Designing Healthy Communities

Designing Healthy Communities[i] is an inspiring and essential book for all who care about how to improve conditions for ourselves and for our children in our communities. Dick Jackson, a world renowned public health expert, speaks directly to the reader with clarity and passion, and provides numerous examples of how each of us can contribute to solving the crisis.

“The United States is confronting a ‘perfect storm’”, Jackson announces, “where three powerful threats are converging to create near-catastrophic conditions. The first threat is social: an aging population and a hurricane of chronic diseases. The second threat is environmental… including resource depletion and global heating. And the third is economic, particularly the struggles of middle-class and working people in a stagnant and staggered economy.” The book is heartfelt, calling for courage and integrity to solve these amazing challenges and to discover remarkable opportunities in the process.

Written as a companion to the public television series with the same title, Designing Healthy Communities is organized in three parts. Part One explains clearly the relationships between heath and the built environment. Unlike scientific treatises, Jackson emphasizes the importance of love – how we express our love for our family, our community, our nation and the world through our actions in shaping our environments. Places that convey beauty, safety, comfort and joy instill a sense of well-being and increase happiness, and these positive feelings improve our health.

In examining how physical and mental health is connected to the built environment, Jackson shares his own experiences and backs up anecdotal illustrations with hard data. The problems lie not only in the negative impact of toxic building materials, lead paint and petroleum-based solvents on health. More significant is how our unwalkable, sprawling suburbs are contributing to the epidemic of obesity, which leads to escalating diabetes, heart disease, stroke, and other chronic illnesses, and how unlivable, unsafe and unhealthy have become our neglected poor neighborhoods.

As defined by the World Health Organization, health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Our sense of well-being can be influenced by many factors, but central among these, is the sustenance we experience in our relationships with other people, family, friends and community. We have created a living environment that is making even our children unhappy and depressed. “Why would a pre-schooler need an antidepressant?” Jackson asks, and yet research found a 66% increase in antidepressant prescriptions to pre-schoolers over a recent 5-year period. We must understand what makes us happy, and rearrange our environment so that we feel more connected to others, and can enjoy contact with nature.

Rebuilding community is a huge part of this challenge. Jackson provides some excellent examples of how the design of the built environment either supports or hinders social life in public and the development of community. Older neighborhoods, he points out, were built around squares or parks that provided places where people could sit, play, eat together, and get to know one another. Schools and other places where people naturally congregate need once again to be designed to facilitate social interaction.

Architecture conveys messages: a building may be hospitable for everyday life, or designed to provide an impression of power; it may be austere and off putting, or snug and welcoming; it may be designed as a unique corporate icon, or carry forward community identity. Good buildings, like good leadership, help to hold the community together. In communities where people are more invested in community life they tend to be healthier and live longer lives.

Part Two presents stories of communities across the United States that identified symptoms of ill-health, diagnosed the environmental causes, and made changes in the built environment to effect a cure. Through seven case studies, Jackson charts the decisions and actions that have transformed a neighborhood or city center.

One community, for example, (Belmar District of Lakewood, CO) recognized that their neighborhood lacked a sense of cultural identity. There were no public places that drew the community together to eat, to celebrate, to enjoy social life and to get to know one another. The community was an auto-dependent monoculture, and it was dying. The indoor shopping mall, Villa Italia did not fulfill community-building functions, and besides, it was deteriorating and needed to be replaced. This gave city government and residents the opportunity to create a vision of what was needed to revitalize their neighborhood, enhance well-being and build a sense of community.

A decision was made to attract new residents by creating a dense, pedestrian-friendly, mixed-use development with a new light rail station to connect to downtown Denver (4 miles away). This new, 55-acre center needed to be hospitable for children and elders, so safe, walkable streets and plazas were important, and these elements encourage pedestrian traffic, viable retail, and outdoor cafes. A traffic-free plaza with an outdoor café at the heart of the new development fosters social life and community celebration, and becomes an ice rink in winter.

The story of Charleston, SC illustrates the importance of having wise leadership to ensure downtown’s steady, healthy recovery over an extended period. Mayor Riley, first elected in 1976, steadfastly believes that a city’s public settings, parks, streets, and community festivals must be accessible and hospitable for all. In the context of Charleston, a southern city with historical roots in the old plantation system, the importance of ensuring healthy social relationships by bringing together the most diverse groups in a beautiful setting may be even more important then elsewhere. Mayor Riley’s efforts to restore neighborhood parks, and create beautiful new parks that make almost the whole waterfront publically accessible for all, offer incalculable benefits to the long-term health of Charleston citizens.

Beauty is important for everyone, Mayor Riley asserts, but especially for the poor. A child who grows up proud to show his friends where he lives, in an attractive traditional house with roses growing above the door, like houses of wealthier folk, will love his city and protect his community. One of Mayor Riley’s major achievements over the years has been to re-house residents of ugly public housing blocks in individual new or restored infill houses identical to adjacent historic houses.

Historic buildings, especially in a city like Charleston, embody the community’s identity and express its DNA. It is essential to restore this heritage, not to destroy it and replace it with modern high-rise development. Human scale infill development is needed to reflect this DNA, Riley emphasizes. This strengthens community pride and the commonality of values. It is especially important to protect the city’s DNA downtown, while ensuring its liveliness, and economic success. Downtown is “a public ground, a place that people own. They know this is where they celebrate their citizenship, the diversity, the rich, the poor, the young, the old, the shops, the energy, the elbow contact, the eye contact – the pulse.” This philosophy offers a firm foundation for a healthy society.

Of all the case studies presented in this book, Detroit faced imminent death from decline of the auto industry, unemployment, poverty and out-migration. An abandoned city in disrepair, it became vulnerable to crime and violence. But now, there are a number of courageous efforts to save the life of this devastated city.

Some abandoned lots have been transformed into urban farms to provide healthy food for the poor. Neighborhood famers markets are appearing, and the Eastern Market is now a thriving farmers market. An urban greenway, Dequindre Cut, has been transformed into a safe recreation area in a stable older neighborhood. A new upbeat heart for the city, Campus Martius, offers a central public space that instills pride and brings people together at outdoor restaurants, an ice rink, and performance venues. These are not enough to ensure the continued health of Detroit but little by little, with community involvement and shoestring economics, saving a neighborhood park here, a school playground there, recovery has begun.

The purpose of this book becomes evident in Part Three. Here, the reader is addressed directly with the question “What can we do to improve health and well-being in our own community, in our own town? How can we identify the problems and make improvements? How do we find the necessary team, and how do we work together? Here we find a guide to diagnosing the problems, developing a vision, transforming vision into action, finding the tools and the partners, and achieving success. Here are practical ideas, checklists, tips for organizing and finding partners who can help. We, the community members are closest to the problems. We can be the catalysts for change, involving the help of professionals and elected representatives as needed.

This is a courageous book by an icon in the public health field, and it inspires all of us to be courageous, to get involved, and to work with others to improve the health of our community.

[i] Jackson, Richard J. (2011). Designing Healthy Communities. San Francisco: Jossey-Bass