PLEASE SCROLL DOWN FOR ARTICLE

This article was downloaded by:

On: 28 September 2008
Access details: Access Details: Free Access
Publisher Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK
Journal of the American Planning Association
Publication details, including instructions for authors and subscription information:
http://www.informaworld.com/smpp/title~content=t782043358
Longer View: From Congestion to Sprawl: Planning and Health in Historical
Context
David Charles Sloane
Online Publication Date: 31 March 2006
To cite this Article Sloane, David Charles(2006)'Longer View: From Congestion to Sprawl: Planning and Health in Historical
Context',Journal of the American Planning Association,72:1,10 18
To link to this Article: DOI: 10.1080/01944360608976720
URL: http://dx.doi.org/10.1080/01944360608976720
Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf
This article may be used for research, teaching and private study purposes. Any substantial or
systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
:c
From Congestion to
Sprawl
Planning and Health in Historical Context
David Charles Sloane
A
new generation of professional planners and activists aims to design
healthy cities, sustain healthy environments, and encourage healthy
communities. Why is it so noteworthy for planning and public health
to have found each other yet again, especially since, as Baltimores health ofcer
Huntington Williams (:,) reminded his wartime audience, planning and
public health have been partners since the days of the early cities of the Chaldean
civilization? (p. ::,). The nature of the relationship, I argue, is obscured until
collaboration develops based on a perception of common issues and approaches.
It rst happened when congestion provided a cause around which a group of late
:,th and early :cth century activists collaborated to reform the environment of
the American city. Recently, sprawl has offered a new overarching concept that
connects efforts against obesity to reforming land use regulation, and concerns
about adolescent suicides to innovative community design. The earlier villain was
density, now it is decentralization; previous reforms aimed at cities, now they
aim at suburbs. Against a common enemy, planning and public health each
recognize the need for the other. In the intervening years, though individual
planners and public health professionals worked together on a wide range of
issues, the professions seemed to circle different suns.
The normative visions of both planners and public health professionals are
sometimes inuenced by environmental determinism. Prescription is an impor-
tant parallel between the professions. In the late :,th century, public health
professionals and urban planners laid out a powerful vision of a decentralized
American metropolis with neighborhoods that embodied their own values. A
century later, the same professions rejected the implicit paternalism and racism
of the earlier period, yet they, too, envisioned an ideal environment, capable of
inuencing people to eat better and exercise more.
Congestion as a Unifying Issue, 18801910
A wide range of reformers agreed the industrial city was troubled (Schultz,
:,,; Spain, :cc:). They viewed the city as a place where strikers, beggars, and
criminals disturbed the public order, and outdoor privies, polluted waterways,
and mountains of garbage affected the peoples health (Melosi, :ccc; Painter,
Why havent planners and public health
professionals worked together consistently
throughout the last century? This article
puts their relationship in historical per-
spective, arguing that while the elds have
always been connected, the bond has been
stronger when upheld by converging the-
ories and commonly perceived problems.
Under such a conceptual umbrella, the
two elds can collaborate. In this article,
I address whether the concept of sprawl
is rich enough to foster sustainable, long-
term connections between the elds.
David Charles Sloane is a professor in
the School of Policy, Planning, and De-
velopment at the University of Southern
California, where he holds a joint appoint-
ment in the Department of History. His
studies reach into topics including medi-
cal history, health disparities, planning
history, social policy, cultural landscapes,
and community planning.
Journal of the American Planning Association,
Vol. ;:, No. :, Winter :cco.
American Planning Association, Chicago, IL.
Longer View

D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
Sloane: From Congestion to Sprawl ::
:,;). Migrants and immigrants were crammed into newly
built tenements without sufcient light, ventilation, or
plumbing (Smith, :,::). The streets were disorderly and
dangerous:
With the exception of a very few thoroughfares, all the
streets are one mass of reeking, disgusting lth, which
in some places is piled to such a height as to render
them almost impassable by vehicle. . . . The dirt, like
an epidemic, prevails all over. . . . (Mitchell, quoted in
Larsen, :,o,, p. :,,)
The development of steel-structured construction and
elevators enabled the rise of skyscrapers, further blocking the
sun and adding to the density of the built environment in
the uncoordinated cityscape. Despite the efforts of city gov-
ernments to cope with the rapid changes, streets, sidewalks,
and homes were increasingly congested and disorderly.
John Stockton-Hough (:;,) inquired . . . whether
the noticeable decline in health, fecundity, and longevity of
the human race, and of the American people in particular,
were not due to the too great crowding into cities? (p. ::o).
Grace Peckham (:o) noted that high infant mortality of
the tenement districts resulted in part from congestion:
The child comes to . . . an already large family occupying
. . . rooms, crowding them at night, so that in winter the
air is like that of the black hole of Calcutta (p. :). High
infant mortality coupled with epidemics of yellow fever
and the chronic problem of tuberculosis put children
particularly at risk (Lee, :;o; Meckel, :,,c; Platt, :).
Another researcher (Donaldson, :;,) summed up the
inuence of city life and occupations in developing pul-
monary consumption by listing reasons that city life was
dangerous: impure air, decient sunlight, a sedentary
life, ill ventilated hospitals, imperfect alimentation due
to improper diets, and city life (pp. :c::c,), a category
in which he summed up the superstitions and practices that
reinforced unhealthy environments. Unattractive conditions
outside encouraged an indoor, sedentary life for people in
housing that aggravated their ill health. Thus the reformers
perceived a vicious cycle intimately tied to life in the city.
As the scientists language and their denition of the
citys problems suggest, the reform movement was imbued
with their own values, which reformers assumed appropri-
ate for all city residents. Whether proposing bath houses
or campaigning to clean up city governments, reformers
feared for the moral consequences of congestion. When
Mrs. T. J. Bowlker, president of the Womens Municipal
League of Boston, proclaimed that women must now learn
to make of their cities great community homes for all the
people (Bowlker, quoted in Spain, :cc:, p. ;,), she was
encouraging homes that looked like those of her friends and
neighbors, not the multigenerational, multi-unit, mixed-
use housing of the typical working class neighborhood.
The Progressive Era alliance of settlement house work-
ers, tenement reformers, playground and kindergarten
organizers, public health and public bath advocates, and
promoters of municipal art campaigns exemplied a
happy marriage of . . . public spirited citizens providing a
model of complementary comportment under the banner
of sanitary science (Rosenkrantz, :,;, p. ,;; Schultz,
:,,; Melosi, :ccc). The national coalition spanned pro-
fessions, and to some extent crossed the lines of race and
class (Smith, :,,,). Women especially were leaders of the
movement, moving from keeping the family home to
municipal housekeeping to save the city (Spain, :cc:).
A diverse group made common cause against urban
congestion, all believing that they were ghting the same
problem by xing the sewers and building new water
systems, clearing the roads of unnecessary trafc, ensuring
the safety of childrens milk, relegating certain activities to
alleys or service corridors, teaching immigrants new social
and business skills, constructing housing with more natural
light and space, and setting aside land for parks and play-
grounds (Cavallo, :,:; Davis, :,o;; Howe, :,::; Meckel,
:,,c; Walzer Leavitt, :,:). As settlement house leader
Florence Kelley said, Instead of assenting to the belief that
people who are poor must be crowded, why did we not see
years ago that people who are crowded must remain poor?
(quoted in Davis, :,,, p. :; Davis, :,o;). Reformers be-
lieved that ending congestion would improve the city in a
myriad of ways (Boyer, :,;; Riis, :,c; Wright, :,:).
This coalition reshaped the American industrial city
using local governments new police powers to separate
land uses, improve tenement design, establish playgrounds
and parks, and dramatically improve private and public
sanitation. As Peterson (:,;,) once concluded, Together
they [the coalition] yielded a virtual city planning agenda
for nineteenth-century American cities (p. ,). That
agenda presumed a better environment led to improved
behavior, tying the search for a healthier urban society to
better-planned communities.
Fracturing the Coalition, Establishing
the Professions
In the rst decades of the :cth century, planners
embraced the tenets of the city beautiful and the city ef-
cient (Bledstein, :,;o; Corburn, :cc; Kirschner, :,o;
Rosenkrantz, :,;:). However, the City Beautiful planning
activity seemed curiously to ignore the lessons taught by
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
earlier generations of city planning advocates . . . [its]
promoters [tending] to value aesthetics over substance
(Schultz, :,,, p. ::: ). Daniel Burnham, the mastermind
behind the Plan of Chicago, and Frederick Law Olmsted,
Jr., rst president of the American City Planning Institute,
came to personify the aesthetic and economic emphases
within planning, while the pioneering work of reformers
such as Florence Kelley, Mary Simkhovitch, and Lillian
Wald was marginalized (Peterson, :cc,; Spain, :cc:;
Wirka, :,,o). As planning historian Peter Hall has re-
marked, in Burnhams Plan for Chicago, beauty clearly
stood supreme, with health almost nowhere (Hall,
:,, p. :,).
With the start of the new century, a generation of
public health professionals rejected the sanitary movement
as a viable model for improving public health in favor of
germ theory, which focuses on the individual (Corburn,
:cc). Public health leaders such as Charles Chapin (:,c:)
noted: The daily press and even the medical press speaks
as if street cleaning, scavenging, modern plumbing and
tenement house reform were the mainstay in ghting
infection and reducing the death rate (p. :,;). Chapin
disagreed, believing it more appropriate that public health
focus on persons and their behavior. This narrower focus
prevented continuing cross-eld collaboration.
Health in the Background of Planning
As a result, as Peterson (:cc,) pointed out, public
health would not play a lead role in the birth of American
city planning (p. ,,). However, while the two professions
drew away from each other, health remained a concern of
the planning profession, and the two elds did not sever all
connections, especially outside America (e.g., Fleming,
:,:o). In the U.S., one planner noted that health is and
must be the background of planning (Rosenauer, :,,
p. :,c). Without a unifying concept, professionals in the
two elds worked together episodically around specic
issues related to a variety of subelds (Britten, :,,; Frank,
:,; Hyde, :,; Pond, :,,;; Smith, :,,).
Canadian Matthew Lawson (:,o), symbol of the con-
tinuing interest in health in planning outside the United
States, reminded his audience at the national planning con-
ference that while physical standards were often established
using functional, nancial, real estate, and aesthetic ar-
guments, such standards were rst established to create a
city which was a good place for people to live in (p. :;).
He, along with an earlier generation of city planners,
believed that all sorts of social evilscrime, bad health,
the breakdown of the family, and so forthwere due in
large measure to bad living conditions (p. :;), conclud-
ing that these problems would disappear only when these
living conditions were improved to an adequate standard
(p. :;). Though planners focused on economic, func-
tional, and aesthetic justications for physical standards,
these were no more important than the social aim of a
ne place to live (Lawson, :,o, p. :;,; also see Fleming,
:,:o).
Perhaps the most remarkable contribution that public
health professionals made to planning practice during this
period related to housing, blighted neighborhoods, and
urban renewal. The American Public Health Associations
Committee on Hygiene of Housing, chaired by the dis-
tinguished Yale University professor of public health
Charles-Edward Amory Winslow, produced its rst Basic
Principles of Healthful Housing in :,, (American Public
Health Association, :,:). Four sets of principles concerned
how physiological needs, psychological needs, protection
against contagion, and protection against accidents should
be incorporated into housing construction, linking the
interests and skills of technicians in public health and
housing (p. :o). Like the earlier sanitary movement, the
principles were accompanied by minimum standards to
ensure natural light and reduce noise, as well as newer ideas
such as designing to provide privacy and opportunities for
a family life as part of a larger effort by health and plan-
ning organizations as well as the federal government to
design safe, healthy homes for the coming generation
(Hise, :,,;).
Such standards gured prominently in urban planners
efforts to revitalize downtowns in the mid :cth century.
For instance, the Community Redevelopment Agency
(CRA) of Los Angeles justied its :,,: decision to declare
,, acres southeast of downtown a blighted area (Commu-
nity Redevelopment Agency of Los Angeles, :,,:) with a
survey of the areas population, ascertaining the prevalence
of crime and delinquency, and family income, and health
status, specically the rate of active tuberculosis. The CRA
used the Committee on Hygiene of Housing of the Ameri-
can Public Health Associations appraisal method to assess
the housing stock, and nding ,:% of the housing to lack
toilets, baths, water supply sources, or sufcient sleeping
areas per person, declared it blighted (e.g., American
Public Health Association, :,,c).
This was another example of reformers middle-class
values inuencing public health and planning. The com-
munities designated as blighted areas were often poor,
working-class neighborhoods with rich social lives and
community identities (Gans, :,o:). Communities of color
were designated blighted and became sites for urban re-
newal, also called Negro removal (Fogelson, :cc:).
:: Journal of the American Planning Association, Winter :cco, Vol. ;:, No. :
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
Sloane: From Congestion to Sprawl :,
Healthy communities were, by denition, places that
embodied the values of the nations White middle class.
According to a survey conducted by Cecil Sheps
(:,,:), in the middle of the :cth century planning and
public health agencies communicated only on a narrow
range of concerns. Most planning agencies were simply not
interested in many health-related issues, including hospital
sites, emergency planning, and environmental pollution.
A survey :o years later (American Society of Planning
Ofcials, :,o) found that most planning agencies (,%)
spent less than :% of their time planning for health serv-
ices and facilities. Health was still in the background.
Rebirth of a Relationship
As early as the :,ocs, a growing chorus of critics began
to question suburbanization and investigate more critically
its effects on society (Gottman & Harper, :,o;; Helphand,
:,; Jacobs, :,o:). Their environmental, psychological,
and political concerns would eventually motivate interna-
tional organizations to support a new approach to health
and planning.
Environmentalism re-energized natural resource plan-
ning, and eventually led the environmental justice move-
ment to call attention to potentially hazardous land uses.
Criticism of suburban developments consumption of
natural resources, devoting water to suburban lawns, and
the environmental consequences of automobile use gradu-
ally led to a growing chorus of calls for changes in Ameri-
can development practices (Bormann, :cc:; Rome, :cc:).
In :,o, at a panel on planning for sanity held at the
national planning conference, Herbert Gans rejected the
argument that the physical environment played a major
role in mental health, but argued that planners could none-
theless play a role in the removal of stress (Gans, :,o).
He admonished planners to reject the bulldozer approach
to planning, advising them instead to combat poverty and
racial discrimination, and ensure that the physical envi-
ronment will give people as much satisfaction as possible,
and help them live the way they want to live (p. ::).
Others would maintain that the suburbs were a teenage
wasteland of alienation, suicide, and dysfunctional family
life (Gaines, :,,; Oliver, :cc,).
Planners and other social scientists responded by
reinvigorating an older literature on the relationship of
environment to behavior that remains part of the founda-
tion for studies of sprawl. Spurred by such books as Amos
Rapaports House, Form and Culture (:,o,), the literature
looked at the cultural context of behavior (Wapner, Dem-
ick, Yamamoto, & Minami, :,,,). When evidence sug-
gested that suburban development might be tied to a
sedentary lifestyle, these studies provided a methodology
to test such a relationship.
A brief but memorable effort attempted to bring
planning and public health professionals together to man-
age the provision of health services in the United States.
After the Hill-Burton Act of :,o, which provided funding
to support the construction and expansion of hospitals,
and passage of Medicare and Medicaid in the mid :,ocs,
Congress attempted to rationalize health care through the
Comprehensive Health Planning Act of :,oo (Gottlieb,
:,;; Greeneld, :,oo; Lave & Lave, :,;). The act re-
sponded to rising waiting times, lack of personal attention,
and a shortage of nurses.
A :,o report produced for the federal government by
the American Society of Planning Ofcials (ASPO) asserted
that these problems would not be necessarily solved by
placing more doctors, more hospitals, or more money into
the present system (ASPO, :,o, p. ,). Thus the report
proposed managing the development of new services and
limiting redundancy and cost within the system. Not
surprisingly, ASPO (:,o) maintained that urban planners
can and should play supporting roles in community health
planning (p. o). The report approached the topic cau-
tiously, recognizing that most planning agencies had
played at most, a marginal role (p. :) in such activities up
to that time. The new legislation offered an opportunity to
move from the fragmented, voluntary approach to health
issues in the past to comprehensive community health
planning, something that planners were eminently suited
to support. Ultimately, though, opponents of greater
public control of the largely private health care system
ended the experiment in the early :,cs, demonstrating
again, as the ASPO suggested, that one explanation for the
minimal attention planners gave to health was the historic
resistance of the health eld to . . . comprehensive plan-
ning approaches (p. :).
Starting the mid :,cs, the World Health Organization
drew on the more active relationship between planning
and public health outside the United States to develop the
healthy cities movement (Ashton, :,,:; Duhl & San-
chez, :,,,). This alliance focused on individual cities
prompted by old health concerns such as inuenza and
new ones such as AIDS, examining health in a broad en-
vironmental context, followed by targeted interventions to
improve the health of city residents, particularly the poor
and underserved. The healthy cities movement spread
rapidly into the United States. The California Healthy
Cities and Communities Project was founded in :,;
(Twiss, Duma, Look, Shaffer, & Watkins, :ccc), and
included a varied group of health professionals, civic lead-
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
ers, and other professionals, facilitating their cooperation
on health issues.
As late as :,,, however, a survey of the planning and
public health literature found the two elds still in differ-
ent orbits (Greenberg, Popper, West, & Krueckeberg, :,,).
This review observed that the Journal of the American
Planning Association considered issues of resource, land use,
and economic development, while the American Journal of
Public Health concentrated on the health of the people.
Although the components of a consolidated movement
existed, they remained separate.
The Sprawl Synthesis
In the :,,cs, sprawl became a rallying cry that created
a new coalition across professional boundaries. Sprawl and
the geography of nowhere (Kunstler, :,,,) galvanized op-
position among activists and professionals in architecture
(Duany, Plater-Zyberk, & Speck, :ccc), urban planning
(Frumkin, Frank, & Jackson, :cc; Ewing, :,,;), historic
preservation (Moe & Wilkie, :,,;), public policy (Wolch,
Pastor, & Drier, :cc), and public health (Lopez, :cc).
Some critics of sprawl identied themselves with earlier
parallel movements, such as Main Street America (National
Trust for Historic Preservation, :,;;), New Urbanism
(Calthorpe, :,,,), and Smart Growth (Bollier, :,,; Wolch
et al., :cc). A wide range of environmental, historic pres-
ervationist, architecture, and planning groups organized
opposition to sprawl (Sierra Club, :,,,; Sprawl City,
:ccc; Sprawl Watch, :,,).
:
Early opponents focused on two consequences of
sprawl: its impact on the natural environment, primarily
through the loss of farmland; and the growth of trafc
congestion (Galster et al., :cc:). Indeed, transportation
researchers played an important role in dening sprawl as
a planning issue, contrasting American reliance on auto-
mobiles to the mix of transportation modes elsewhere.
Eventually, researchers used the level of active travel,
including public transportation as well as walking or
biking, to help dene sprawling areas (Boarnet & Crane,
:cc:; Ewing, :cc,).
In the rst years of the ::st century, health stepped out
from the background in urban planning. A newly recognized
epidemic of obesity was linked to the built environment,
creating new visibility and credibility for scholars and
practitioners arguing for the need for the two professions
to work together (U.S. Department of Health and Human
Services, :cc:). The signal event occurred in :cc,, when
the two leading public health journals, the American Jour-
nal of Public Health (AJPH) and the American Journal of
Health Promotion (AJHP), published issues on the relation-
ship between health and the built environment.
These issues cemented the connection between urban
planning and public health through the effect of the built
environment on physical activity and body weight. While
Frumkin (:cc:) identied eight areas of common concern
(air pollution, heat, physical activity patterns, motor vehi-
cle crashes, pedestrian injuries and fatalities, water quality
and quantity, mental health, and social capital), the plan-
ning/public health literature has focused overwhelmingly
on sprawls relationship to sedentary lifestyles (Langdon,
:,,; Must et al., :,,,; Poston & Foreyt, :,,,; U.S. De-
partment of Health and Human Services, :,,o). The
obesity epidemic continues to receive widespread media
attention, and foundations and the federal government
nance research on the relationship of the built environ-
ment to physical activity and health (Lopez, :cc; U.S.
Department of Health and Human Services, :cc:).
The link between physical activity and urban form
illuminates the potential benets and challenges of collab-
oration between public health and urban planning profes-
sionals under the conceptual umbrella of sprawl (Handy,
Boarnet, Ewing, & Killingsworth, :cc:). Planners interest
in Americans physical activity has a long history, going
back at least to the playground movement of the social
progressives and the recreation planners of the mid :cth
century (Boyer, :,;; Hyde, :,). The new effort is more
ambitious, aiming to explain sedentary lifestyles in order to
understand and avert their adverse effects on health. This
has led to a signicant critique of the postwar American
development paradigm (Boarnet & Crane, :cc:; Frank &
Engelke, :cc:; Humpel, Owen, & Leslie, :cc:; King et al.,
:,,,; Lee & Vernez Moudon, :cc). The anti-sprawl pro-
ponents argue that this paradigm, constructed around use
of the automobile, has produced settlements that discour-
age physical activity and diminish social capital, resulting
in adverse health consequences (Putnam, :ccc; Srinivasan,
OFallon, & Dearry, :,,,). Thus the two main targets of
the coalition are the automobile and obesity, though other
issues, such as insecure food systems and mental health,
have also made lesser contributions to collaboration be-
tween the elds. Proponents of this perspective suggest
increasing settlement densities, in direct opposition to their
predecessors concern over congestion.
Will the Umbrella Hold?
The anti-sprawl literature has its critics. Gordon and
Richardson (:ccc) question simplistic economic analyses,
while others argue that sprawl may be good for a wide
: Journal of the American Planning Association, Winter :cco, Vol. ;:, No. :
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
Sloane: From Congestion to Sprawl :,
range of Americans, including minorities (Kahn, :cc:;
Lemmon, :ccc). Some question whether the evidence
proves the relationship between urban form and health
(Transportation Research Board & Institute of Medicine,
:cc,).
A different group of scholarsinterested in the social
environment of healthclaim that lower-income commu-
nities bear an urban penalty (Freudendberg, Sandro, &
Vlahov, :cc,), manifest in poorer food security (Sloane et
al., :cc,), access to care (McCord & Freeman, :,,c), and
health status (Geronimus et al., :,,o; Vlahov & Galea,
:cc:). They concern themselves with the tendency to
overlook the racial and social disparities that inuence
health (Day, :cco).
Identifying a common concern appears to enhance
collaboration across professional boundaries. Umbrella
concepts have allowed urban planners and public health
professionals, as well as architects, engineers, geographers,
political scientists, and others, to span boundaries. But will
sprawl retain its ability to unify critics of current practice
and their visions of better alternatives in the future?
The answer depends on whether the sprawl literature
matures into more sophisticated, scientically rigorous
study. First, sprawl is not just about suburbs. Political,
social, and economic decentralization have seriously af-
fected vulnerable inner-city minority populations even as
they created opportunities (Gordon & Richardson, :ccc).
Highly segregated communities with poor nutritional and
recreational environments aggravate high rates of obesity
(Lewis et al., :cc). The literature should address the
diverse health challenges communities face (Day, :cco).
Second, obesity is not the only adverse outcome of
sprawl, and physical activity is not the only contributor to
overweight. The air that inner-city children breathe as they
play is also unhealthy. Rates of asthma have increased.
Although causes are not fully understood, recent studies
suggest that transportation corridors contribute to higher
rates of respiratory diseases (Gauderman et al., :cc;
Spielman et al., :cco).
Further, as noted above, higher concentrations of fast
food restaurants in minority neighborhoods with high rates
of obesity suggest it may be valuable to increase food se-
curity as well as physical activity (Pothukuchi & Kaufman,
:ccc). Encouraging franchise ownership among minority
businesspeople may foster undesirable eating habits in the
communities those businesses serve.
Inevitably, public interest and funding will eventually
shift away from sprawl and obesity. Sustaining the relation-
ships sprawl has created between planning and public
health professionals may depend upon an institutional net-
work that reects a broader vision. The American Planning
Association and the Association of Collegiate Schools of
Planning could make the interdisciplinary focus on plan-
ning and health a permanent feature of future conferences
and activities to encourage this.
Planners also need to assert themselves and lead on
these issues rather than only reacting. The shift to an in-
dividual focus played an important role in fracturing the
older alliance between planning and public health. Health
professionals once again lead the campaign against obesity
and sprawl, even though planners were pioneers in den-
ing sprawl and understanding its consequences for society
(Jackson, :cc,). Planners can and should continue to
provide their unique perspective on these health issues.
It may be, however, that the umbrella is impossible to
sustain. At some moments in time professionals and advo-
cates make common cause around an issue that reects their
generations perspectives. Transferring that issuehanding
on the umbrellamay be difcult. A new generation of
environmentalists debates whether environmentalism is
dead (Shellenberger & Norhaus, :cc). Those who feared
the effects of decentralization replaced the critics of con-
gestion. The opponents of sprawl may soon nd their
concerns pass.
Regardless, planners should resist environmental
determinism and remain open to the inuence of social,
political, cultural, and economic inuences, as well as those
of the built environment, on human behavior. Research has
demonstrated the importance of socioeconomic status and
race on health outcomes (Kawachi, Daniels, & Robinson,
:cc,). Planners can play a crucial role in the international
policy debate, and can speak from experience of the dan-
gers of stereotyping classes of people. They should lead the
effort to redress economic and social inequities, promote
environmental sustainability, and develop communities
that are economically prosperous as well as healthy places
for a diverse population to live.
Acknowledgements
I would like to thank Marlon Boarnet, Beverlie Conant Sloane, Dowell
Myers, and anonymous reviewers for reading versions of this article.
Notes
. For instance, the bibliographies on sprawl by Howard Frumkin
(:cc:) and Ashwani Vasishth (:cc) include :;, citations and ::
citations respectively.
References
American Public Health Association, Committee on Hygiene of
Housing. (:,:). Basic principles of healthful housing (:nd ed.). In
American Public Health Association, Committee on Hygiene of
Housing, Housing for health: Papers presented under the auspices of the
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
Committee on Hygiene of Housing of the American Public Health Associa-
tion (pp. :::o). Lancaster, PA: Science Press Printing Company.
American Public Health Association, Committee on Hygiene of
Housing. (:,,c). An appraisal method for measuring the quality of
housing: A yardstick for health ofcers, housing ofcials and planners (Vols.
:,). New York: Author.
American Society of Planning Ofcials. (:,o). The urban planning in
health planning. Washington, DC: U.S. Department of Health, Educa-
tion, and Welfare, Public Health Service, and Health Services and
Mental Health Administration, Community Health Service.
Ashton, J. (:,,:). Healthy cities. Philadelphia: Open University Press.
Bledstein, B. (:,;o). The culture of professionalism: The middle class and
the development of higher education in America. New York: Norton.
Boarnet, M. G., & Crane, R. (:cc:). Travel by design: The inuence of
urban form on travel. New York: Oxford University Press.
Bollier, D. (:,,). How smart growth can stop sprawl. Washington, DC:
Essential Books.
Bormann, F. H. (:cc:). Redesigning the American lawn: A search for
environmental harmony. New Haven, CT: Yale University Press.
Bowlker, T. J. (:,::). Womans homemaking function applied to the
municipality. The American City, o, o,o,.
Boyer, P. (:,;). Urban masses and moral order, 18:v1,:v. Cambridge,
MA: Harvard University Press.
Britten, R. H. (:,,). Housing and health. American Journal of Public
Health, :8, ,,;,oc.
Calthorpe, P. (:,,,). The next American metropolis: Ecology, community,
and the American dream. New York: Princeton Architectural Press.
Cavallo, D. (:,:). Muscles and morals: Organized playgrounds and urban
reform, 188v1,:v. Philadelphia: University of Pennsylvania Press.
Chapin, C. V. (:,c:). Dirt, disease, and the health ofcer. Public health
reports and papers presented at the thirtieth meeting of the American Public
Health Association, volume XXVIII, New Orleans, December ,1:, 1,v:
(pp. :,o:,,). Columbus, OH: Berlin Printing Company.
Community Redevelopment Agency of the City of Los Angeles. (:,,:).
Olympic industrial area blight. Los Angeles: City of Los Angeles.
Corburn, J. (:cc). Confronting the challenges in reconnecting urban
planning and public health. American Journal of Public Health, ,(),
,:,o.
Davis, A. (:,o;). Spearheads for reform: The social settlements and the
progressive movement, 18,v1,1. New York: Oxford University Press.
Davis, A. (:,,). Playgrounds, housing and city planning. In D. A.
Krueckeberg (Ed.), Introduction to planning history in the United States
(pp. ;,;). New Brunswick, NJ: Rutgers University Press.
Duany, A., Plater-Zyberk, E., & Speck, J. (:ccc). Suburban nation: The rise
of sprawl and the decline the American dream. New York: North Point Press.
Duhl, L. J., & Sanchez, A. K. (:,,,). Healthy cities and the city planning
process: A background document on the links between health and urban
planning. Copenhagen: World Health Organization Regional Ofce for
Europe.
Ewing, R. (:,,;). Is Los Angeles-style sprawl desirable? Journal of the
American Planning Association, o, (:), :c;::o.
Ewing, R. (:cc,). Can the physical environment determine physical
activity levels? Exercise and Sports Science Reviews, ,, (:), o,;,.
Fleming, A. G. (:,:o). Planning for health [Pamphlet No. in the
McGill University Publications Series XIII (Art and Architecture)].
Montreal: McGill University.
Fogelson, R. (:cc:). Downtown: Its rise and fall, 188v1,,v. New Haven,
CT: Yale University Press.
Frank, L. (:,,). Urban planning with particular emphasis on child
care. In B. J. Hovde, T. H. MacDonald, G. S. McLaughlin, & H.
Williams (Eds.), Report of the Urban Planning Conferences at Evergreen
House, 1,,, under the auspices of the Johns Hopkins University (pp. :::
::,). Baltimore: Johns Hopkins University Press.
Frank, L. D., & Engelke, P. O. (:cc:). The built environment and
human activity patterns: Exploring the urban form of public health.
Journal of Planning Literature, 1o(:), :c:::.
Freudendberg, N., Sandro, G., & Vlahov, D. (:cc,). Beyond urban
penalty and urban sprawl: Back to living conditions as the focus of
urban health. Journal of Community Health, ,v(:), :::.
Frumkin, H. (:cc:). Urban sprawl and public health. Public Health
Reports, 11;, :c:::;.
Frumkin, H., Frank, L., & Jackson, R. (:cc). Urban sprawl and public
health: Designing, planning, and building for healthy communities.
Washington, DC: Island Press.
Gaines, D. (:,,). Teenage wasteland: Suburbias dead end kids. Chicago:
University of Chicago Press.
Galster, G., Hanson, R., Radcliffe, M. R., Wolman, H., Coleman, S.,
& Freihage, J. (:cc:). Wrestling sprawl to the ground: Dening and
measuring an elusive concept. Housing Policy Debate, 1:(), o:;:;.
Gans, H. (:,o:). The urban villagers: Group and class in the life of
Italian-Americans. New York: Free Press of Glencoe.
Gans, H. (:,o). Planningand city planningfor mental health. In
American Society of Planning Ofcials, Planning 1,o: Selected papers
from the ASPO National Planning Conference, Boston, Massachusetts,
April ,,, 1,o (pp. :o:). Chicago: Author.
Gauderman, W. J., Avol, E., Gilliland, F., Vora, H., Thomas, D.,
Berhane, K., et al. (:cc). The effect of air pollution on lung develop-
ment from :c: years of age. New England Journal of Medicine, ,,1 (::),
:c,;:co;.
Geronimus, A. T., Bound, J., Waidmann T. A., Hillemeier, M. M., &
Burns, P. B. (:,,o). Excess mortality among blacks and whites in the
United States. New England Journal of Medicine, ,,, (::), :,,::,,.
Gordon, P., & Richardson, H. (:ccc). Defending suburban sprawl.
The Public Interest, 1,,, o,;:.
Gottlieb, S. R. (:,;). A brief history of health planning in the United
States. In C. Havighurst (Ed.), Regulating health facilities construction
(pp. :c:). Washington, DC: American Enterprise Institute for Public
Policy Research.
Gottman, J., & Harper, R. A. (Eds.). (:,o;). Metropolis on the move:
Geographers look at urban sprawl. New York: John Wiley.
Greenberg, M., Popper, F., West, B., & Krueckeberg, D. (:,,).
Linking city planning and public health in the United States. Journal of
Planning Literature, 8(,), :,,:,,.
Greeneld, M. (:,oo). Health insurance for the aged: The 1,o, program
for Medicare, its history and a summary of other provisions of PL 8,,;.
Berkeley: Institute of Governmental Studies, University of California.
Hall, P. (:,). Cities of tomorrow: An intellectual history of urban
planning and design in the twentieth century. New York: Blackwell.
Handy, S., Boarnet, M., Ewing R., & Killingsworth, R. (:cc:). How
the built environment affects physical activity: Views from urban
planning. America Journal of Preventive Medicine, :, (Suppl. :), o;,.
Helphand, K. I. (:,). McUrbia: The 1,,vs and the birth of the contem-
porary American landscape. Places, ,, c,.
Hise, G. (:,,;). Magnetic Los Angeles: Planning the twentieth century
metropolis. Baltimore: Johns Hopkins University Press.
Howe, F. C. (:,::). The city as a socializing agency: The physical basis
of the city: The city plan. American Journal of Sociology, 1;, ,,coc:.
Humpel, N., Owen, N., & Leslie, E. (:cc:). Environmental factors
associated with adults participation in physical activity. American
Journal of Preventive Medicine, ::(,), ::,,.
:o Journal of the American Planning Association, Winter :cco, Vol. ;:, No. :
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
Sloane: From Congestion to Sprawl :;
Hyde, J. W. (:,). Recreational planning. In B. J. Hovde, T. H.
MacDonald, G. S. McLaughlin, & H. Williams (Eds.), Report of the
Urban Planning Conferences at Evergreen House, 1,,, under the auspices
of the Johns Hopkins University (pp. ::;:,c). Baltimore: Johns Hopkins
University Press.
Jackson, J. R. (:cc,). The impact of the built environment on health:
An emerging eld. American Journal of Public Health, ,,, :,::,.
Jacobs, J. (:,o:). The death and life of great American cities. New York:
Vintage Books.
Kahn, M. (:cc:). Does sprawl reduce the black/white housing con-
sumption gap? Housing Policy Debate, 1:(:), ;;o.
Kawachi, I., Daniels, N., & Robinson, D. E. (:cc,). Health disparities
by race and class: Why both matter. Health Affairs, :(:), ,,,,:.
King, A. C., Jeffrey, R. W., Fridinger, F., Duesenbury, L., Provence, S.,
Hedlund, S. A., et al. (:,,,). Environmental and policy approaches to
cardiovascular disease prevention through physical activity: Issues and
opportunities. Health Education Quarterly, ::(), ,,,::.
Kirschner, D. (:,o). The paradox of professionalism: Reform and public
service in urban America, 1,vv1,v. New York: Greenwood.
Kunstler, J. H. (:,,,). The geography of nowhere: The rise and decline of
Americas man-made landscape. New York: Simon & Schuster.
Langdon, P. (:,,). A better place to live: Reshaping the American suburb.
Amherst: University of Massachusetts Press.
Larsen, L. H. (:,o,). Nineteenth-century street sanitation: A study of
lth and frustration. Wisconsin Magazine of History, ,:, :,,:;.
Lave, J. R., & Lave, L. B. (:,;). The hospital construction act: An
evaluation of the Hill-Burton program, 1,81,;,. Washington, DC:
American Enterprise Institute for Public Policy Research.
Lawson, M. B. M. (:,o). Social implications of physical standards. In
American Society of Planning Ofcials, Planning 1,o8: Selected papers
from the ASPO National Planning Conference, San Francisco, May ,
(pp. :;:;). Chicago: Author.
Lee, B. (:;o). The cost of a great epidemic to a great city, or penny-
wisdom and pound-folly. Public health reports and papers presented at the
meetings of the American Public Health Association, volume II in the years
18;, (pp. :c,,). New York: Hurd and Houghton.
Lee, C., & Vernez Moudon, A. (:cc). Physical activity and environment
research in the health eld: Implications for urban transportation plan-
ning practice and research. Journal of Planning Literature, 1,(:), :;::.
Lemmon, W. (:ccc). The anti-sprawl mantra. Planning Commissioners
Journal, ,;. Retrieved February ::, :cc,, from: http://www.plannersweb
.com/wles/w:c,.html
Lewis, L. B., Sloane, D. C., Nascimento, L. M., Diamant, A. L.,
Guinyard, J. J., Yancey, A. K., et al. (:cc,). African Americans access to
healthy food options in South Los Angeles restaurants. American Journal
of Public Health, ,, () ooo;,.
Lopez, R. (:cc). Urban sprawl and the risk for being overweight or
obese. American Journal of Public Health, ,(,), :,;:,;,.
McCord, C., & Freeman, H. P. (:,,c). Excess mortality in Harlem.
New England Journal of Medicine, ,::(,), :;,:;;.
Meckel, R. (:,,c). Save the babies: American public health reform and the
prevention of infant mortality, 18,v1,:,. Baltimore: Johns Hopkins
University Press.
Melosi, M. (:ccc). The sanitary city: Urban infrastructure in America from
colonial times to the present. Baltimore: Johns Hopkins University Press.
Mitchell, D. W. (:o:). Ten years in the United States, being an English-
mans view of men and things in the north and the south. London: Smith,
Elder.
Moe, R., & Wilkie, C. (:,,;). Changing places: Rebuilding community in
the age of sprawl. New York: Henry Holt.
Must, A., Spadano, J., Coakley, E. H., Field, A. E., Colditz, G., &
Dietz, W. H. (:,,,). The disease burden associated with overweight and
obesity. Journal of the American Medical Association, :8:(:o), :,:,:,:,.
National Trust for Historic Preservation. (:,;;). The Main Street
Project. Retrieved February , :cc,, from: http://www.mainstreet.org/
Oliver, J. E. (:cc,). Mental life and the metropolis in suburban Amer-
ica: The psychological correlates of metropolitan place characteristics.
Urban Affairs Review, ,, (:), :::,,.
Painter, N. (:,;). Standing at Armageddon: The United States, 18;;
1,1,. New York: W. W. Norton.
Peckham, G. (:o). Inuence of city life on health and development.
Journal of Social Science, :1, ;,,.
Peterson, J. (:,;,). The impact of sanitary reform upon American
urban planning, :c:,c. Journal of Social History, 1,, ,:c,.
Peterson, J. (:cc,). The birth of city planning in the United States, 18v
1,1;. Baltimore: Johns Hopkins University Press.
Platt, W. (:). Certain injurious inuences of city life and their
removal. Journal of Social Science, :, :,c.
Pond, M. A. (:,,;). The inuence of housing on health. Marriage and
Family Living, 1,, :,:,,.
Poston, W., & Foreyt, J. (:,,,). Obesity is an environmental issue.
Atherosclerosis, 1o(:), :c::c,.
Pothukuchi, K., & Kaufman, J. L. (:ccc). The food system: A stranger
to the planning eld. Journal of the American Planning Association,
oo(:), ::,::.
Putnam, R. (:ccc). Bowling alone: The collapse and revival of American
community. New York: Simon & Schuster.
Rapaport, A. (:,o,). House, form and culture. Englewood Cliffs, NJ:
Prentice Hall.
Riis, J. (:,c). How the other half lives. New York: C. Scribners Sons.
Rome, A. (:cc:). The bulldozer in the countryside: Suburban sprawl and the
rise of American environmentalism. New York: Cambridge University Press.
Rosenkrantz, B. G. (:,;:). Public health and the state: Changing views in
Massachusetts. Cambridge, MA: Harvard University Press.
Rosenauer, M. (:,). Discussion of health, recreation and welfare
session. In B. J. Hovde, T. H. MacDonald, G. S. McLaughlin, & H.
Williams (Eds.), Report of the Urban Planning Conferences at Evergreen
House, 1,,, under the auspices of the Johns Hopkins University (p. :,c).
Baltimore: Johns Hopkins University Press.
Rosenkrantz, B. G. (:,;). Cart before horse: Theory, practice, and
professional image in American public health, :;c:,:c. Journal of the
History of Medicine, :, ,,;,.
Schultz, S. K. (:,,). Constructing urban culture: American cities and city
planning, 18vv1,:v. Philadelphia: Temple University Press.
Shellenberger, M., & Norhaus, T. (:cc). The death of environmental-
ism: Global warming politics and a post-environmental world. Retrieved
February ::, :cc,, from: thebreakthrough.org/images/Death_of_
Environmentalism.pdf
Sheps, C. G. (:,,:). Responsibilities of the city planner in public health.
In American Society of Planning Ofcials, Planning 1,,:: Proceedings of
the ASPO Annual National Planning Conference held in Boston, Massa-
chusetts, October ,,, 1,,: (pp. ,:,,). Chicago: Author.
Sierra Club. (:,,,). Solving sprawl. Retrieved February :,, :cc,, from:
http://www.sierraclub.org/sprawl/report,,/acknow.asp
Sloane, D. C., Diamant, A. L., Lewis, L. B., Yancey, A. K., Flynn, G.,
Nascimento, L. M., et al. (:cc,). Improving the nutritional resource
environment for healthy living through community-based participatory
research. Journal of General Internal Medicine, 18(;), ,o,;,.
Smith, J. C. (:,,). Progress in performance standards for zoning. In
American Society of Planning Ofcials, Planning 1,,: Proceedings of the
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8
Annual National Planning Conference held in Philadelphia, September
:o,v, 1,, (pp. :oc:oo). Chicago: Author
Smith, S. (:,::). The city that was. New York: Frank Allaben.
Smith, S. (:,,,). Sick and tired of being sick and tired: Black womens
health activism in America, 18,v1,,v. Philadelphia: University of Penn-
sylvania Press.
Spain, D. (:cc:). How women saved the city. Minneapolis: University of
Minnesota Press.
Spielman, S.E., Golembeski, C.A., Northridge, M.E., Vaughan, R.D.,
Swaner, R., Jean-Louis, B., Shoemaker, K., Klihr-Beall, S., Polley, E.,
Cushman, L.F., Ortiz, B., Hutchinson, V.E., Nicholas, S.W., Marx, T.,
Hayes, R., Goodman, A., Sclar, E.D. (:cco). Interdisciplinary planning
for healthier communities: Findings from the Harlem Childrens Zone
Asthma Initiative. Journal of the American Planning Association, ;:( :),
:cc:c.
Sprawl City. (:ccc). Sprawl City: A web site about consumption growth
and population growth and their roles in the urban sprawl that destroys
natural habitat and farmland around U.S. cities. Retrieved February :,
:cc,, from: http://www.sprawlcity.org/
Sprawl Watch. (:,,). Sprawl watch clearinghouse. Retrieved February
:,, :cc,, from: http://www.sprawlwatch.org/
Srinivasan, S., OFallon, L. R., & Dearry, A. (:cc,). Creating healthy
communities, healthy homes, healthy people: Initiating a research agenda
on the built environment and public health. American Journal of Public
Health, ,, ( ,), :o:,c.
Stockton-Hough, J. (:;,). On the relative inuence of city and country
life, on morality, health, fecundity, longevity, and mortality. Public
health reports and papers presented at the meetings of the American Public
Health Association, 18;,. New York: American Public Health Association.
Transportation Research Board & Institute of Medicine. (:cc,). Does
the built environment inuence physical activity?: Examining the evidence
(TRB Special Report ::). Retrieved April :, :cc,, from: http://trb.org
/publications/sr/sr::.pdf
Twiss, J. M., Duma, S., Look, V., Shaffer, G. S., & Watkins, A. C. (:ccc).
Twelve years and counting: Californias experience with a statewide
Healthy Cities and Communities program. Public Health Reports,
11, ( :,), ::,:,,.
U.S. Department of Health and Human Services. (:,,o). Physical
activity and health: A report of the Surgeon General. Retrieved January ::,
:cc,, from http://www.cdc.gov/nccdphp/sgr/sgr.htm.
U.S. Department Of Health and Human Services. (:cc:). The Surgeon
Generals call to action to prevent and decrease overweight and obesity.
Retrieved February :,, :cc,, from http://www.ss.gov/topics/obesity.
Vasishth, A. (:cc). Smart growth and sprawl: A working bibliography.
Retrieved February ::, :cc,, from: http://www-rcf.usc.edu/~vasishth/
Smart_Growth+Sprawl-biblio.htm
Vlahov, D., & Galea, S. (:cc:). Urbanization, urbanicity, and health.
Journal of Urban Health, ;, (Suppl. :), S:S::.
Walzer Leavitt, J. (:,:). The healthiest city: Milwaukee and the politics of
health reform. Princeton, NJ: Princeton University Press.
Wapner, S., Demick, J., Yamamoto, C. T., & Minami, H. (Eds.).
(:,,,). Theoretical perspectives in environment-behavior research: Under-
lying assumptions, research problems and methodologies. New York:
Kluwer Academic/Plenum.
Williams, H. (:,). Public health and urban planning. In B. J. Hovde,
T. H. MacDonald, G. S. McLaughlin, & H. Williams (Eds.), Report of
the Urban Planning Conferences at Evergreen House, 1,,, under the
auspices of the Johns Hopkins University (pp. ::,:::). Baltimore: Johns
Hopkins University Press.
Winslow, C.-E. A. (:,:). Health and housing. In American Public
Health Association, Committee on Hygiene of Housing, Housing for
health: Papers presented under the auspices of the Committee on Hygiene of
Housing of the American Public Health Association (pp. ;:;). Lancaster,
PA: Science Press Printing Company.
Wirka, S. M. (:,,o). The city social movement: Progressive women
reformers and early social planning. In M. C. Sies & C. Silver (Eds.),
Planning the twentieth-century American city (pp. ,,;,). Baltimore:
Johns Hopkins University Press.
Wolch, J., Pastor, M., Jr. & Drier, P. (Eds.). (:cc). Up against the
sprawl: Public policy and the making of Southern California. Minneapolis:
University of Minnesota Press.
Wright, G. (:,:). Building the dream: A social history of housing in
America. Cambridge, MA: MIT Press.
: Journal of the American Planning Association, Winter :cco, Vol. ;:, No. :
D
o
w
n
l
o
a
d
e
d

A
t
:

1
2
:
0
9

2
8

S
e
p
t
e
m
b
e
r

2
0
0
8