Healthy Cities: Learning from Dr Richard Jackson
If you don’t know of Richard Jackson and his work, you should.
Not just because he was Arnold Schwarzenegger’s head of public health or he was a high muckity-muck in the Centers for Disease Control, but because he’s put together some of the best work I’ve seen on the connection between good urban design and better health. And, conversely, how we are killing ourselves by building our cities as if health doesn’t matter.
He recently gave a talk at the 50th International Making Cities Livable Conference in Portland, Oregon and, although I’ve heard his speech before and own the DVD of his television series (available here), each time I hear Dr. Jackson speak, the urgency and value of re-thinking the car and its place in our communities is so vivid I always come away with something new.
“Health care expenditures are on track to bankrupt the United States. Already we are spending 20% of the Gross National Product on healthcare yet our health outcomes are no better than Costa Rica’s that spends 1/7 as much per capita.”
He compares today’s health emergencies to the early 1900s when investments in infrastructure–clean water supplies, sewage control and immunization–led to a 30+ year increase in average lifespan. It wasn’t miracle drugs but basic hazard reduction. And, he maintains, it will take the same focus on infrastructure to address the huge increase in health problems caused by a sedentary lifestyle forced on us by the heedless surrender of our communities to the automobile.
Let’s do a quick comparison of the health of people aged 45-64. In 1988, 32% of people surveyed said that they enjoyed “excellent health.” According to the Journal of the American Medical Association, in 2010, only 13% of this age cohort said they enjoyed “excellent health.” Obesity increased from 29% to 39% and the percent who were physically inactive soared from 17% to 52%. I’ve written here about the campaign that Nike is leading to focus attention on the critical role that urban design has on levels of physical activity. The Designed to Move materials are also powerful story-telling.
“We are hungry for opportunities to socialize, for active civic lives, happiness and security. Our cities don’t provide these anymore. We are isolated, lonely and unhappy. So we eat.”
Not one to blame car-oriented urban design for all problems, Jackson points to other public policies that are contributing to the problem. In particular, high levels of subsidy ($5B annually) for “bad” foods–those that contribute little but calories like corn and soy–now cost less than half of what they did in 1980. But “good for you” foods like fresh fruits and vegetables now cost twice as much as they did in 1980–and get no subsidies in the federal farm bill.