Designing Healthy Communities: NewPublicHealth Q&A with Richard Jackson
"Designing Healthy Communities,” a four-part series funded in part by the Robert Wood Johnson Foundation, debuts this month and next on many Public Broadcasting stations. The program looks at the impact the built environment has on key public health problems such as obesity, diabetes, heart disease, asthma, cancer and depression. In the series, host Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, connects bad community design with burgeoning health costs, then analyzes and illustrates what citizens are doing about this crisis by looking upstream for innovative solutions.
NewPublicHealth recently caught up with Dr. Jackson, who will also be a featured speaker at the New Partners for Smart Growth Conference in San Diego next week, leading a session on “Health as a Messaging Tool.” Dr. Jackson received the New Partners for Smart Growth Lifetime Achievement Award in 2008.
NewPublicHealth: What prompted the "Designing Healthy Communities" series?
Dr. Jackson: My background is that I’ve worked in environmental health in one form or another for over 30 years. I started out as a pediatrician and have become more and more focused on the whole mix of environment and health and the outcomes and the impacts on our population, acute impacts such as asthma, car injuries, all the way through to chronic diseases, cancer and birth defects, and I’ve investigated all of them. And then beyond chronic diseases, long-term health impacts such as endocrine disrupters in the environment and health effects of global climate change.
I spent nine years as the Director for the National Center for Environmental Health and I was State Health Officer for California for a year and a half, and I’ve become increasingly convinced that I’m sitting at the end of the disease pipeline waiting for somebody to come in the door with obesity-related diabetes, with injuries related to a bad urban design or for that matter a lack of adequate crosswalks. Asthma and even heart disease are related to very poor air quality. That it is not feasible for the future of our country. When I was a young doctor, seven percent of all the money in the United States that was going to medical care. It’s now more than 17 percent, and the U.S. is still ranked about number 50 in life expectancies worldwide.
So, we’re not doing something right, and I would assert that what we’re not doing right is we’re failing to really operate in the realm of prevention. We’re not going far enough upstream in thinking about what things are affecting our health. What I would assert is a big driver that’s affecting our health but it’s also affecting our happiness, our prosperity, and our future is how we have built America. We have built it for the needs of cars and other short-term needs, maximizing sale of commodity foods of various kinds and we have not built it with an eye towards people and an eye towards future generations.
I co-wrote a book ten years ago called “Urban Sprawl and Public Health,” and then became much more focused on these issues of built environment and co-wrote a textbook, where we very deeply document the impact of the built environment on everything that you would imagine, but also further upstream to obesity and lack of fitness, and even further upstream to unhappiness, to depression, and we began to think that just as this damaged environment can have multiple negative health outcomes, creating health environments should have positive health outcomes. And that’s why the television series is called “Designing Healthy Communities."
Ten years ago there really was very little recognition of this issue, but that’s changing. There were almost 300 sessions that either had the words “built environment” or “land use” at the last American Public Health Association National Meeting in early November in Washington, DC.
NPH: What’s driving that increasing interest?
Dr. Jackson: I would assert that what’s driving it is both push and pull. You look at places where people have much more walking and bicycling capability, they are more fit. You look at the places where people live longest, it’s a mix of the physical environment they’re in and what they’re eating, it’s not that they’re genetically different from one place to another.
I would say there’s pull as well. I think the big contribution is data, including research studies from federal funding, such as the National Institutes of Health and private funding, such as the healthy eating and active living programs of the Robert Wood Johnson Foundation. There’s also a perceived need for things to get fixed, and a good solution solves multiple problems.
In the 20th century we were very good at reductionism. We broke down problems smaller and smaller and we solved them by splitting them out and going after them. But the panorama of challenges we’re facing in the 21st century, whether it’s population pressures, depletion of resources, climate change, economic movement around the world with real economic depression in many parts of our country, we’ve got to come up with solutions that work for people across their health, economic and environment domains. Really changing our built environments would do a lot in that direction, whether it’s school gardens or community gardens or walkable communities or local parks.
NPH: What can individuals do to change the built environment they’re in?
Dr. Jackson: In the video series we visited about a dozen cities some that have really done a beautiful job like Charleston, South Carolina; others that are desperately struggling like Detroit, Michigan. One in the middle is Elgin, Illinois; a city that was very much dependent on the Elgin Watch Company and when that essentially collapsed in the 1950s, the economy collapsed and the city had to reinvent itself. A couple of things are critical: one is the community really needs to get together and decide on what its values are. The dialogue process with the community, with the business leaders and with the planning leaders is important. What Elgin did is they decided sustainability was going to be their brand that was going to be their model. They recovered their river, they recovered some pretty desperate industrial land down by the river, created parks, created mass use housing and really revitalized their downtown. Guess what? Bright, young people now want to live in Elgin and there’s fortunately a train that goes into Chicago. So it’s gone from being a repelling pole magnet to a positive pole magnet by having its own identity.
NPH: In the series and in conversation you talk about the impact green spaces can have on our lives. Why is that so important?
Dr. Jackson: We have known for thousands of years, that when people are suffering from depression, they needed to revitalize. They created baths, they created spas and they created green places with water features that enabled people to have the repose and connection. People who get more physical exercise have substantially lower rates of depression. If you have physical exercise in an environment that is green, that has plants, that has nature contact, there is even more substantial improvement in mental status over that time.
When we look at children who walk and bike to school compared to children who sit in a vehicle to go to school, that first set of kids learns better, behaves better, and socializes better than the kids who are forced to sit still.
NPH: What are the questions that communities should start with as they begin to look at public health problems that are caused by their own built environment?
Dr. Jackson: Start with getting people together and ask them what they want. Oftentimes, even if people come in with as their preconceptions about what they want, when they get into the dialogue and they see the computer-generated pictures and they listen to their neighbors, it’s amazing how ultimately a pretty unified vision comes forward, and a unified vision is really important because if a community goes to the political leadership with a unified vision, it’s very likely that it will happen.
NPH: For those communities that might need some good ideas, what’s a checklist of things to be thinking about?
Dr. Jackson: You know, I’m probably going to leave a whole bunch out, but one is make sure it works for children, make sure that a child can go about the occupation of the child, which is to explore his or her environment, to have increasing amounts of autonomy. No one’s going to let their child wander around if there are not good eyes on the street. You know, if there are store fronts and there are second floor balconies and windows and people can see what’s going on, you feel much safer. Every child ought to have a right to walk or bicycle safely to school. If you do that for our kids, it makes it better for our elderly, and more than a quarter of all the people over 65 don’t have a driver’s license and most disadvantaged people in the United States as a group are people without a car. And it’s very difficult to not have a car in the United States. Build it for kids, build it for non-drivers.
Two is bring in the natural environment. It can be parks, and maybe it will be small parks. There should be more local businesses, the local stores, the ice cream shop, the drug store, people that are embedded in that community and bringing funding back into their community, maybe even making something or manufacturing something that is unique and has an identity with that community.
And we need places of the heart. We need a place to work, we need a place to worship, we need a place to live, but we also need a place that we can come together and feel safe and be with our neighbors and socialize.
NPH: Is reassessing the built environment now also part of the curriculum in schools of public health?
Dr. Jackson: Yes, increasingly so and a number of the public health schools are working on joint degrees with urban planning. Urban planning students, when they hear from the folks within public health thinking about injury say, “Oh, I never really thought about how I design things can either make injury problems worse or better," they are shocked. You can either make it smart or you can make it foolish, and to leave out human well-being in these big decisions that shape the quality of our life for a hundred years makes no sense.
>>Find out when PBS is airing "Designing Healthy Communities" in your neighborhood here.
>>Bonus: Read a related interview with Dr. Jackson on the National Research Council report on Health Impact Assessments.