How the places we live make us sick, and how they could heal us instead
Photo: sanaThe news came out a couple of weeks ago, and then it got swept away in the ongoing torrent of information: The Centers for Disease Control projects that by 2050, one in three American will have diabetes.
One. In. Three.
If we needed any more of a wakeup call about the catastrophic state of American public health, this should provide it.
Why is this happening? According to the report, “These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer.”
Fair enough. But why are people — minority or otherwise — getting diabetes in the first place? Scientists have proven the link between diabetes and obesity. And we have become a society where the road to obesity is quite literally built into our environment. Studies have shown that more vehicle miles traveled result in more obesity. Our broken food system is another huge contributing factor, but even there, the built environment factors in — our inner cities are quite often “food deserts” where no healthy nutrition is available.
So if the places we live are making us sick, could they heal us instead — if only they were designed better?
That’s the fascinating question being raised by the Healing Cities Working Group of planners and health professionals in Vancouver.
Why are those crazy Canadians thinking all these radical thoughts about the health-planning-transportation connection? To find out, I called Mark Holland, a principal with planning and design firm HB Lanarc in Vancouver, B.C., which is piloting the Healing Cities initiative.
One of the first things he told me was this: It’s possible to interest public officials in the health impact of the built environment because Canada has nationalized health care.
“When you have a public health care system like we have in Canada, we all collectively pay the end-of-pipe costs,” said Holland. “So anything we have in our society that makes us unhealthy, we end up paying for it.” Of course, that’s true in the United States as well, but there is much less transparency and awareness of those costs because of the way our system is set up.
In Canada, Holland hopes to be able to involve doctors and public health authorities in the fight against sprawl and for more walkable and transit-oriented neighborhoods. Among the Healing Cities Working Group’s many planned initiatives is a partnership with health officials to advocate for more health-enhancing infrastructure and development at the local level.
“We’re starting a dialogue with the health authorities out here to develop actual planning tools for them to use with local governments,” Holland said. “They have significant credibility and ability to comment on things. We can help give them a toolbox of facts and statistics. We can arm them so they can engage that discussion with city councils very directly to say, listen, if you approve this kind of development the probabilities of significant increases in health problems are going to go up. You’re probably going to have an obesity level 15 percent higher.”
Holland points out that any development or infrastructure style costs significant amounts of money, so the cash might as well be spent in ways that can save health-care costs down the line — not to mention enhancing people’s quality of life.
“What if we ask more of our cities and planning processes — to not simply move cars and house people and provide a park for kids to play in?” Holland said. “What if we actually ask about a more conscious approach to health in how we do that? What if cities could actually heal the people who live in them rather than be the source of significant amounts of disease for them?”
The Healing Cities idea is based on “eight pillars of a healthy community.” The eight pillars are:
- Complete community (land use, density)
- Healthy mobility (transit)
- Healthy buildings (green buildings)
- Thriving landscapes (open space)
- Green infrastructure (water, sewers etc)
- Healthy food system (organic agriculture, nutrition)
- Healthy community (facilities, programs)
- Healthy abundance (sustainable economic development)
The danger of talking to planners and developers about “healing,” “wellness,” and similar touchy-feely concepts is not lost on Holland. He knows these are professionals more comfortable discussing traffic counts, or how to brand a new project, as the case might be. Trying to quantify the more ephemeral aspects of human experience — the stress caused by, the isolation experienced in a lifeless neighborhood — is risky territory. So Holland and his team are busy gathering scientific data about the relationship between these things and human health, such as a study by Ugo Lachapelle and Larry Frank at the University of British Columbia on the link between public transit use and physical activity. And he chooses his words carefully.
“Everyone knows exactly what you’re talking about, but you have to be careful about how you frame it,” says Holland. “Everyone knows what a bleak place feels like — if you just leave it with the word bleak they all understand what you mean. But if you start to talk about how it’s soul-deadening, if you start to talk in more emotional terms, you have to be pretty careful about it. We’re working with truth, but we have to shape-shift it into language for professions that traditionally do not choose to acknowledge the emotional tenor of places and the social interactions that happen there.”
Eventually, the Healing Cities team would like to develop a LEED-like set of standards for healthy communities. And maybe someday, the idea that we should design places to make people healthy — both physically and spiritually — won’t seem strange at all. Even in the United States.