International Making Cities Livable Conference: UCLA’s Richard Jackson on Shaping Healthy Suburban Communities

Jun 25, 2013, 11:35 AM

"We have medicalized what is in fact an environmental-driven set of diseases," said Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, in a keynote presentation that energized and galvanized discussion among the diverse audience of city planners, architects and public officials at this week’s International Making Cities Livable Conference. This year’s conference focuses on bringing together a vision— across sectors—of how to shape healthy suburban communities.

Jackson, a prominent pediatrician and host of the “Designing Healthy Communities” series that aired on PBS, told an all-too-familiar story of a child who comes into a doctor’s office overweight and with alarming cholesterol and blood pressure results even at a young age. So the doctor prescribes behavior change: No soft drinks in the house. No screens in the bedroom. Exercise, do more, and come back in two months. In two months, what’s changed? Nothing. The food at school is still unhealthy, the neighborhood is still unsafe to play in and the family still uses the car to get absolutely everywhere because there is no other choice. The likely outcome for that child and so many others, said Jackson, is to end up on costly cholesterol medication just two months later when the child’s vital statistics continue to spiral out of control.

"It’s a 20th century idea that our minds are separated from our bodies, and our communities are separated from ourselves,” he Jackson, who reminded the crowd that the most critical health advancements in the last century took place because of changes in infrastructure, not medicine—primarily new sanitary standards to curb out-of-control infectious disease.

Now, said Jackson, “We’ve built America around the car” and we need a whole new set of infrastructure changes to re-build communities that offer better opportunities for health as part of everyday life. “The built environment is social policy in concrete.”

And the reliance on cars brings its own set of unique health problems, according to Jackson, including air pollution (which can cause everything from asthma to heart disease); injury and deaths from car crashes; and sedentary lifestyles. The United States has removed enough trees and paved over 60,000 square miles of land—equivalent to the state of Georgia. We’ve paved the equivalent of Puerto Rico in parking lots alone.

“The more we drive the more lottery tickets we buy for death,” said Jackson. One traffic death occurs per 87 vehicle miles traveled, and the leading cause of death among ages 18 to 34 is car crashes. “Why aren’t we building places that help children to be safe?” he asked.

The more time spent in a car, the more likely a person is to be obese regardless of age, sex or race, said Jackson, and the difference between people who live in walkable versus un-walkable neighborhoods is about 7 pounds. Between 1988 and 1994 the percentage of U.S. adults who got no regular physical activity was 17 percent. The percentage has now skyrocketed to 52 percent.

“We’ve got to build physical activity irresistibly into people’s lives,” said Jackson. “Telling them to go to the gym is not going to work.”

The good news is that there have been pockets of success stories across the country. “If I’d said five years ago you could bike around Manhattan safely and people would smile at you, you’d think I was crazy. Now you can safely bike 32 miles around the island,” said Jackson. He also cited the enormous leap in the number of joint urban planning and public health degree programs (there are now 14 such programs in the United States alone); light rail and other expanded transportation options in communities across the country; and joint city planning efforts such as Healthy By Design from Sonoma County.

Going back to the hypothetical child, Jackson envisioned a new future for that family: one where the child walks to school every day; the family walks to the local farmers’ market to buy fresh produce for healthy dinners; the school serves locally-sourced and delicious lunches; the next doctor’s check-up is a glowing report on the child’s health; and the family lives happily ever after.

And with a room full of passionate people committed to creating a healthier, more livable future, that vision may become more than just a hopeful fairy tale.

This commentary originally appeared on the RWJF New Public Health blog.