Designing Healthier
Environments to
Conquer Disease
Epidemics: Successes
in NYC and Elsewhere
Karen K. Lee, MD, MHSc
Can Design Help Address Today’s Health Epidemics?
THE 19th CENTURY:
Infectious
Diseases
THE 21st CENTURY:
Chronic Diseases,
many of which are
“Diseases of Energy”
19th Century codes, planning and
infrastructure as weapons in the
battle against contagious disease
The emerging design solutions
for health parallel sustainable
design solutions
These strategies were built into the
city fabric, and they were effective
Effective designs will have to be
an invisible, pervasive, and
inevitable part of life
Decreases in deaths from infectious diseases
57.1%
BEFORE the wide use
of antibiotics!
45.8%
AFTER the wide use of
antibiotics!
11.3%
1880
1940
2.3%
9%
2011
Environmental changes in 19th and early 20th centuries
1842
New York’s water system established – an
aqueduct brings fresh water from Westchester.
1857
NYC creates Central Park, hailed as “ventilation
for the working man’s lungs”, continuing
construction through the height of the Civil War
1881
Dept. of Street-sweeping created, which eventually
becomes the Department of Sanitation
1901
New York State Tenement House Act banned
the construction of dark, airless tenement buildings
1904
1916
First section of Subway opens, allowing population
to expand into Northern Manhattan and the Bronx
Zoning Ordinance requires stepped building
setbacks to allow light and air into the streets
The epidemics of today are:
CHRONIC DISEASES
(obesity, diabetes, heart disease
& strokes, cancers)
Top 5 Causes of Death in U.S.:
1.
Energy in:
Food
Tobacco, 2. Obesity, 3. High Blood Pressure,
4. High Blood Sugar, 5. Physical Inactivity
Energy out:
Exercise
Today……. over
70%
of deaths each year
are from
chronic
diseases.
Diabetes trends among U.S. adults
No Data
2009
2000
1994
<4.5%
4.5-5.9%
6.0-7.4%
7.5-8.9%
Source: CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
>9.0%
Obesity and Diabetes have increased rapidly.
Our genetics have not changed in one generation, but
our built environment has!
Translating Health Evidence into Non-Health Policies
Affecting Health
•
The Need for Partnerships Across Sectors
•
Finding Synergies and Co-Benefits
•
Complementary Roles of Partners
– Health: Presenting available research-based evidence and statistics on key health issues; help
organize conferences for cross-sector discussions; help coordinate initiatives; health evaluation
–
Design and Construction, Transportation and City Planning: Ideas of what’s feasible in the current
local context; identifying opportunities and mechanisms, including and especially synergistic efforts;
Co-Leadership in efforts
–
Other Agencies (Buildings, Housing, Parks, School Construction) – Inputs and leadership on their
issues also
–
Researchers: evidence reviews and synthesis, evaluation research
•
Using Evidence-Based and Best-Practice Strategies
•
Using Annual Conferences to Highlight Successes and Next Steps
•
Key Roles for Peer-to-Peer Partnerships and Mentoring among Cities
Inter-Sectoral Initiatives to Improve Health
Synergies:
• Health
• Safety
• Environmental
Sustainability
• Universal Accessibility
• Economic Benefits
Co-benefits of Active Design: Improve the
Environment
Fuel / Electricity Use
Air Quality
/ Landfill
Obesity/Diabetes/
Heart Disease
Biking or walking rather
than automotive
transport



Stairs rather than
elevators and escalators



Active recreation rather
than television



Safe tap water rather
than bottled and
canned beverages



Fresh produce rather
than unhealthy
processed foods



Co-benefits: Reduce infrastructure costs
More compact, walkable development patterns save money
on avoided infrastructure costs
Water & Sewer
Laterals Required
Water & Sewer
Costs (billions)
Road Lane Miles
Required
Road Land Miles
Costs (billions)
Sprawl Growth
Scenario
45,866,594
$189.8
2,044,179
$927.0
Compact Growth
Scenario
41,245,294
$177.2
1,855,874
$817.3
Savings
4,621,303
$12.6 (10.1%)
188,305
$109.7 (6.6%)
Sprawl Costs: Economic Impacts of Unchecked Development, Robert W. Burchell, Anthony Downs, Barbara McCann and Sahan Mukherji, Island Press, 2005
Co-benefits: Save people money
People in walkable, transit-rich neighborhoods spend only
9 percent of their monthly income on transportation costs; those in
auto-dependent neighborhoods spend 25 percent.
Source: Center for Transit-Oriented Development
Co-benefits: Create more jobs
Building bicycle
and pedestrian
infrastructure
creates more jobs
per dollar
invested,
compared to road
infrastructure only
Source: Political Economy
Research Institute: June 2011
Co-benefits: Create desirable places to live,
work & play
Sprawl Community :
Smart Growth Community :
Preferred by 43%
Preferred by 56%
There are only single-family houses on large lots
There are no sidewalks
There is a mix of single-family detached houses,
townhouses, apartments, and condominiums on various
sized lots
Almost all of the streets have sidewalks
Places such as shopping, restaurants, a library, and a
school are within a few miles of your home and you
have to drive most places
Places such as shopping, restaurants, a library, and a
school are within a few blocks of your home and you
can either walk or drive
There is enough parking when you drive to local stores,
restaurants, and other places
Parking is limited when you decide to drive to local
stores, restaurants, and other places
Public transportation, such as bus, subway, light rail,
or commuter rail, is distant or unavailable
Public transportation, such as bus, subway, light rail, or
commuter rail, is nearby
Source: National Association of Realtors National Poll, 2011 Q: In which community would you rather live?
Active Design Guidelines – DDC, DOH, DOT, DCP
Chapters:
1) Environmental Design and Health:
Past and Present
2) Urban Design: Creating an Active
City
–
E.g. Land use mix, pedestrian and bike
networks, transit, access to parks and
playgrounds, healthy food and beverage
access
3) Building Design: Creating
Opportunities for Daily Physical
Activity
–
E.g. Stair placement / design / signage,
active recreation amenities, bicycle
parking, tap water facilities
4) Synergies with Sustainable and
Universal Design
www.centerforactivedesign.org/guidelines
Initiatives in NYC
IMPROVED CHILDREN’S ENVIRONMENTS
• Passed Daycare Regulations for physical activity time (1h min.),
healthier foods & beverages, limits to TV
• Improved school foods and beverages
• Salad bars, water jets, 1% milk
• Increased physical activity opportunities in schools
• Gymatoriums
• School PlayStreets
• Train teachers to add physical activity
throughout the day
Initiatives in NYC
IMPROVED FOOD AND BEVERAGE ENVIRONMENTS
• Passed laws banning trans fats, requiring calorie postings and
limiting sugary drink sizes in restaurants
• Increased tap water drinking facilities in buildings and public places
• Created tax and zoning incentives for supermarkets in food deserts
• Increased access to farmers markets
• Created Greencarts
• Adopted food standards for foods
served at and by city agencies
Initiatives in NYC
IMPROVED ENVIRONMENTS FOR PHYSICAL ACTIVITY
• Developed and implementing the Active Design Guidelines (ADGs)
• Distributed >15,000 copies internationally; Trained >3000
• Integration into public sector design and construction projects,
standards (schools, supportive housing), & RFPs
• Created incentives – e.g. LEED Innovation Credit for PA
• Required bicycle parking in new buildings
• >30,000 “Burn Calories, Not Electricity” stair prompt signs to >1,000
NYC buildings, including city-owned and operated buildings
Building Strategies
Stairs: signage and prompts
Motivational Signage placed at points of decision
Promoting stair use at work – Stair Week
Building Design Strategies
Stairs: aesthetics
Stairs prominent and
visible, and receive
natural daylight
Art in stairs to increase
visual interest
Stairs designed to
invite users
Building Design Strategies
Recreational programming
Provide fun and affordable
recreational opportunities
Initiatives in NYC
IMPROVED ENVIRONMENTS FOR PHYSICAL ACTIVITY
• Improved urban realm for walking, cycling, transit (incl. BRT)
• Increased children’s play spaces and co-located adult rec spaces
• Schoolyards to Playgrounds
• Summer Streets and Community PlayStreets
(streets closed to cars, opened up for active recreation and
transportation)
Impacts
Increased:
- Commuter cycling 289%
- Bus and subway ridership 10%
- Stair use where stair prompts are used – in city worksites;
>40% increase at 9 mos in 10-story low-income housing
- Fruit and vegetable consumption
- Job creation in high needs areas through new supermarket
development
Decreased:
- Traffic fatalities 37%
- Traffic volumes 1.5%
- Car registrations 5%
Started Reversing Childhood Obesity
Cheonggyecheon Area before Retrofitting
http://www.metro.seoul.kr/kor2000/chungaehome/en/seoul/2sub.htm/
Cheonggyecheon Area after Retrofitting
http://www.metro.seoul.kr/kor2000/chungaehome/en/seoul/2sub.htm/