Connecting Urban Design and Public Health

When did you first start to make the connection between the design of our national landscape and the health of our citizens?

In July 1999 the head of the CDC invited his dozen directors to the central office to work on a paper about the ten leading diseases of the twenty-first century. I'm driving over there, and as always I'm thinking about pesticides, herbicides, cancer, and birth-defect clusters-you name it. I'm late, stuck in traffic on Buford Highway, voted one of the ten worst streets in North America. It's a seven-lane road surrounded by garden apartments, mainly for poor immigrants, with no sidewalks and two miles between traffic lights. It's 95 degrees out, 95 percent humidity. I see a woman on the right shoulder, struggling along, and she reminds me of my mother. She's in her seventies, with reddish hair and bent over with osteoporosis. She has a shopping bag in each hand and is really struggling.

Carless in the car zone...

This woman stayed in my mind during the whole discussion we were having about the future of public health. Afterward I e-mailed Howie Frumkin and said, "If that poor woman had collapsed from heat stroke, we docs would have written the cause of death as heat stroke and not lack of trees and public transportation, poor urban form, and heat-island effects. If she had been killed by a truck going by, the cause of death would have been 'motor-vehicle trauma,' and not lack of sidewalks and transit, poor urban ­planning, and failed political leadership." That was the "aha!" moment for me. Here I was focusing on remote disease risks when the biggest risks that people faced were coming from the built environment.