Healthy City Living

Are suburbs making us sick?

Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities, by Howard Frumkin, Lawrence Frank, and Richard Jackson, Washington, D.C.: Island Press, 338 pages, $30

During the summer, we often pack up our kids for a little sun and fun at the local pool, nestled in our low-density, sprawling suburb in the Midwest. My kids eat a balanced diet, are physically fit, and are certainly not overweight. The pool is one of our tactics for moderating their time in front of video games and the television. It also ensures that they get a little exercise.

Each year we’re surprised to find that other parents don’t see things the same way, at least to judge by their children’s girth. As our kids frolic, we sit amazed that other parents let their overweight children walk up to the snack bar to consume ice cream, hot dogs, and other high-calorie snacks. We know American kids face an obesity problem—we see it every summer in the jiggling rolls of sunburned fat at our local pool.

So I welcome any book that wants to inform the public about ways to keep us and our children fit. That’s what the authors of Urban Sprawl and Public Health seem to promise. Unfortunately, the book doesn’t deliver, partly because authors Howard Frumkin, Lawrence Frank, and Richard Jackson can’t solve the problems we see every summer.

They are, to be sure, well qualified to write this book. They are among the most prolific researchers on the subject of land use and public health, and they have strong credentials: Frumkin chairs Emory’s Department of Environmental and Occupational Health, Frank holds an endowed chair in transportation planning at the University of British Columbia, and Jackson is an officer in California’s Department of Health Services. And their book’s basic premise is plausible: Choices about where and how people live have potentially significant implications for their health. Living on top of a toxic waste dump, to pick an obvious example, probably increases the odds of getting cancer.

The large lots with segregated residential and commercial land uses perpetuated by standard zoning codes and planning procedures work against good health, Frumkin and his colleagues argue. Low-density suburbs, they say, encourage automobile use and discourage walking, contributing to sedentary lifestyles while disrupting healthy fitness habits and spewing more pollutants into the air. Unfortunately, the evidence they provide isn’t nearly as convincing as they claim, and they miss an opportunity to discuss how everyday habits such as dipping into a bag of potato chips after work (or school) or plopping down in front of the TV contribute to the health problems that concern them.

The opening chapters provide useful, objective overviews of how recent North American land use patterns have evolved. We started out on farms and the frontier, but rapid productivity gains and the industrial revolution crammed people into dense, congested cities. This migration created its own problems: poor sanitation, epidemics, stifling air quality, overcrowding. The lure of the countryside prompted the wealthy and then the middle class to move jobs and homes out.

Land has always been romanticized in American culture and literature, the authors point out. Cities were dirty, crowded, and unhealthy; the push into the suburbs was a natural response to the worst aspects of city life.

Outward expansion was encouraged by revolutionary changes in transportation, first the trolley car and then the automobile. The introduction of low-cost construction methods made new housing cheap, and abundant land outside the city center made housing more affordable in low-density areas. Suburbs were in some ways inevitable destinations for the North American working class and a growing middle class.

Things changed dramatically after World War II. The interstate highway program, the authors claim, subsidized automobile use and travel, making suburban areas more accessible. Federal financing made mass-production suburbs like Levittown possible, and zoning and planning effectively locked in place low-density lifestyles that segregated residential and commercial uses. The effect, they suggest, was the destruction of the urban neighborhood.

Frumkin and his co-authors argue that low-density housing patterns created a new set of public health challenges. In addition to the health problems associated with dense cities, they say, regions now confront sprawl-induced problems with air quality, obesity, traffic deaths, water quality, and mental stress, along with a loss of community (or “social capital”) and an inability to address the health issues of specialized groups such as children, the elderly, and the disabled.

The authors provide a service by pulling together the growing body of academic research examining links between land use and human behavior in an accessible and readable way. But their conclusions often do not adequately reflect the richness and complexity of the research. In some cases, the contrary evidence is so obvious that knowledgeable readers will be scratching their heads, wondering why the authors don’t address countervailing data.

If urban sprawl destroys air quality, why has air quality improved in every major metropolitan area in the same period that North American cities have sprawled the most? Ozone in the Los Angeles basin, for example, has been cut in half since 1973, according to the South Coast Air Quality Management District. If living in automobile-oriented suburbs increases the risk of personal injuries, why are fatality rates for commuter and light rail transit two times higher than for urban roads and almost three times higher than urban interstate highways? If automobile injuries and fatalities are a significant drawback of suburbs, why aren’t the higher risks of property and violent crime significant drawbacks of dense, mixed-use, transit-oriented cities?

If this book were a polemic, Frumkin, Frank, and Jackson could perhaps be excused for ignoring countervailing evidence. But Urban Sprawl and Public Health is supposed to serve as a guide for citizens, planners, architects, landscape architects, and legislators.

The authors do note some of the paradoxes in their research, and they seem genuinely perplexed. On the one hand, they believe communities should be designed for higher densities to encourage walking or bicycling to work. On the other hand, higher densities expose neighborhoods to higher levels of pollution at the street level. Walking and bicycling expose people to that pollution longer, and they breathe polluted air at higher and more intense rates. High densities can reduce pollution only if significant numbers of people opt for slower, less flexible public transit over the mobility and speed of cars. Yet the flexibility and speed of the automobile still trumps transit in most high-density areas. Even in dense, congested, mixed-use London, England, with its extensive public transport system, almost half of all trips are by automobile.

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