Sprawl On: Suburbs Top the Hierarchy of Healthy Places

A new finding by Univ. of Wisconsin Population Health Institute reveals that when the health variable is isolated, suburban living beats living in the city and in rural areas.

The County Health Rankings (CHR) measured four types of health factor: (1) health behaviors of residents; (2) access and quality of clinical care; (3) various socio-economic elements, such as household income and education attainment; and (4) overall quality of physical environment.

The Wall Street Journal columnist Melinda Beck broaches the research results:

On suburbia living: "In many measures, residents of suburban areas are the best off. They generally rate their own health the highest and have the fewest premature deaths than either their urban or rural counterparts. Suburbanites also have the fewest low-birth-weight babies, homicides and sexually transmitted diseases."

On city living: "[C]ity dwellers live with more air pollution and violent crime. They also have higher rates of sexually transmitted diseases and low-birth-weight babies and are more likely to drink excessively. But overall, urbanites tend to rate their own health more highly and are less likely to die prematurely than rural Americans."

On rural living: "Rural residents are now more likely than other Americans to be obese, sedentary and smoke cigarettes. They also face higher rates of related health problems including diabetes, stroke, heart attacks and high blood pressure. [...] About 25% of the U.S. population lives in rural areas, but they are served by only 10% of the country's physicians. They are also less likely to have private health insurance, prescription drug coverage or be covered by Medicaid."

Full Story: City vs. Country: Who Is Healthier?



Sprawl Is Not Healthier

This study does not really show that sprawl is healthier.

It shows that people who live in the suburbs are healthier because of a variety of factors, including higher income and better access to health care.

If we controlled for these socio-economic factors, and just looked at the impact of different urban designs on health, we would find what many earlier studies have shown: it is healthier to live in a walkable neighborhood and to get exercise as part of your daily activities by walking than to live in an auto-dependent neighborhood where you do not exercise as part of your daily activities.

Charles Siegel

Sprawling waistlines generalizations.

So we know that obesity has risen on a lag with VMT. We also know that stress is higher in cities. Our real problem with sprawl is that it is inefficient and for some it is isolating. For others it is fattening. It is an error in my view to assert that cities and density will solve some health problems for McSuburb dwellers. It may cause others like unhappiness, because that is where some people do not want to live.

There are tradeoffs in everything and some people will live out in BFE regardless of what we do. That's how it is. Sprawl may be healthier for some, but not for all. Density may be healthier for some, but not for all. More choices is what we need, not more of one choice.



Inappropriate conclusions drawn from this study.

Mr. Siegel is spot on. While the WSJ article leaves a bit to be desired in explaining the study, the Planetizen summary comes to completely inaccurate conclusions, implying that living in the suburbs will make you healthier. As we know, correlation does not equal causation. Socioeconomic factors are stronger predictors of health than are built environment factors (though both definitely play a role), and it just so happens that people living in American suburbs generally rank higher on most socioeconomic measures than do people living in urban or rural areas. So it's not surprising that suburbanites also rank higher on health outcomes. But the suburbs did not cause their residents to be healthier, any more than the suburbs caused residents to be wealthier and better educated. Since this study only looks at data from one point in time, anyone claiming that one factor caused another based on this study is drawing a false conclusion, as we would need data from at least two points in time to begin to understand what causes what.

Loudoun County in my home state of Virginia provides a good example. Loudoun is a highly affluent suburb (exurb???) of Washington DC and ranks 3rd in Virginia's Health Outcomes. If you look at the health factors (i.e. the key determinants of health outcomes), Loudoun ranks 1st in socioeconomic factors, 4th in health behaviors, 17th in clinical care, and 119th (out of 132) in Physical Environment. To say that the suburban environment is causing Loudoun residents to be healthier runs completely counter to the data. Saying that the Loudouners' affluence is strongly associated with their good health would be far more accurate. (see Fairfax County for an even more extreme example) On the flipside, Galax City ranks a middle-of-the-pack 76th in health outcomes, despite ranking 113th in clinical care and 119th on socioeconomic factors. Does their 2nd ranked physical environment help encourage their 63rd ranked health behaviors to help raise their health outcome ranking despite these other factors? Perhaps, though it is really tough to draw conclusions of this type from this type of data.

Jared Ulmer, AICP, MPH

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