The magazine of the UW School of Public Health

Health and the Built Environment

by Laura Larsson and Yuki Durham

Precautionary Principle

Bay Area Working Group on the Precautionary Principle and Californians for Pesticide Reform
The Bay Area Working Group on the Precautionary Principle is a diverse collaborative of organizations and individuals that promotes and implements precautionary action to protect public health and the environment. The working group's Web site gives information on: "The basics of the precautionary principle and how it can be used to protect public health and the environment; what the precautionary principle looks like in action; the work and accomplishments of the Bay Area Working Group on the Precautionary Principle; and resources on precautionary action locally, regionally, nationally, and globally." Factsheets, articles, and information on how to become involved are the key links in the site.

Debating the Precautionary Principle
This memo from Stephen Tvedten, Get Set Inc, debates the Precautionary Principle in nine points. Worth reading because it provides an alternative viewpoint.

Generations at Risk: How Environmental Toxins May Effect Reproductive Health in Massachusetts. Ted Schettler, MD, MPH [], Gina Solomon, MD, MPH, Paul Burns, JD and Maria Valenti. The Greater Boston Physicians for Social Responsibility (GBPSR) and the Massachusetts Public Interest Research Group (MASSPIRG) Education Fund. [].
This Executive Summary of this report describes the scope of the problem, naming the suspected and known chemicals discussed in the report, and discusses why policy reform is needed and what right-to-know data reveal. It also offers policy recommendations on this important topic.

Precautionary Principle
Founded in 1994 by a consortium of North American environmental organizations, SEHN "is concerned with the wise application of science to the protection of the environment and public health. SEHN is also a think tank for the environmental movement, framing concepts and ethical considerations that give direction to the movement in North America and internationally. The leading proponent in the United States and Canada of the precautionary principle as the basis for environmental and public health policy, SEHN focuses on key issues—including agriculture biotechnology, reproductive and developmental toxins, and the practice of science in the public interest—that represent the interface of science, ethics, and the environment." Describes the precautionary principle in depth with essays and government and non-government positions. Essays and related links on ecological medicine and economics and on public interest research are available. Policy statements, access to issues of The Networker and news can be read online. The newsletter "covers political, economic, philosophical, scientific and social issues related to the environment and public health."

Wingspread Statement on the Precautionary Principle
This statement, which was drafted and finalized at a conference at the Wingspread Conference Center, Racine, Wisconsin, in 1998 is signed by its thirty-two authors. This short statement outlines their beliefs in how the environment is being affected "by the release and use of toxic substances, resource exploitation, and physical alterations of the environment" and that these releases and alterations are having unintended consequences. It outlines the Precautionary Principle: "Where an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically."

Suggested keywords to use to search for additional sites on the Web
  • Precautionary Principle

The Role of the Natural Environment in Healing

American Horticultural Therapy Association (AHTA)
This professional association's mission is to "advance the practice of horticulture as therapy to improve human well-being." Become a member and learn about the publications and research being done in this area; educational events, grants, and awards are also offered by AHTA. Publications of all kinds and on a variety of topics are available for purchase.

Casitas: Gardens of Reclamation. Daniel Winterbottom. Environmental Design Research Association Conference Proceedings, April 1998
This article appeared in the April 1998 Environmental Design Research Association Conference Proceedings. It describes the community garden spaces that have been created by individuals and groups on land owned by the City or on vacant private property. Combining a small structure, landscape such as garden plots, open space, and pathways as well as art, the casitas form a social focus for the community. Casitas serve many purposes—a social refuge, a place of cultivation that reduces stress, a community center, a safe place for children to play, and a means of reinforcing cultural identity for the group.

Healing by Design: Healing Gardens and Therapeutic Landscapes. Implications, 2(10). [PDF]
This University of Minnesota newsletter article describes how "hospitals and health care institutions often keep up extensive gardens and landscapes as an important part of healing." It also describes the history of why gardens are important, the research surrounding "healing gardens," a "term frequently applied to gardens designed to promote recovery from illness." Some design principles are included, such as providing a variety of spaces, growing a prevalence of green material, encouraging exercise, providing positive distractions, minimizing intrusions, and minimizing ambiguity. In addition, seven design elements are suggested. A short bibliography is included. A second article in the newsletter titled, "Healthcare Costs and Environmental Design" covers approximate costs of providing therapeutic gardens.

Healing Gardens: Therapeutic Benefits and Design Recommendations. Clare Cooper Marcus (Editor), Marni Barnes (Editor), New York: Wiley, May 1999. 624 pages ISBN: 0-471-19203-1.
Healing Gardens "provides up-to-date coverage of research findings, relevant design principles and approaches, and best practice examples of different types of healing gardens." The book "celebrates this renewed interest in nature as a catalyst for healing and renewal by examining the different therapeutic benefits of healing gardens and offering essential design guidance from experts in the field." View the book's description, and examine the table of contents and information on the editors.

The Healing Power of Nature. Colin Allen []. Psychology Today, May 1, 2003
This article summary states that kids with more greenery around them cope better with stress. Rural children who have access to nature seem better equipped to handle stress than kids in a room without a view. What's more, children who are the most vulnerable to stress benefit the most from adding greenery to their lives. (Web site)

Meristem - Restorative Gardens for Health Care Environments
Meristem is "an educational, not-for-profit organization based in New York City. The organization's mission is to promote nature's role in the improvement of human health and well being through the development of restorative gardens in healthcare environments. We work to unify the bodies of knowledge, standards of design and professionals required to successfully develop restorative gardens that meet the needs of healthcare environments; to expand and improve health care services through the integration of restorative gardens; and to develop a critical body of physicians, architects, horticultural therapists, and other professionals committed to the improvement of patient environments and community public health through restoration of local environments." A short description of what restorative gardens are is found in the "About Restorative Gardens" link. Learn about their staff and Boards; visit their library to find scientific literature, conference proceedings, popular press articles, and books. A literature review and review methodology is included in this section. Their Programs link offers educational resources including slides, lectures and a resource database, professional consultation, and help with garden development.

Restorative Gardens: The Healing Landscape. Nancy Gerlach-Spriggs, Richard Enoch Kaufman, and Sam Bass Warner, Jr. New Haven, CT: Yale University Press, November 1998.
"Restorative gardens for the sick, which were a vital part of the healing process from the Middle Ages to the early twentieth century, provided ordered and beautiful settings in which patients could begin to heal, both physically and mentally. In this engaging book, a landscape architect, a physician, and a historian examine the history and role of restorative gardens to show why it is important to again integrate nature into the institutional—and largely factorylike—settings of modern health care facilities." This book is the winner of a 1999 Merit Award given by the American Society of Landscape Architects Professional Awards Program.

Therapeutic Landscapes Database
The Therapeutic Landscapes Resource Center is a not-for-profit organization dedicated to providing information to the public about restorative landscapes, healing gardens, wellness gardens, and other research-based healthcare design. The Therapeutic Landscapes Database provides web-based information and creates a forum for discussion" and is free. No registration is required to search the database.

Daylighting in Schools and Other Settings

Daylighting Initiative, Pacific Gas and Electric Company (PG&E)
Full-text of several reports and case studies assembled by PG&E. Cases run from commercial/business sites through schools, supermarkets, and hardware stores. Project reports emphasize daylighting in schools and the influence of skylights on retail sales.

Human Lighting Requirements. Center for Building and Systems
The mission of this site is "to gain insight in how lighting affects the performance, mood and health of people and to create and develop new ways of illuminating the built environment based on a natural lighting approach. Since 1983 lighting research has been carried out in the collaboration of TU/e and TNO. This research was initially focused on day lighting. Over the year more and more emphasis has been put on the lighting quality of the working environment." The site describes the research questions that this group is studying.

The Invisible Environment: Seasonal Affective Disorder. Joe E. Heimlich. Ohio State University Extension Fact Sheet, CDFS-202-98.
This fact sheet describes what Seasonal Affective Disorder (SAD) is, how sunlight affects humans, and how to prevent SAD.

A Literature Review of the Effects of Natural Light on Building Occupants. L. Edwards and P. Torcellini, Golden, Colorado: National Renewable Energy Laboratory, July 2002. NREL/TP-550-30769. [PDF]
This technical report discusses the effects of light on the body and goes into detail about daylighting in offices, schools, retail establishments, health care facilities, and industrial environments. The conclusions state, "With properly installed and maintained daylighting systems, natural light has proved to be beneficial for the health, productivity, and safety of building occupants. Natural light helps maintain good health and can cure some medical ailments. The pleasant environment created by natural light decreases stress levels for office workers. Productivity increases with the improved health of workers, and with better productivity comes financial benefits for employers. Students also perform better with natural light. Across the nation, studies have shown students in daylit rooms achieve higher test scores than students in windowless or poorly lit classrooms." This is a U.S. Department of Energy-sponsored report.

The Non-Visual Effects of Natural Light on Student Performance
This PowerPoint presentation reviews what is known about the effects of lighting on students. The two studies reviewed are the Alberta Light Study and the PG&E Daylighting Initiative (1999). Other studies are reviewed in the presentation.

The Role of Emerging Energy-Efficient Technology in Promoting Workplace Productivity and Health: Final Report. Satish Kumar and William J Fisk, February 13, 2002. [PDF]
The Indoor Health and Productivity (IHP) project "aims to develop a fuller understanding of the relationships between physical attributes of the workplace (e.g., thermal, lighting, ventilation, and air quality) in nonresidential and non-industrial buildings and the health and productivity of occupants. A particular emphasis of the IHP project is to identify and communicate key research findings, with their practical and policy implications, to policymakers, design practitioners, facility managers, construction and energy services companies, and building investors." The two tasks of this project were to assemble a bibliography and to communicate the key research findings from relevant citations. The citations examined by the project staff are listed in Appendix A of the report. An explanation of why the paper was included is appended to each article.

A Study into the Effects of Light on Children of Elementary School Age: A Case of Daylight Robbery. Warren E. Hathaway. [PDF]
Data on 327 students, in Grade 4 at the end of the 1986-87 school year, were collected at the start and at the conclusion of the study, which spanned two years. The results indicated that over the two-year period, students under full spectrum fluorescent lamps with ultraviolet supplements developed fewer dental cavities and had better attendance, achievement, and growth and development than students under other lights. Students under the high-pressure sodium vapor lamps had the slowest rates of growth and development as well as the poorest attendance and achievement. On the basis of the findings of this study it was concluded that lights have important non-visual effects on students who are exposed to them on a regular basis in classrooms. (Partial Abstract)

Suggested keywords to use to search for additional sites on the Web
  • daylighting
  • natural light
  • Seasonal Affective Disorder
  • human lighting requirements
  • horticultural therapy
  • restorative gardens
  • healing gardens
  • hospital healing gardens
  • therapeutic landscapes
  • therapeutic landscape design

Building Healthy Communities

Active Living by Design
Active Living by Design "is a national program of The Robert Wood Johnson Foundation and is a part of the UNC School of Public Health in Chapel Hill, North Carolina. This program establishes and evaluates innovative approaches to increase physical activity through community design, public policies and communications strategies. 25 community partnerships across the country have been funded to develop environments that support physical activity." Of particular interest are the featured tools, publications, conference, and news. Key navigation elements include: Active Living Domains, Active Living Programs, Active Living Resources, Active Transportation, and Community Partnerships. Be sure to look at the Tools section for tools, guides, and how-to manuals that provide help in creating and supporting an Active Living environment. These tools are drawn from a variety of disciplines such as urban planning and design, public health, community development, transportation, and parks and recreation.

Designing and Building Healthy Places
This useful site covers a lot of ground: healthy environments, poorly planned growth, healthy community design and healthy places envisioned. In keeping with its efforts to promote healthy design, CDC provides articles on physical activity, respiratory health, children's and elder's health, injury, mental health, social capital, accessibility, and water quality. The glossary of terms related to designing and building healthy places is adequate and covers such topics as "bicycle friendly," "social capital" and "urban growth boundary (UGB)." Events related to healthy places and a list of related articles and resources makes this a very useful site for those interested in this topic.

Healthy Communities Project, Washington State Department of Health
Describes two projects funded by the Washington State Department of Health. These projects intend to get people walking by developing a network of linked paths that will be used for exercise, recreation, transportation, and tourism to promote healthier lifestyles for this community. In addition, community gardens will encourage healthier leisure, will help people get better food, and will encourage the consumption of more fruits and vegetables. Other food and exercise activities are linked from the left-hand navigation bar. These are worth exploring for additional information.

Moses Lake Healthy Communities Project
Several groups within the Moses Lake Healthy Communities Project were active. Gardeners grew fresh produce in 2004 and are planning workshops on "soil building, early-start greenhouse growing, and preparing winter crops." The Youth Wellness Team seeks to improve food choices in the Jobs Corps Center and will participate in Farm-to-Cafeteria training initiatives. The Trails Planning Team is "coordinating with both the city and county around road widening projects and developing "ring road" paths that are bicycle and pedestrian friendly." The Moses Lake Breastfeeding Coalition "continues to provide training to local health care providers on the benefits of breastfeeding and breastfeeding support to pregnant women."

Mount Vernon Healthy Communities Project
The Mount Vernon Healthy Communities Project is supported by the Mount Vernon city council, which has incorporated the Healthy Communities Project Action Plan into the city's long-term action plan. Developed from community feedback and local data, the action plan consists of three priority recommendations: access to health-promoting foods (in schools); increase the number of healthy community environments (using urban planning approaches to improve physical activity); and increase the number of physical activity opportunities available to children by encouraging policies to provide children with physical activities outside physical education classes.

Washington State Nutrition and Physical Activity Plan: Policy and Environmental Approaches. Washington State Department of Health, 2003.
The Washington State Nutrition and Physical Activity Plan was launched in June 2003 "to promote environmental and policy changes that encourage healthy eating and physical activity." The Executive Summary and the State Plan are linked from this page. The purpose of the plan "is to provide a framework in which policy makers can work together to build and support environments that make it easier for Washington residents to choose healthy foods and be physically active. The report examines obesity, chronic disease, healthy aging, nutrition, and physical activities problems and defines goals and objectives in two areas: nutrition and physical activity. The report is intended to improve the quality of life and create a healthier environment for Washington residents. A glossary of terms, the conceptual framework, the US Healthy People 2010 goals for nutrition, physical activity, and obesity, are included in the appendices. Other strategies and essential academic learning requirements as they relate to health and fitness are described.

Suggested keywords to use to search for additional sites on the Web
  • Healthy Communities project
  • physical activity plans


Bicycling Guide Map (King County, WA)
Sponsored by GroupHealth Cooperative, the King County bicycling Guide Map is available online in two different versions/sizes: by select area and as a large poster (25.5" x 37.75"). To select the area you want to explore, click the area map. Locate bike trails and important landmarks such as airports, major employers, and so on. The one-page maps show street names, indicate the steepness of the grade, and have a scale and a guide to traffic and street conditions. Parks are shown. If you want to take public transit to a location to start your biking trip, the Park and Rides/Transit Centers are clearly marked.

Critical Assessment of the Literature on the Relationships Among Transportation, Land Use, and Physical Activity. Susan Handy. TRB Special Report 282. [PDF]
The purpose of this report "is to provide a theoretical framework for discussion and to review and evaluate empirical evidence regarding the relationship between the built environment and physical activity behaviors." Handy describes the need for additional research into the significance of the connection between the built environment and physical activity. She also describes the studies that have been done and makes recommendations regarding the problems she found in examining current research into the built environment and physical activity. (Other papers by Handy related to this topic are located at:

Cycling in Montana
Site lists the "best" cycling routes in Montana, gives a brief description of each route and its length and gives a map (PDF). Thirty-three different routes are available for the intrepid cyclist. Some safety information is given.

Does the Built Environment Influence Physical Activity? Examining the Evidence -- Special Report 282. Committee on Physical Activity, Health, Transportation, and Land Use, Transportation Research Board. National Academy Press, 2005, 224 pages (approximate)
This forthcoming publication is not yet available in print. A PDF is available for online viewing. Seven chapters and two appendices make up the content. In addition to the introduction, the book covers physical activity and health, long-term trends affecting physical activity levels, contextual factors affecting physical activity, designing research to study the relationship between the built environment and physical activity, current state of knowledge (with a literature overview, a review and analysis of findings and knowledge gaps), and future directions with findings, conclusions, and recommendations. Report summary. Also available are the seven background papers used by the committee to help develop the report. These are listed in Appendix A and are available online at: An extensive glossary of transportation and terms related to health and exercise enhances understanding of the content.

Does the Built Environment Influence Physical Activity: Examining the Evidence. Report Summary. Transportation Research Board, Institute of Medicine of the National Academies. January 2005. (Summary of the report listed above.) [PDF]
Examining the Evidence reviews the broad trends affecting the relationships among physical activity, health, transportation, and land use; summarizes what is known about these relationships, including the strength and magnitude of any causal connections; examines implications for policy; and recommends priorities for future research.

Environmental Health Perspectives. Environews by Topic: Built Environment
Environmental Health Perspectives (EHP) is a monthly journal of peer-reviewed research and news on the effect of the environment on human health. EHP content is free online and available in print issues through paid subscription. This site aggregates articles from various topics into the broad topic of the built environment. Many different topics are covered from obesity in children to Rx for Sick Buildings. (/docs/2003/111-13/innovations-abs.html)

Environmental Health Perspectives: Built Environment
This CD-ROM includes a selection of the best built environment-related articles published in Environmental Health Perspectives (EHP), as well as a recent report on the state of the science of built environment by the National Institute of Environmental Health Sciences. To request a CD copy of "Environmental Health Perspectives: Built Environment," send an e-mail to: . Include your name, address, and a daytime phone number. The articles can also be downloaded from the Web.

Features of the Neighborhood Environment and Walking by U.S. Adults. Richard R. Suminski, Walker S. Carlos Poston, Rick L. Petosa, Emily Stevens, and Laura M. Katzenmoyer. American Journal of Preventive Medicine, 28(2): 149-243 (February 2005)
This study "examined the relationships between features of the neighborhood environment and walking in the neighborhood by U.S. adults. Prospective studies are needed to determine if changes in neighborhood safety and awareness of neighborhood destinations promote increases in walking by women. Evaluations of the relationships between other environmental features and walking behavior in men are warranted."

Health and Community Design: The Impact of the Built Environment on Physical Activity. Lawrence D. Frank, Peter O. Engelke, and Thomas L. Schmid. Island Press, Washington, DC, 2003. 242 pages. $30 (paperback).
This book was reviewed in Journal of Epidemiology and Community Health (JECH Online), 2005;59:250 by Brooke Fischer, Sarah Dash and David Berrigan . The first 150 words of the full text of the article are available for viewing. Health and Community Design "is a comprehensive examination of how the built environment encourages or discourages physical activity, drawing together insights from a range of research on the relationships between urban form and public health. It provides important information about the factors that influence decisions about physical activity and modes of travel, and about how land use patterns can be changed to help overcome barriers to physical activity."

Helena Area Non-Motorized Transportation Plan (Proposed plan; not yet adopted as of 4/10/05)
This site makes available the plan, the design guidelines, and several maps.

How Land Use and Transportation Systems Impact Public Health: A Literature Review of the Relationship Between Physical Activity and Built Form. Lawrence D. Frank, PhD, and Peter Engelke. ACES: Active Community Environments Initiative Working Paper #1. [PDF]
This lengthy document (147 pages) describes the literature review and then breaks the review into seven chapters. Chapter 1 defines the purpose and structure of the review. Chapter 2 looks at physical activity and public health. Chapter 3 describes physical activity in the built environment and covers travel patterns, characteristics of non-motorized travel, demand for walking and biking, vulnerable populations and non-motorized travel, factors influencing non-motorized travel decisions, and testing the effects of built form. Chapter 4 looks at transportation system characteristics and physical activity patterns. Land development patterns and physical activity make up Chapter 5. Chapter 6 provides information on urban form and physical activity. Chapter 7 offers the reader the conclusions drawn from this literature review. A complete bibliography and an appendix of online resources complete the document. An executive summary is included.

Journal of the American Public Health Association, September 2003.
Richard Joseph Jackson, MD, MPH, director of the Centers for Disease Control and Prevention's National Center for Environmental Health, served as guest editor for this special issue, which features new research on the effect of land use and community design on public health. Experts from CDC and from a wide range of professional disciplines present research articles, commentaries, and field action reports on how the design of the built environment affects physical activity, air and water quality, injuries, mental health, social capital, and environmental justice.

MDT's Bicycle and Pedestrian Connection
The Montana Department of Transportation's TranPlan 21 set out two goals. One of these goals is to "continue to improve bicycle and pedestrian facilities and institutionalize these modes of travel in Montana. The other is to target bicycle and pedestrian improvements based on current use, anticipated use and in coordination with local planning." This page asks for help from Montana residents in achieving these two goals and offers access to their quarterly newsletter, Newsline.

Obesity and the Built Environment: Improving Public Health Through Community Design. May 24-26, 2004, Wardman Park Hotel, Washington, DC.
This conference was intended to "provide a forum to discuss and illustrate how different elements of the built environment contribute to obesity via access to food and physical activity, and how environmental health research and interventions can address this public health problem." Presenters come from academia, government, and business. The Conference site provides presentation slides and supplementary information (in PDF format) located under Post Conference Information.

Our Built and Natural Environments: A Technical Review of the Interactions Between Land Use, Transportation and Environmental Quality. United States Environmental Protection Agency Development, Community, and Environment (2127), Washington, DC 20460.Publication: EPA 231-R-00-005, November 2000.
In Our Built and Natural Environments, "the U.S. Environmental Protection Agency (EPA) summarizes technical research on the relationship between the built and natural environments, as well as current understanding of the role of development patterns, urban design, and transportation in improving environmental quality. Our Built and Natural Environments is designed as a technical reference for analysts in state and local governments, academics, and people studying the implications of development on the natural environment."

Public health and the built environment: historical, empirical, and theoretical foundations for an expanded role. Wendy C. Perdue, Lawrence O. Gostin, and Lesley Stone. Journal of Law, Medicine & Ethics, Winter 2003 v31(4) p557 (8358 words) Special issue on Emerging Issues in Population Health: National and Global Perspectives.
There "is a demonstrable connection between public health and the built environment and as a result of this connection, the government has and continues to intervene in the built environment. This article argues that such intervention is appropriate and supported by theory as well as historical practice and empirical evidence."

Safe Routes to School Projects (Washington State)
This grant program aims "to protect children from traffic deaths and injuries and promotes a healthy lifestyle through biking and walking. It also provides sensible transportation by reducing the number of car trips to and from schools." The eleven projects selected in 2004 for funding uniformly included information on "community involvement in the development of safety, education, enforcement and traffic improvement programs to get more kids walking and biking to school safely. Most of the selected projects include improved sidewalk connections or new pathways and safety education for students and parents. Related links on bicycling and walking offer resources, safety information, and more.

Surface Transportation Policy Project
The Surface Transportation Policy Project "is a diverse, nationwide coalition working to ensure safer communities and smarter transportation choices that enhance the economy, improve public health, promote social equity, and protect the environment." An important consideration of the built environment, the transportation system "should be socially equitable and strengthen civil rights; enabling all people to gain access to good jobs, education and training, and needed services." Issues such as health and safety, economic prosperity, equity and livability, the environment, and action alerts are tracked on the site. Learn how Americans travel/commute and how transportation investments affect the environment.

TranPlan 21 (Montana Department of Transportation)
TranPlan 21, Montana's long-range transportation policy plan, "is part of an ongoing process that regularly identifies transportation issues, evaluates public and stakeholder needs and priorities, and establishes and implements policy goals and actions. This process guides MDT in the development and management of a multimodal transportation system that connects Montana residents and communities to each other and the world. The Web site contains a copy of the TranPlan 21 2002 Update, including policy papers, public involvement activities, the implementation plan, and additional informational publications. Also available are the most recent TranPlan 21 Annual Report, Public Involvement Telephone Survey, and Transportation Stakeholder Survey. The importance of public involvement in the planning process is stressed throughout the document.

Suggested keywords to use to search for additional sites on the Web
  • bicycling or cycling
  • safe walking
  • transportation plans
  • bicycling guides
  • bicycling maps
  • bicycling safety
  • built environment
  • physical activity communities
  • walking

Urban Density, Sprawl, and Land Use Planning

About Healthy Places
Since 1900, life expectancy in the United States has increased by approximately 40 years. Only seven of those years can be attributed to improvements in disease care; the rest are the result of improved prevention efforts (such as immunizations) and improved environmental conditions, including sanitation and water. The link between the nation's health and the environment is unmistakable.

Active Living Research
Active Living Research is a $12.5-million national program of The Robert Wood Johnson Foundation (RWJF) that supports research ( to identify environmental factors and policies that influence physical activity. Findings from this research will be used to help inform policy, design of the built environment and other factors to promote active living ( Active Living Research is administered by San Diego State University and led by expert staff and advisors (

Active Living Network
Since World War II, "physical activity has been engineered out of many parts of American life. The Active Living Network is part of a coordinated response to find creative approaches for integrating physical activity into American life. Rather than solely addressing obesity as an individual health problem, the Network focuses on how the built environment—including neighborhoods, transportation systems, buildings, parks, and open space—can promote more active lives." Resources, a toolkit, information about the partners involved in trying to solve this problem, and an extensive news section make this a site worth visiting.

The Built Environment and Children's Health. Susan Kay Cummins, MD, MPH, FAAP, and Richard Joseph Jackson, MD, MPH. [PDF]
The built environment embraces a wide range of concepts, from the design and integrity of housing, to land use and urban planning. A high quality environment is essential for children to achieve optimal health and development. Building and land use policies, including the quality and design of a child's physical environment, can cause or prevent illness, disability, and injury, and degrade or preserve natural resources. Although many common pediatric conditions, such as obesity, asthma, and lead poisoning as well as injuries, are associated with risk factors in a child's built environment, this issue has received little attention from researchers or policy makers. The authors suggest that this new field is ripe for etiologic and prevention research and that we need pediatric advocates to speak out for children's needs within this arena.

Note: Single copies of this article may be downloaded and printed only for personal research and study.

Creating a Healthy Environment: The Impact of the Built Environment on Public Health. Richard J. Jackson, MD, MPH and Chris Kochtitzky, MSP. [PDF]
Jackson and Kochtitzky outline the importance of exercise on health and in the reduction of obesity. They describe the "housing characteristics, land-use patterns, transportation choices, or architectural or urban-design decisions, as potential health hazards" and make recommendations for ways public health professionals, and others, can get involved in supporting research into how changes in the built environment can affect health and into changing land use policies that encourage environments that do not support exercise and that degrade the environment.

Environment, Energy and Transportation Program, Promoting Health through Planning and Design. Audio from the National Health Policy Meeting, Hilton Charlotte and Towers 8:00 to 10:45 a.m. Friday, December 1, 2000.
The pre-conference focused on: "Demonstrating the connection between health and built environment, emphasizing how planning policies can have tangible impacts on human health and well-being; providing examples of successful models and policies of healthy communities; and exploring the indicators of healthy communities."

Health Impacts of Sprawl. Howard Frumkin, MD Presentations and handouts from the Health and Environment Chairs Meeting, July 23rd, 2002
Presentation and notes from a session that discusses "the effects on health and how state and city policies can act as either barriers or incentives to developing city designs that incorporate health and well being."

Healthy Environments (Radio interview of Richard Joseph Jackson, MD, MPH, on the Paula Gordon Show on WGUN-AM 1010 in Atlanta, June 6, 2003).
Richard Joseph Jackson, MD, MPH, is the former director of CDC's National Center for Environmental Health. Learn why healthy people require a healthy environment.

Living Well: Walkability Is a Big Step Toward Shaping Up a Community. Bob Condor. Seattle Post Intelligencer, Monday, February 14, 2005.
Article describes how living in a well-planned urban environment can keep you healthy through walking to work, to shopping, and for recreation. Also gives information on the report commissioned by King County executive Ron Sims that will rate walkability in the county's cities.

Reducing Nationwide Obesity Starts in Neighborhoods. U.S. Department of Health and Human Services, National Institutes of Health (July 3, 2003).
This report summarizes the effectiveness of the Hearts N' Parks program, an intervention developed by the National Heart, Lung, and Blood Institute, and the National Recreation and Park Association (NRPA), to reduce the growing trend of obesity and the risk of coronary heart disease in the United States. Links to the Hearts N' Parks Web site and the full performance report are included.

Report on Public Health and Urban Sprawl in Ontario, Executive Summary. Ontario College of Family Physicians. 2002.
This report "summarizes pertinent information on the relationship between urban sprawl and health. It serves to identify the key issues that are relevant to the growing number of sprawl-related health problems in Ontario, which is comparable to US situations and is far worse compared to Europe." The summary goes on to say, "the best available evidence indicates that greenspace is an essential part of human health. People cannot continue to lead healthy lives without sufficient farmland to produce local food, forests to help purify the air, and protected watersheds to provide safe drinking water. Neither of these complementary goals—protecting environmental systems and protecting human health—can be accomplished, however, without curbing urban sprawl". A link to the complete document is posted.

Smart Growth America
Smart Growth America "is a coalition of nearly 100 advocacy organizations that have a stake in how metropolitan expansion affects our environment, quality of life and economic sustainability. Our diverse coalition partners include national, state and local groups working on behalf of the environment, historic preservation, social equity, land conservation, neighborhood redevelopment, farmland protection, labor, town planning … and we're growing all the time." The site has a significant amount of information on urban sprawl, social equity, transportation, open space and farmland, preservation and revitalization, children and schools, the environment, health and aging, housing, and the economy. Read their annual report, sign up for software and publications, and read the latest news on urban growth and related topics.

Special Report: Measuring the Health Effects of Sprawl. Barbara A. McCann and Reid Ewing. Smart Growth America. September 2003. [PDF]
In the first such national study, health researchers "found that people who live in counties marked by sprawl-style development tend to weigh more, are more likely to be obese and are more likely to suffer from high blood pressure." The report provides an executive summary, an introduction to the problem, a methodology section, and an extensive findings section that discusses how sprawl relates to weight, physical activity, and chronic disease. It also discusses the need for further research and makes recommendations for developers to consider health when planning communities.

The Sprawl Guide. Planning Commissioners Journal 2000 June 9.
Defines what urban sprawl is in a variety of ways. Visitors to the site are invited to submit their definitions to supplement those given by experts.

Sprawl Guide. Problems: Health Impacts
Useful annotated list of publications dealing with the health effects of urban sprawl is presented here. It includes articles on pedestrian safety, walking, the effects of the built environment on public health and, of course, sprawl. The rest of the site is worth visiting for information on the roots of the problem of sprawl, possible solutions, resources including articles and books, and links.

Urban Sprawl: What's Health Got To Do With It? Public Health Grand Rounds. University of North Carolina, Chapel Hill, 2002. [Webcast]
This topic was the subject of a January 18, 2002 webcast by the Centers for Disease Control and Prevention and the University of North Carolina at Chapel Hill School of Public Health. The one hour webcast, which can be viewed in its entirety, focused on the health effects that sprawl can have and the need to involve public health professionals in land use discussions.

Urban Sprawl and Public Health, by Howard Frumkin, MD, DrPH. Public Health Reports, May-June 2002;117:201-217. [PDF]
This article discusses the relation between sprawl and health based on eight considerations: air pollution, heat, physical activity patterns, motor vehicle crashes, pedestrian injuries and fatalities, water quality and quantity, mental health, and social capital. It describes the effects of cars on the environment and discusses the effects of land use decisions on physical activity, water quantity and quality, and the social aspects of sprawl (mental health, social capital). Environmental justice considerations and possible solutions to the problem of urban sprawl are suggested. (Note: The preprint version of this article is available at:

What Olmsted Knew. Richard Joseph Jackson, MD, MPH, director, National Center for Environmental Health, Centers for Disease Control and Prevention. From the March, 2001 issue of Western City magazine.
Medicine "will not be adequate to deal with the health challenges of the 21st century, not even with the help of the sequenced genome and advances in robotic surgery. Even though the United States spends one of every seven dollars on medical care, we will not significantly improve health and the quality of life unless we pay more attention to how we design our living environments. Healthy living environments include not just a clean and heated kitchen, bath, or bedroom but also the landscape around us. Health for all, especially for the young, aging, poor, and disabled, requires that we design healthfulness into our environments as well."

What's Health Got to Do With It? Leslie Robbins, Glen Andersen, and Larry Morandi. State Legislatures, June 2004.
"As Americans grow in girth, policymakers are looking at community design to encourage physical activity and lower obesity rates." Article describes the price we pay in obesity and early death due to a lack of public health concern for land use planning and the resulting sprawl. It describes how walkable communities are making a comeback and emphasizes the potential health benefits of promoting healthy lifestyles through enhancing the built environment.

Working for the Nation's Wellness. National Recreation and Park Association and U.S. Department of Health and Human Services.
This article describes a partnership between the U.S. Department of Health and Human Services and NRPA to promote community-based health education and activity programs aimed at increasing physical activity and reducing obesity. The purpose of the partnership "is to improve public health by encouraging physical activity, reducing overweight/obesity, and improving the health of communities including children, families, and seniors through programs, products and services."

Suggested keywords to use to search for additional sites on the Web
  • active living research
  • urban sprawl
  • urban density
  • land use planning
  • non-motorized transportation
  • healthy environments


National Charrette Institute (NCI)
The National Charrette Institute (NCI) "is a nonprofit educational institution that helps people build community capacity for collaboration to create healthy community plans. "We teach professionals and community leaders the art and science of Dynamic Planning, a holistic, collaborative planning process that harnesses the talents and energies of all interested parties to create and support a feasible plan. And we advance the fields of community planning and public involvement through research and publications." Used by a variety of professions including planners, designers, architects, citizen activist groups, public officials, and non-governmental organizations, charettes bring people together in workshops and open houses to brainstorm and create plans that can transform a community. Charettes can be used for regional/comprehensive planning, for rewriting development codes, and for creating affordable housing developments and community master plans. NCI has links to other sites with relevant content (sustainable growth in planning, environmental and transportation), and to its publications, presentations and case studies. This is a definite starting point for anyone interested in charrettes and their use in consensus-building.

The Neighborhood Charrette Handbook: Visioning & Visualizing Your Neighborhood's Future. Dr. James A. Segedy, AICP and Bradley E. Johnson, AICP. Sustainable Urban Neighborhoods, University of Louisville, April 21, 2003.
Liberally spiced with relevant quotes and valuable process information, this one-page Web site gives readers ideas on how to use a charrette workshop "to provide a forum for building community consensus on a vision for the neighborhood's future through active involvement and visualization - bringing the vision to life." Worth reading for the overview information on what a charrette is (a short, intensive design or planning activity designed to stimulate ideas and involve the public in the community planning/design process). A charrette is a valuable tool for laying the foundation for the development of a more formal plan (i.e., comprehensive plan, master plan, strategic plan, etc.). It is most effective as a component of the formal planning and design process, and the processes that can be followed to make the charrette event successful.

Suggested keywords to use to search for additional sites on the Web
  • Charrette