Policymakers, public health officials and urban planners agree: the patterns of settlement and (in)activity in the places we live, work and play are to blame for the obesity epidemic.
The graphics below (borrowed from the CDC) demonstrate the veracity of this epidemic. In 1990 less than 14% of adults in all each state were obese. Nearly twenty years later in 2009, at least 25% of the adults were obese in all but one state.
The Active Living approach — or increasing physical and healthy eating through community design — dominates discourse, policy and planning at all levels of intervention. But ultimately, Active Living presents more questions than answers. Namely: When it comes to reducing obesity, is there a greater role for urban planners than simply redesigning physical space in such a way that encourages activity?
Although I do not have all of the answers about how we can rethink the role of urban planners in reducing obesity, the thesis interviews I did with urban planners across the nation who are working to improve health through the built environment gave me a few ideas:
• Planners need to look more closely at the fundamental causes of disease and disregard any policies or design proposals that solve only one disease.
The fundamental causes of disease are the underlying social and environmental conditions, such as poverty, that contribute to poor health and undermine the promise of Active Living interventions. The fundamental causes of disease contribute to a spectrum of diseases, and therefore policies designed only to impact one disease will fail to positively effect health in a significant way. As a critique to Active Living, the fundamental causes approach suggests that many planning interventions — for instance, the addition of bicycle lanes or streetlights — are only at the intermediate level of change. Instead, planning, programming and policy interventions must address the fundamental causes of disease in order to improve health for all populations.
• Planning to promote health needs to be sensitive to, and embedded in, its cultural contexts.
Active Living and healthy urban planning approaches should develop greater cultural competency, specifically noting the way that different cultures use and interact with the city differently. For instance, many cultures value modesty and it is considered inappropriate to exercise vigorously alongside the opposite sex. In many Latino cultures it is considered inappropriate for seniors to partake in may of the activities promoted by active living urban design, but gardening among seniors is accepted and encouraged. The built environment should reflect how people interact with it, which is a significant break from the solutions of bicycle lanes, running trails and wide sidewalks that are so entrenched in the planners’ toolbox.
• Planning to promote health must be linked to efforts to preserve undeveloped land in the urban fringe and vacant land in the city.
We need to look closely at the role of urban parks both for the ecological services they provide to the city and also as cultural, recreational and health resources. Planners should work closely with land trusts and legislators to implement tax incentives that encourage the donation of land for permanent preservation for public use.
• To carry the current momentum around active living into permanence, planners, researchers and program managers must evaluate the cost savings associated with active living and healthy planning at the city and county level.
Similar to the way we can now estimate the economic benefits of public spaces, namely in terms of property values, we must work diligently to quantify the benefits of improved health linked to healthy urban planning and programming.
• Economic development must be a central component of Active Living and healthy urban planning.
Efforts to complete the streets or create safe and accessible pathways are only viable if there is a destination. As one planner I spoke to explained, if a neighborhood is not “a designated gem” — meaning it is currently undergoing gentrification with climbing property values — very little investment will be directed to it. Planners must remember that people walk and bicycle not only for recreation, but to get somewhere. However, due to disinvestment and suburbanization, not all communities have destinations and not all people are able to complete their errands within their own communities. This is especially true in low-income communities where the obesity problem is most acute and least understood. To promote health in low-income and high-income communities, it is important to link more closely with economic development efforts than strictly physical planning and design.
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Planners do indeed have a much larger role to play in reducing obesity in the built environment than just carrying out the Active Living approach. When we, as planners, start from the foundation of the fundamental causes of disease, we can see the strictly design- or physical-based planning only acts at the intermediate level of disease and does not actually ameliorate those factors that are linked to ill health. When we internalize the fundamental causes approach into our encounters with community members, our research and our planning toolbox, we will have a diversity of solutions that supports physical activity and makes active and healthy living a possibility for all communities.
Laura Tolkoff recently completed her Masters degree in Urban and Environmental Policy and Planning at Tufts University. Her thesis is titled:From Active Living to Healthy Planning: Rethinking the Role of Urban Planners in Reducing Obesity. Laura currently lives in Brooklyn, New York and is pursuing a career in urban planning.