Health and smart growth: Safety tops obesity
Most of the discussion on the built environment and health focuses on sprawl and obesity. A recent Massachusetts Institute of Technology (MIT) report on Health + Urbanism downplayed this relationship, but did not take household income into account. Blogger Michael Lewyn reports that when poverty is factored in, a strong correlation emerges between drive-only places and higher rates of obesity.
This debate, however, misses an elephant in the room: Automobile crashes. "A glaring omission in this (MIT) study is that it does not account for traffic crash risk and the much lower traffic fatality rates in smart growth communities," Researcher Todd Litman said.
Vehicle crashes are not fully addressed as a community health issue because all Americans have been facing this danger their entire lives. Our conventional methods of building communities and thoroughfares appear to raise the carnage — and that word is justified here — significantly. We have chosen to ignore that underlying cause, and address this problem through improved technology — a strategy that has reduced automotive deaths significantly over the years. The carnage is still tremendous.
Traffic fatalities are the leading cause of death between the ages of 5-34, according to the Centers for Disease Control (CDC). Before age 5, the leading cause is birth defects. After 35, cancer and failure of key organs such as the heart and kidneys take over. Yet for three decades of our lives, traffic accidents are the leading reason for finding an early grave.
These deaths are particularly tragic because of their randomness and the youth of the victims. "Although traffic accidents cause a relatively small number of deaths, because crash victims are younger on average than people who die from diseases, they cause relatively large potential years of life lost," Litman notes.
I don't wish to downplay this significance of obesity and its relationship with the built environment. As the CDC attests, obesity has reached epidemic proportions and contributes greatly to health problems and costs. A built environment that discourages regular exercise through walking adds to this problem.
Yet the differences in obesity between outer suburb and in-town neighborhood is relatively small compared to that of automobile deaths. Cities like New York, San Francisco, Portland (OR), and Boston have traffic fatality rates less than one-third that of the US as a whole (10.8 in 2012).
Similarly, A 2010 study of 20 California cities reported in New Urban News (now Better! Cities & Towns) points to why automobile accidents in the suburbs are more severe and why they trump other safety concerns. California cities with more sprawling, disconnected street networks (built after 1950) had automobile fatality rates three times as high (10.1 per 100,000 population from 1997 to 2005) compared to cities with connected street networks, according to that study, by traffic engineers Norman Garrick and Wesley Marshall. Cities with street networks built mostly before 1950 had only 3.1 fatal crashes per 100,000 population.
Traffic deaths are the proverbial tip of the iceberg. For every death, more than 60 injuries are caused by automobile crashes. That's car-nage indeed.
Automobile accidents are the reason why suburbs are more dangerous than cities. The likelihood of dying from violent injury is higher in the suburbs. That fact is hardly conventional wisdom, because one of the main selling points of suburbia is safety, but it has been confirmed in numerous studies. The most recent study, by researchers at Children's Hospital of Philadelphia (CHOPs) and the University of Pennsylvania, is the first to look at overall death rates nationwide for all sorts of accidental and intentional injuries — crashes, gunshots, drownings, falls, poisonings, even animal attacks - across the nation. The more "urban" the county, the safer, researchers concluded. Homicides are higher in cities, but many other causes of death like suicides and drownings are not. Fatal automobile accidents are much higher in suburban, exurban, and rural locations.
For health policy wonks, the impact of the built environment means a great deal. At $2.7 trillion a year, we spend more on health than any other nation. Anything that can help reduce health costs and problems deserves attention. Health professionals could be powerful allies to smart growth. They already are, to a degree, but this alliance could grow as healthy community initiatives take off.
A new urbanist, Peter Swift, first shined a spotlight on how suburban-style roads contribute to injury and death. His 1997 study of Longmont, Colorado, (which for years was published only in our publication while it was going through peer review), shows a 485 percent increase in injury accidents when a street increases in width from 24 to 36 feet, regardless of vehicle volume. (link here, and here). In the last 17 years, the US has made only minimal progress in allowing narrower travel lanes.
There are two primary fronts in the healthy communities movement — safety and obesity. As smart growth advocates pursue a health agenda, I believe that an emphasis on safety is more likely to succeed with citizens and public officials than one that focuses mostly on obesity.
Safety is near the top of most peoples' agendas, including highly influential bureaucrats like transportation engineers and planners. For this reason, the safety argument is particularly effective in the battle for complete streets and transportation reform. It can be used effectively to fight for specific improvements, especially in places where pedestrians and bicyclists are likely to be at risk.
Safety also brings in the well-established Safe Routes To School movement, which could align with healthy communities, smart growth and New Urbanism.
Obesity alone has limited leverage with citizens. Ordinary folks may be concerned about obesity, but probably don't feel they need help from planners in this regard. On a personal level, obesity can be controlled through diet and exercise.
Obesity is an effective appeal, along with safety, in making allies of health organizations. In the political battle for smart growth reforms, allies are crucial.
Robert Steuteville is editor and publisher of Better! Cities & Towns.
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