Sprawling Cities and Our Endangered Public Health

Stephen Verderber

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136313714
• Edition: 1
• Topic: Architecture
• Subtopic: Urban Planning & Landscaping

Sprawl is an unsustainable pattern of growth that threatens to undermine the health of communities globally. It has been a dominant mid-to-late twentieth century growth pattern in developed countries and in the twenty-first century has shown widespread signs of proliferation in India, China, and other growing countries. The World Health Organization cites sprawl for its serious adverse public health consequences for humans and ecological habitats. The many adverse impacts of sprawl on the health of individuals, communities, and biological ecosystems are well documented. Architects have been rightly criticized for failing to grasp the aesthetic and functional challenge to create buildings and places that mitigate sprawl while simultaneously promoting healthier, active lifestyles in neighbourhoods and communities.

Sprawling Cities and Our Endangered Public Health examines the past and present role of architecture in relation to the public health consequences of unmitigated sprawl and the ways in which it threatens our future. Topics examined include the role of twentieth century theories of architecture and urbanism and their public health ramifications, examples of current unsustainable practices, design considerations for the creation of health-promoting architecture and landscape urbanism, a critique of recent case studies of sustainable alternatives to unchecked sprawl, and prognostications for the future.

Architects, public health professionals, landscape architects, town planners, and a broad range of policy specialists will be able to apply the methods and tools presented here to counter unmitigated sprawl and to create architecture that promotes active, healthier lifestyles. Stephen Verderber is an internationally respected evidence-based researcher/practitioner/educator in the emerging, interdisciplinary field of architecture, health, and society. This, his latest book on the interactions between our buildings, our cities and our health, is an invaluable reference source for everyone concerned with sustainable architecture and landscape urbanism.

1
INTRODUCTION: AN EPIDEMIC ON OUR DOORSTEP

Sprawl is unsustainable. It threatens to undermine the health and well being of communities globally. It was the predominant 20th century growth pattern in developed countries and now, in the 21st century it proliferates in the developing world. The World Health Organization (WHO) cites sprawl as a source of serious adverse public health consequences for humans and for natural ecological habitats. Its adverse consequences for individuals, communities, and biological ecosystems have been well documented, particularly since 2000, and have drawn increasing attention in global mainstream and cyberspace mass media.¹ A number of non-communicable diseases (NCDs), specifically obesity, heart disease, stroke, diabetes, asthma, hypertension, depression, chronic kidney disease, osteoporosis, and cancer, are the most prevalent unhealthful outcomes empirically associated with sprawl, to date. An NCD is defined as a medical condition or disease of a non-infectious nature, and are generally diseases of long duration and of generally slow progression. The WHO reports NCDs as by far the leading cause of annual mortality rates, representing over 60 percent of all deaths globally. Out of the 35 million people who died worldwide from NCDs in 2005, half were under the age of seventy and half were women. Risk factors such as lifestyle and the built environment are increasingly being linked with NCDs.²

The world is becoming a heavier place, especially the most affluent Western nations. Chronic NCDs were once a problem limited to high-income countries and were known as “diseases of affluence.” Among developed nations, Americans are the heaviest, and the Japanese the slimmest. But global obesity rates have doubled in the past three decades even as blood pressure and cholesterol levels in these parts of the world have dropped. Every year, at least 5 million die globally around the world due to tobacco use and more than 2.8 million die from being overweight. By 2030, global deaths due to chronic NCDs are expected to increase to 52 million per year while deaths caused by infectious diseases, maternal and perinatal conditions, and nutritional deficiencies are expected to decline by 7 million per year during the same period. In response, in 2009 the WHO established the Global Non-Communicable Disease Network (NCDnet) to better coordinate the worldwide battle against this emerging public health challenge.³ In 1980, about 5 percent of men and 8 percent of women worldwide were obese. By 2008, the rates were nearly 10 percent for men and 14 percent for women. This translates into 205 million men and 297 million women. Another 1.5 billion adults were overweight, according to recent studies using body mass index (BMI), cholesterol levels, and blood pressure as key metrics.⁴

Epidemiologists warn that the increasing numbers of obese could lead to a global “tsunami” of cardiovascular disease, and diabetes. By 2011, obesity alone was linked to more than 3 million deaths annually.⁵ Especially since 2010, international attention has been solidly trained on combating this epidemic, e.g. the Pan American Conference on Obesity, held in Aruba, the XI International Conference on Obesity, held in Stockholm, the European Association Conference for the Study of Obesity, held in Munich, the UN Standing Committee on Childhood and Adolescent Nutrition and Obesity Conference, held in Abu Dhabi, a WHO Summit on global NCDs, held in Oslo, Norway, and a UN/WHO first-time High level Meeting on Non-communicable Disease Prevention and Control, held in New York City.

In the U.K., the number of people with NCDs, including diabetes, soared by 150,000 in a single year (2009). One in twenty adults in the U.K. is now afflicted and almost one in ten adults, or 5.5 million people, are obese, with nearly one quarter of all adults now classified as clinically obese, and 24 percent of children aged two through fifteen in the U.K. are now classified as such.⁶ About 90 percent of diabetics—2.5 million people in the U.K.—suffer from the Type 2 condition. Ten percent of the total National Health Service (NHS) budget is now consumed by treatment for NCDs and this figure is expected to significantly rise in the coming decade unless preventive measures are put in place.⁷ A London-based not-for-profit organization, C3 Collaborating for Health, focuses on health promotion initiatives in the U.K. It functions as a clearinghouse for the review of public policy and on increasing public awareness. This organization posted a 2011 Lords report on the national need for more extensive health-promoting policies and new public health incentives for people to take better care of themselves in this regard in the face of the U.K.’s current epidemic.⁸

The U.S. population alone is predicted to reach nearly 600 million by 2100, about double its current population. Its society is aging rapidly—and its future healthcare costs will be staggering; the deleterious consequences of unmitigated sprawl will be a major contributory factor, unless something is done. What is it like to live in a post-WWII suburban sprawl landscape that fosters sedentary lifestyles, and as a consequence, poor health? Too many of us already know what it’s like. Everyday life is nearly entirely automobile dependent. Families typically live in subdivisions with neither sidewalks nor destination points within a walkable distance. In these places, persons of all ages develop feelings of isolation and alienation. As for the automobile, since 1982, the U.S. population has increased by 20 percent but the time Americans spend in traffic has increased by an astonishing 236 percent. The average U.S. driver now spends 443 hours each year behind the wheel—the equivalent of fifty-five nine-hour days or eleven workweeks per year. By 2010, the average U.S. household owned 2.8 cars, and approximately half of all Americans lived in suburbia. Meanwhile, between 1986 and 1998, obesity among children in the U.S. doubled; 14 million (24 percent) between the age of two and seventeen became obese. Children in the U.S. who reside in neighborhoods with disproportionately fewer recreational facilities and lacking in amenities such as sidewalks tend to be more overweight than children who live in neighborhoods with more recreational facilities and related amenities.⁹

The planet’s roadways are becoming clogged with fuel-consuming vehicles. By 1997, smog pollution was responsible for more than 6 million asthma attacks in the U.S., 159,000 visits to emergency departments for treatment, and 53,000 hospitalizations; this number has grown significantly since.¹⁰ As for the health costs of sprawl, the nation’s obesity bills are ramping up. Annual obesity-related healthcare expenditures are expected to rise by nearly $265 billion a year between 2011 and 2018, while annual Medicare expenditures are expected to increase by about $360 billion during this same period. The U.S. Centers for Disease Control and Prevention (CDC) recently attributed $147 billion a year in U.S. medical costs to obesity alone—over 9 percent of all U.S. healthcare spending. And obese Americans are living longer due to factors such as cholesterol-reducing medicines, but many of these added years are lived in poor health; annual medical bills are nearly 42 percent higher than those of the non-obese.¹¹ The cohort of clinically obese rose from 24 percent of adults in 1960 to 47 percent in 1980 to 64 percent by 2000. Obese persons are nearly forty times more likely to develop diabetes compared to the non-obese, and this includes overweight children.¹²

Researchers have measured the effects of sprawl in relation to age, socio-economic status, travel behaviors, air quality, density, urban infrastructure, water quality, behavioral typologies, and morphological attributes of transport catchment areas as a means to predict ridership probabilities.¹³ Special constituencies with disabilities, including the poor, the medically underserved, the extreme aged, and children and adolescents, are particularly susceptible to the deleterious public health consequences of sprawl. ¹⁴ The health of our children and adolescents is in peril due to sedentary lifestyles and poor nutrition. Of course, sprawl alone cannot account for the obesity epidemic and yet it is a fact that children in developed countries are spending less time outdoors engaged in healthful behaviors such as walking, running, cycling and swimming, than before. This unhealthful trend is in part attributable to the lure of technology, i.e. computers and video games. Traditional play outdoors is in steep decline. The consequences of outdoor play avoidance can be profound—it itself is a growing crisis. As outdoor play declines, fitness levels decline, waistlines expand, and a host of other health problems can follow. For centuries, outdoor play was an essential ingredient in aiding children in their physical and emotional development, and in their acquisition of essential Vitamin D from sunlight exposure.¹⁵

Physicians know they are on the front line in the fight against global obesity, but they also know they alone cannot reverse this epidemic and its associated highly sedentary lifestyles. Education and consistent reinforcement are necessary on the part of parents, schools, and by the support provided by the neighborhoods and buildings where they live.¹⁶ In a recent study of 290 primary care physicians, 89 percent of respondents believed it was their responsibility to help their patients lose weight, although 72 percent claimed they were not properly trained to provide weight loss education; only 45 percent indicated they regularly discussed weight with their patients. In another recent study of 1,002 adults in the U.S., only one-third of those who were obese (defined as weighing roughly 30 or more pounds over their normal healthy weight level) indicated their healthcare professional had informed them they were overweight.¹⁷ The healthcare system itself is too often the culprit. Highly hospital-centric healthcare systems over-rely on hospital-dispensed care. They have historically tended to undervalue sickness prevention in public education and awareness. In such a system a patient may not take “ownership” of his/her health condition until it is far too late—by then accruing, by default, very costly hospital-based emergency care that could have otherwise been avoided at far less expense.¹⁸

Battling the Status Quo

A century ago, the nascent fields of planning and public health converged over the need to mitigate the unhealthful effects of slums and tenements constructed literally at the doorsteps of dirty, noisy factories. Workplaces spewed billowing clouds of highly toxic substances into their surrounding neighborhoods.¹⁹ As is discussed in later chapters, this resulted in the establishment of zoning laws now viewed as archaic and in need of a total overhaul. After decades of the status quo, with relatively little serious discourse between these disciplines, they have recently re-converged.²⁰ During this “lost period,” decades of inattention and ineffectiveness, combined with careless actions on the part of developers, politicians, and others resulted in the construction of vast stretches of suburbia that seemingly had no beginning, no middle, nor end, not unlike a very poorly fitted shag carpet stretched beyond its reasonable limits across the landscape. One tool developed by public health specialists working in consort with urban planners has been the Health Impact Assessment (HIA) developed by the CDC in the U.S. It parallels the environmental impact statement of the U.S. Environmental Protection Agency (EPA).²¹ HIAs generally focus ...

Table of contents

• Cover
• Sprawling Cities and Our Endangered Public Health
• Full Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• Preface and Acknowledgements
• 1 Introduction: An Epidemic on Our Doorstep
• 2 Sprawl, Architecture, and Health: A Brief History
• 3 Global Sprawl Machines
• 4 Transfusion: Design Considerations
• 5 Case Study: New Orleans
• 6 The Future
• Appendix: Mall Typologies
• Index