Land use can influence health outcomes positively by presenting opportunities for healthy behavior or negatively by restricting access to healthy options. Key land-use characteristics that affect health include:
Patterns of land use within a community.
The design and construction of spaces and buildings within a community.
The transportation systems that connect people to places.
The industrial era of the 19th and early 20th centuries created cities that provided economic opportunity to millions of foreign immigrants and migrants from rural and small-town America. But with so many people moving into cities, overcrowding, poor sanitation, substandard housing and high poverty rates contributed to widespread outbreaks of infectious diseases, such as cholera and tuberculosis. The new professions of public health and urban planning developed in response to the desire to improve living conditions in growing urban centers.
Planning and community design can affect a community’s health in a variety of ways including influencing physical activity, food and nutrition, air quality, traffic safety, and access to parks and open space.
As decision-makers, local officials can play a critical leadership role in efforts to improve community health, because there are so many ways that local decisions can affect residents’ health and well-being.
A wide array of local officials — those elected to serve on the city council or county board of supervisors, residents serving on advisory boards and commissions as well as local agency administrators and staff — have many opportunities to integrate health considerations into local programs and policy decisions. Some of the most important types of local decisions with health implications are outlined below.
How local officials choose to plan and lay out communities — through the general plan, zoning and other land-use regulations — affects health.
For example, if homes, stores, schools and other places people need to go are near one another and connected by safe and convenient walking and bicycling routes, people are more likely to walk or bike than if these amenities are located farther from one another. Studies show that when residents take advantage of these opportunities to increase their everyday activity, it reduces their risks of obesity, diabetes and other chronic health conditions.25 Spending less time in cars gives people more free time to spend with their families and communities, which can improve emotional well-being.26
Decisions on how buildings are designed, constructed and renovated have implications for health.
Many communities have established architectural standards, green building requirements and other local policies that affect the health and safety of residents and tenants. For example, incorporating “universal design” principles into residential construction — such as simply requiring that at least one entry to each new or renovated residence be accessible for people with disabilities — can make a neighborhood safer for people of all ages and abilities.
Decisions on the type and character of public facilities and infrastructure affect the health and safety of residents.
For example, neighborhood streets that carry fast auto traffic can be modified through traffic-calming measures to slow vehicle speeds. “Complete streets” programs can provide safe routes for vehicles, bicycles, pedestrians and people with disabilities (for more about complete streets, see “An Overview of Planning Concepts for Health and the Built Environment.”) These programs can help seniors and those with limited mobility cross busy streets and make it easier for children to safely walk and bike to school. As a result, the rate of injuries and deaths from traffic accidents typically declines.27
Decisions about the programs that are funded through the city or county budget can affect health.
This applies to decisions beyond those typically thought of as health related, such as funding for clinics, senior meals and other traditional health and social services. For example, responding to a local budget crunch by closing parks or limiting the hours they are open can make it more difficult for residents to be physically active, even in neighborhoods where quality recreational facilities can be safely reached by biking or walking. This in turn can lead to declines in levels of health and fitness.
Loss of farmland, wildlife habitat and natural resources as low-density development spreads into formerly undeveloped areas.
Air-quality and climate-change issues associated with vehicle emissions and energy use in buildings.
Inefficient water use and water-intensive plant selections in traditional landscaping.
Investments in infrastructure and services that can’t keep pace with growth and the need for maintenance and replacement.
Changes in the nature and location of work, along with a declining economic base in older urban neighborhoods and aging suburbs as jobs and businesses shift to newer areas or leave the region altogether.
As the field of urban planning has evolved, issues that were once peripheral to planning have become more central. For example, concern about the environmental consequences of land use spurred policies and procedures to ensure that decision-makers and the public understand the environmental effects of decisions and that officials take steps to minimize or avoid environmental damage.
Demographic trends have also spurred changes in the types of housing and neighborhoods that people seek at each stage of their lives. These trends include changing family patterns, such as an increase in the number of smaller households, growing numbers of households with three or more generations under one roof and “downsizing” by empty-nest couples and retirees.
In fact, the fastest population growth is occurring at both ends of the age continuum, among young people and the elderly. Squeezed in between these two growing groups is a busy “sandwich generation” of middle-aged adults, many of whom are caring for children, grandchildren or elderly parents. As a result of these demographic changes, local communities have found that they must plan for new patterns of land use and transportation and a wider variety of types of development.
Concerns about the relationship between health and the built environment are increasingly reflected in land-use planning. Local communities are working to invigorate downtowns and main streets, retrofit auto-oriented suburbs, find new uses for old strip malls and shopping centers and build new neighborhoods that work socially, economically and environmentally. Many efforts like these are motivated in part by a desire to create healthier and safer communities where residents have more opportunities to be physically active and have access to a variety of nutritious foods.
The leading causes of death in the United States have shifted from infectious and communicable diseases to chronic diseases: medical conditions that are long-lasting, persistent or recurrent. Physical activity and proper nutrition can largely prevent many chronic diseases, such as heart disease and Type 2 diabetes. In response to the rising rates of chronic disease, many local agencies are adopting land-use measures that facilitate healthy eating and active living.
Local authority to regulate land use derives from the police power — the prerogative to act to promote the health, safety and welfare of the community. Historically local agencies have pioneered efforts to protect health and safety. For example, beginning in the early 1900s, municipalities established sewer systems and sanitation facilities to control waste and reduce infectious disease.These local efforts eventually led to state and federal sanitation and water-quality policies. More recently, state restrictions on air pollution and smoking grew out of local initiatives to protect public health.