Boston University School of Public Health
Department of Environmental Health
Course Title:
The Built Environment: Design Solutions for Public Health
Instructors:
Russ Lopez, DSc, MCRP, Adjunct Assistant Professor
Credits:
4
Meeting dates: Wednesday 6:00 – 8:45
September 2 – December 16
Course goals:
This course will provide an overview of urban planning to public health students and introduce
public health concepts to urban planners. At the conclusion of the course, students will be able
to:
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Explain the rationale behind historical and current theories on the relationship between
the built environment and public health
Identify contemporary features of the built environment such as parks, public works
projects, single family homes, apartment buildings, transportation systems and highways,
etc., that reflect past efforts to influence health.
Critique historic patterns of development and assess the health consequences of
contemporary urban forms.
Evaluate the evidence for the built environment–health link.
Explain the role of the built environment in the context of other factors that influence
health.
Understand how the built environment might influence other efforts to protect and
promote health.
Utilize studies and methodologies developed by sociologists, anthropologists, urban
planners and architects to evaluate the health impacts of the built environment.
Propose built environment-based interventions, based on current evidence and the lessons
learned from the past studies of the built environment, to promote public health.
Develop and implement new programs and policies that utilize built environment and
design to promote public health.
Course Rationale
This course provides students with an understanding of how the built environment impacts
public health and the critical tools to evaluate specific design features. The modern urban
planning and public health disciplines both had their beginnings over 100 years ago as reformers
sought to address the problems associated with rapid urbanization, industrialization and
immigration. Together, these reformers helped implement a wide variety of policies and
programs including urban parks, water works and sewerage, zoning, and building codes. By the
mid 20th century, however, advances in medicine, the emphasis on individual responsibility for
disease and the professionalization of both disciplines resulted in a divergence of public health
from planning. But at the end of the century, the persistence of risky health behaviors and the
increase in obesity rates, particularly in the United States, prompted renewed attention to the link
between built environment and health. The result has been a recent increase in connections
between planning and public health. For example, the American Public Health Association now
includes a Built Environment Institute at its annual meeting, and the American Planning
Association holds training sessions on public health.
This course places students at the intersection of this newly growing field. At the end of this
class, students will be able to “read” the built environment, i.e., to identify elements whose
design roots are based on solving specific health issues. These solutions have dramatically
impacted the built environment and underpin the ways in which buildings, neighborhoods and
cities are built today. As our understanding of public health has evolved over the past century,
and as the unintended public health consequences of previous design solutions have become
recognized, attempts to address public health through design have also evolved rapidly, and in
ways which affect us every day. This course gives students a framework for evaluating historic,
current and future design programs and policies. This framework is based on past
epidemiologic, anthropological and economic studies of the built environment. Throughout this
course, key studies are presented and the quality of the evidence is discussed.
Course Overview
The course is organized in a generally historical sequence, with overlaps in periods
corresponding to overlaps in architectural and programmatic trends.
All course readings will be available on the course website.
Teaching method
The course will consist of lectures and class discussions. Students are encouraged to draw on
their own experiences—the neighborhoods they grew up in, the houses they live in now, how
they access school and employment—and contribute these examples to class discussions. The
goal is to encourage students not to take the contemporary built environment as immutable or
purposeless, but instead be able to identify elements that reflect past concerns for health and
assess current programs and policies in light of new understanding of the built environment –
health connection.
Course Requirements
The written coursework will consist of four short assignments and a final paper.
Assignment 1: Boston’s South End (Due Class 4 – September 23)
Assignment 2: Neighborhood Audit Checklist (Due Class 7 - October 14)
Assignment 3: London’s Congestion Charge (Due Class 10 - November 4)
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Assignment 4: Urban Renewal in Mumbai (Due Class 13 – December 2)
Assignments: These Assignments will be based on short handouts that will be made available on
the Course Web Site. Two first two are observational and will require short walks (one through
the South End, one in a neighborhood of your choice). The second two are policy focused. Each
Assignment length should be 2 pages (double spaced, 12 point type, 1 inch margins), not
including references (if any).
Final Paper: The paper will be on a topic proposed by the student and approved by the course
instructor. Topics can be any relevant public policy, theory or specific case example related to
the built environment and public health. Papers should describe the policy, theory or case;
identify how it represents an attempt to manipulate the built environment; connect it to other
types of interventions or activities; critique it from the standpoint of health and suggest possible
modifications that might strengthen it. Final paper length should be 10 pages (double spaced, 12
point type, 1 inch margins), not including references. Representative paper titles include:
o Celebration, Florida: A health, equity and sustainability critique.
o Smart growth and affordable housing: Do growth controls hurt the poor?
o Mass transit vs. subsidies for automobile ownership: How to increase
transportation options for the urban poor.
Important paper deadlines are:
Class 8: Paper topics due
Class 11: Literature Review Due
Class 14: Paper Due
Class 14 and 15: Final presentations
Grading
Assignment 1: Boston’s South End 10%
Assignment 2: Neighborhood Audit Checklist (10%)
Assignment 3: London’s Congestion Charge 10%
Assignment 4: Urban Renewal in Mumbai 10%
Final Paper:
40%
Final Presentation:
10%
Class Participation:
10%
1.
Introduction: Course overview and themes. Sept. 2
In this session, we cover the role of the built environment in health. We begin with a review of
health, which is more than the absence of disease, and explore the concepts of association and
causation, and the proximate and underlying factors affecting health. This overview stresses that
the built environment is just one factor among many affecting health. It lays a foundation for
assessing and understanding the various strands of evidence linking the built environment to
health. We describe the issues to be covered during the course and place these issues into the
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context of other forces affecting cities. We explain the differences and relationship between the
health of cities, a complex of economic and social activity, and the health of individuals living in
cities, whose health status reflects the influences of these activities on individual outcomes.
There will also be a discussion of three frameworks for assessing the built environment: health,
equity, and sustainability.
Objectives: At the end of this session students should be able to:
- Discuss the basic problems and advantages of cities;
- Articulate and describe the historical and current trends of urbanization in the US and
in the world;
- Assess their own assumptions about cities and urban public health.
Readings
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2.
Frumkin H. 2003. Healthy places: Exploring the evidence. American Journal of
Public Health. 93(9):1451-6.
Galea S, Freudenberg N, Vlahov D. 2005. Cities and population health. Social
Science and Medicine. 60(5):1017-1033
Owen D. 2004. Green Manhattan. The New Yorker, 10/18/04.
19th Century: The Urban Health Crisis . Sept. 9
Cities in the Western world grew rapidly because of industrialization, immigration and
urbanization. The results of the rapid growth of cities were large slums with substandard and
dangerous housing, high levels of infectious diseases including tuberculosis, and overburdened
roads and infrastructure. Between epidemics of cholera and rising levels of urban violence, it
seemed that the very ideas of progress and modernity were at risk. At this time, wealthy and
middle class people began to leave cities and modern attitudes toward urban living were formed.
A lasting legacy is that cities continue to be seen to be unhealthy and dangerous places, leaving
the United States with a deep bias toward suburban living.
Objectives: At the end of this session students should be able to:
- Describe the health and environmental characteristics of 19th century cities;
- Connect these 19th century city characteristics to 21st century attitudes toward cities
and urban residents, and explain how these attitudes continue to drive current social,
health and environmental policies;
- Describe the history of the early public health movement and its connections to urban
problems;
- Understand the connections between urban planning and public health and use this
understanding to critique policies and programs in both disciplines.
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Readings
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3.
Garb M. 2003. Health, morality and housing: the “tenement problem” in Chicago.
American Journal of Public Health. 93(9):1420-1430
Peterson J. 1979. The impact of sanitary reform upon American urban planning,
1840 – 1990. Journal of Social History. 13(1):83-103
Wirth L. 1938. Urbanism as a way of life. Am J Sociology. 44(1)1-24
The age of reform. Sept 16
Public health advocates and social reformers found a connection between living in tenements and
neighborhoods near large factors and communicable diseases such as tuberculosis and chronic
diseases such as depression and disabilities. To counter these problems, a number of initiatives
were developed including the sanitarian movement, the development of water treatment and
sewerage, and the separation of land uses to protect workers from industrial air pollution. The
culminations of the 19th century reform movement include the great urban park systems (New
York City’s Central Park, Boston’s Emerald Necklace, etc.), new water supplies, and other
important contributions to health and welfare.
Objectives: At the end of this session students will be able to:
- Identify contemporary built environment features in the Boston area and elsewhere
which date back to attempts by planners and health officials to address 19th century
concerns;
- Articulate the health concerns being addressed by these development features, and
evaluate the success of those attempts;
- Use contemporary urban environmental characteristics to illustrate past efforts to
improve social outcomes;
- Critique past efforts to incorporate health into planning and development.
Readings
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4.
Cutler D. Miller G. 2005. The role of public health improvements in health
advances: The Twentieth-Century United States. Demography 42(1):1-22
Blodgett G. 1976. Frederick Law Olmsted as conservative reformer. The Journal
of American History 62(4):869-889
The triumph of theory: Frank Lloyd Wright and Le Corbusier. Sept 23
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These two architects have shaped much of the 20th Century’s architecture and urban form. Both
sought to address the health problems and social failures of the early 20th Century city, but in
very different realms. Wright conceived of “Broadacre City”, a community of single family
houses set on one acre plots – a design that describes much of modern American suburbs. Le
Corbusier developed radical new designs for center cities, at one time proposing to tear down the
Right Bank of Paris and replace it with large skyscrapers set in parks. Both had ideas that
represent orthodox design to this day.
At the end of this session, students will be able to:
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Describe the influences on architectural theory in the first half of the 20th century;
Understand the role of health in creating Modern architecture;
Identify current design elements dating back to Wright’s and Le Corbusier’s theories;
Identify how health was conceptualized and addressed in these architect’s designs;
Critique these design elements given our current concern regarding chronic diseases.
Readings
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5.
Grabow S.1977. Frank Lloyd Wright and the American city: The Broadacre
debate. Journal of the American Planning Association. 43(2):115-124
Wright FL. 1935. Broadacre City: A new community plan. Architectural Record
Bauer-Wooster C. 1965. The social front of Modern Architecture in the 1930s.
The Journal of the Society of Architectural Historians 24(1):48-52
The suburbs mature: Zoning, building codes and environmental design. Sept 30
The 20th Century saw the professionalization of public health and urban planning. Much of the
effort of reformers was centered on the standardization of building and design techniques.
Zoning was typical. It arose out of a failure of English Common Law to adequately protect
health and property values from nuisances. (It was also used to preserve racial and religious
purity of neighborhoods – a practice the supreme court ultimately over-ruled). Over time,
standard zoning codes were developed and enabling legislation, with minor modifications, were
adapted in almost every part of the US. The result is that new development has tended to look
the same everywhere. Though we now know there are fundamental flaws with Euclidean Zoning
(named after the community which was involved in the suit that resulted in zoning was declared
constitutional – Euclid OH), it was very successful in eliminating and reducing the health and
environmental problems of the late 19th and early 20th century urban environment. Suburban
development has changed over time and this class session will cover some of the later theories
linking development form and health.
At the end of this session, students will be able to:
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Describe the health basis for zoning and building codes;
Understand the vital role of public health in the development of these codes;
Identify how these codes were developed and adopted;
Understand the goals of these codes and the health and environmental issues they were
addressing.
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Readings
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6.
Schilling J, Linton LS. 2005. The public health roots of zoning: in search of
active living's legal genealogy. Am J Prev Med. ;28(2 Suppl 2):96-104.
McHarg I. 1964. The place of nature in the city of man. Annals of the American
Academy of Political and Social Science 352(1):1-12
Malizia E. 2005. City and regional planning: a primer for public health officials.
American Journal of Health Promotion 19(5):Supplement 1-13.
Suburban Discontent (guest lecture: Tammy Vehige) Oct 7.
Suburbs were populated, at least in part, by families desiring a healthier environment than was
possible in inner cities. These desires were fueled at least in part by the very real problems of
infectious disease, sanitation and pollution that afflicted cities prior to World War II. But while
suburbs were at one time healthier, improvements in the urban environment have reduced the
suburban health advantage. Now there are new concerns about the suburbs: suburban design
may discourage physical activity and increase, they eat up large parts of the natural environment,
promote higher energy use and may erode social capital.
At the end of this session, students will be able to:
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Describe the evidence linking suburban development and health;
Assess the adequacy of suburban health research;
Describe how the built environment is measured and assessed in health research;
Outline some of the additional impacts of suburbanization.
Readings
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7.
Frank L, Anderson M, Schmid T. 2004. Obesity relationships with community design,
physical activity, and time spent in cars. Am JPrev Med. 27(7):87-96
Northridge ME, Sclar ED, Biswas P. 2003. Sorting out the connections between the
built environment and health: a conceptual framework for navigating pathways and
planning healthy cities. J Urban Health. 80(4):556-68.
Lopez R. 2007. Neighborhood risk factors for obesity. Obesity 15(8):2111-2118
Transportation. Oct 14.
Virtually all development in the United States since World War II has been heavily automobile
dependent, and thus both highly resource intensive and, we argue, antagonistic to public health
goals. An important consideration is that not everyone can drive. The elderly, people with
disabilities and the young may not be able to drive, others may not be able to afford a car. Most
alternatives to car-oriented development center on relatively dense urban areas in which
transportation can be more efficient, and often, human powered. In this class we will discuss
specific design solutions intended to improve public health, environmental impacts, and energy
use. These include communities built to favor the pedestrian and bicyclist, as well as transitoriented development. Some specific local design features (traffic calming devices; pedestrian
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and bike amenities) will be discussed. What are the specific goals of these interventions? How
do they hope to realize these goals? How effective are various design elements in promoting
physical activity? The passage by Congress of the Intermodal Surface Transportation Efficiency
Act of 1991, and its subsequent reenactments, created new funding and political channels by
which these types of development might be realized; we will give an overview and discuss some
examples.
Objectives: At the end of this session students should be able to:
- Describe the essential components, economic and environmental advantages, and
public health impacts of walkable and bikeable communities;
- Assess the health impacts of transit-oriented developments;
- Describe the impact of ISTEA (and other funding sources) on urban and suburban
development. Propose new projects fundable under ISTEA which might promote
health;
- Propose specific health-promoting design changes to local communities.
Readings
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Jacobsen, P. L. (2003). "Safety in numbers: more walkers and bicyclists, safer walking
and bicycling." Inj Prev 3): 205-9.
Novacco, Stokols, Milanessi L. 1990. Objective and subjective dimensions of travel
impedance as determinates of community stress. Am J of Community Psychology.
18(2):231-257
8. Urban renewal and public housing: Afflicting the poor. Oct 21
Urban renewal had a tremendous impact on US cities, destroying hundreds of neighborhoods and
displacing millions of people. These negative effects, along with a shift in government priorities,
have resulted in new programs designed to revitalize inner cities. These projects include large
sports and cultural facilities, loans to upper income households to purchase housing, and
rebuilding of older public housing projects and downtown business districts. But do these
programs have a more benign impact on the poor? To a certain extent these newer programs
mimic older policies that sought to replace poor people with middle class or upper income
households. But they also include steps to improve the economic status of existing residents as
well. All of them have potentially large health and environmental impacts.
Objectives: At the end of this session students will be able to:
- Describe the impact of urban renewal on the urban poor and racial minorities;
- Understand how urban renewal and public housing programs were developed and
implemented;
- Analyze contemporary urban policies from a health perspective;
- Describe the past and current “tools” planners have used to change neighborhoods.
Readings
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Fullilove M, Green L, Fullilove R. Building momentum: An ethnographic study of innercity redevelopment. American Journal of Public Health. 1999. 89(6):840-845
Leventhal T Brooks-Gunn J. 2003. Moving to opportunity: an experimental study of
neighborhood effects on mental health. Am J Public Health. 93(9):1576-1582
Bauer C. 1945. Good neighborhoods. American Academy of Political and Social
Science. 292:104-115
Lopez R. 2009 Public health, the APHA, and urban renewal. Am J Public Health. 2009
Sep;99(9):1603-11
9.
Urban Ecology (Guest Lecture: Steven Miller). Oct 28
A major focus in this course is on solutions to the health problems posed by the built
environment. In the Boston area, the Livable Streets Alliance has been working on community
and advocacy. Steve Miller, the founder of Livable Streets, will be presenting on the how the
group was organized, its methods for working for change, and its current initiatives.
Readings:
- To be announced
10.
Contemporary design and programs. Nov 4
Public health, architecture and planning have responded to current critiques on the health effects
of orthodox development by developing a new set of tools. These hold the promise of promoting
health in ways that address the chronic disease issues of our time. There are critics, however,
and we will explore how well New Urbanism, LEED, and other programs are achieving the goals
they have set for themselves.
Objectives: At the end of this session, students will be able to:
- Describe and critique some of the key attributes of New Urbanism and Smart Growth,;
- Understand how architects and planners have responded to the perceived problems
with traditional zoning. Assess the potential of newer proposals for application in
different communities;
- Critique proposals to modify the built environment from a capital and temporal
perspective;
- Assess New Urbanist and smart growth developments using traditional
zoning/development frameworks of analysis.
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Readings
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11.
Geller A. 2003. Smart growth: a prescription for livable cities. American Journal of
Public Health. 93(9):1410-1415.
Burton, E. (2000). "The compact city: Just or just compact? A preliminary analysis."
Urban Studies 37(11): 1969-2001.
Lund H. 2003. Testing the claims of new urbanism: local access, pedestrian travel, and
neighboring behaviors. J American Planning Association. 69(4):414-429
Tools: Evidence based design and health impact assessment. Nov 11
A major critique of earlier efforts to promote health via built environment improvements has
been that it was not based on solid epidemiological evidence. Nor did they adequately address
the full range of health and social impacts that may arise from new projects. The past few years
have seen the development of two new assessment ideas: evidence-based design and health
impact assessment. These will be presented and critiqued in class.
Objectives: At the end of this session students should be able to:
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Describe methodologies for evidence-based design and health impact assessment;
Understand the strengths and limits of these techniques;
Interpret the results from these assessment tools.
Readings
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Evidence-based design could help quality of care. Healthcare Research Quality Imrpv
11(8):92-94
Ulrich R. 1984. View through a window may influence recovery from surgery. Science.
224(4647) 420-421
Bhatia R. Protecting health using an environmental impact assessment: a case study of
San Francisco land use decision making. Am J Public Health. 2007 Mar;97(3):406-13.
Epub 2007 Jan 31.Click here to read
Dannenberg et al. 2008. use of health impact assessment in the U.S.: 27 case studies,
1999-2007. Am J Prev Med. 34(3):241-256
12. The Developing World: Colonialism, Globalization and Urbanization. Nov 18
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13.
Campbell and Campbell. Emerging disease burdens and the poor in cities of the
developing world. J Urban Health. 2007 May;84(3 Suppl 1):54-64
Wei Y. Urban policy, economic policy, and the growth of large cities in China.
Habitat International 1994 18(4):53-65.
The Developing World: Infrastructure, Land Tenure and Other Contemporary
Dec 2
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To a certain extent, many of the problems confronting rapidly growing urban areas in the
developing world today have parallels in the problems that US and European cities had to
address 100 years ago including housing quality, infrastructure improvements, clean water and
sanitation. But many of the issues are different including problems with land tenure, greenhouse
gas emissions and global transport of capital and people. Some areas are not only successfully
overcoming these challenges, but they may also be providing models for how older Western
cities might adapt and change to a new global environment.
Objectives: At the end of these sessions students should be able to:
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Describe the social/economic constraints operating on 21st Century developing cities;
Critique contemporary urbanization models from the course’s sustainability, equity,
health framework;
Propose and evaluate alternative infrastructure scenarios for developing world cities.
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Bai X, Imura H. 2000. A comparative study of urban environment in East Asia:
Stage model of urban environmental evolution. International Review for
Environmental Strategies. 1(1):135-158
Harris N. 1995. Bombay in a global economy: structural adjustments and the
role of cities. Cities 13(3):175-184
14.
Final paper presentations Dec 9
15.
Final paper presentations Dec 16
Final papers will be due during this session.
Objectives: The goal of the class project is to provide students with experience in applying
theory learned in previous classes to built and proposed projects in urban design, urban planning,
or transportation planning, with an eye to the affects of the project on public health. With the
lessons and techniques learned in this class, how might these projects affect health? Are they
sustainable? Do they represent an attempt to remediate the impacts of the built environment or
do they represent a repeat of past mistakes?
Readings: none
A NOTE ON PLAGIARISM
Plagiarism, including the copying of any work in whole or in part without citation, is an
extremely serious offense and will not be tolerated. It violates the trust between students and
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faculty, renders ineffective the pedagogical activities of the class and deprives students of the
learning experience derived from course requirements. Violation of plagiarism guidelines will
be treated severely and reported to the school for further action.
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