Latest Surgeon General's Warning: Your Neighborhood?

In the interest of public health, the Surgeon General has issued warnings about vices including cigarettes and alcohol. But what does the nation's top doctor have to say about the neighborhood you live in? Should poorly designed communities that discourage walking, social interaction and accessibility come with a similar warning?

That's a question raised by the Centers for Disease Control and Prevention (CDC) in a new report that lends considerable weight to the case for creating walkable, sustainable communities.

You might not get cancer from it, but the fact is, the community you live in can affect your physical and mental health. Many of the chronic diseases that the CDC deals with -- such as asthma, obesity, diabetes and depression -- have been linked to poor neighborhood design. These diseases also contribute mightily to the nation's soaring healthcare costs. That's why the CDC has been turning its attention to issues that are typically the domain of developers, architects and city planners.
"How we build and maintain our communities' transportation systems, infrastructure, and public spaces can either exacerbate or reduce obesity, chronic diseases, injury rates, poor mental health, and the adverse effects of climate change," says Dr. Howard Frumkin, special assistant to the director of the CDC for Climate and Health.

The report, based on results from a gathering last fall of experts from academia, architecture, building, development, government, planning, and public health, looks at ways to bring health experts into the planning and development of housing and communities.

Much of the discussion centers on pedestrian-friendly neighborhoods and reducing the need for cars. But other considerations include promoting social interaction, reducing carbon footprints, providing access to grocers, and preserving green space. According to the U.S. Department of Health & Human Services, two-thirds of U.S. adults and nearly one-third of children are overweight or obese.

It takes more than getting health officials a seat at the table in local decisions, says Ellen Dunham-Jones, associate professor with the Georgia Institute of Technology's College of Architecture and co-author of "Retrofitting Suburbia: Urban Design Solutions for Redesigning Suburbs."

"We need to fundamentally build on the legal basis of protecting health, safety and welfare, and figure out how we get to the point of having Surgeon General warnings on zoning codes and subdivision regulations," she said in the report. "Imagine the impact of, 'The Surgeon general warns: This zoning code may be bad for your community's health.' That would really change the system."

Dunham-Jones is also the chair of The Congress for the New Urbanism's CNU 18 conference being held May 19-22 in Atlanta with assistance from the CDC, which will pick up on many of these issues.

There's no official word on whether the Surgeon General is considering a neighborhood warning, but the Surgeon General's "Vision for a Healthy and Fit Nation" does include this:
Improving our communities – Neighborhoods and communities should become actively involved in creating healthier environments. The availability of supermarkets, outdoor recreational facilities and the limitation of advertisements of less healthy foods and beverages are all examples of ways to create a healthier living environment.
The CDC report cites examples of communities that have taken coordinated steps to become more pedestrian friendly and healthful, such as Decatur, Ga., Tyson's Corner, Va., and Lakewood, Colo., where a mixed-use urban village replaced an old, car-dependent mall.

Better performance measures are needed, the authors acknowledge. But plenty of studies point to the benefits of designing healthy communities that promote walking, reduce the need for cars, and provide plenty of green space and opportunity for interaction.

A study funded by the National Institute of Health found that a 5 percent increase in a neighborhood's "walkability" index was associated with a 0.23-point drop in Body Mass Index.

Research conducted in Alameda, Calif., meanwhile, makes the case that unhealthy neighborhoods play a far greater role in triggering diseases than germs, bad genes or irresponsible behavior.

But the most persuasive results of all might involve another kind of green: homes in areas with a higher walkability rating have kept their value better during the housing downturn. A recent analysis using data from found that the 10 least walkable cities on the Case-Shiller index suffered price drops of more than a third, while prices in the 10 most walkable cities have dropped by less than a quarter overall since June 2006.
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