Healthy Communities, Healthy People

I work just blocks from one of the poorest areas in Washington, D.C. There are liquor stores, convenience stores, and gas stations, but nothing resembling a grocery store with fresh, affordable produce. The playgrounds are dilapidated, with rusting swing sets and forlorn basketball poles. Kids don't have safe places to play, and adults don't have easy access to exercise.

Miles away in my quiet suburban neighborhood, kids are bused to school because the main route isn't safe for walking. Likewise, the nearby supermarket sits across a busy, four-lane road.

While suburbia is a far different environment than the inner city, one factor directly affects human health no matter where we live: the “built environment.” The built environment -- the places we live, work, play, and learn -- can dramatically influence our health. Stress and poor nutrition lead to heart disease. Ending the day on the couch instead of strolling around the block promotes obesity. In neighborhoods without a pharmacy, residents skip recommended doses of critical medication. And in those lacking access to preventive health services, children and adults may risk their very lives.

A healthy community, on the other hand, gives residents access to nutritious foods, daily exercise, clean air outdoors and indoors, convenient public transportation, and much more. With increased understanding and research supporting the link between community design and public health, we are seeing more such communities rise up across the nation. Meantime, our public-health colleagues are telling everyone who will listen: Healthy communities help make healthy people.

Senator Barack Obama of Illinois and Congresswoman Hilda Solis of California have elevated the issue by introducing the Healthy Places Act of 2006, the first legislation aimed at comprehensively addressing the health of communities. It would provide state and local grants to support healthy development, and spur new research on the link between environment and health, as urged recently by the Institute of Medicine. It would also encourage local “health impact assessments,” much the way environmental impact assessments are mandated for new construction today. The idea is to help factor health into community design -- and to prevent healthy communities from being engineered into extinction. Other recent legislation to promote healthier communities enjoys bipartisan support.

Already, we have innovative models to guide our way. During National Public Health Week last April, we recognized five blue-ribbon communities that illustrate what a healthy community can be. One, Centennial Place in Atlanta, was formerly a crime-ravaged public housing project, one of the nation's oldest. Razed and rebuilt mainly with federal funds, it is today a diverse, mixed-income community, blending affordable and public housing units with market-rate homes, recreational facilities, and a magnet elementary school. Hazards like lead paint and outdated plumbing are gone, and crime has dropped some 90 percent, making it a dramatically healthier environment for residents and neighbors alike. (Our other “blue-ribbon” winners were in Riverside County, California; Denver, Colorado; Delaware County, Ohio; and Richmond, Virginia.)

Children are especially vulnerable to the types of environmental contaminants that arise when communities aren't healthy -- smog that leads to asthma, lead-based paint that can cause developmental delays and learning disabilities, and obesity linked to poor diet and exercise that is threatening to become the nation's leading cause of death.
Unfortunately, low-income residents and people of color, who already face higher rates of premature disease and death, also disproportionately live in communities with the worst built environments. Yet in wealthier suburbs, healthy investments are often overlooked, too.

The lack of smart growth in suburbs translates into neighborhoods that lack bike paths and parks, that are too far from offices, schools, and shopping centers for residents to walk, and that are inaccessible to public transportation. The health of our nation's suburban population is suffering, with much of America growing more sedentary and at greater risk for preventable diseases such as heart disease and diabetes.

What's the fix? A comprehensive commitment to building healthy communities around the needs of individuals -- with access to health care, affordable and secure housing, social networking, fresh food and clean air, public transportation, safe sidewalks, streets, and playgrounds. The federal government's Healthy People 2010 report describes a healthy community as “one that continuously creates and improves both its physical and social environments, helping people to support one another in aspects of daily life and to develop to their fullest potential.” We agree, and are working daily to realize that vision.

Georges C. Benjamin, MD, FACP, is executive director of the American Public Health Association.

For more on building healthy communities for healthy people, see:
American Planning Association

California Endowment

CDC's Designing and Building Healthy Places program

EPA's
Smart Growth program

Local Government Commission

Prevention Institute

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