The Nexus Between The Built Environment And Public Health

Earlier this month pediatrician Neal Kaufman, M.D., and The Planning Report publisher David Abel, with the support of Majestic Realty, brought professionals from across the civic spectrum together to address the relationship between the built environment and public health. In two excerpts from this "Unhealthy by Design?" Conference, California Endowment CEO Dr. Robert Ross & L.A. Planning Director Gail Goldberg address how dense, well-designed cities can be more livable—and more healthy.

Gail Goldberg, Director, L.A. City Planning

Planners by nature are sort of environmental determinists. We really believe that you are where you live. And that is a powerful concept with enormous responsibility. I have to tell you that because of that enormous responsibility, I felt really guilty when I saw the title, “Unhealthy by Design?” It made me think about what kinds of neighborhoods we have created in the past and what the unintended consequences were.

Dr. Robert Ross, President and CEO, California Endowment

"So now what creeps up among the top-ten killers are chronic diseases – heart diseases, cancer, stroke, diabetes, etc. And these are very expensive to treat. Studies report that 1 percent of the population is consuming 22 percent of health care costs. The less healthy 50 percent of America are consuming 97 percent of health case costs. So the healthier portion is consuming only 3 percent of the $1.7 trillion that is spent annually on health care.

Those chronic diseases are influenced by how and whether you exercise, what you eat, whether you smoke or not, whether you have violence in your neighborhood, whether you have toxic fumes, or brownfields—those things are having an increasingly disproportionate burden on health and productivity of this country, and even more disproportionately on low-income communities. So we are shifting focus to chronic diseases.

The third revolution in public health is how to produce health. The shift will be from thinking about health as a transaction, between doctor and patient and patient and hospital, to thinking about health more holistically—from the standpoint of root causes. Seventy percent of what influences your health has nothing to do with the heath care you can buy."