Posted July 26th 2011 at 7:40 am by
in Health by Design

Addressing the Obesity Epidemic: A New Role for Urban Planners

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.

What Urban Planners Can Do About the American Obesity Epidemic

What Urban Planners Can Do About the American Obesity Epidemic

What Urban Planners Can Do About the American Obesity Epidemic

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.

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8 Responses to “Addressing the Obesity Epidemic: A New Role for Urban Planners”

  1. Christina says:

    Laura, this is really interesting. Did the planners discuss any correlation between obesity and dining/restaurant options? I ask because I recently moved from a community in the Northeast U.S. that had virtually no fast food restaurants, to a city in the Southern U.S. that is loaded with them. Before it was out of sight/out of mind, but here people are constantly tempted by fast food. It would be interesting to hear if you had any findings on this.

  2. Laura Tolkoff says:

    This is a very important issue. I did not ask my interviewees about this question, but my sense is that the existence/prevalence of fast food restaurants isn’t really seen as within the purview of what planners can change. However, I definitely think that there is more that planners can do to address the issue–specifically in helping to educate planning and appeals boards and those who work in the permitting process about the severity of obesity within their own communities. The city of Los Angeles placed a moratorium on new fast food restaurants in 2008. I haven’t followed this intervention closely, but if it peaks your interest, you should definitely check it out!

  3. Daniel says:

    I appreciate the enthusiasm you bring to this important issue. However, I wouldn’t be so dismissive of actions that have only limited positive impacts on our obesity epidemic. Most would agree that public health problems in general are the result of many different causes, and therefor are in need of many different responses. Creating a physical environment that is conducive to walking and bicycling will not, in and of itself, solve disease, but it may be one component of a broader effort to marginally improve health for everyone. It also happens to be one part of the effort that planners are uniquely situated to help with.

    It’s also not clear to me that increasing “vacant land” in cities will lead to healthier outcomes across the boards. Some cities may indeed be in need of more parks, but others have a greater need for destinations that can be walked to, or affordable housing, or employment centers that offer career-ladder jobs. Really the land use that offers optimal health impacts ought to be determined on a site-by-site basis. Broad rules about which kinds of uses are inherently healthy than others can be misleading.

    Thanks for some thought-provoking ideas.

  4. Laura Tolkoff says:

    Hi Daniel,

    I agree with you entirely–this article is a critique of the pure Active Living approach, calling for more than just a physical environment that is conducive to bicycling and walking. Obesity is a result of a complex host of conditions–the social determinant of health. The built environment alone is not the cause of obesity–in fact, other issues, such as the level of segregation, may be equally important to consider when we talk about health.

    As per the ‘vacant land’–I don’t mean to keep vacant land vacant. Vacant land can often be a deterrent to walking and bicycling–not only is it often a eyesore but it can also be hazardous. And yes, when you talk about “destinations that can be walked to” or “affordable housing”–this is precisely what I talk about in my second and my last suggestion.

  5. Mara says:

    Laura,

    Thank you so much for taking the time to write this article. I am currently an undergraduate student applying to graduate school for a masters in public health and eventually a masters in urban planning as well. I enjoy both fields but I haven’t really found much information about how the two can work hand in hand. I am planning to pursue a career that somehow combines both public health and urban planning. I found your article to be both fascinating and inspiring. Keep up the good work!

  6. Alexa Mills says:

    Mara: I think you’re on to something. I know several students like you who are seeking a masters than combines public health and urban planning. I know one student who came to MIT for urban planning but took a lot of her classes at Harvard to get the public health classes. Although I don’t know of a program that ingrates the two fields successfully, I think it would be great if a university did something to create such a program. Let us know if you find one.

  7. Rudy says:

    I’m currently an undergraduate student, pre-med, but I have been researching alternative programs similar to what interests Mara. I found one in my home state of California at UC Berkeley. Here is their page: http://dcrp.ced.berkeley.edu/ – Go under concurrent programs, and you will find the MPH/and Urban Planning masters degrees. I’m not sure how well the topics are brought together, but I like the idea.

    Thanks for the article btw!

  8. Jeanne Leccese says:

    Hi Laura,

    As a professional urban planner working on a local health promotion program, I appreciate your insight and would be interested in reading further about your results. Would you be willing to share your thesis? Thanks so much!

    Cheers,
    Jeanne