City Limits

Urban sprawl is hazardous to public health. Where do we go from here?

Do Americans really want to spend their lives fat, sick, and stuck in traffic? Judging by our tacit acceptance of urban sprawl, it appears we are willing to pay the price for spreading far and wide. Dr. Howard Frumkin, chair of environmental and occupational health at Emory University's Rollins School of Public Health in Atlanta, Georgia, has spent more than two decades studying the health effects of sprawl. With Atlanta's horrendous traffic and unenviable air pollution problems, Frumkin benefits from having a city-wide laboratory right in his own backyard. Perhaps then it should be no surprise that Frumkin and co-authors Lawrence Frank and Richard Jackson recently published what is arguably the definitive book on the relationship between health and environment (“Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities,” Island Press). Failure spoke with Frumkin about the ongoing battle between urban sprawl and public health, and the hell-on-earth experience of driving in Atlanta.

What makes "Urban Sprawl and Public Health” unique?

It tries to tackle two entirely different worlds and bring them together. One is the world of planning and design and the other is the world of public health. Those are different worlds because the practitioners go to different schools, attend different meetings, work in different offices, and generally don't interact with each other. 

They are also different culturally, because in the public health world—like in the medical world—we have a strong impulse to back up everything we do with evidence. If I give you medication, you have every right to expect that I have evidence that the medication is safe and effective; otherwise I wouldn't be giving it to you. 

In urban planning there is much less of an empirical tradition. So urban planners, designers, and architects will declare what they think is the best way to do things, but often without having done formal studies to show that that is the best thing to do. On the other hand, urban planning has a very strong tradition of community involvement—incorporating community input into decisions—something that public health is only now learning to do. 

These are two different cultures that we try to bring together and suggest that if we want to get it right in building safe, healthy communities then we need to draw on both of those. 

One of the most striking statistics in the book is that the people of Atlanta drive 102 million miles per day. Describe what it is like to drive in Atlanta these days.

[Laughs]. When I first came to Atlanta fifteen years ago you would go to a party and people would be standing around complaining about HMO's. For the last few years, when people are bitching and moaning at a party it's about the traffic. If you go anywhere it's a half-hour to an hour. When I go two or three miles from the Emory campus into town to a meeting at the State [house] or at Georgia Tech it's a half hour each way—at least—and that means that a one-hour meeting becomes a two-and-a-half hour time commitment. 

The topic of road rage is in the newspapers here every few months. It's almost understandable, if not excusable. It is an excruciating thing to be stuck in traffic and need to get somewhere. It's no surprise that people lose it sometimes. 

What other cities have similar problems? Perhaps there are some that would surprise people? 

I don't know that there are too many surprises. It's pretty predictable. The obvious ones are Sunbelt cities like Houston, Phoenix, Jacksonville, and Orlando—which are all facing problems like this. Los Angeles got there a little earlier, and in some ways is doing better than some other cities. 

But there are two kinds of surprises. One is when the traditional, older pre-automobile cities like Boston and Chicago suffer the consequences of sprawl, as they are. As those cities expand out, despite very good infrastructure in the central city, you are seeing a lot of the consequences of sprawl on the periphery. Places like Portland [Oregon] and Minneapolis, which have quite good downtowns, have been in the vanguard of developing responses to sprawl, precisely because they have had problems. 

Wherever you've got affordable petroleum and enough wealth for people to buy cars and some available land outside the city you are seeing this phenomenon happen.

How does over-use of automobiles damage the health of individuals? 

There are several ways. One is when you replace walking and bicycling trips with automobile travel you forfeit an opportunity for physical activity. Walking turns out to be the most common form of physical activity for adults in this country so if you engineer walking out of your daily life then you have taken a major step, so to speak, towards a sedentary lifestyle. 

The next problem is that lots of driving causes lots of air pollution. In automobile dependent cities like Atlanta we see high levels of certain air pollutants directly related to the use of automobiles. 

Another is that an automobile is a dangerous way to travel. Every hour that you spend in an automobile really has to be thought of as an hour at risk of a car crash. Car crashes are the major killer of young people in this country—enormously costly in terms of suffering and finances. 

Then there is one that is a little less tangible but maybe the most important. It's the effect of the automobile culture on social capital and sense of community. If you walk along a sidewalk and encounter other people you may smile and make eye contact. You may wave or even have a little conversation. In contrast, if you are in a car and are encountering people through the windshield of your car, very often it turns out that the interaction is characterized by hostility and competitiveness and anger. 

So at least in those four ways—air pollution, injuries, physical activity, and sense of community—our heavy reliance on driving probably isn't very good for us. 

In a nutshell, how did we get to the point where—outside of New York City and a handful of other places—it's very difficult to get along without owning a car? 

There were push factors and pull factors. There was the pull of life in the country and owning one's own land and having a private place for a nuclear family to live. Then there were push factors. At times cities became very crowded, squalid places from which people really wanted to escape. Particularly in recent years there have been problems with school systems and crime in cities that pushed people out. We also had a large number of policy decisions—mortgage and tax policy decisions—that greatly encouraged buying a new house rather than buying or renting. We had huge amounts of federal dollars flowing toward highway construction, but not toward public transit in cities. So that really facilitated and subsidized moving to the suburbs. 

Interestingly, if you project forward we are probably now peaking in the availability of petroleum worldwide. That may profoundly change the way the suburbs function. If that suburban house is no longer easily reachable by car that may soon become the only choice for many people.

How do you respond to those people who say that it isn't possible to turn back the clock? Is it inevitable that sprawl-related problems are only going to get worse? 

No, I think we are actually seeing some reversal already. If you look at all the major American cities you see several things going on. The first is that there is a revival of interest in living in town. If you look at the trajectory of property values they are substantially steeper in-town as compared to suburban areas, suggesting that there is a market scarcity of in-town properties relative to suburban properties. It's not a surprise. We have really served up one main dish on the housing menu for the last 50 years and that dish has been suburban subdivisions. So there is a relative scarcity of alternatives. 

We are also changing demographically as a country. As the next few decades unfold many more of us will be elderly. Elderly people may be unable to drive and really value walkable neighborhoods. More of us will be immigrants or the children of immigrants, many from parts of the world like Asia and South America where urban living is the norm. 

Many of us will not be the traditional nuclear families. There will be the dual-income, no kids arrangement, there will be singles, there will be unmarried couples living together. Many of those demographic categories prefer in-town living to suburban living. So demographically we are going to see increasing demand for in-town living as well. 

That said, we are not going to reverse the trend overnight. There will still be people who prefer suburban living and this is a free country; they will be perfectly entitled to act on that preference. 

Secondly, we currently have a lot of suburban housing and not much in-town housing. It has taken 60 or 70 years to build the country out this way and it is going to take decades to reverse it. But in every major city we are seeing very impressive developments in town, bringing people back into the city. That's the harbinger of development trends to come. 

Do you ever run across critics who believe you are promoting an old-fashioned ideal? 

It is an old-fashioned ideal. This is received wisdom that is centuries old that we have forgotten for the last 50 years that we have to re-discover now. What's wrong with that?

Is there anything positive about urban sprawl? Do you ever talk to people who are willing to fight for it? 

Sure. Actually, there are positives that we need to pay attention to and try to incorporate into design principles, even in in-town areas. One is contact with greenery. People love a backyard that has some trees in it. One of the lessons for urban planners is that we should have an urban park within a five-minute walk of where everybody lives in every city. There is something restorative, refreshing, and probably health sustaining in nature contact. 

Privacy is another one. We are a pretty private people. A lot of Americans would have difficulty living in a Japanese context where they are living in very close quarters. That means that the design of density—cities are going to be denser places than suburbs—should be part of the design principles of smart growth. But there is good density and bad density. We can take a lesson from suburbs where people actually have a fair amount of privacy when they want it and design that into good urban design in cities. 

If people just don't feel right these days—as you say in the book—then why do we put up with sprawl? 

There is a certain malaise that seems to set in with driving long distances, working too many hours, and not having enough time to nurture our friendships and family relationships. I think we've all been caught on a treadmill. Americans work too hard and are very acquisitive. But collectively we seem to think we should be striving to get more stuff. Part of the reason is that this image of the dream suburban home has really permeated our thinking over the last couple of generations. So people in some cases think that is the best thing and they go for it. 

It seems like sprawl-related issues are so huge and overwhelming that any one individual might be tempted to throw up his or her hands and say, "I'm one person. What can I do to make things better?” What can an individual do to combat urban sprawl?

There are many things an individual can do. One is to make the decision to live close to where one works, to live in communities where one can walk to recreation and where the kids can walk to school. 

For people who are inclined to be civically involved there are opportunities to go to the zoning board or county commission and push for ordinances and rules that allow smart growth development to occur. Many developers complain that they are blocked in every direction by antiquated ordinances and laws, so changing policies to accommodate this kind of thing matters a lot. 

Lastly, I think we need a national conversation about what kind of country we want to have and what kind of physical environments we want to live in and leave to our children. The census bureau predicts that the U.S. population will double by the year 2100. We are not going to have a single additional acre of American land. It really becomes a pressing question for us: How are we going to utilize this land in ways that are tasteful, attractive, healthy, and environmentally sustainable? Getting the conversation going is something that everybody can do.

What has to be done on a large scale to solve this problem?

There are several things we need. One is better research, because we still don't fully understand which design principles will be most effective at achieving health and environmental well-being and economic goals. So we need to learn more. 

We need good partnerships, which grow out of multi-disciplinary thinking. That sounds like an academic egghead thing to say. But you go to a typical city—Atlanta is a good example—and your mortgage lenders aren't talking with your public health people, who aren't talking with the developers, who aren't talking with the landscape architects, who aren't talking with the planners. We need collaborative processes where entire communities come together and envision how we want the communities to look, and go ahead and move in that direction. That's a big picture issue. 

Then we need infrastructure changes. By infrastructure I don't just mean bricks and mortar, but mortgage practices, tax policy, transportation policy, housing policy, and so on. All of those are ingredients of good community design. Just take one example: transportation policy. We pass an enormous transportation bill every six or seven years. If some of the many billions of dollars that flow from the federal government into transportation were diverted from the predominant use [building highways] into sidewalks and bicycle trails in urban areas we would achieve a better balance. 

You can do a similar balance for almost every major aspect of domestic policy. Housing and urban development policy needs to favor the installation and maintenance of good housing in cities, including a lot of affordable housing so that people who work in the cities can also afford to live there, not just the well off. There are a whole range of policy initiatives that we need in government and in the private sector to begin to turn the ship. 

You are certainly living and working in the quintessential city for the study of urban sprawl. Is there any place you'd rather be? 

I love being here because I love the challenge of addressing sprawl issues. But if I were parachuting in from outer space, what are the kinds of places that would be most appealing to me in America? Places like Charleston, Savannah, Annapolis, Georgetown—pre-automobile cities that are charming to live in, where you can walk to most activities, where there is good transit, and ready access to parks. We have plenty of good examples in the country and they are awfully attractive places. Our challenge is to make more and more of the country look and function like that.