Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1042 (doi:10.1542/peds.2007-0635)

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LETTER TO THE EDITOR

Deterrent to Healthy Lifestyles in Our Communities: In Reply

James Fisk, MD
Department of Pediatrics
University of New Mexico
Albuquerque, NM 87131

I am gratified that the group from British Columbia has expanded on my comment and pointed out the distressing hazards to child safety posed by both vehicles and the roadways they occupy, the design of which seldom shows much thought for pedestrians or cyclists. Long distance and parents' fear of crime are other notable barriers to walking or biking to school that they cite. Long distance is inherent in urban design subservient to automobiles, where the fabric must be stretched just to make room for cars, their storage, and the possibility that they can move at all.

Parents' fear of crime suggests another overarching issue precipitated by our automobile cities: the loss of social capital. Social capital can be defined as mutual trust, psychological sense of community, neighborhood cohesion, and community competence.¹ Jane Jacobs, an early influential scholar of American urban design, argued that the active pedestrian street life of older neighborhoods with shops, small streets, and mixed uses promoted safety. She coined the term "eyes on the street" and noted the sense of community in these neighborhoods. The concern of inhabitants for their fellows was in stark contrast to the high-rise projects and streets empty except for cars, which makes robbery and personal attack easier.²

Urban sprawl adds to the problem by segregating neighborhoods by income, taking good schools, jobs, and other resources to the periphery and leaving behind poverty and pollution in the inner city. Commentary on pollution generated by automobiles, profligate water and energy use, and global warming, all exacerbated by urban sprawl, is beyond the scope of this letter. However, one further issue might be mentioned as an example. Asthma remains a burdensome pediatric problem, and that burden is borne disproportionately by black children.³ A study from Hartford, Connecticut, an urban minority community, used the health-field concept and studied factors that determine the health of communities: environment, human biology (genetics), personal behavior, and health care organization. The study concluded that "[i]mproved personal behaviors and medical care will have a limited sustained impact on childhood asthma until basic environmental issues are modified."⁴

Approaches to modifying environmental issues can be small or big. A neighborhood in Portland, Oregon, created a gathering place at a formerly busy intersection by painting a giant sunflower across the intersection, installing a fountain, an art wall, and an information kiosk. Walking and biking increased, as did measures of social capital and a neighborhood sense of well-being.⁵

The big approach is illustrated by the urban-design principles advocated by the New Urbanism,⁶ including walkability, mixed use and diversity, mixed housing, traditional neighborhood structures, increased density, and smart pedestrian-friendly transportation. Big or little approaches to problems of the built environment could go a long way in mitigating a number of health issues, including obesity.

REFERENCES

1. Lochner K, Kawachi I, Kennedy BP. Social capital: a guide to its measurement. Health Place. 1999;5 :259 –270[CrossRef][Web of Science][Medline]
2. Jacobs J. The Death and Life of Great American Cities. New York, NY: Random House; 1961
3. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002;110 :315 –322[Abstract/Free Full Text]
4. Cloutier M, Wakefield D, Hall C, Bailit H. Childhood asthma in an urban community. Chest. 2002;122 :1571 –1579[CrossRef][Web of Science][Medline]
5. Semenza J. The intersection of urban planning, art, and public health: the Sunnyside Piazza. Am J Public Health. 2003;93 :1439 –1441[Abstract/Free Full Text]
6. New Urbanism. Principles of new urbanism. Available at: www.newurbanism.org/newurbanism/principles.html. Accessed February 26, 2007

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Fisk, J. Search for Related Content PubMed Articles by Fisk, J. Related Collections Office Practice Social Bookmarking                         What's this?