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Urban Sprawl and Public Health
HEESOctober 4, 2001
Richard Jackson, M.D., M.P.H.National Center for Environmental Health
Howard Frumkin, M.D., Dr.P.H.Rollins School of Public Health
Agenda
1. Background: “Urban form” as a public health issue
2. Sprawl: a definition3. Health implications of sprawl4. A public health approach to sprawl
Background: Urban form as a determinant of public health
The Epidemiologic Transition of Cities
1. The Age of Pestilenceand filth
“As a rule, the streets are extremely dirty and offensive, and the gutters obstructed with filth. The filth of the streets is composed of house-slops, refuse vegetables, decayed fruit, store and shop sweepings, ashes, dead animals, and even human excrements….The reeking stench of the gutters, the street filth, and domestic garbage of this quarter of the city, constantly imperil the health of its inhabitants.”
Eleventh Ward Inspector, New York City, 1864
2. The Age of Industrialpollution
Pittsburgh, 1890
3. The Age of Social Pathology
The summer of 1967: 130 urban riots across the United States
All persist today
Manila
Port au Prince
But we can also identify…
4. The Age of UrbanSprawl
What is sprawl?
• Land-extensive, low density, leapfrog development
• Segregation of land uses• Extensive road construction• Architectural homogeneity• Economic and racial homogeneity• Shift of development and capital investment from
inner city to periphery• Absence of regional planning
A pattern of urban regional developmentthat features:
Sprawl: A Schematic
Suburban Development
Traditional Neighborhood
Land consumption: Changes in population and land area, selected metro areas, 1970-90.
-50
0
50
100
150
200
250
300
Cleveland Chicago New York Seattle L.A. PopulationLand Area
Source: Benfield et al., Once There Were Greenfields, NRDC and STPP, 1999.
Population Density:Selected Cities, 1997
Area (square miles)
Pop’n (in 000s)
Density (people/sq.
mile)
Washington 1,000 3,465 3,465 Boston 1,155 3,015 2,610 San Diego 755 2,610 3,455 Atlanta 1,790 2,580 1,440 Phoenix 1,090 2,400 2,200 Dallas 1,610 2,320 1,440
Population shifts:Suburbanization of the U.S., 1990-98
Travel patterns
Driving in Atlanta, 1997
Total Per Capita
Vehicle Miles Traveled (VMTs)/day
95,110,000 36.9
Hours of delay/year 136,590,000 52.9 Excess fuel consumed/year
214,000,000 82.6
Source: Texas Transportation Institute, 1999
How might sprawl affect health?
• ↑ air pollution• greenhouse gas emissions• ↑ heat island effect• ↓ physical activity• ↑ car crashes• ↑ pedestrian injuries• water quantity and quality• mental health consequences• ↓ social capital
Air pollution
Major pollutants of concern:
ozone leadNOx SOxCO air toxicsparticulates allergenshydrocarbons
Air pollution
Major pollutants of concern:
ozone leadNOx SOxCO air toxicsparticulates allergenshydrocarbons
Produced by cars and trucks
Ozone
Ozone health effects
• Respiratory effects:Airway inflammationDecreased air flowIncreased symptoms, ER visits, medication use, hospitalizations
• Cardiovascular effects:Increased mortality
• Immune effects:Increased susceptibility to infection
Greenhouse gas emissions
Total Per Capita
Vehicle Miles Traveled (VMTs)/day
95,110,000 36.9
Hours of delay/year 136,590,000 52.9 Excess fuel consumed/year
214,000,000 82.6
Excess CO2 produced/year
2.09 million tons
Source: Texas Transportation Institute, 1999
The Heat Island
Atlanta’s Heat Island: May 11, 1997
Source: NASA Marshall Space Flight Center
Health Consequences of Heat
• Heat syncope• Heat edema• Heat tetany• Heat cramps• Heat exhaustion• Heat stroke
INCREASING SEVERITY
Physical Activity
sprawl
• ↑ trip distances• ↑ vehicle trips• ↓ walking
↑ overweight↑ obesity
Want to take a walk?
Sedentary Lifestyle
Overweight / Obesity
•↑ overall mortality (2 to 3-fold)•↑ cardiovascular disease (3 to 5-fold)
The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking
Sources: Wei et al., JAMA 1999; Blair et al., JAMA 1996
•↑ risk of overall mortality (up to 2.5-fold in the 30-44 age group, less at older ages)•↑ risk of cardiovascular mortality (up to 4-fold in the 30-44 age group, less at older ages)•↑ risk of diabetes (up to 5-fold)•↑ risk of hypertension•↑ risk of some cancers•↑ risk of gall bladder disease
Source: Willett et al., New Eng J Med, 1999
Diabetes Prevalence, 1991-92
Diabetes prevalence, 2000
Car Crashes
Car crashes• Leading cause of deaths among persons
1-24 years old• Each year in the United States, motor
vehicle crashes account for:42,000 deaths3.4 million nonfatal injuries24 million vehiclesestimated $200 billion in costs
Source: NHTSA
Automobile fatality rates by city, 1998(excluding pedestrian fatalities; deaths/100,000/year)
New York 2.51San Francisco 3.76Philadelphia 5.36Portland 6.55Houston 9.80Phoenix 10.52Dallas 11.33Atlanta 13.12
Source: NHTSA
Pedestrian fatalities
Pedestrian fatality rates by city, 1998(deaths/100,000/year)
New York 2.33San Francisco 4.55Philadelphia 1.88Portland 2.58Houston 3.41Phoenix 4.09Dallas 4.28Atlanta 6.44
Source: NHTSA
Pedestrian fatalities
Pedestrian fatalities in Cobb, DeKalb, Fulton, and Gwinnett counties, Georgia, 1994-98, by race/ethnicity Race/Ethnicity Number Rate Black 140 3.85 White 117 1.64 Hispanic 40 9.74
Source: MMWR, 1999
Water quantity and quality• Quantity:
↑ runoff, ↓ groundwater recharge• Quality:
↑ non-point source pollution↑ siltation
Atlanta Journal-Constitution, May 13, 2000, p 1.
Mental Health
Road Rage• “driver behavior most people wouldn’t dream
of doing if they were face to face with another person” (Wisconsin DHFS)
• 1990-96: 51% ↑ rate of “events in which an angry or impatient driver tries to kill or injure another driver after a traffic dispute.” 10,000 reported incidents, 12,610 injuries, 218 deaths (AAA Foundation for Traffic Safety, 1997)
Self-reported aggressive driving behaviors (% respondents in each category)
Never Rarely Some-times Often
Say bad things to yourself about other drivers 15.3 22.9 39.5 22.1
Complain or yell about other drivers to a passenger in your vehicle 25.5 22.2 39.0 13.1
Give another driver a dirty look 41.8 17.6 32.7 7.7 Honk or yell at someone 61.1 17.9 17.9 2.9 Keep someone from entering your lane because you are angry 80.2 12.9 5.9 0.8
Make obscene gestures to another driver 83.7 9.2 6.1 0.8
Think about physically hurting another driver 89.0 5.4 4.4 1.1
Make sudden or threatening moves to intimidate another driver 94.6 4.0 1.1 0.1
Follow or chase another driver in anger 96.5 3.2 0.3 0.0
SOURCE: Mississippi State U., 1999 National Highway Safety Survey. January, 2000.
Social capital
Social capital defined as:• Social networking and engagement• Trust and reciprocity
Sprawl and social capital• More driving time means less time with
family, friends, and civic organizations.
• Putnam: every 10 minutes of commute time means a 10% decline in social capital
• Suburban voters tend to favor more individualized, less collective solutions.
• Residential stability across the lifespan: The need for elders to change neighborhoods.
• Aggravated income inequality?
Sprawl and income inequality
Sprawl and income inequality
Health implications of sprawl: Summary
• ↑ air pollution• greenhouse gas emissions• ↑ heat island effect• ↓ physical activity• ↑ car crashes• ↑ pedestrian injuries• water quantity and quality• mental health consequences• ↓ social capital
Solutions
Atlanta Journal-Constitution, May 12, 2000, May 17, October 30, 2000
Smart Growth: A definition
A pattern of regional development that:• protects and improves the quality of life for
all citizens• permits and promotes healthy behaviors• minimizes or eliminates hazards to people• protects, preserves, and restores the
natural environment
Smart growth is likely to feature:• Higher density, more contiguous development with
walkable neighborhoods• Preserved green spaces and other environmental
amenities• Mixed land uses• Limited road construction, balanced by transportation
alternatives (pedestrian, bicycles, mass transit)• Architectural heterogeneity• Economic and racial heterogeneity• Development and capital investment balanced between
central city and periphery• Effective, coordinated regional planning
A Public Health Approach to Sprawl
Issues to consider:• Enormous and growing interest among
policymakers and the public.• Possibility of “collateral benefits” of
interventions• The action is at the state and local level
The Intersection of Public Health and Sprawl
Potential loci of public health involvement:• Zoning decisions• Greenspace preservation efforts• Mass transit decisions• Design issues e.g. sidewalks• Watershed protection programs• Public education
Public health officials do not just work in the Health Department. They also include:
• Urban planners• Transportation engineers• Landscape architects• Developers• Lenders• Neighborhood activists
...and many others.
