SUNDAY, Dec. 14, 2003 (HealthDayNews) -- Inviting, tree-lined sidewalks. Speed bumps that make roads safe for bikers. Zoning laws that inspire people to walk to work.
This kind of community might actually end the nation's obesity epidemic, and all the attendant diseases that come with it.
That's what experts in a variety of fields are beginning to think, and they're joining forces to try and create places to live that are also good for your health.
"There's a new subfield, a marriage of urban planning and public health," says Reid Ewing, a research professor at the National Center for Smart Growth at the University of Maryland. In the past five years, experts have begun to realize that one's physical environment may be directly linked to one's level of physical activity, he explains.
That connection may become critical as Americans grapple with a collective weight problem that many now believe rivals smoking as a major public health issue. As a matter of fact, more Americans are expected to die from obesity-related causes than from smoking by the end of the decade, according to the American Journal of Health Promotion.
This crisis didn't happen overnight.
The sprawling cities of the second half of this century have slowly but surely led to a world where it's almost impossible to get anywhere without a car. Walking and biking have become something people save for the weekends, not a daily activity that would consistently burn precious calories and keep pounds off. The U.S. Centers for Disease Control and Prevention estimates that a difference of 100 calories of exercise per person per day -- a 20-minute walk -- could eliminate the obesity epidemic.
That's where urban planning initiatives might make a difference, and cities and towns across the country are beginning to apply for grants to make their communities more pedestrian-friendly and bring daily physical activity back into peoples' lives.
The war on smoking is serving as a model for the current push to change environments. Instead of educating individuals, strategists are turning their attention to changing how communities are designed. As policies such as cigarette taxes have succeeded with smoking, perhaps efforts to change the character of where people live and work will succeed when it comes to excess weight and its associated ills, which include diabetes and heart disease.
Given that the National Institutes of Health has found nearly two-thirds of Americans are overweight and almost a third are obese (with roughly 300,000 adult deaths in the United States each year attributable to bad diet and sedentary behavior), the task is daunting. That's not to mention the 18.2 million people in the United States who have diabetes, 5.2 million of whom don't know it. Then there's heart disease: 61.8 million had it in 2000, according to the American Heart Association. And with 945,836 people dying from cardiovascular disease in that same year, it is this country's leading killer.
However, there's good reason to try to reverse this frightening trend.
A study conducted by Ewing that appeared in the September issue of the American Journal of Health Promotion found a relationship between urban sprawl, inactivity, obesity and, most important, morbidity. People who call the suburbs home weigh an average of 6 pounds more than those living in compact areas, and they were also more likely to be obese.
One likely explanation for this phenomenon is that people in sprawling areas tend to drive more than those in compact areas, where they tend to walk. "We realized that the way we build communities may be a major contributor," Ewing says. "We're building for automobiles as opposed to pedestrians."
Adds John Pucher, a professor of urban planning and transportation at Rutgers University: "Currently, we make automobile use extremely easy, convenient and cheap. A car becomes such an irresistible temptation even for those short trips. That's one of the issues."
So, one of the main thrusts of planners has been to make suburbs resemble small towns at the turn of the 19th century, which is to say places where people want to walk.
Improving the sidewalks is a strong first step. Pucher cites the example of Old Pasadena, Calif., which one Web site now describes as "L.A.'s premier pedestrian neighborhood." The town installed parking meters and used all the revenues to beautify the streets, including benches, planters, palm trees and twice-monthly steam cleanings.
"You can't even recognize it," Pucher says. "There's no question that we can much, much improve the quality of our sidewalks by making the sidewalk portion cleaner, replacing sidewalks that are old, uneven or have holes, putting in a few trees, benches, putting in more pedestrian-level kind of lighting. That's not rocket science, and it's not even that expensive."
Traffic calming is another inexpensive and relatively simple enhancement. This includes speed bumps and curves that slow down cars and make a neighborhood safer for pedestrians and cyclists. Bike lanes and bike paths, and even auto-free zones, are other initiatives that are being considered and implemented in different regions.
But it has to go beyond that, experts say.
"It's not enough to just build sidewalks or bike paths. Land-use patterns have to be supportive of walking and biking," Ewing says.
Zoning codes need to allow a more innovative mix of uses, Pucher says. An obvious example is to combine shopping and residential districts so people can walk or cycle to work. "That's being worked on right now," he says. "It's not a huge tidal wave, but it's promising."
Mortgage breaks are another incentive. The Location Efficient Mortgage, for instance, increases borrowing power for people who chose to buy a home in an urban community. The net effect: People buy houses in neighborhoods where they can walk to stores, schools, parks and public transportation. The program is currently available in Chicago, Seattle, Los Angeles, San Francisco and Orange County, Calif.
Having an environment in place that encourages exercise is only part of the equation: "People need to get the message that it is really dangerous for their health not getting that exercise," Pucher says.
"Eventually, the evidence may accumulate to the point where in several years just about everyone thinks there's a connection between community design and health," Ewing adds.
Learn more about connecting health and community design at Active Living By Design or the National Center for Smart Growth. The Natural Resources Defense Council has more on Location Efficient Mortgages.