Planning: The Next Public Health Revelation

Posted January 1, 1970

“How we build and how we design our communities has a greater impact on whether people are healthy than what we do in our hospitals.” Rick Kozin, Director of Public Health for Polk County, believes city planning holds the key to improving some of our most complex health problems and allowing us to live fuller lives. This is no small claim, but research and history back him up.

The origin of city planning in the U.S. was, in part, an answer to a public health crisis. Overcrowding and poor sanitation in 19th century urban America created cities where infection spread easily, air and water quality were abysmal, and living spaces were dark, damp and unventilated. Early city planning interventions, such as housing codes and zoning, saved lives and improved quality of life for millions of urban dwellers.

After 100 years of drifting apart, planning and health professionals are now coming back together to respond to rising rates of chronic diseases such as diabetes and asthma, and mental health challenges such as stress and depression. Research shows promise for treating and preventing these conditions, and others, through changes to our surroundings. Kozin recounts the common refrain in his field: “your zip code is a better predictor of your health than your genetic code."

One prime example of the “zip code” effect is whether a place encourages active transportation, such as walking. Walking as a form of transportation can improve physical activity levels and social connections, both of which improve health outcomes. Your neighborhood can have a profound impact on how easy or appealing it is to get in a daily walk.

Kozin gives a local example: “On a nice day like to today, if you go to Gray’s Lake [a Des Moines park], the parking lot is going to be full of cars - people who drove there so they can walk. At the same time of day, if you go to almost any elementary school, you will see a line of cars of parents picking their kids up - to keep kids from having to walk.” People want to walk, and make time to do so, yet they actively avoid a daily opportunity to walk and improve their health. The reason may lie in the design of our cities: does the neighborhood feel unsafe, do the streets lack sidewalks, are the homes too spread out, or is the walk simply not attractive or socially engaging?

Much like our 19th century counterparts, we are in desperate need of a breakthrough in understanding about how community design affects health. Although it seems painfully obvious to us now, the link between open sewage and health problems was a true revelation for health workers in the 1800s. Now it’s time for a modern revelation of our own. “We tend to think of disease as something your doctor takes care of, not something your community takes care of,” says Kozin. “We still have some catching up to do to think about health in a much broader way.”

Kozin and co-presenter Jake Tanumihardjo will bring their message about public health and planning to the 2016 APA Iowa conference, October 19-21st in Burlington. Their keynote talk, “Public Health and Urban Planning: Resuming the Partnership,” will trace the origins of the two fields, and the promise of partnership for the future.

Planning: The Next Public Health Revelation