New York City collectively gained 10 million pounds between 2002 and 2004. In those two years more than 170,000 New Yorkers became newly obese. As a city, we have a weight problem that has created a health problem -- and it's getting worse.
While a number of factors contribute to this obesity epidemic -- and to heart disease, stroke, asthma and some forms of cancer -- more and more experts attribute it, in part, to the shape of the city and the physically inactive lifestyle it has created. With this in mind, public health professionals, policy makers and designers are taking a closer look at how the built environment affects the public's health and, more importantly, ways in which they can work together so that New York City can, by its very structure, encourage physical activity.
Earlier this month, the commissioners of five city departments -- Health and Mental Hygiene, Design and Construction, Transportation, City Planning, and Parks and Recreation gathered for a conference -- called Fit-City to see what could be done. City employees, public health experts, urban planners, architect, and policy specialists packed the Center for Architecture on LaGuardia Place to discuss what has become a hot topic.
Creating Healthy Cities
The idea of using design to fight illness is not new. In the late 19th and early 20th centuries, infectious disease experts banded together with planners, sanitation specialists, and urban reformers to combat tuberculosis and waste-born diseases. The structures, laws and regulations they created remain essential to New York City's infrastructure. However, as that health crises faded, so too did the unusual and productive partnership that helped curb it.
Only in recent years, with the sharp rise in obesity-related chronic illness, has the connection between the design of a place and its health reemerged in policy circles. According to Dr. James Sallis, a professor at San Diego State University and the Fit-City conference's keynote speaker, in 2000, fewer than 50 academic papers focused on the relationship between the built environment and physical activity. In 2006, more than 300 academic papers made that same connection.
That research has not simply stayed on the shelf. In recent years, public health professionals have become increasingly involved in planning, transportation, and design decisions. Interagency reports and task forces now often include representatives of the health community. The Fit-City conference itself, with its goal of "promoting physical activity through design" and a diverse roster of speakers and attendees, is testament to the growing importance of public health considerations on design and vice versa.
The Cost of Inactivity
The rates of chronic illnesses that regular physical activity can help combat, or at least reduce the risk of, like diabetes and heart disease, are skyrocketing in New York City. According to Department of Health and Mental Hygiene statistics, more than 500,000 New Yorkers have been diagnosed with diabetes, more than 1 million are obese, more than 2 million are overweight and more than half report having no physical activity or significantly less than "healthy people."
Other chronic illnesses are of great concern too. About 6 percent of New Yorkers have had an asthmatic episode in the past 12 months, and in some communities, like northern Manhattan where hospitalization rates for asthma are 21 times higher than in the least affected New York City neighborhoods, estimates of childhood asthma rates are as high as one in four. Increasingly reports link high rates of these chronic illnesses to certain patterns in the built environment, such as location of highways, traffic patterns and citing of certain facilities, such as bus garages.
Researchers have found that asthma rates and the frequency of asthma episodes are correlated with air quality, which in turn is related to proximity to high vehicular traffic. Numerous students have highlighted the high asthma rates in Washington Heights in northern Manhattan and Hunts Point in the Bronx (see related article). Both neighborhoods are flanked by highways and inundated with truck traffic.
Furthermore, studies from around the country point to the correlation between obesity and a lack of physical activity. In 2006, the Journal of the American Medical Association published "Prevalence of Overweight and Obesity in the United States, 1999-2004," which found that 25 million kids are overweight or obese. That is more than one third of all children in the U.S. According to 2006 estimates by the office of the surgeon general, nearly two thirds of all adolescents do not engage in the recommended hour a day of moderate activity.
The effects of all this extend far beyond the ill individuals and their families. Asthma hospitalizations cost the city more than $240 million in 2000, and the Centers for Disease Control estimate that the obesity epidemic cost the United States $117 billion in the same year in direct medical expenses and indirect costs, including lost productivity.
Couple those numbers with the litany of studies that conclude the design of neighborhoods, schools and parks can greatly influence physical activity and it is simple to see why health professionals and planners are talking more and more about how they can help each other confront these problems.
Places to Exercise
New York City, according to many at the conference, has already taken steps to promote this collaboration. Although Mayor Michael Bloomberg's sustainability initiative PlaNYC focuses primarily on accommodating growth in the city while improving the environment, many of its goals, participants said, would also make for healthier communities.
Take for example the schoolyards to parks initiative. To help meet its aim of ensuring that every New Yorker lives within a 10-minute walk of a park, Bloomberg and Parks and Recreation Commissioner Adrian Benepe have opened 30 school playgrounds during off-school hours so they can be fully enjoyed by community members. The city plans to open 260 more schoolyard playgrounds by 2030 and claims that the program will make a space for physical activity easily available to approximately 360,000 New York children.
By all accounts, park access can play a key role in improving fitness. A 2006 study published in the journal "Pediatrics" found teenage girls reported an additional "35 minutes of physical activity per week for each park located within a half-mile from home." A national study published in the same journal concluded, "Communities with seven recreational facilities within a five mile radius had 32 percent fewer overweight teens than did communities with no facilities."
Getting People Moving
The city's efforts extend beyond recreational facilities. Health, transportation and other city agencies together are examining the ways that residents move between destinations in their neighborhoods. A review of 33 studies published in 2006 found that having walkable streets and destinations near one's home increased physical activity among children, while unsafe intersections and dangerous traffic lowered the likelihood of physical exertion. This kind of data provides backing for the long-standing Safe Routes to School program, which former Gov. Elliot Spitzer secured $32 million in federal funding for last September and the Safe Streets for Seniors initiative.
PlaNYC also aims to promote cycling as a healthy means of transportation (see related story). This will include an increase in the number of bicycle lanes on city streets, along with efforts to make indoor bike parking more available to building tenants. Legislation encouraging reasonable provisions for indoor bicycle storage has been pending for some time.
Seemingly simple moves, such as getting people to climb more stairs, could have a major impact. At Fit-City, the Department of Health and Mental Hygiene premiered new signage encouraging New Yorkers to take the stairs, and David Burney, commissioner of the Department of Design and Construction, spoke of changes in building code, such as allowing the use of transparent materials for stairwell doors, that would allow architects to focus more attention to stairs and make them more appealing to use. City officials played up both the environmental and health aspects of this effort by tag-lining it "Burn Calories, Not Electricity. Take the Stairs."
The Department of Design and Construction has also been working on high performance building guidelines. The agency reports that buildings with better lighting, ventilation and design are beneficial to employee health and productivity and could potentially save employers between $2 and $5 per square foot in regained productivity and between $.87 and $1.15 per square foot in a reduction of sick days. PlaNYC, however, has little to say about improving conditions in buildings, other than those owned by the city.
A Permanent Shift?
Although the city has launched many efforts to increase physical activity and health through infrastructure and design, advocates say there is still more to do.
For one, there is sometimes a gap between the goals of PlaNYC and the administration's accompanying pronouncements and the realities of some of its policies. In his proposed budget for next year, for example, Bloomberg calls for a decrease of $17.2 million in the parks department budget (see related story). The budget also does not restore the council's playground associates initiative, which funds full-time employees to oversee the city's playgrounds.
Plans to promote fitness in design can falter as they conflict with other city priorities. To cite one case currently in the news, the city sacrificed parkland and recreational facilities in the Bronx to make way for a new Yankee Stadium. As the New York Times reported, none of the replacement parks have been completed, the efforts to create new facilities have fallen behind schedule, and the area will be without some sports fields until at least 2011. NYC Park Advocates has concluded that, if and when all the parks are built, the area will lose parkland as a result of the deal.
Even if the administration managed to follow through on all the relevant proposals in PlaNYC, Bloomberg almost certainly will leave office on Jan. 1, 2010 -- and no one can be sure what will happen then.
To avoid these and other pitfalls, some advocates would like to see changes in laws and regulations. "What we need to see is more policy-based systematic oversight and less ad hoc good-faith efforts. That's the way to make things stick," said Wiley Norvell, a spokesman for Transportation Alternatives.
This sentiment is one echoed on the national level. In "The Built Environment and Its Relationship to the Public's Health," an article from the "American Journal of Public Health," the authors write, "Law can be a potent tool in creating a built environment that is conducive to public health. Public health practitioners can best influence design decisions by intervening early in the process, when broad policies are being made about population density, land-use configurations, transportation, and other-important issues."
Certainly in the late 19th and early 20th centuries, in the midst of the last great union of public health professionals and urban planners, real change did not come about until legislative reforms like the New York State Tenement House Act of 1901, which set light and ventilation guidelines for tenement buildings. With such laws, health and quality of life truly started to change for the better, and the infectious disease epidemic started to taper off.
Of course, prior to the passage of effective legislative reforms a century or so ago, there were conferences, one-off attempts, progressive visionaries and failed legal maneuvers for the better part of 50 years. Judging from the passion, commitment and enthusiasm on display at Fit-City, New York City may not have that long to wait for history to repeat itself.
Graham T. Beck is the managing editor of Transportation Alternatives' StreetBeat and a freelance writer. He lives in Brooklyn. Â