How did we get here? A history of health and the built environment in the United States

How did we get here? A history of health and the built environment in the United States

Research on health and the built environment, often focused on obesity and physical activity, exploded after 2000.  In the past ten years, the number of published papers has dramatically increased and a consensus has emerged as to what is the ideal environment for promoting the health of everyone.  Part of this effort has resulted in new criticisms of conventional development patterns that has features which separately and in concert contribute to a variety of negative health outcomes.

Given the health problems now associated with conventional development, observers might conclude that conventional development resulted from ideas about the built environment that consciously ignored their potential health impacts or were created without any underlying thought or theory at all; conventional development is the result of mindless chaos.  But this is wrong.  The very features of conventional development now known to be negative for health are actually the result of thoughtful responses to the perceived health and environmental problems of earlier times.

Health has played a major role in shaping the built environment since the middle of the nineteenth century.  The professions of public health and urban planning both arose during this time in response to the health and environmental problems associated with industrialization, immigration, and urbanization.  Health provided the legal rational for public policy interventions that shaped urban law, zoning, and building codes.  It was an important force in conventional suburban design theory, ideas regarding urban growth and decay, and major architectural movements such as modernism and suburban neighborhood design.

This has important implications for current efforts to produce active living environments.  Battles over the legal authority to regulate housing parallel current efforts to limit access to unhealthy food in schools and neighborhoods, for example. The findings also suggest the need for continuing reassessment and evaluation.  A central problem underlying many of the policy failures of past efforts to improve the built environment to promote health is that hypotheses were untested and implemented programs were not evaluated.  Thus the health effects of the conventional suburban cul de sac neighborhood were not assessed until the end of the 1990s, nearly 45 years after the large scale post war suburban growth surge began and over 100 years after the theory of neighborhood design that produced it began to emerge.

By learning about the struggles, successes, and failures of past policies, we can make current and future efforts to use the built environment to promote health more effective.












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