LOVE OUR FAMILIES AND OUR COUNTRY, BUT DO WE REALLY LOVE OURSELVES?

When looking at health data, we have to wonder, do we really care about us? Do we care enough to eat well and make healthy choices? Food should be a good sensory experience, from selecting ingredients to preparing a dish to consuming it. Eating involves a blending of color, texture, temperature, taste, smell, and even sound. It can be a social experience, and food choices also reflect our cultural identity. So why don’t we eat better? We keep blaming individuals who get fat and do not eat sensibly, but the truth is we have a powerful national apparatus that is designed to make us fat and unhealthy (Figure 1.1).

Figure 1.1 Fast-food choices.

Source: Wikimedia Commons; photograph posted by Christian Cable. Used with permission.

We eat poorly because the food that is bad for us is cheap and abundant, tastes pretty good, is easy to get, and is full of salt, sugar, and fat. Taking the time to purchase, prepare, and enjoy healthy food requires a mind-set of self-caring. Although we might exert the effort for others, we often will not do it for ourselves, preferring to “pick up something quick” or “eat on the run” rather than to prepare, present, and patiently enjoy a meal alone. Doctors and nurses are often the worst offenders.

The food that is good for us tends to be perishable, can be comparatively costly, is often unfamiliar to most of us, and requires more attention and development than sugar, salt, and fat. Although we are subjected to limited educational efforts telling us to eat healthy food, the whole marketing system is directing us, is pushing us, toward unhealthy food. Obesity is on the rise, and children are building unhealthy eating habits from a very early age. Childhood obesity has increased to 12.4 percent for every age group (Figure 1.2). Whereas children ages two to five and twelve to nineteen are seeing some decline in obesity recently, the six- to eleven-year-olds are surpassing the rest of the young population, with nearly 20 percent of these children being obese.¹

Figure 1.2 Obesity trends among children and adolescents: United States, 1963–2008.

Note: Obesity is defined as a body mass index (BMI) greater than or equal to the sex- and age-specific 95th percentile on the 2000 CDC Growth Charts.
Source: C. Ogden and M. Carroll, Prevalence of Obesity Among Children and Adolescents: United States...

Table of contents

• Cover
• Table of Contents
• Title
• Copyright
• Foreword
• Preface
• The Author
• Dedication
• Prologue
• Part One: Health and the Built Environment: An Introduction
• Part Two: Examples of Change
• Part Three: Be the Change you Want to See in the World
• Epilogue
• Index
• Portfolio
• End User License Agreement