“We do not inherit the earth from our ancestors, we borrow it from our children.” This ancient proverb opens the book Making Healthy Places by Dannenberg, Frumkin, and Jackson, and the focus on resolving current issues of sustainability and health resonates throughout it. The book addresses the complicated and linked issues of health and environmental sustainability, outlining a “toolbox” of solutions to reshape the built environment for posterity. The topic provides a healthy-environment-design-and-policy manual of biblical proportions, and the theme of changing the shape of the built environment for future generations holds as a guiding ethos throughout this excellent compilation.
The roughly 400-page volume begins at much the same place that it ends, with a section devoted to key terms and themes. It includes a case for reintegration of health into the planning and design fields, which has been called for by the likes of Corburn (2004, 2007) and Krieger (2000). The book also outlines how many educational “training pathways” for architects, urban planners, and engineers have not included a balanced framework that integrates public health—something seminal in the formation of these fields—and argues for reengagement of these fields. One of the best features of these sections is a 17-page glossary of relevant terms and acronyms that defines everything from the D’s of design to urban heat islands and xeriscaping— an excellent reference tool for the aspiring urban aficionado.
After this introduction, the book is divided by topic, outlining and summarizing the literature on the relationship between community design and health. This includes summaries on: transportation and walkability; healthy housing, workplaces, health care establishments, and schools; healthy places policy, community engagement, and benchmarking techniques. It also includes topics such as how to influence healthy behaviors, universal design and accessibility, and disaster resiliency. The book provides an exhaustive assortment of literature that reinforces synergies between planning and health, citing not only from books by Jacob Riis, Upton Sinclair, and Jane Jacobs but from papers by Robert Cervero, Reid Ewing, Lawrence Frank, and James Sallis, that it can leave the reader feeling bewildered and somewhat overwhelmed. At times it might be likened to looking at a Jackson Pollock painting that leaves one thinking: What does this all mean? How does it fit together? What do I do with this?
This sense of bewilderment, created from extensive amounts of information that the reader is required to digest and then associate, provides one of two weaknesses of the book. First, in trying to cover everything for everyone, and providing virtually all of the information available that links environmental design to health, transportation, and sustainability, the book provides no singular take-away. This lack of clarity may leave some readers in a muddle. It may make them sense that the authors are trying to prove a point rather than provide an objective overview of the field. Intuition may make them wonder if they are getting the whole story.
For example, in a suggestive chapter dedicated to biophelic design, the authors make the case that “designing with nature” can improve physical health. This is not a new argument. It has been embedded in planning practice from the time of Ebenezer Howard to Ian McHarg. Making Healthy Places, however, cites more recent empirical data and examples, including studies by Ulrich (Ulrich 1984 Ulrich et al. 1991) and Takano (Takano, Nakamura, & Watanabe 2002); yet this case for a beneficial “dose of nature” walks a fine line between equating correlation with causality. Some might question if the authors are being overly deterministic given the “complex web” of causation where no one has been able to find the spider (Krieger 1994).
This leads to a second weakness. In some cases, the contrarian perspective does not appear to be presented. For example, in a discussion of the benefits of walking, data is presented using what has become the established metric for measuring walkability—indexed mixes of land use, street grid connectivity, and residential density (Frank, Schmid, Sallis, Chapman, and Saelens 2005). This includes data showing how walkability is connected to higher levels of physical activity and reduced risk of obesity. However, some readers might pose questions about elements not captured by these metrics, such as crime, topography, and street safety improvements such as pedestrian bulb-outs and high-visibility crosswalks. They also might draw the distinction between incidental and recreational behaviors and the merits of ‘less walkable’ suburban areas. These are places that have been proven to have more capacity to support leisure physical activity (Forsyth, Oakes, Schmitz, and Hearst 2007) —a provocative statement in the eyes of many smart growth advocates and noticeably absent from the book.
Despite these weaknesses, Dannenberg, Frumkin, Jackson, and their collaborators demonstrate an outstanding command of the literature. They make a strong case for policies that can better connect environmental design to health and sustainability. Making Healthy Places serves as both a primer for those new to the field and a reference manual for practicing planners looking for design answers to complex, wicked problems in their respective communities. And to paraphrase T.S. Eliot from his 1949 work Christianity and Culture, the fact that these problems may take time to solve, even generations, is no justification for postponing them—on the contrary, dealing with these “permanent difficulties” is dealing with the “difficulties of every moment.” With this book Dannenberg, Frumkin, and Jackson capture this solutions-oriented spirit, and outline how practitioners and researchers in the fields of architecture, planning, and public health can help shape a legacy of health for our children.
William Riggs recently completed his PhD in the Department of City and Regional Planning at UC Berkeley.
Corburn, J., “Confronting the Challenges in Reconnecting Urban Planning and Public Health,” American Journal of Public Health, 94(4), 541, 2004.
Corburn, J., “Reconnecting with our Roots: American Urban Planning and Public Health in the Twenty-First Century,” Urban Affairs Review, 42(5), 688, 2007.
Forsyth, A., Oakes, J. M., Schmitz, K. H., & Hearst, M., “Does Residential Density Increase Walking and Other Physical Activity?” Urban Studies, 44(4), 679–697, 2007.
Frank, L. D., Schmid, T. L., Sallis, J. F., Chapman, J., & Saelens, B. E. , “Linking Objectively Measured Physical Activity with Objectively Measured Urban Form: Findings from SMARTRAQ,” American Journal of Preventive Medicine, 28(2), 117–125, 2005.
Krieger, N., “Epidemiology and the Web of Causation: Has Anyone Seen the Spider?” Social Science & Medicine, 39(7), 887–903, 1994.
Krieger, N., “Epidemiology and Social Sciences: Towards a Critical Reengagement in the 21st Century,” Epidemiologic Reviews, 22(1), 155, 2000.
Takano, T., Nakamura, K., & Watanabe, M., “Urban Residential Environments and Senior Citizens’ Longevity in Megacity Areas: The Importance of Walkable Green Spaces, Journal of Epidemiology and Community Health, 56(12), 913, 2002.
Ulrich, R. S., “View Through a Window May Influence Recovery from Surgery, Science, 224(4647), 420, 1984.
Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A., & Zelson, M., “Stress Recovery During Exposure to Natural and Urban Environments,” Journal of Environmental Psychology, 11(3), 201–230, 1991.