Editor’s note: This is one of two stories today about city planning’s victories and mistakes, with enormous impact on the wellbeing of individuals, communities and the natural world.
It’s not hard to picture ways disease spreads in a city: those unchecked coughs on commuter rail and in crowded rooms, the germy hands on doorknobs or handrails. But cities have noncommunicable ills, too: epidemics of obesity and loneliness, depression and anxiety.
While those each have numerous causes, one that is both an overlooked contributor and possible solution is how cities are designed.
The modern urban environment is both a blessing and a curse. Studies show city dwellers have a longer life expectancy than those in rural areas. But high-density development is plagued with issues of air quality, accessibility and affordability. City structure plays a large role in promoting health, with urban sprawl increasing the likelihood of noncommunicable diseases like obesity and respiratory illness. City planners are looking for new ways to tackle these complex issues, focusing on the “human scale.”
Numerous urban design experts told the Deseret News a healthy community is one in which everyone can thrive. That hinges on factors as diverse as tree stock, street design, where grocery stores are placed and transportation systems.
They also say America’s obsession with cars as a key element of community planning could be harming America’s health on multiple fronts. Nor is it acting alone.
“Cities should be usable by everyone: bicyclists, people with luggage or carrying groceries, those with disabilities, older adults, children and any other category you can come up with,” says Jordana Maisel, assistant professor of urban and regional planning and director of research at the Center for Inclusive Design and Environmental Access at the University at Buffalo. “If you’re designing and thinking about the most vulnerable populations, it’s more likely you’ll come up with a plan that fits anyone.”
Inclusive design in cities is not just about accessibility. It's about choice — having a variety of transportation options and opportunities to engage with your neighbors, for all demographics.
In its “livable community guide,” AARP describes neighborhoods that are safe and give people choices about where to live and how to get around. Good design lets people age in their communities and “engage fully in civic, economic and social life.”
Stemming the sprawl
Scads of studies tie health to where people live, including nearby access to nature, says climate adaptation ecologist Sarah Hurteau. She was the Nature Conservancy’s director of urban conservation in New Mexico before moving temporarily to France. By phone from Europe, she says people need to be outdoors enjoying green space and exercise daily.
Hurteau thinks neighborhoods are best suited to provide that daily fix. If green space is part of urban design, people become more active outdoors, naturally reaping benefits like lower blood pressure, less obesity and reduced risk for stroke, heart disease and other chronic ills. Exercise and nature also powerfully boost mental health and relieve anxiety, depression and loneliness.
Still, that only works if where you live provides inviting, accessible destinations nearby.
Good urban planners know this. Cities are increasingly moving away from the sprawl created by freeway systems and wide roads that divide more than they unite. They are promoting more compact mixed-use zoning that includes single-family homes and apartment buildings within easy walking or biking distance of public spaces with trees and greenery, schools and businesses. The more transportation options the better.
Sadly, trees in urban areas nationwide are disappearing by the millions every year.
If you think your city is just the way it is, you’re wrong. While Maisel admits most cities have “grown the way they’ve grown,” there are ways to redesign them to make them healthier and more people-focused. “You can’t perpetuate bad practices,” she says bluntly. “Reworking things is often more complicated and more expensive. But I think there are opportunities when things are retrofitted or rehabbed or under construction to do it better the second time.”
Hurteau agrees. City planners are redoing cities to be more intertwined, with fewer commercial districts far from residential space. People can work, live and play in the same area.
Gas pedal or bike pedal?
Pockets of Salt Lake City and other cities along Utah’s Wasatch Front are nearly unrecognizable from a decade ago, apartments seemingly sprouting overnight. While some lament any loss of older homes, there’s growing recognition that communities need a mix of housing types, says Peter Calthorpe, renowned internationally for his urban design work.
Across the country, housing is becoming more densely populated, often with businesses located on the ground floor of apartment buildings and visible to passersby. This higher density requires better transportation solutions.
Urban designers are rethinking America’s fixation with automobiles. The U.S. has long cut highways through communities, creating sprawl. But it’s not just traffic causing the issues. In dense areas, parking is a huge challenge. “We use an amazing amount of space, and spend an amazing amount of money to store our cars,” says urban designer Scott Fregonese. Those resources could be directed toward more promising alternatives.
Some communities are boosting other transportation modes and encouraging people to get outside and explore, socialize and slow down. That’s Hurteau’s idea of a good place to live. “Everything accessible within a 10-minute bike ride of where you live. Maybe you drive across town to go to special events,” she adds, “but you don’t live in your car.”
She’s seeing a paradigm shift. Take a four-lane street down to two lanes with a protected bike lane. Add shade trees and people happily walk there or push a stroller. “The more appealing a street space is — the more accessible it is to someone who is not in a car — the more interaction they can have,” says Hurteau.
In France, her family has no car. They ride bicycles. While it may strike one as and can be inconvenient, there are advantages, including to health, experts say.
She believes the U.S. is in the early stages of a design movement that’s well-established in many countries and that will counter some of those bad-health epidemics. In New Mexico, Hurteau lived on a slow-speed bicycle boulevard where she could easily pedal to work. But safety in urban design has a ways to go. She remembers nearly getting hit by a car, which cooled her ardor considerably.
Still, some believe it’s impractical to try to emulate European cities. Architect Juan Miró, a professor at the University of Texas at Austin, grew up in Spain and studies the formation of cities across the Americas. “There’s a constant perception that everything that comes from Europe is better,” Miró says. But cities on this continent have different challenges and strengths than those in Europe. “You cannot put a subway system like Paris or Madrid in Salt Lake City. You cannot pretend that the city has a DNA it doesn’t have.”
Nor are designs interchangeable. “You have to be mindful of where you are,” Maisel says. Elements like elevation, climate and precipitation matter. What works in Denver might not work in the Northeast, she adds.
Miró encourages urban designers to focus on what makes American cities their best — specifically, their connection with nature. “Reconnecting with nature can be the global consensus of the 21st century. … Whether you believe that is a scientific thing or a spiritual thing, I don’t care. There’s common ground.”
How ‘walkable’ buoys health, happiness
Urban design experts like Calthorpe universally cite “walkable” as vital to community health. That means shade, but it also means “the buildings on that street need to be interesting. You know, not a series of garage doors.”
A community where people are active outside is also safer. Calthorpe says crime goes down where people naturally come and go. Once you have walkable streets, places to walk to become important, from parks and civic institutions to shopping and schools. It’s a simple framework.
He says design contributes greatly to value — including to one’s health. If where you live makes you want to huddle inside, you miss the active mobility for which human bodies were designed.
Meanwhile, people who feel depressed and live in deprived urban neighborhoods may age faster and die sooner, according to a Canadian study led by researchers at McMaster University published in the Journals of Gerontology. Researchers from the Netherlands, Norway and Switzerland found that living amid material and social inequities, combined with depression, are “independently associated with premature biological aging, even after accounting for individual-level health and behavioral risk factors, such as chronic conditions and poor health behaviors,” as the Gerontological Society of America noted in a news release about the study.
The “New Urbanism Best Practices Guide” highlights a five-minute walk concept. The idea is that neighborhoods could be organized around short walks that let people reach parks or stores or other venues within a quarter mile.
Researchers at the University of Colorado Boulder in a 2023 study in Urban Forestry & Urban Greening found “more shade and trees, higher levels of maintenance and the presence of a buffer between the street and sidewalk increase the likelihood of intuitively choosing a street for walking.” They urge city planners to consider people’s preferences regarding walking routes.
A new study in the Journal of the American Planning Association, based on a household survey of 1,064 adults in multiple Dublin neighborhoods and suburbs, found community design and maintenance impacts residents’ happiness, health and trust.
Living in a walkable neighborhood was directly linked to happiness for those ages 36 to 45 and, to a lesser extent, those 18 to 35. The link was indirect but real for older adults, too. “Our findings suggest that mixed-use neighborhood designs that enable residents to shop and socialize within walking distance to their homes have direct and indirect effects on happiness,” the researchers said, urging “ongoing dialogue and evaluation” of urban and suburban planning “so people can live in walkable places that better enable health and well-being.”
Their definition of walkability was being able to reach 16 types of destinations without vehicles, including local shops, cafes, parks, public transportation and more, akin to a small village.
Such a concept has great benefits and appeal, says Calthorpe, who believes urban design will increasingly embrace it. “God gives you a chance to say, ‘OK, if you’re going to live a more compact life, you’re not just losing things like a yard, you’re gaining things like neighborhood vitality, walkability, accessibility on the transit.’ So it’s a trade-off instead of a sacrifice,” he says.
How ‘forest bathing’ reduces lung problems
No one talks about walkability without mentioning plants, especially trees.
In 2019, the Deseret News extolled their impact on health: A tree “may one day support a canopy that lowers temperatures warmed by city-hot asphalt, scrubs air, filters water, reduces flooding and shelters readers, strolling seniors and kids playing hide-and-seek. They may even slow mental decline.”
In Japan, being in nature — even strolling a tree-lined street — is called “forest bathing.”
The Nature Conservancy says trees benefit people in multiple ways, including:
- Eating greenhouse gases that cause climate change. Managing U.S. trees, plants and soils well could store the equivalent carbon of taking 57 million cars off the road.
- Boosting mental and physical health.
- Scrubbing air.
- Sheltering wildlife, including pollinators.
- Cooling temperatures. “Neighborhoods with lots of pavement absorb more heat” and stay hotter at night, bad for health.
- Filtering water.
A 2016 study in Environmental Health Perspectives quantified the greenery in the vicinity of more than 108,000 women. After controlling for socioeconomics, age, race, body mass, physical activity, smoking, education and behavioral or health factors, researchers found the one-fifth most surrounded by nature had 12% lower mortality, 34% lower respiratory illness and 13% lower cancer death rates, compared to the one-fifth surrounded by the least greenery.
Green space also counters construction and environmental challenges. “If everything is concrete, you have increased runoff that creates greater pollution,” Maisel says. With a lot of impermeable surfaces, pollution gets pulled into streams.
Green space mitigates some of the extreme climate impacts on communities. Hurteau says more people die in the U.S. from heat-related causes than other weather conditions or natural catastrophes. City design and construction decisions make that better or worse.
Streets, parking lots and buildings collect heat. The Environmental Protection Agency says if temperatures don’t drop at night so people can recover, they may end up in the hospital. Plus heat exacerbates certain conditions like trouble breathing and high blood pressure.
Additionally, 2018 U.S. Forest Service research says America’s 5.5 billion trees contribute about $18 billion a year in pollution removal and carbon sequestration, boosting energy efficiency by shading buildings and reducing vehicle emissions. Trees reduce flooding, noise and ultraviolet radiation.
But trees are disappearing from U.S. communities at a frightening pace. Oregon’s KPTV recently reported that Portland alone has lost the equivalent of 823 acres of trees since 2015, mostly in residential areas. Jeff Ramsey, of Portland Parks and Recreation, told KPTV trees are the “best tool we have for improving air quality.”
The problem is national and ongoing. In 2018, the U.S. Department of Agriculture reported tree cover is declining at a rate of about 36 million trees a year. Per Urban Forestry & Urban Greening, cities in 40 states and Washington, D.C., by 2018 lost 175,000 acres of trees — an area of about 273 square miles. The trees fall to urban development, destructive pests, weather, neglect and age, among other causes.
As climates change and people flee too-hot, too-cold and wildfire-plagued areas, Maisel believes human-friendly city design will be crucial. “I think demographics are going to shift quite extensively in the next two decades,” she says.
Accessible vs. inclusive
Accessibility and inclusivity are different issues, both vital to urban design. Accessibility means what’s being constructed meets code requirements. Inclusive design goes beyond, creating broader outcomes like health and social participation.
Maisel’s example is a wheelchair-accessible entrance behind a theater. “It meets code, but it’s not really inclusive in a social, participatory way,” she notes. “When you’re thinking about an age-friendly community or designing for the future, really having inclusive design is important.”
While polls routinely show 9 in 10 Americans want to age in their own homes, Maisel notes most housing remains single-family homes that may not work for older adults.
With urban sprawl, unless well-developed transportation options are nearby, older adults could struggle to get around. To live independently, people must be connected to services and to transportation networks that reach places they want to go.
Design mistakes are plentiful. Maisel’s list includes new pavement with a pole in the middle so someone using a wheelchair can’t benefit. Concrete barriers to keep cars off a path can also keep wheelchairs out. Poor signage and wayfinding make the list. “Maybe there’s a new park, but I have no idea where the entrance is,” she says.
Maisel has seen ramps built so someone in a wheelchair can get into a building, but due to miscalculation, there’s a tiny step at the end. It’s not usable. Or a ramp with no landing “so you’re on an incline when you try to open the door.”
She has a slideshow of good intentions poorly executed.
The power of one
Community members play a role in healthy neighborhoods. “You can do the best sidewalks, but if it snows and no one’s shoveling, how is that helping? It’s more complicated than just designing sidewalks and crosswalks and extended countdown timers and rescue islands in the middle of the street if it’s too far to cross,” says Maisel.
City planners and urban designers realize cities must provide privacy and community in proportion. Says Miró, the architect, a “city works well when people have the dignity of a private space to live,” and spaces where they can socialize. “They can relate to culture, they can relate to sports, they can be related to whatever. Loneliness is hurtful for everything else.”
The role of urban designers, however, is to build the foundations from which societies can grow. There is a limit to what they can do. “Please don’t pretend that urban design can solve the problems of poverty, inequality, racism and economic difference,” Miró says. “There are too many forces making those things happen.”
Experts work to create the opportunity, but the community has to be engaged. Says Miró, “The community is built around the willingness of people to build that community.”
