Health policy is about more than medical care. It is about farm policy. Transportation. Housing. And so much more, Dr. Richard Jackson says.
Because how healthy we are is determined largely by where and how we live.
Jackson, a professor of Environmental Health Services at the UCLA School of Public Health and the former state health officer for California, is an expert on the connections between urban design and health. He was the lead speaker at a conference in Sacramento recently that brought together environmentalists, planners, physicians and developers to share ideas and look for common ground on issues connecting the urban environment and health.
Jackson traces many of our current health problems to our dependency on the automobile. And that, he says, was an unintended consequence of public health reforms a century ago that separated residential, commercial and industrial uses to reduce disease.
“We have built America around cars,” Jackson said. “We have not built it around people.”
Jackson noted that America has more cars than it has licensed drivers. And while he said crashes kill about 40,000 people a year, he estimates that pollution from vehicles leads to premature death for more people than that.
But that is only the beginning of the problem. Our dependence on cars has made walking passé and created a culture hostile to bicycling. The result is a society in which few people move under their own power, starting with children.
“Often in the neighborhoods we build, the only way to get from one place to another is by car,” he said.
Fewer and fewer children walk or bike to school, because their routes are not safe. When he was a child, Jackson recalls, he never saw a traffic jam outside his school. Now they are commonplace, as parents drop off and pick up their children before and after classes.
“We have engineered fitness out of their lives,” Jackson said.
It shouldn’t be a surprise, then, that 30 percent of California ninth graders are overweight or obese. The lack of physical activity, the rise of video games and the prevalence of television, and the shift from whole foods to processed and fast-food have all played a role.
From there, the connection to health care is clear. The cost of caring for people with diabetes, a disease that often follows obesity, now accounts for two percent of America’s gross domestic product, Jackson said. Heart disease and other ailments linked to an immobile, car-bound society are also taking a human and financial toll on the nation.
Jackson, a pediatrician, believes that focusing on kids is the first step toward reversing these trends. He recommends working on safe routes to school, the elimination of sweetened drinks and junk food from school cafeterias and vending machines, a tax on sweetened sodas to finance prevention programs, and school gardens to reconnect children to the joys of real food.
In the long term, though, urban design will have to play a role if Californians are going to be able to get out of their cars and homes and move. Three developers who spoke at last month’s conference offered some insights into how at least some builders are approaching the issue with a new mindset.
John Anderson, a principal in Anderson/Kim Architecture + Urban Design, is a Chico builder who has worked closely with the city of Chico to adopt zoning codes that encourage infill and walkable communities. He sees tremendous potential in redeveloping land that was built upon in the 1950s and 1960s, strips that he refers to as “corridors of crap.”
“We have been building incredibly bad places with incredible precision,” Anderson said.
In the future, he said, builders need to focus on projects that are compact, connected, complete, complex and convivial.
And that’s exactly what Randy Sater, a vice president of Teichert Construction, said his firm is doing. Sater heads a Teichert subsidiary that is planning the development of several gravel quarries the firm is phasing out on the edge of Sacramento near Highway 50.
In planning the project, Sater said, the company is looking for lessons from the inner ring neighborhoods near downtown Sacramento that have held much of their value during the housing downturn. Some of the qualities he wants to include: parks and trees, garages in the back rather than the front of the homes, stores and restaurants within walking or biking distance.
The company envisions a seven-mile walking and biking trail and a right-of-way to accommodate a local transit loop that will connect to Sacramento’s light rail system nearby. The entire project, he said, will be designed with an emphasis on wellness.
One radical idea Sater is contemplating is the inclusion of an urban farm that would offer residents local produce delivered in boxes to their doors. Surplus vegetables would be donated to local food banks.
“We think that the urban farm and our park system is going to be the new golf course,” Sater said. “Golf courses are passé. They are overdone and they are not popular anymore. We think the new trend is regional park systems…and urban farms. We are looking at the farmer as community builder.”
It will be a long way from Sater’s vision to reality on the ground. The planning landscape is littered with the promises of developers who pledged to build mixed use, walkable communities and then delivered the same old isolated suburbia. But just the fact that leader of a major company – and Sater is also president of the Sacramento Metro Chamber of Commerce – is talking this way shows how deeply the latest ideas about connecting urban design and wellness have penetrated.
A somewhat more practical view comes form Randall Lewis, executive vice president of Lewis Operating Company, part of one of the state’s biggest development companies.
Lewis said he firm has been trying to build suburban communities that are “pedestrian seductive” and attractive to cyclists with amenities that will also help people stay fit even if they do not walk or bike a lot. The projects have community centers with pools, tennis and basketball courts and gyms, and professionally led programs for residents.
Beyond that, Lewis said his firm is working city by city to embed wellness into the general plans that will guide future development. He does not want the rules to change in the middle of the game.
“For the really progressive cities, the general plan is the business the plan, the operating model for the city for the next 10 years,” he said. “We want to be in a spot where we say we are not going to change things just at the whim of an elected official.”
Although Lewis has been working with several Southern California cities to insert health and wellness planks in city policy, he said he thinks Northern California will be even more receptive to this idea.
“The mindset in Sacramento and Northern California is better conditioned to these kinds of movements,” he said. “There is more concern for the environment. There is more concern for the outdoors.”