The Driving Force Behind Chronic Disease

by Marisa Mead on February 22, 2012

Imagine an America without cars. Surely, efficiency of daily life activities for many Americans would go down if cars were forced off the roads. Suburban residents commuting to cities would have trouble getting to work, and daily errands like grocery shopping would be a lot harder without a car for transportation. Our society is dependent on cars because of the way we designed our urban space. Unfortunately, our dependence on cars also negatively impacts human and environmental health.

Dr. Richard Jackson, an advocate of better urban design for public health, has zeroed in on urban sprawl and car dependence as leading factors for chronic diseases epidemics such as obesity and diabetes. His PBS documentary series (previewed below) explores how poorly planned communities contribute to chronic disease.

Urban sprawl is loosely defined as low-density, automobile-dependent development beyond the urban centers of services and jobs. In the 19th century, cities were designed to keep factory and industrial emissions away from residences in order to promote health. This early city planning helped keep infectious disease under control. However, as our places of residency moved away from city centers, our dependency on the automobile has increased, and so have rates of chronic diseases such as asthma, obesity, and diabetes.

Laura Jackson of the Environmental Protection Agency (EPA) compiled a plethora of research linking mental, physical, and environmental health to urban design. The review article, published in Landscape and Urban Planning, highlights the negative health impacts of widespread car usage.

Automobile exhaust not only exacerbates existing asthma, but is also linked to asthma development in children who exercise outdoors in southern California (notorious for its smog emissions). Pregnant women exposed to high ambient levels of auto emissions are three times as likely to give birth to infants with serious heart defects. Car emissions are associated with bronchitis and school absences in children, and up to 129,000 adult deaths each year are due to car exhaust pollution. When traffic was reduced in Atlanta for the 1996 Olympics, ozone concentrations decreased by almost 30 percent and the number of asthma related medical emergencies decreased by over 40 percent.

And it’s not just the car pollutants that harm us. The automobile creates a lifestyle and culture that negatively impacts health. The review by Jackson shows that driving on congested roadways leads to stress, road rage, and deaths. Road rage is a factor in half of all fatal crashes, and is more likely to occur in urban areas with low public transportation use. Urban sprawl encourages strip mall development and other constructions easily accessible by car but not conducive to walking, biking, or public transportation. As a consequence, people spend more time in their cars and physical activity declines.

A study conducted for the American Public Transport Association concluded that people living in public-transit oriented communities drive less and enjoy several health benefits not seen in car-dependent communities. These health benefits include lower risk of fatal car accidents, less pollution, and more physical activity.

In his documentary series previewed above, Dr. Richard Jackson calls for the redesign of our car-centered society as a way to combat the chronic disease epidemics of diabetes and obesity. A few years ago I heard about a place called Vauban, an experimental community on the outskirts of Freiberg, Germany, where cars are not allowed. Stores, restaurants, banks and schools are more interspersed between homes than in a normal suburb, and the narrow streets are reserved for bikes and pedestrians only. Trams to downtown Freiberg are easily within walking distance from each home, and communal cars can be available for weekend getaways or bigger trips to IKEA. While these communities promote environmentally and health-friendly lifestyles, starting a car-less neighborhood can be expensive and is not always welcomed, especially in places where people love their cars.

While experimental places like Vauban are at the extreme end of city redesign and may not be a realistic goal for America, it is clear that our current car-driven (pun intended) society is not conducive to health. Focusing on increasing access to efficient public transportation, and encouraging alternatives like walking and bicycling to reduce our dependency on cars may be an important part of the solution to battling increasing rates of chronic diseases such as asthma, diabetes, obesity, heart disease, and cancer. More research linking urban design with public health can help policy makers influence laws and create regulations which redesign public space in a way that promotes public health.



Laura E. Jackson. The relationship of urban design to human health and condition. Landscape and Urban Planning 64 (2003): 191-200.

Angela February 22, 2012 at 12:26 pm

Thank you for the nicely flowing post and for addressing this issue. I recently watched the documentary ‘Taken for a ride’, which critiques how America’s public transport was destroyed. Already at the time this took place, people raised health concerns. I hope that there is going to be a nice high speed rail network some day, so you can easily travel between cities. Lack of public transport is putting me off going anywhere beyond Ann Arbor. But maybe that’s the idea? ; ) Btw a lot of German islands don’t allow cars – I think only electric ones (and bicycles and horses…).

Marisa Mead February 22, 2012 at 6:02 pm

Thanks for reading Angela. I’ll check out “taken for a ride”, I’m very interested in how we got to the condition we’re in today. Public transportation is way better across Europe than in the states, I think the US should follow their example!

Eric Greenwood February 22, 2012 at 12:28 pm

Great title! As an urbanist and perennial bike commuter, I feel strongly about the way our cities are structured. Simple things like safe streets and easy access to parks & playgrounds have a huge impact on quality of life – that we overlook all the time.

Marisa Mead February 22, 2012 at 6:03 pm

Thanks Eric. I agree-very simple solutions have a huge impact. It’s a shame they don’t get the attention or funding they deserve.

Matt Shipman February 22, 2012 at 3:12 pm

Great example of a well-written post. Organized, coherent structure. Whenever a question cropped up in my head, you answered it. In short, the post doesn’t need anything.

That said, this would be the great lead-off post in a series. Are there any examples of “good” urban planning — such as older cities whose designs precluded auto-centric design? If so, has anyone done an assessment of health issues in those places compared to other cities with similar populations/sociocultural dynamics (e.g., diet)?

Have any efforts gotten underway to implement healthier urban designs (other than Vauban)? And, speaking of Vauban, has anyone looked at the health data there? I imagine it’s too new to provide a robust epi data set, but perhaps there’s some info that might reflect #s of public health issues related to acute exposures (e.g., asthma attacks)?

Great work. Would love to see more.

Marisa Mead February 22, 2012 at 6:10 pm

Thank you Matt, I’m glad you enjoyed it. There’s so much to write about on this topic, I think I’d enjoy writing a couple follow up posts. I couldn’t find any data on Vauban specifically, but since the popularity of neighborhoods like these is increasing, I bet there are some statistics out there.

Ginny Kendall February 22, 2012 at 4:25 pm

Amen to Matt’s comments. This article is well-written with nice flow, and would be a great start for a series.

Marisa Mead February 22, 2012 at 6:10 pm

Thanks Ginny!

Mary M February 23, 2012 at 10:36 am

That’s a nice assessment of one piece of the problem. I get so tired of everyone blaming teh GMOz! teh vaccines! when there are real lifestyle choices with measurable impact like this. But few people want to take that on.

I choose to live in a walkable community. It’s an old New England city that existed prior to autos. (In fact, Paul Revere rode down my street that night.) My doctor, my dentist, library, restaurants, all sorts of services are walkable here. Only a few things require a car, and there are ways around that if you don’t have one. I love this life. And I also didn’t notice gas prices were going up until I heard that on the news this week. There are lots of benefits.

Ashley Alexander February 26, 2012 at 6:40 pm

I also loved your title! In Health Behavior and Health Education we often talk about how urban planning influences behaviors, and with car-centered communities being the norm, the resulting behavior often negatively impacts our health. Also, very interesting point about the stress involved with commuting and how that impacts our health. Stress, itself, is a contributor to chronic disease development, and it’s scary to think that so many accident fatalities are associated with manic drivers!

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