Planning as a public health issue
The way we plan and design urban environments can have a profound effect on the long-term health of citizens. The tendency to build extensive housing estates with few community facilities and local destinations, long distances to public transport, and almost total reliance on the motorcar means not only social isolation and the alienation of young people, but also unhealthy car-dominated, physically inactive lifestyles. In a recent study of more than 200,000 people in the USA it was found that people living in the most spread out suburbs spend less time each month walking, and weigh about 2.7 kilograms on average more than people who live in the more densely populated neighbourhoods. The announcement of the findings brought immediate denials from some policy analysts that the correlation held any lessons for the planning of urban development. Yet cardiologists have observed that the everyday regular exercise of walking has a lot to do with fitness. Door-to-door car travel is not the boon it was once thought to be. Exercise has become commodified, so that people who do not get enough of it in their daily lives pay large amounts to go to the gym. Those who can't pay don't get it.
This is not an argument for compact cities, though it may be one in favour of better public transport, because public transport almost always entails a walking component. In this respect too, public health and safety are connected. Much attention is paid to the insidious danger of air pollution from vehicle fumes, but the much more patent danger of death and physical injury from vehicles is not, by and large, seen as a public health issue. Why are vehicle fatalities normally measured in deaths per kilometre travelled rather in than deaths per thousand people? The answer is not necessarily the obvious one. If a car-dependent society is viewed as a public health problem then the measure of mortality should be comparable with other public health statistics. Instead car 'accidents' are viewed as self-inflicted. So, once, was smoking. Provision for safe, pleasant walking and cycling is almost everywhere under-funded compared with roads. The line between private and public responsibility is a fuzzy one.
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