Creating Healthy Places is not Rocket Science
The minute you step outside your front door, there are three things that if addressed could measurably improve our “healthspan” and likely save billions of dollars in health care costs. These consist of creating the conditions so we can 1. move safely, 2. be outside comfortably, and 3. be together.
This is simplistic, but here are a handful of facts:
- 11 minutes a day of brisk walking could be sufficient to lower the risk of diseases such as heart disease and a number of cancers. Cardiovascular diseases are the leading cause of death globally — responsible for 1:5 deaths in the United States and costs us $252 billion.
- Cyclists who commute to work have a 47% lower risk of early death and a 50% lower risk of cardiovascular disease. The debate is somewhat out on e bikes, but people who ride to work on any form of bike, ebike included, are literally happier when they get there.
- People who spend time outdoors sleep better, have lower blood, pressure, and reduced risk of chronic disease. Studies also link time outdoors with improved mental health and decreased risk of psychiatric disorders among adults and children. Even just 15 minutes outside can reduce cortisol levels, boosting serotonin and dopamine levels in the brain.
- A clinical review of nearly 150 studies found that people with strong social ties had a 50% percent better chance of survival (controlling for all major factors) than those without. And yet, almost one-quarter of the world feels lonely. Breaking that down, approximately 36% of Americans, 51% of young mothers, and 73% of Gen Z reported feeling alone sometimes or always. Social isolation is associated with a 50% increase in developing a neurocognitive disorder, 29% increase of heart disease, and a 32% risk of stroke. Some say this is the equivalent of smoking 15 cigarettes a day.
It’s my view that if the built environment can make it welcoming to be active, spend time outside, and take measures to bring people together, there will be dramatic progress. Of course, this isn’t a 1 to 1 relationship. But, for those of us that shape our built environment, this could be the most important thing we do.
So what can we do?
We can make our sidewalks more welcoming: Sidewalks, curb cuts and ramps for strollers and wheelchairs, lighting, traffic calming measures, clearly delineated crosswalks, and right-turn visibility make a difference. People with sidewalks are 47% more likely to be active at least 39 minutes a day. Some cities have gone further: Hermosa and Redondo Beach’s public schools set up “walking school buses,” an organized program where kids walk to school together. This, combined with other measures like healthier lunches and farmers markets, reduced childhood obesity 68% between 2007–2019.
We can add bike infrastructure: Dedicated sidewalks and painted bike lanes make a huge difference. Cities used to look where people cycled and added bike lanes there. Now, they have a “build it and they will come approach” and it has worked. Studies from cities across North America show that adding protected bike lanes significantly increases bike ridership on those streets, with rates ranging from 21% to 171%. And, when safety improves more women and older age brackets start biking. And while we can argue that e-bikes/scooters add more danger, the CEO of Lime recently spoke on Bloomberg noting that they have done over 700 million trips across the world and 99.9% of trips — over the entire seven year history of Lime — were incident free.
We can make it easier to be outside: Areas with trees lower temperatures between 5–8 degrees Fahrenheit, and reduce air pollution by up to 24%. They also change our blood’s biomarkers. A remarkable seven-year study in Louisville, Kentucky, led by University of Louisville’s Aruni Bhatnagar, Ph.D. in partnership with The Nature Conservancy, Washington University in St. Louis, Hyphae Design Laboratory, and others, sought to quantify the benefits of trees. The study evaluated an area over four-square miles with 750 (socially and economically diverse) residents. The team planted 8,000 trees in one area vs. a control group. The people living in the newly tree lined neighborhoods saw on average a 17% drop in an inflammatory marker in their blood. This can be correlated to a 10% drop in heart related illnesses; meanwhile heart disease costs the city an estimated $650 million a year.
We can bring people together: The availability of social offerings is the #1 driver of belonging. As someone who has been in this space for 15+ years, I can also attest that what makes a great place is the people that are there. To that end, developers, cities, non-profits, brands…etc. can and should put on events like s’mores nights, set up run clubs, and take a hit on net operating income (if needed) to ensure there are restaurants, grocers, coffee shops, daycares, barbers — and the like. One of my favorite examples comes from London’s Barking and Dagenham borough, where the nonprofit Participatory City transformed two vacant storefronts into vibrant community hubs. Here, residents engaged in or developed their own programs, including teen STEM initiatives, sewing workshops, and cooking classes.Thousands of residents took part, and they even went beyond the storefront, independently creating welcoming committees for new residents, community gardens and outdoor learning centers, and scheduling soccer clubs. The testimonials and data from this project fill a 401 page document. After a year of programming, participants ranked their feelings of trust in their neighbors at an eight out of ten — despite it being a very transitory community — with 25% of its population moving in and out between 2012 -2014. “I didn’t have a single friend in Dagenham before I got involved with the project,” one woman remarked. Another noted, “I no longer feel intimidated by the young guys round here, because I know them … It’s been the best year of my adult life.”
The point: Several years ago, I read Alain Bertaud’s Order without Design: How markets shape cities, and I was motivated by his perspective that the #1 responsibility of city planners should be to improve transportation. By prioritizing efficient movement across cities, planners could expand access to job markets. Now, I’d argue welcoming streets, opportunities to be outdoors, and creating community are now #1. We’re measurably harming people’s lives and bankrupting our country with health costs, and the solutions are right in front of us.
