Obesity: An exploratory study
between public health and urban
planning
Devin Myers
Community, Environment, and Planning
University of Washington
Table of Contents………………………………………………………………………………1
Executive Summary………………………………………………………………………...4
Chapter 1: The Obesity Epidemic……..………………………………………………..7
What is obesity................................................................................................................7
Problem…………………….…………………………………………………………………….8
Causes……………………..…………………………………………………………………...10
Chapter 2: The Built Environment……………………………………………………12
What is a built environment..………………………………………………………………12
Urban Sprawl………………………………………………………………………………….13
Relationship between urban sprawl and obesity...………………………………………14
Reasons for obesity in sprawling communities…………………………………………..14
Solutions to Urban Sprawl: Increase density…………………………………………….16
Transportation problems in suburbs……………………………………………………....18
Highway and commuting issues……………………………………………………………19
Solutions for transportation and walkable communities……………………………….21
Transportation design changes, Complete Street Policy, Transit
Infrastructure…………………………………………………………...…………………….22
Transit-Oriented Development……………………………………………………………..23
Bicycle infrastructure………………………………………………………………………..24
Walkable communities……………………………………………………………………….26
Pedestrian Infrastructure and design features…………………………………………..27
Environmental impacts of Urban Sprawl: Habitat destruction…………………….…29
Solutions to land-use impacts of urban sprawl: Urban growth management: Growth
Limits, Moratoriums, Land Acquisition Programs, agricultural or conservation
zoning, Transferrable Development Rights………………………………………………30
Inner-city Decay………………………………………………………………………………33
Definition………………………………………………………………………………………33
Context…………………………………………………………………………………………34
The relationship between inner-city decay and obesity………………………………...35
Socio-economic Status………………………………………………………………………..36
Residential Segregation……………………………………………………………………..37
Psychological Stresses of Urban Living…………………………………………………...38
Built Environmental Problems in dense cities…………………………………………..39
Solutions: Social Capital…………………………………………………………………….40
Open Spaces…………………………………………………………………………………...42
Solutions into building vibrant open spaces……………………………………………...49
Diversity of open space recreational activities…………………………………………...50
Reclaim and reuse abandoned or vacant spaces…………………………………………51
Build community gardens…………………………………………………………………...52
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Walkable areas……………………………………………………………………………......52
Built Environment conclusion…...…………………..……………………………………..56
Chapter 3: The Food Environment……………………………………………………58
Problem…………………………………………………………………………………………58
Socio-Ecological Model……………………………………………………………………….59
Environmental Barriers……………………………………………………………………..61
Food Insecurity………………………………………………………………………………..62
Food Insecurity and Health…………………………………………………………………64
Obesity and Mental Health…………………………………………………………………65
Eating Habits………………………………………………………………………………….65
Food Marketing……………………………………………………………………………….66
Solutions to improve our food environment………………………………………………69
Food Financing Initiatives…………………………………………………………………..70
Local Food Programs…………………………………………………………………………72
Urban Agriculture…………………………………………………………………………….74
Case Studies for Urban Agriculture……………………………………………………….75
Land-Use strategies for Urban Agriculture: Adopt Zoning and General Plan
language………………………………………………………………………………………..77
Permitted Use of Community Gardens…………………………………………….……..78
Open Space Protections for Community Gardens ……...……………………………….83
Additional Plans of Action that cities can implement……….………………………….84
Plan Language for community gardens…………………………………………………...85
Lease Agreements…………………………………………………………………………….88
Farmers Market………………………………………………………………………………89
Policy and Pricing Interventions in restaurants and schools………………………….92
WIC……………………………………………………………………………………………..93
SNAP……………………………………………………………………………………………94
Food Environment conclusion………………………………………………………………97
Chapter 4: Education…………………………..…………………………………………98
Issues of K-12 education on health………………………………………………………...98
What is nutrition and how can it apply to obesity………………………………………99
Nutrition in K-12 schools…………………………………………………………………..103
The state of physical activity and physical education in schools…………………….105
Let’s Move! Campaign and the Taskforce on Childhood Obesity..…………………..107
Healthy Schools Program………………………………………………………………….109
CPPW………………………………………………………………………………………….112
Legislation for healthy schools - meal options through policy changes…………….113
Case Study: Philadelphia…………………………………………………………………..113
Healthy, Hunger-Free Act…………………………………………………………………114
School Breakfast Program…………………………………………………………………116
After School Snacks and Meals……………………………………………………………119
Summer Food Service Program…………………………………………………………...121
Fresh Fruit and Vegetable Program……………………………………………………..124
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Physical exercise and physical education……………………………………………….125
Safe Routes to School Program……………………………………………………………126
Nutrition education…………………………………………………………………………127
Farm-to-school opportunities……………………………………………………………...128
Conclusion……………………………………………………………………………………130
Bibliography……………………………………………………………………………….132
3
Executive Summary
This literature review explores the role that obesity has on our built environment. Using a
multi-disciplinary framework, various sources were identified as to why we have rising obesity
rates. This review also examines how we can address obesity through theoretical and practical
approaches.
The issue of obesity has gained national attention for a number of reasons. For one,
obesity rates in the United States have steadily climbed over the years, and no state is immune to
it. Health care costs have skyrocketed and more people’s health has been compromised by
obesity related ailments such as heart disease, diabetes, hypertension, liver disease, stroke, and
mental health conditions. Obesity rates have climbed for a variety of reasons. Individual factors
such as unhealthy eating habits and not getting enough physical exercise are considered the main
culprits. Genetic predisposition such as children being born obese is also becoming more
common because of their parents genetic traits. However, more research has shown that
environmental factors contribute to poor health outcomes.
Individual factors can determine obesity, but it isn’t the only factor. The built
environment, which is simply a living environment constructed by humans, also has a significant
impact on human health. For example, people who live in the suburban environment often rely
on personal vehicles to get from place to place. This subtracts opportunities for physical exercise
to get the necessary physical activity a person needs.
People who live in dense cities are more likely to walk instead of drive because amenities
are likely to be within walking distance. Plus, there are other options to get around. It is also
important to note that for cities to be functional and attractive, planning for transportation is
imperative. Cities are increasingly focusing on transit-oriented development, bicycle
4
infrastructure, and creating safety design features for pedestrians to use to attract more people to
walk instead of drive. Investing in local transportation projects instead of highways has been
shown to minimize environmental impacts, improve health, and save money in the long run.
However, dense cities can be problematic for those trying to access open spaces. Dense
cities are often more crowded and space is taken up by more development. Suburban areas are
more likely to offer more open spaces but might be further away from where people live.
Therefore, its important that communities also focus on providing more open spaces such as
parks and recreational areas for people to get exercise and reduce stress. Open spaces can also be
used as an opportunity to access natural settings and grow food for people who can’t afford it or
has limited access to healthy food.
Food access for many Americans is limited by socioeconomic factors. Socioeconomic
factors focus on specific social and economic categories in the discipline of sociology. There’s a
correlation between ethnic groups, income levels, and education levels that impact the rate of
obesity. Other factors include age, person’s geographical location, and family history. In short,
people who are poorer and have less education are more likely to acquire obesity-related
diseases. On the other hand, people with higher levels of education will more likely acquire more
income and have better health outcomes. They also tend to grow up in more favorable conditions
growing up with more resources.
The report also examines the role that the food environment has on our health. The food
environment influences the food choices and eating behaviors that a person makes.
Fortunately, there are government institutions, organizations, and local groups that
recognize these problems and have been able to fill in the gaps. Various government food
subsidies are offered for poor families; along with various food programs, urban agricultural
5
programs, and increasing farmers markets in cities have been touted to improve health outcomes
by increasing access along with making food affordable.
While making food more accessible and affordable is an important step to addressing
obesity, the role of education is extremely important. For one, obesity rates have skyrocketed and
there are more obese children today than there was in the past. This generation is expected to
have a shorter lifespan than their parents because of their expected health outcomes. For this
reason, it is important to teach children the value of nutrition, physical exercise, and daily
healthy lifestyles. It is also important that schools invest in providing healthy food options for
schoolchildren not only for healthy weight but also to help children succeed in academically.
There are a number of government programs that are aimed to improve the school meals
for children and ongoing case studies are showing that they improve the health outcomes for
children. There are more studies that show the value of having Farm-to-School programs that
give children the opportunity to where food comes from and how it grows. When children get the
chance to make the connection to food, they are more likely to value food on a higher level.
Schools also need to continue to invest more time and resources for children to commit to
physical exercise through physical education and extracurricular activities. Schools can also
promote other physical activity programs such as the Safe Routes to School program where
children are encouraged to walk or ride a bike to school.
Obesity is an issue that needs to be addressed through a variety of approaches. Through
changes in the built environment, improving the food environment, and the way we teach future
generations about how to practice healthy lifestyles will give our nation a better future healthwise.
6
Chapter 1: The Obesity Epidemic
What is obesity?
The meaning of obesity is simple, but its definition is broad. The Center for Disease
Control and Prevention (CDC), a federal public health government agency, refers to obesity as
“weight that is greater than what is generally considered healthy for a given height” for a given
person.1 It is also often referred to as a medical condition in which a person has excess body fat
to a degree in which a person might be susceptible to a set of health problems that affects the
person’s well-being and quality of life. Obesity is most commonly measured or defined through a
method called the Body Mass Index (BMI), a statistical measurement which quantifies the
amount of body fat that a person has. BMI determines body types by calculating the “weight in
kilograms divided by height in meters squared”.2 For example, a person who has a BMI between
25 and 29.9 is considered overweight, a person who has a BMI of 30 or more is considered
obese.
However, there are flaws in this statistical method as it does not directly measure body fat
and only assumes that you fall into a particular bodyweight range. It might fail to recognize that
some people carry extra muscle or have a thick bone structure and fall under the overweight
category. Some people might be considered underweight but contain less muscle and bone tissue
while carrying more body fat. These people are more susceptible to some of the obesity health
problems such as diabetes or hypertension.
1
“Defining Overweight and Obesity.” http://www.cdc.gov/obesity/adult/defining.html.
“Obesity and Socioeconomic Status in Adults: United States, 2005-2008.”
http://www.cdc.gov/nchs/data/databriefs/db50.pdf.
2
7
Why is it a problem?
Particular health problems associated with obesity are heart disease, diabetes, high-blood
pressure, arthritis, strokes, and certain types of cancer. These problems are serious because of the
health care costs all American citizens must ultimately pay for.
Health care costs continue to burden Americans as serious illness cases continues to rise
due mainly to obesity-related diseases. It costs the US more than $150 billion annually to pay for
obesity-related health care. These obesity-related cases also cost approximately $73 billion in
lost worker productivity due to absenteeism.3
More than 112,000 Americans die every year from obesity.4 The problem is prevalent
more than ever; approximately 68 percent or 190 million adults are either overweight or obese,
72 million US adults are obese.5 Since 1980, obesity rates averaged around 15 percent; it has
since exploded to 34 percent in 2008.6 Every state except Colorado has obesity rates over 20
percent and that state is expected to pass the threshold soon.
There are other socioeconomic factors that affect the rate of obesity. Racial and ethnic
background, income brackets, and educational accomplishment all have an impact on obesity
rates. Adult obesity rates topped over 30 percent in 42 states for African Americans, 30 percent
in 23 states for Hispanics while rates only topped 30 percent or more in four states for white
people.7
Overall, obesity rates for adults have declined with increasing household income and
education. Rates were about 34 percent for household incomes less than $15,000 while obesity
3
“What we as a community can do to increase physical activity and improve nutritional choices.” Partnership for a
Healthy Community. Retrieved from http://www.pfahc.org/play_eat_well.
4
http://www.cdc.gov/PDF/Frequently_Asked_Questions_About_Calculating_Obesity-Related_Risk.pdf
5
http://www.cdc.gov/vitalsigns/pdf/2010-08-vitalsigns.pdf
6
National Center for Health Statistics. “Prevalence of Overweight, Obesity and Extreme Obesity Among Adults
7
“F as in Fat: How Obesity Threatens America’s Future 2012.” Robert Wood Johnson Foundation. 2012.
8
rates were about 25 percent for household incomes greater than $50,000. The percentage of
obesity declines with an increased level of schooling. Of all obese Americans, 33 percent did not
graduate from high school while 21.5 percent graduated from college or technical school.8
Problems associated with the epidemic are the negative social stigmatization, attitudes,
and systematic discrimination obese people face. Obese workers on average take more sick leave
which increases employer costs and decreases employee productivity. Research shows that
obese workers face discrimination with job interviews, and with health care premiums.
“Overweight employees are assumed to lack self-discipline, are lazy, less conscientious, less
competent, sloppy, disagreeable, and emotionally unstable. Obese employees are also believed to
think slower, have poorer attendance records, and are poor role models. These stereotypes could
affect wages, promotion, and termination”.9 Obese workers are penalized by working for lower
wages and paying higher insurance premiums than non-overweight employees. Studies have
shown that “obesity lowered wage growth rates by nearly 6%”.10 Employers may force
overweight employees to pay larger insurance health care premiums for the same health care
benefits of non-overweight employees. One research study shown 26 percent of overweight
employees were denied benefits from their employers because of their weight and 17 percent
“reported being fired or pressured to resign because of their weight”11
Obese children and adolescents face problems like bullying, social ridicule, and peer
rejection. Research has reported that overweight children have significantly lower self-esteem
than non-overweight children and that most believed they were responsible for their own weight.
91 percent of overweight children “felt ashamed of being fat, 90 percent believed that teasing
8
http://www.healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf
“Bias, Discrimination, and Obesity” by Rebecca Puhl and Kelly D. Brownell
10
“Weight Bias: A social Justice Issue.” Yale Rudd: For Food Policy and Obesity. 2012.
11
“The relationship between obesity, employment discrimination, and employment-related victimization.” By J
Vocational Beh. 1990: 37: 251-66
9
9
and humiliation from peers would stop if they lost weight, and 69 percent believed that they
would have more friends if they lost weight”.12
The issue is also recognized for college students. Obese women were shown to have
lower college acceptance rates. These low rates were usually blamed on the lack of financial
support. Studies prove that overweight students received less family financial support than
normal weight college students. Overweight students depended more on financial aid and student
jobs.
What are the causes?
There is no one single cause to obesity and the epidemic depends on a multitude of
variables. On a macro scale, the causes range from individual behavior and genetics to the
structural environment that people live in. The structural environment is outside the control of
the obese subject. It is complex and instead affects and controls those that inhabit it.
Of course, genetics contributed to obesity. The CDC has reported that genetic traits are
passed down through families that contribute to the accumulation of fat and the need to overeat.
These genetic traits helped these families survive famines. Studies suggest that children are born
genetically programmed with “a diminished ability to use dietary fats as fuel; and an enlarged,
easily stimulated capacity to store body fat”.13 There is ongoing and evolving research into the
epidemic.
The purest, most basic causes of obesity, however, are lifestyle choices and individual
behavior such as consuming too much food while not getting enough physical activity to stay fit.
12
13
“Promoting size acceptance in elementary school children: the EDAP puppet program.
http://www.cdc.gov/Features/Obesity/
10
Adults have consumed approximately 300 more calories on a daily basis than they did in 1985.
This makes up about 110,000 calories annually.
Food portions have increased as food prices have come down. Food marketers run with
larger portion sizes, pushing the most unhealthy foods. This is because they are the cheapest.
Eating food that is considered unhealthy is a prevalent problem. Food that is energy-dense, low
in vital nutrients, containing the highest levels of calories and fat are often labeled as “junk”
food. Certain types of unhealthy food are often much cheaper and more accessible than healthy,
nutritious food. Some families cannot afford or even access healthy and nutritious food such as
fruits and vegetables. This problem runs rampant in “rural, minority and lower-income
neighborhoods”.14
14
Ibid., 8.
11
Chapter 2: The Built Environment
The built environment has an enormous impact on our health. Research has shown that
the built environment has a great influence on our lifestyles, behaviors, and physical activities.15
The relationship between physical activity and obesity in the built environment has shown that
certain limitations change people’s behaviors through educational and motivational programs.
This is because motivating a person to change their behaviors in an environment that contains
barriers would likely not be effective. Interventions are effective only when there is a supportive
social and built environment that is conducive to physical activity.
What is a built environment?
The built environment is defined as an urban environment constructed by humans that
includes buildings, open spaces, human-made infrastructure, transportation vehicles, parks and
trails.16 In many cities around the country, physical activity and social interaction has been
discouraged by the urban environment. The social environment, in many ways, is getting worse
due to social inequities. These disparities include high unemployment, lack of housing, and poor
access to health care; all of which contribute to persistent poverty and obesity.17 The issue of
poverty and obesity will be explained further in depth but it’s important to note that these issues
are interrelated with the built environment. Decisions that promote healthy cities will require
consideration within the social, political, and economic schools of thought.
It is critical to identify the key elements of the built environment that affects obesity.
Only then, can strategies be discussed on improving people’s health. In the remaining sections,
15
Sallis, J.F., B. Saelens, M. Floyd, D. Rodriguez, “Role of Built Environments in Physical Activity, Obesity, and
Cardiovascular Disease.” Circulation 125 (1): 729-737.
16
Frank LD, Engelke P, Schmid T. Health and Community Design, The Impacts of The Built Environment on Physical
Activity. Washington DC: Island Press; 2003.
17
Tabatabai H, Fouad M. The Incidence of Poverty in Developing Countries: An ILO Compendium of Data. 1993
12
we will focus on two problems found within the built environment that have made an impact on
obesity in the United States. These two problems are urban sprawl and urban decay.
Urban sprawl
Urban sprawl is defined as the spread of urban development into undeveloped land from
existing cityscapes.18 It is often associated with residential and commercial developments that
are constructed in a homogenous fashion, largely to minimize costs.19 Urban development and
growth extends into what is known as the suburbs or suburban cities. Particular characteristics of
the suburbs are low population density and single-use zoning that separates from other types. For
example, residential land-use areas might be spaced out further from grocery stores, parks, and
schools than in urban cities.
In America, most of the country’s population resides not in central cities but in suburban
areas. About two-thirds of America’s urban population resides in suburban communities which
are generally located outside of major cities. These people still constitute part of the urban
population. Between 1970 to1990, suburban populations grew 60 percent while major urban
areas grew a modest 12 percent.20 One stark example is the city of New York. The city itself had
a population of 8.2 million in 2005 but the entire metropolitan area of New York had a
population more than 18 million.
There are a number of reasons why suburban cities were created. One of the primary
reasons is that many major cities in the 19th century were facing overcrowding populations,
sanitation problems, and diseases. In response, more cities were created that limited the
18
“A Definition of Sprawl.” Cornell University Department of Development Sociology. Cornell University. 2010.
Web. Apr. 2014.
19
Frumkin, H., L.D. Frank, and R.J. Jackson. 2004. Urban Sprawl and Public Health: Designing, Planning, and
Building for Healthy Communities. Washington, DC: Island Press.
20
Miller, D. 2008. Urban Sprawl: Current Controversies. Pennsylvania. Greenhaven Press.
13
population density and dwellings in a given area. This has become a standard practice in
suburban cities and has contributed to urban sprawl.21
Relationship between urban sprawl and obesity
There is a strong correlation between suburban sprawl and obesity. Studies have shown a
quantitative correlation to obesity rates over time. One research study demonstrated a 145%
increase in obesity rates from 1976 to 2001 based on declining population density over time.22
Another cross-sectional study concluded a relationship between a person’s residence, their travel
patterns and how these factors affected their BMI rates. The results demonstrated there was a 6%
increase in the likelihood of obesity for each hour spent in a car and a 4.8 percent decline with
every kilometer a person walked each day. It’s important to note other factors were included
such as age, income, education, and gender.23 Urban sprawl usually results when outward
population growth occurs but density decreases. When there is a decline in population density,
there is basically an increase in obesity rates.
Reasons for obesity in sprawling communities
How does urban sprawl contribute to obesity? There are a number of reasons. There are
environmental factors that impact our health. There are also factors that point to our food choices
and factors that encourage us to exercise. There are a number of factors in determining our food
choices. They include:
21
Heaton, S., Balbus J., Keck J., Dannenberg, A. Chapter 14: Healthy Communities, Environmental Health: From
Global to Local, 2nd edition. 2010.
22
22. Zhao, Zhenxiang, and Robert Kaestner. Effects of Urban Sprawl on Obesity.Thesis. University of Illinois at
Chicago, 2010. Chicago: n.p., 2010. Web. 25 Apr. 2014.
23
Frank, L., Anderson, A., and Schmid, T. 2004. “Obesity relationships with community design, physical activity, and
time spent in cars.” American Journal of Preventive Medicine. (27): 2. Pg. 87-96.
14
1: Environmental factors that work at the individual level. These aspects include our motivations,
cognitive ability, genetics, and self-efficacy that take part of our food choices and behaviors.
2: The social environment. The social environment is impacted by the individual’s involvement
with friends, family, and others in our community. These forces influence our food choices
through social norms, support, and personal role models. 3: The physical environment. The
physical environment refers to where people eat or prepare meals. Homes, work settings,
restaurants, supermarkets, and schools are examples of our physical food environment.
4: The macro-level environment operates in a distant and an effect that is indirect. Examples of
the macro-level environment are characterized by food marketing, food production, agricultural
policies, and food prices. All these forces impact on our eating behaviors and the choices people
make.24
The other factor is people’s decisions to exercise. People in the US have increasingly
become sedentary and there are a number of reasons. Some reasons include poor access to
destinations such as shops, parks, residential areas, and schools. This may detract people from
walking or biking because it is time-consuming and auto-mobiles are more convenient.
In urban settings, many routes between destinations do not require automobile
transportation because they are within walking distance. Conversely, many suburban towns are
plagued by the necessity of automobile transportation in order to travel wide separations between
destinations. Residential areas are separated from shopping centers, work centers, and
recreational areas. People have no choice but to drive to get to these places. The list of
environmental characteristics promoting the rise of obesity rates keeps growing: transportation,
retail placement, and housing are just a few.
24
Story, M., K. Kaphingst, R. Robinson-O’Brien, and K. Glanz. 2008. “Creating Healthy Food and Eating
Environments: Policy and Environmental Approaches.” Annual Review of Public Health 29: 253-72.
15
Solutions to Urban Sprawl: Increase density
There are many benefits to increasing urban density. Cities that increase density make
walking more attractive, which encourages active lifestyles for residents. Easy access to mass
transit creates an environment less dependent on automobiles. Increased density often correlates
to more diversity and accessibility, providing a variety of basic services to meet the needs of
citizens.
Diversity, in the urban sense, is defined as providing a land-use mix in which there is a
multitude of land uses within a given area. It focuses on providing a balance in terms of land
use, employment, and square footage. Creating a diverse environment will attract a large range
of public interests and various destinations. Improved accessibility is measured through the
number of jobs, retail stores, parks, schools, public facilities, and other locales that is located in
close proximity within a certain timeframe. Providing basic services such as transit, libraries,
grocery stores, repair shops, and recreational areas creates a diverse, accessible, and attractive
environment; a place that is a healthy, walkable, safe and enjoyable hometown with a sense of
community.
In order to create dense communities, it is important to focus on urban designs that
promote healthier and more livable cities. There are a many design approaches that focus on
these traits. Smart growth and new urbanism are approaches at the forefront combatting the
challenges to these characteristics. The approach of smart growth aims to preserve open space,
redevelopment, promote mixed land uses, and creating a greater sense of community.25 New
Urbanism focuses on urban design before the rise of automobiles.
The principles of smart growth are as follows:
2525
Downs, A. 2001. “What does Smart Growth Really Mean?” Planning 67 (4): 20-25.
16
1) Housing opportunities and choices: providing quality housing for people of all economic
backgrounds.
2) Walkable neighborhoods: providing walkable neighborhoods make places more desirable to
live, work, learn, and play.
3) Foster stronger community and stakeholder collaboration: when people work together to
create a vision for where it wants to go as a community, it can create attractive places to live.
4) Promote distinctive and attractive communities with a strong sense of place: encourage
communities to craft a vision and set standards for development and construction that responds
to community values of architectural beauty.
5) Development decisions that are fair, predictable, and cost effective: communities need to
embrace the private sector in order to be successful.
6) Mix land uses: supports integration of mixed land uses into communities as a critical
component of achieving a better place to live.
7) Preservation of open space, farmland, and important environmental areas: preserving
such spaces strengthens local economies, preserves critical environmental areas, improves the
quality of life, and provides new growth opportunities.
8) Transportation choices: In addition to providing more choices for housing, shopping and
leisure activities, transportation is an important factor to smart growth.
9) Strengthen and support development toward existing communities: directing and
investing development towards existing communities already served by infrastructure, utilizes
neighborhood resources, and conserves natural resources and open spaces.
17
10) Take advantage of compact building design: incorporate more compact building design
and living systems as an alternative to conventional, land consumptive development.26
New Urbanism focuses on how to make a more connected network of mixed-land uses
keeping a simpler, automobile-less society in mind. The approach makes special use of
buildings such as city halls, libraries, and congregations. Most urban design approaches all have
similar goals in mind. All try to create a mixed-land use environment, with higher population
density, transit access, walkable streets and open spaces. Providing well defined town centers
with a greater sense of community is a common endeavor.
Innovative designs and development in urban cities requires land-use planning. This kind
of planning requires local governments to make decisions based on a set of priorities. There are
three basic ways to do this. First, governments use zoning ordinances to regulate how the
development or space can be used. Zoning is defined as “the legal regulation of the allowable
use of property and the physical configuration of development on tracts of land, for the
protection of public health, safety, and welfare.”27 Second, local governments provide city
infrastructure, such as utilities, police, roads, and parks. Taxes, levies, and other fees pay for
infrastructure. Lastly, local governments decide and initiate specific development projects.28
Transportation problems in Suburbs
Suburbs are characterized by openness in space, large building setbacks, wide multilane
streets, and extensive parking which accommodates automobile use and travel. Suburban
communities have been criticized for the lack of good sidewalks and bike trails many people
26
26.
“Smart Growth Principles.” Smart Growth Online. National Center for Appropriate Technology, 2014.
Web. 25 Apr. 2014. <http://smartgrowth.org/engine/index.php/principles/>.
27
Ibid., 13.
28
Malizia, E.E. 2005. “City and Regional Planning: A Primer for Public Health Officials.” American Journal of Health
Promotion 19 (5): 1-13.
18
looking for physical exercise need. Many suburban communities are not pedestrian or bicyclist
friendly which can pose problems for people who struggle with weight issues.
Highway and commuting issues
Major highway roads in sprawling communities are characterized by an extensive
“network of well-built, high speed roads [that] may have indirectly contributed to increased
motor vehicle injuries by fueling urban sprawl, thereby increasing commute time, vehicle miles
traveled, and exposure to traffic crashes”.29 Areas that have less urban sprawl and less vehicles
traveling have lower fatality rates.30 Driver’s health and safety are problems in suburbs because
of high speeds, distance, and commuting time.
Highway safety is not the only concern for drivers. Rising commuting time for drivers
has been a problem for a number of years. A study by the Texas Transportation Institute
concluded that in 2010 American drivers were spending roughly 34 hours a year in delayed
traffic around major urban areas compared to 14 hours of delayed traffic in 1982.31 There is a
wide discrepancy in the amount of congestion that major urban areas have. The table that follows
shows cities with the most traffic delays per commuter in the US. The report also postulates that
while average traffic congestion declined from 39 hours in 2005 to 34 hours in 2010, the decline
was due to the economic recession. Past recessions have shown when the economy rebounds,
congestion gets worse.32
29
Ewing, R., R.A. Schieber, and C.V. Zegeer. 2003. “Urban Sprawl as a Risk Factor in Motor Vehicle Occupant and
Pedestrian Fatalities.” American Journal of Public Health 93(9): 1541-45.
30
Ewing, R., and E. Dumbaugh. 2009. “The Built Environment and Traffic Safety: A Review of Empirical Evidence.”
Journal of Planning Literature 23 (4): 347-67.
31
31. Schrank, David, Tim Lomax, and Bill Eisele. “TTI’s 2011 Urban Mobility Report.” Texas A&M University
System, Sept. 2011. Web. 25 Apr. 2014. <http://mobility.tamu.edu>.
32
Ibid., 19.
19
City
2010 Yearly Delay per Auto Commuter
Washington DC
74 hours
Chicago, IL
71 hours
Los Angeles, CA
64 hours
New York City
54 hours
Boston, MA
47 hours
Seattle, WA
44 hours
Phoenix, AZ
35 hours
Denver, CO
49 hours
The amount of time spent in automobiles can be attributed to commuting long distances
from home to work. These long commutes not only have implications on our physical health,
they can cause increased stress, having consequences on mental health and family
relationships.33 Other health concerns related to driving are air pollution, respiratory problems,
cardiovascular health, and increased risk of cancer.34 Also, people that live in sprawling cities
drive 20 to 40 percent more on average than in metropolitan compact cities.35 Car ownership of
all American households is 89.7 percent. Rates in rural areas are higher at 94.6 percent while
lower in urban areas at 87.8 percent.36
33
Koslowsky, M., A.N. Kluger, and M. Reich. 1995. Commuting Stress: Causes, Effects, and Methods of Coping. New
York: Plenum.
34
Frumkin, H., L.D. Frank, and R.J. Jackson. 2004. Urban Sprawl and Public Health: Designing, Planning, and
Building for Healthy Communities. Washington, DC: Island Press.
35
Ibid., 20.
36
Ver Ploeg, M., V. Breneman, T. Farrigan, K. Hamrick, D. Hopkins, P. Kaufman, B. Lin, M. Nord, T. Smith, R.
Williams, K. Kinnison, C. Olander, A. Singh, E. Tuckermanty, R. Krantz-Kent, C. Polen, H. McGowan, S. Kim. “Access
to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences” 2009. US
Department of Agriculture, Economic Research Service.
20
One other problem with traffic in the suburbs is the lack of investment for pedestrian and
bicycle infrastructure that promotes health and safety. Suburban communities often lack good
sidewalks and bike trails that are conducive to their needs of physical exercise. Only 1 percent
of federal transportation funding gets allocated for pedestrian and bicycle infrastructure.37 Many
of these problems are exacerbated for suburban fiscal constraints on street and sidewalk
infrastructure, limiting options to increase connectivity or opening up to a greater street network
access.38 This does not accommodate to the needs of pedestrians or walkers. Many suburbs in
fact do not have sidewalks or have good sidewalks since road space is focused more on the use
of automobiles.
Some suburbs are not pedestrian friendly due to safety concerns. Pedestrian deaths in the
United States are three times higher than in Germany and 5 times higher than in the Netherlands;
largely due to road design systems that separate vehicles from pedestrians and bicyclists as well
as reducing vehicle speeds.39
Solutions for transportation and walkable communities
There are a number of solutions that suburban cities can adopt to promote a more
walkable environment and discourage the use of cars. Many of the solutions require other landuse changes that affect transportation decisions.
37
Alliance for Walking and Biking. 2010. Bicycling and Walking in the United States: 2010 Benchmarking Report.
Washington, DC: Alliance for Walking and Biking.
<http://peoplepoweredmovement.org/site/index.php/site/memberservices/bicycling_and_walking_benchmarking
_project/>.
38
38. Harwood, Stacy A. “Environmental Justice on the Streets: Advocacy Planning as a Tool to Contest
Environmental Racism.” Journal of Planning Education and Research 23.1 (2003): 24-38. SAGE Journals. Web. 25
Apr. 2014. <http://jpe.sagepub.com/content/23/1/24.abstract>.
39
Pucher, J., and L. Dijkstra. 2003. “Promoting Safe Walking and Cycling to Improve Public Health: Lessons from the
Netherlands and Germany.” American Journal of Public Health 93 (9): 1509-16.
21
Transportation design changes
The first solution to discouraging the use of automobiles is through a series of design
changes. These changes encourage traffic safety, promote active transportation options
(walking or bicycling), embrace compact urban development, and create a cohesive urban
environment that provides a range of benefits for a community.
Complete Street Policy
Cities can also adopt a complete street policy that requires cities to provide pedestrian and
bicycle infrastructure whenever new or reconstructed roadways are installed.40 The state of Oregon,
through its Oregon Bike bill, requires the entire state and local government to implement footpaths and
bicycle lanes “wherever a highway, road, or street is being constructed, reconstructed, or relocated.”41
Transit Infrastructure
Providing mass or public transit is an important aspect to creating healthy cities. The
World Health Organization created the Healthy Cities: Promoting Health in the Urban Context.
One of its primary criteria for healthy cities is Distance to transit which measures “home or work
to the nearest rail station or express bus stop, and is operationalized in terms of transit route or
stop spacing”42. Communities that provide adequate service in convenient locations within
walking distance from residential or commercial areas tend to reduce reliance on automobiles.
40
National Complete Streets Coalition. 2010. “Policy Elements.” http://www.smartgrowthamerica.org/completestreets/changing-policy/policy-elements/.
41
Bicycle & Pedestrian Program. 1971. “Bike Bill and Use of Highway Funds.”
http://www.oregon.gov/ODOT/HWY/BIKEPED/Pages/bike_bill.aspx /.
42
Hancock,T.,and L. Duh. 1986. Healthy Cities: Promoting Health in the Urban Context. Healthy Cities Paper #1.
Copenhagen: WHO Europe.
22
Mass transit often requires “at least twelve units per acre to support rapid rail service and seven
units per acre to support local bus service every hour”.43
Typical mass transit options seen in cities include bus transit and rail services. In addition
to the health benefits of transit infrastructure, there are also environmental and land-use benefits
of public transit. Public transit has demonstrated that it is more energy efficient and creates less
pollution than automobiles occupied by less people. A recent study has shown that automobiles
“emit about 95 percent more carbon monoxide, 92 percent more volatile organic compounds and
almost twice as much carbon dioxide and nitrogen oxide than public vehicles for every passenger
mile traveled.”44 In short, using public transit lowers a person’s carbon footprint while easing
traffic congestion by taking automobiles off the road.
Mass transit also facilitates greater use of limited space in cities. Many economic centers
are built around mass transit to efficiently use space and create a more compact urban
environment.
Transit-Oriented Development
A relatively new concept called transit-oriented development (TOD) has become a
standard for transportation design in many American cities such as Boston, Washington, DC,
Miami, Portland, San Francisco, Seattle, Dallas, and Bethesda, Maryland. The principles of TOD
43
Booth , G. , Leonard , B. , and Pawlukiewicz , M. “Ten Principles for Reinventing America ’ s Suburban Business
Districts . Urban Land Institute.” http://www.smartgrowth.org/pdf/uli_Ten_Principles.pdf,
2002 .
44
Layton, L., 2002. “Study Lists Mass Transit Benefits.” The Washington Post, Page B05
23
include “a walkable design with the pedestrian as the highest priority; a high-density, highquality, mixed-use development within a ten-minute walk of a transit station”.45
Transit is classified as active travel meaning people who use it will most likely require
walking at some point of the trip which gives people an opportunity for physical exercise.
Bicycle infrastructure
Cities should invest in bicycle infrastructure to encourage people to get physical exercise
while still making it a viable transportation option. Important considerations are to make it
accessible, convenient, and safe. Investment in bicycle lanes has become more prevalent in a
number of cities and people are demanding it. Cities such as Portland, Seattle, Santa Monica, Los
Angeles, Baltimore, Eugene, Washington, D.C., and Cincinnati have begun to dedicate more
money into bicycle infrastructure such as bicycle parking lots, on-street bike corrals, and parking
garages.46 There are economic benefits to doing so.
Automobile parking is estimated to cost about $2,200 for a surface lot and about $12,500
on average to construct a single garage parking space while continuing to rise. Costs are related
to location, foundation requirements, appearance, code requirements, and other factors.47
Bicycle parking has a number of costs. The cost to install bike racks that can park two
bicycles has been estimated to be about $150 to $300. The cost for bicycle lockers is about
45
Cervero, R., S. Murphy, C. Ferrell, et al. 2004. Transit Oriented Development in the United States: Experiences,
Challenges, and Prospects. TCRP Report 102. Washington, DC: Transportation Research Board.
http:onlinepubs.trb/onlinepubs/tcrp/tcrp_rpt_102.pdf
46
Blue, Elly. “The Economic Case for On-street Bike Parking.” Grist. 11 Apr. 2011. Web. 25 Apr. 2014.
<http://grist.org/biking/2011/-04-11-the-economic-case-for-on-street-bike-parking/>.
47
47. “General Inquiry.” Parking Garage FAQs. Carl Walker Construction, Inc., 2012. Web 25 Apr. 2014.
<http://www.carlwalkerconstruction.com/faq.php>.
24
$1000 to $4000. There are also bike corrals that can replace one on-street automobile parking
space allocating 11 bicycle parking spaces48
The city of Fort Worth recently installed 80 bike racks that can hold up to 160 bicycles in
a busy shopping district that cost about $12,000. This amounts to $78 per space. An estimated
$160,000 was spent to restripe the streets that replaced two car lanes with bike lanes. A nearby
automobile parking garage cost more than $5 million dollars for 320 parking spaces which costs
about $16,000 per space.49
There is another economic consideration for replacing automobile parking with bicycle
parking. A study by Alison Lee concluded that space used for bicycle parking is more efficient
at generating revenue than automobile parking. Even though automobile drivers on average
spend more money than cyclists, in terms of space-efficiency, cyclists generate more economic
activity than automobile users. For example, the study concluded that about 140 square feet of
parking generated $78 per hour for one automobile in a given parking space. On the other hand,
6 bicyclists would generate $47 each for a total of $283 per hour in an area of about 140 square
feet.50
Cities might want to consider increasing their investment in bicycle parking if they are
located in bicycle friendly communities and there a number of bicycle customers in a given area.
Aside from the significant cost savings of bicycle parking over automobile parking, there’s
added value in investing in bicycle parking near business districts. Investing in bicycle parking
can add value to local neighborhoods because bicyclists parking in attractive, convenient, and
48
Ibid., 24.
Ibid., 24.
50
Lee, Alison. What is the Economic Contribution of Cyclists Compared to Car Drivers in Inner Suburban
Melbourne’s Shopping Strips? Thesis. University of Melbourne, 2008. N.p.: n.d. Web. 25 Apr. 2014.
<http://colabradio.mit.edu/wp-content/uploads/2010/12/Final_Thesis_Alison_Lee.pdf>.
49
25
safe locations near destinations such as shops are more likely to spend more locally.51 In
addition, businesses that value bicycling as a form of sustainability and livability can spur future
users to support them. Businesses that don’t value bicycling can miss out on these opportunities.
In addition to the economic and health benefits of bicycling, there is the consideration of
improved air quality. The city of Bogota, in the country of Columbia has revamped much of its
mass transportation because of poor air quality. Air quality has improved because they replaced
a less efficient transportation system that caused automobile congestion and air pollution. In
place is a system with a dedicated bicycle path system and lanes dedicated to rapid-transit. The
result has been less air pollution.52
Walkable Communities
Walkable communities are those where residents can walk easily and safely to nearby
destinations such as retailing, bus stops, recreational spaces, or to work.53 One of the biggest
measures that determine how walkable a community is through a walkability index.54 Its index
measures mixed land use, street connectivity, and residential density to determine how walkable
neighborhoods are. Studies have shown that people of all ages engage in more physical activities
in neighborhoods with more mixed land use than in neighborhoods with single-uses.55
Furthermore, destinations within 1 kilometer or 0.5 miles has been shown to increase more
51
Ibid., 24.
Gilbert, A. 2008. “Bus Rapid Transit: Is Transmilenio a Miracle Cure?” Transport Reviews 28 (4): 439067.
http://www.informaworld.com/smpp/content~db=all~order=page.
53
Saelens, B.E., and S.L. Handy. 2008. “Built Environment Correlates of Walking: A Review.” Medicine & Science in
Sports and Exercise 40: S50-66.
54
Frank, L.D., J. F. Sallis, et al. 2009. “The Development of a Walkability Index: Application to the Neighborhood
Quality of Life Study.” British Journal of Sports Medicine.
http://bjsm.bmj.com/content/early/2010/04/22/bjsm.2009.058701.full.
55
Frank, L.D., T.L. Schmid, et al. 2005. “Linking Objectively Measured Physical Activity with Objectively Measured
Urban Form: Findings from Smartraq.” American Journal of Preventive Medicine 28: 117-25.
52
26
physical activity.56 For example, living in close proximity to open spaces such as parks, trails,
and other recreational spaces has been associated with higher levels of recreational activitiy.57
People that lived within a quarter of a mile of a park were the most frequent users, about 43
percent. Those that lived more than a mile away from a park were only 13% as likely to use the
parks.58 The quality of recreational spaces is equally important. Parks and trails that are kept
maintained, safe, and well-lit are more attractive.
Cities that have greater street connectivity often have in shorter routes, like homes to
parks. Higher residential density can be built near destinations and retailing which can result in
more walking opportunities.
Pedestrian Infrastructure and design features
Safety is one of the most important measures for pedestrians and can encourage more
physical activity. Designers can implement pedestrian safety zones which are designated areas to
“separate vehicles from pedestrians and bicyclists”.59 These areas are targeted to improve
conditions for pedestrians, often by decreasing vehicle speeds through street modifications,
increased police enforcement, or community outreach. Areas with safe crossings, speed humps
and traffic lights have more physical activity because traffic is calmer.60 Traffic calming gives
pedestrians and bicyclists safer opportunities for physical activity as it alters driver’s behavior.
56
Kligerman, M., J.F. Sallis, et al. 2007. “Association of Neighborhood Design and Recreation Environment
Variables with Physical Activity and Body Mass Index in Adolescents.” American Journal of Health Promotion 21:
274-77.
57
Kaczynski, A.T., and K.A. Henderson. 2007. “Environmental Correlates of Physical Activity: A Review of Evidence
about Parks and Recreation.” Leisure Sciences 29: 315-54.
58
Cohen, D.A., et al, 2007. “Contribution of Public Parks to Physical Activity.” American Journal of Public Health 97:
509-14.
59
NHTSA (National Highway Traffic Safety Administration). 2008. Countermeasures That Work.3rd Ed. Washington,
DC: US Department of Transportation.
60
Carver, A., A.F. Timperio, and D.A. Crawford. 2008. “Neighborhood Road Environments and Physical Activity
among Youth: The Clan Study.” Journal of Urban Health: Bulletin of the New York Academy of Medicine 85: 532-44.
27
These modifications can be made to prevent pedestrian and bicycle accidents or injuries. Other
typical approaches that can be taken are “installing traffic signals, in-pavement flashing lights,
pedestrian overpasses, fences that inhibit street access, and sidewalks”.61 Adding roundabouts in
residential areas and four-way stops are other traffic engineering strategies used to manage
vehicle speeds. Also, speed humps are an effective measure to manage speeds.62
Amenities to parks are equally important to create walkable communities. Access to
recreational facilities and spaces is essential for people to meet their physical activity needs. Park
amenities such as restrooms, drinking fountains, and exercise equipment contribute to higher
levels of physical activity for users.63
There are other considerations to note in the designing of healthier communities for
pedestrians. One is reducing fall injuries in people’s homes and other public facilities. Fallrelated injuries for elderly people have been rising.64 Modifications such as lighting
improvement, bathroom guard rails, and stairway banisters reduce the potential for injuries. The
Americans with Disabilities Act (ADA) requires many new buildings to implement universal
design features that can be used to reduce walking injuries. Older Americans also should
participate in regular physical exercise to improve strength and balance.
Walkable communities need attractive features and destinations to encourage people to
do join in. Retail and recreational spaces need to be located near people’s homes, but people
61
Retting, R.A., S.A. Ferguson, and A.T. McCartt. 2003. “A Review of Evidence-Based Traffic Engineering Measures
Designed to Reduce Pedestrian-Motor Vehicle Crashes.” American Journal of Public Health 93(9): 1456-63.
62
Tester, J.M., G.W. Rutherford, Z. Wald, and M.W. Rutherford. 2004. “A Matched Case-Control Study Evaluating
the Effectiveness of Speed Humps in Reducing Child Pedestrian Injuries.” American Journal of Public Health 94 (4):
646-50.
63
Reynolds, K.D. J. Wolch, J. Byrne, C. Chou, G. Feng, S. Weaver, and M. Jerrett. 2007. “Trail Characteristics as
Correlates of urban Trail Use.” Health Promotion. 21: 335-45.
64
Mack, K.A., and K.D. Liller. 2010. “Home Injuries: Potential for Prevention.” American Journal of Lifestyle
Medicine. 4. (1): 75-81.
28
need to also feel safe in order to use them. Focusing on creating, building, and retrofitting
communities that encourage more walking will lead to more physical activity.
Environmental impacts of Urban Sprawl: Habitat destruction
Between 1970 and 1990, more than 19 million acres of rural land in America was
developed. Sprawl undermines the benefits that ecosystems provide “such as water and air
purification, mitigation of floods, soil generation and fertility and climate stabilization”.65 Urban
development has been found to contribute to the destruction of wetlands and forests, which
decreases biodiversity and increases natural disasters such as floods.
While many people move to the city from rural areas for better jobs and life
opportunities, others are leaving cities triggering more residential and commercial development
in rural areas. Many rural cities are facing commercial and residential development that not only
affects the character of the city but negatively impacts the city’s environment.
One of the most devastating consequences of overdevelopment due to sprawl is flooding.
Many areas end up being developed over wetlands. Wetlands are defined as: “those areas that are
inundated or saturated by surface or groundwater at a frequency and duration sufficient to
support, and that under normal circumstances do support, a prevalence of vegetation typically
adapted for life in saturated soil conditions. Wetlands generally include swamps, marshes, bogs
and similar areas.”66
65
Miller, Debra A. Urban Sprawl. Detroit: Greenhaven, 2008. Print.
66. “Wetlands Definitions.” Home. U.S. Environmental Protection Agency, 25 Sept. 2013. Web. 25 Apr. 2014.
<http://water.epa.gov/lawsregs/guidance/wetlands/definitions.cfm>.
66
29
When wetlands are replaced by development, flooding becomes a large concern.
Development needs a buffer to absorb the water or else it runs the risk of floods. Wetlands also
have the benefit of filtering water, provide habitat, and absorb winds as well as tidal forces.67
According to the Sierra Club, “floods are the most frequent, and the loss of life and property are
greatest, in countries that have lost the most wetlands – especially in the past 30 years.”68 The
Federal Emergency Management Agency (FEMA) has estimated that 892 people were killed
from floods nationwide from 1988-97 and that an average of $4.3 billion were allocated each
year to pay for flood damages.69
Solutions to land-use impacts of urban sprawl
Urban growth management
One of the most effective planning strategies that states or local cities can use to curb
urban sprawl is to establish growth management policies. Growth management is defined as “the
utilization by government of a variety of traditional and evolving techniques, tools, plans, and
activities to purposefully guide local patterns of land use, including the manner, location, rate,
and nature of development.”70 It’s vital not only for public health concerns such as obesity but
also to keep cities livable and attractive. Growth management focuses on the following key
areas71:
1: Concerns with land use and development in small urbanizing cities.
67
67. “Basic Facts about Wetlands.” Wetlands. Defenders of Wildlife, 2013. Web. 25 Apr. 2014.
<http://www.defenders.org/wetlands/basic-facts?glid=CISltrbVir4CFYdrfgodC10ALA>.
68
68. “Sprawl: The Dark Side of the American Dream.” 1998 Sprawl Report. Sierra Club, 1998. Web. 25 Apr.
2014. <http://www.sierraclub.org/sprawl/report98/report.asp#costs>.
69
Ibid., 30.
70
Porter, D.R., Performance Standards for Growth Managagement. PAS Report 461. APA Planning Press: Chicago,
IL. Ed. 1996.
71
Ibid., 30.
30
2: Dynamic policy-making processes that constantly evolve to meet current trends while
updating its objectives.
3: Anticipating and accommodating future development needs by balancing competing
development needs.
4: Urging citizens to look past their own communities and look at regional goals.
One of the considerations for growth management includes preparing for emerging
changes and challenges in their local communities. When governments postpone planning needs,
the quality of life is at risk of being compromised. For example, when a city underinvests in its
city such as public roads, public facilities, public services, and public utilities, then governments
will find it difficult to administrate high level operations. In rapidly growing cities, governments
will find it difficult to manage higher growth when citizens demand a variety of additional public
facilities and services. Cities will also need to recognize the challenge of securing funding for
new development and operations. Unplanned growth can also take up valuable natural and
cultural assets such as farmland, wildlife habitats, and historic features that symbolize the
community’s heritage. However, there are also benefits of having growth if it’s planned well.
More employment opportunities can spring up with the demand for more products and
services. New development such as roads, housing, schools, and business parks would need to be
constructed to facilitate more resident needs. Retail stores would be centrally located to meet the
needs of its residents. More development also could result in a wider tax base for the community
that would produce more social and cultural activities.72
There is a variety of techniques and tools cities can use in community and growth
management programs. Below is a list of examples:
72
Ibid., 30.
31
Growth limits
This technique specifies annual quotas for building permits. This helps limit the rates for
urban growth. There are jurisdictions in California and Colorado that have adopted this system.
This system helps regulate the amount of growth to a pace the city can handle. Some cities use
this technique to retain a small-town character or maintain open spaces.
Moratoriums and Threshold standards
Moratoriums are growth limits used on a temporary basis based on the city’s concerns
and needs. It gives the community time to discuss concerns related to safety, welfare of the
community, or health. Limits can be imposed for a number of months to a few years.
Threshold standards institute rules that must be met before development can proceed.
Standards call for public facilities and services as well as for environmental standards such as air
and water quality.
Land acquisition programs
This is a common approach to protect environmentally sensitive lands from urban and
suburban development. This approach often requires special taxes to fund land acquisition. Land
can be obtained through either development rights or to all right of the property.
Agricultural or conservation zoning
This kind of zoning is intended to protect farmland and other forms of valuable
environmental features from development. These types of regulations often require minimum lot
sizes that protect it from development in areas that are appropriate for farming practices.
32
Transferable Development Rights (TDR)
This common practice is used to recompense property owners whose land is impacted by
regulations that might prevent them from development or utilize its property value. Other
programs are voluntary and work through the free-market. In the state of Washington, counties
such as King County have a TDR program that works by providing incentives to landowners to
give up their development rights by giving them financial compensation. Property owners are
still able to retain their land as long as it remains undeveloped. King County has been able to
protect 141,500 acres of land that has valuable natural resources.73
Sprawl has consequences that impact not only human health but the quality of the
environment which can have an impact on human health as well. Protecting and preserving our
natural environment is important because it has a range of benefits that serve humans as well as
other living things.
Inner-City Decay
Definition
The idea of urban decay takes on a number of meanings. For one, it refers to the physical
decay of buildings and structures that have fallen into disrepair. It also refers to disinvestment in
neighborhoods, depopulation, lack of basic services, and the disappearance of economic centers.
There also might be significant job losses that results in high unemployment, abandoned
buildings and crime.74 Certain characteristics have emerged in depressed or deprived
neighborhoods. These include low housing quality, spatial stratification, and inheritance of
73
“Transfer of Development Rights (TDR) Program.” Sustainable Building. King County, n.d. Web. 2014.
<http://www.kingcounty.gov/environment/stewardship/sustainable-building/transfer-development.aspx>.
74
Andersen, Hans Skifter. Urban Sores: On the Interaction between Segregation, Urban Decay, and Deprived
Neighborhoods. Aldershot, Hants, England: Ashgate, 2003. Print.
33
inequity. These structural problems have promulgated an array of social and economic problems
on an individual as well as a community level.
In this context, we will focus more on the social impact on health rather than the built
environment’s impact on health.
Context
The decline of inner cities is largely attributed to the wealth moving away to the suburbs.
Some cities struggle to keep a sustainable tax revenue system that pays for services such as
schools, parks, and recreation areas. Other deficiencies noted in cities are the rising concentration
of wealth and the spread of poverty with increasing urbanization. Problems such as crime,
violence, disease, and family disruption have created social problems such as class division and
racial segregation.75
Affluent suburbs can generate high real estate values for their properties and offer lower
property taxes. This leads to superior municipal services. On the other hand, some inner cities
with high poverty rates generate “high demand for services but yields low property values; thus
higher tax rates required to support generally inferior services. The end result is a vicious cycle
whereby city taxes are raised to maintain deficient services”.76
Notable cities in the US impacted by urban decay are Detroit, Cleveland, Baltimore,
Memphis, New Orleans, St. Louis, and Oakland. In the past, many of these cities were
considered middle-class stalwarts that have declined considerably over the years.
There are other trends to note. There has been a shift in population and wealth from urban
areas to suburban areas. As a result, poverty is becoming more urbanized while poverty rates in
75
Hynes, H. Patricia., and Russ Lopez. Urban Health: Readings in the Social, Built, and Physical Environments of U.S.
Cities. Sudbury, MA: Jones and Bartlett, 2009. Print.
76
Ibid., 34.
34
suburban areas have declined. Poverty dropped from 44% to 31% from 1970 to 1980 and again
to 28% in 1990 in nonmetropolitan areas. On the flip side, poverty in inner cities rose from 56%
in 1970 to 72% in 1990. Poverty is defined as in which a census tract has a poverty rate between
20 percent and 40 percent.77
These facts suggest that more needs to be done to reduce income inequality and health.
Poorer neighborhoods often lack basic health services because they lack the financial resources
to pay for basic services while affluent neighborhoods often have access to quality health
services.
While urban cities have economic and social problems, health has also been a concern.
Obese people, which are hit harder in urban cities than in the suburbs often lack the necessary
options and healthy choices in order to be healthy. Root problems include lack of healthy food
sources, poor transportation services, poor education, and lack of social support.
The relationship between inner-city decay and obesity
To begin, inner-city populations have higher rates of being overweight or obese than
suburban cities. A study by the National Health Interview Survey showed “that men living in
center cities were more likely to be obese (39.4%) than suburban men (35.5%). Similarly, 20.6%
of center city dwelling women were obese vs. 19.1% of suburban dwelling women”.78 In short,
rates are higher in urban cities than in suburban cities.
There are a number of reasons for higher obesity rates in inner cities. The built
environment itself has presented some challenges in terms of access to healthy food sources and
77
Ibid., 34.
Lopez, Russell P., and H. Patricia Hynes. “Abstract.” National Center for Biotechnology Information. U.S. National
Library of Medicine, 18 Sept. 2006. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1586006/>.
78
35
physical activity centers; however the majority of the problems are related to the socio-economic
status of people and institutionalized racism that leads to health problems.
There are higher rates of non-white people in large metropolitan areas. According to a
Brookings report in 2008, 68 percent of the nation’s multi-race population lives in metropolitan
areas. About 74 percent of the black population and 80 percent of the Hispanic population lives
in major metropolitan areas. Rates are higher among persons of low socioeconomic status and
non-white ethnicities such as Hispanic or black people.79
Socio-economic Status
Race and ethnicity have influenced health based on people’s access to education, jobs,
income, and wealth; all of which are indicators of socio-economic status (SES). SES is related to
most health outcomes such as diabetes, heart disease, and hypertension, all factors related to
obesity. “Socio-economic characteristics might in part explain racial and ethnic differences in
adiposity and health”.80 In general, “people who are poorer and who have less education are
more likely to suffer from diseases, to experience loss of functioning, to be cognitively and
physically impaired, and to experience higher mortality rates.” People of different social statuses
lead different lives − childhood conditions, educational experiences, occupational careers,
personal relationships, recreational activities, health care, and neighborhood circumstances. The
aforementioned life experiences have an indirect impact on the opportunities and life choices
people make that affect our health. Adults with higher SES or resources tend to grow up in
conditions with:
79
Berub, A. Frey, William. Et al. 2010. “State of Metropolitan America: On the Front Lines of Demographic
Transformation.” The Brookings Institution Metropolitan Policy Program.
80
Lovasi, G. Hutson, M. et al. “Built Environments and Obesity in Disadvantaged Populations”. 2009. Epidemiologic
Reviews. http://epirev.oxfordjournals.org/content/31/1/7.full.pdf+html.
36
“[B]etter nutrition, fewer health risk behaviors, safer neighborhoods, and more economic
resources. As adults, higher SES persons mature in more secure and rewarding careers and
residential situations. Higher education provides explicit facts, and leads to attitudes and
behaviors that are conducive to better health as well as a willingness to delay gratification in
order to achieve desired goals. Persons of higher status smoke less, eat better, and exercise more
than persons with fewer resources.”81
A study showed that lower-income neighborhoods are 1.28 to 1.34 times more likely to
have fast-food restaurants compared to higher-income neighborhoods.82 Schools in higherincome neighborhoods have 32 to 50 percent fewer fast-food restaurants and convenience stores
within walking distance than schools in lower-income neighborhoods. Schools with higher
socioeconomic status will offer more healthy options than schools with lower socioeconomic
status. Less healthy options tend to be vending machines, school stores, and snack bars.83
These factors are clues to possible social and economic determinants of obesity. Bridging
this gap can help reduce the negative health outcomes by giving people more opportunities to
practice better health.
Residential Segregation
Other issues are prevalent in economically distressed areas that impact people’s health.
Residential segregation has played a role in maintaining differences in socioeconomic status by
limiting economic and resident opportunities. Residential segregation has discriminated against
81
Crimmins, E., Hayward M., and Seeman T. 2004. “Race/Ethnicity, Socioeconomic Status, and Health.” National
Academies of Sciences.
82
Powell LM, Chaloupka FJ, Bao Y. “The availability of fast-food and full-service restaurants in the United States:
Associations with neighborhood characteristics.” American Journal of Preventive Medicine. 2007; 33:S2405.
83
Delva J, O’Malley PM, Johnston LD. “Availability of more-healthy and less healthy food choices in American
schools: A national study of grade, racial/ethnic, and socioeconomic differences.” American Journal of Preventive
Medicine. 2007; 33:S226–39.
37
minority Americans throughout the 20th century to the present day with government sponsored
housing discrimination, exclusionary zoning practices, and private discrimination. People who
live in neighborhoods which have a poor reputation in regards to high crime rates and
deteriorating housing can be discriminated from obtaining jobs or bank credit.84 This intentional
discrimination still impacts millions of people in America today.85
Psychological Stresses of Urban Living
The socio-economic status and racial segregation isn’t the only issue that affects people
in dense urban areas. There is also the psychological factor; in which a variety of stresses affect
people. There are “stresses of discrimination, segregation, poverty, and racism−all these are
interwoven to influence the growth and development of the black individual and the black
community.”86 Disadvantaged groups of people who go through repeated exposures to traumatic
experiences such as accidents, addiction, malnutrition, and disease are likely to face structural
problems later in life. Those that go through multiple traumatic experiences are likely to do
poorly in school, develop little skills, and not succeed in employment. Some people turn to
crime, drug addiction, acquire mental illnesses, and even commit suicide. Some people look at
their place of residence “as a site of fear and blame rather than choice and pride.”87 In short,
stress of living in areas that are not conducive to personal growth has social and psychological
84
Ibid., 33.
Seitles, M. 1996. “The Perpetuation of Residential Racial Segregation in America: Historical Discrimination,
Modern Forms of Exclusion, and Inclusionary Remedies.” Journal of Land Use and Environmental Law.
86
Jackson, J. 1973. “Psychological Stresses of Urban Living: New Directions for Mental Health Services in the Inner
City” Journal of the National Medical Association. 65. (6): 483-511.
87
Ibid., 33.
85
38
impacts that can affect a person’s ability to get educated, to gain employment opportunities, and
ultimately to stay healthy.88
Built environmental problems in dense cities
Wealth is moving away from cities. Groceries, hospitals, community/recreational centers
are built in neighborhoods where there is an ability to pay. Inner city neighborhoods with low
socio-economic status have widespread building deterioration. In very hard-hit areas,
abandonment can occur. This can attract the most marginalized groups of society such as
criminals and people afflicted with drug addiction. It also can lead to visible anti-social
behaviors such as crime, vandalism, violence, rioting, increased noise, frequent moving, and
racial tension. This will likely drop property values that takes years to rebuild.89
Public transportation is a central need in major cities. However, many cities have poor
transportation systems that may make it difficult for people to access to jobs or other
destinations.
The recession during the late 2000’s made things worse for public transportation across
the country with cuts to services because of lower tax revenues. Despite cuts to public
transportation, ridership has increased because of high gas prices. The American Public
Transportation Association estimated that ridership for mass transit systems have increased by
38% from 1995 to 2008.90 These cuts also created a strain on many Americans, especially the
less well-off who rely on public transportation to reach their jobs. According to a report, “access
88
Jackson, J. 1973. “Psychological Stresses of Urban Living: New Directions for Mental Health Services in the Inner
City” Journal of the National Medical Association. 65. (6): 483-511.
89
Ibid., 33.
90
“2013 Public Transportation Fact Book.” American Public Transportation Association. Retrieved from:
http://www.apta.com/resources/statistics/Documents/FactBook/2013-APTA-Fact-Book.pdf.
39
to jobs is inextricably linked to poverty, which rose 37% between 2000 and 2009…One reason
for this disparity is the lack of access to jobs through public transportation.”91
Many cities are crippled with problems such as long waiting periods for transit, poor
connectivity between transit and jobs, and the low percentage of residents near transit stops.
There has been a spatial mismatch, “between jobs and people in metropolitan America…In some
metro areas, inner-city workers are cut off from suburban labor market opportunities. In others,
low-income suburban residents spend large shares of their incomes owning and operating
cars.”92
A 2009 report from The Center for Transportation Excellence states that low-income
families spend more than 40% of their income on transportation. This has increased by 33% from
1992.93
Solutions
There are strategies for poor communities to improve their health. Since poorer
individuals might lack the financial resources to improve their own lives, approaches can be
taken at the community level. One effective strategy is called the Social Capital approach.
Social Capital
Social capital, broadly defined as “the features of social organization, such as trust,
norms, and networks that can improve the efficiency of society by facilitating coordinated
91
Berr, Jonathon. “The Cities With the Best and Worst Public Transportation.” TopStockAnalysis RSS. N.p., 1 June
2011. Web. <http://www.topstockanalysts.com/index.php/2011/06/01/the-cities-with-the-best-and-worst-publictransportation/>.
92
Ibid., 40.
93
Stranded at the Station: The Impact of the Financial Crisis in Public Transportation. Rep. Washington, DC:
Transportation For America, 2009. Web.
<http://www.t4american.org/docs/081809_stranded_at_thestation.PDF>.
40
actions.”94 Social capital can affect health through “an exchange of network-based resource,
collective action, and the enforcement of social norms for health behaviors.”95 Enhancing the
social capital of communities can improve the quality in a variety of ways.
There are a number of mechanisms in which social capital can improve health. In
communities where social networks are lacking, identifying ways to improve social networks can
lead to better health outcomes. In Oakland, CA, a study was done on the effect of bringing in a
supermarket to a neighborhood uing Social Capital measures. It was shown that psychological
stresses from living in poor communities can be mitigated through the positive psychosocial
effects of social cohesion. When people live in a community with familiar residents, they are
likely to feel safer. This can mitigate the psychosocial stress associated with crime.96 Associated
with this idea, is the use of group enforcement of social norms. A group of concerned citizens
can intervene when they see undesirable behavior such as drug abuse, vandalism, or underage
drinking through informal social control.
Another known mechanisms that links community Social Capital to health outcomes is
the ability of residents to take collective action to improve their communities. Communities can
mobilize collective action to protest closures of community gardens, and get local ordinances
passed to restrict fast-food restaurants through land-use zoning. In short, Social Capital ties
groups of people together to create social support and a sense of community. This can help
people create neighborhoods that are capable of forming organizations and mobilizing for
political purposes to improve their communities.
94
Putnam, R. 1993. Making Democracy Work: Civic Traditions in Modern Italy. Princeton, NJ: Princeton University
Press.
95
Eicher, Caitlin. "Social Capital and Community Design." Trans. Making Healthy Places: designing and building for
health, well-being, and sustainability. Washington, DC: Island Press, 2011. 117-128.
96
Altschuler, A., C. Somkin, and N. Adler. “Local Services and Amenities, Neighborhood Social Capital, and Health.”
Social Science and Medicine 59 (6): 1219-29.
41
There are strategies that communities can take to improve the quality and characteristics
of their local settings which affect our social and mental well-being. Areas that lack green-space
such as trees or other forms of vegetation can increase mental fatigue, anxiety, depression, and
contribute to aggression or violence.97 This also includes areas that are crowded, noisy, and
dilapidated. Re-designing areas that provide more green-spaces, creating more inviting public
spaces, and areas that encourage physical activity.
The next section will explain the problems and solutions of open spaces such as greenspaces. It will explain how they enhance or deter the mental and physical well-being of people in
our communities.
Open Spaces
Open spaces are an essential element for communities to have in creating diverse
compact cities. People need space to exercise, to socialize, and to connect with the outer
environment. Open spaces affect our physical, mental, social, and economic well-being.98 Many
cities, particularly heavily dense cities, do not provide adequate open spaces for people to enjoy
themselves. Conversely, open spaces are more common in suburbs and rural areas because the
density of the built environment is less.
As population in America’s cities continues to increase, the amount of open space
continues to decrease. In addition, reduced funding and rising land values limit the opportunities
to expand and maintain parks. This is especially true in low-income communities with limited
97
Grahn, P., and U.A. Stigsdotter. 2003. “Landscape Planning and Stress.” Urban Forestry & Urban Greening 2 (1):
1-18.
98
Dannenberg, Andrew L., Howard Frumkin, and Richard Jackson. Making Healthy Places: Designing and Building
for Health, Well-being, and Sustainability. Washington, DC: Island, 2011. Print.
42
resources where access to parks is undermined by the lack of safe and nearby parks.99
Regardless, opportunities exist that can make open spaces more accessible, safer, and cost
effective.
What are open spaces?
Open spaces are broadly defined. pen spaces in the urban context are referred to as
outdoor physical areas that are unoccupied and are not covered by buildings or other physical
objects. Open spaces can also be defined as paths wide enough that extend or flow into city
spaces. Examples of urban open spaces are parks, greenways, water shorelines, playgrounds, ball
fields, flower gardens, community gardens, bike trails, and boulevards.
Open spaces can be inclusive and exclusive, depending on how people use the spaces.
People with their personal backyards are often defined as private spaces while parks and plazas
are often defined as public spaces. Other areas such as a courtyard at an apartment, a community
garden, and golf fields might be defined as semi-private spaces. Semi-public spaces are usually
areas that are included by a particular group within society and include spaces with limited
opening times to the public such as school playgrounds.100
Why are they important?
Open spaces in the urban environment are important features that provide benefits for our
human potential while also maintaining important aesthetic and environmental benefits. They
facilitate physical, social, mental, and meditative opportunities. People participate in activities
99
“Parks and Recreation.” Planning and Community Health Research Center. American Planning Association, 2009.
Web. <http://www.planning.org/nationalcenters/health/parks.htm>.
100
Woolley, Helen. Urban Open Spaces. New York: Taylor & Francis, 2003. Print.
43
such as social engagements, sports, gardening, biking, and walking- just to name a few. It’s
important for people to enjoy natural scenery because it can improve or maintain a healthy body,
improves focus, reduces stress and helps in interpersonal interactions. Contact with nature can
also help restore a person’s cognitive abilities.101 Studies have shown that contact with nature
may partly function to mitigate stress. Constant contact with non-natural settings has been shown
to increase stress.102
Another reason to provide open spaces is promoting childhood development. Nature
helps children “develop perceptual and expressive skills, imagination, moral judgments, and
other attributes that [are] greatly enhanced by contact with nature.”103 Natural settings also serve
as an outlet for physical activity and an escape from normal routines.104
Open spaces provide people opportunities for recreation such as exercising and playing
sports or socializing with other people. They can be appreciated for their aesthetic values such as
the enjoyment of nature’s beauty or just getting fresh air. Getting away from the busy city life in
the built environment relieves a lot of problems such as stress.
Other open spaces aren’t used just for people; some spaces such as wetlands and lakes in
urban areas are used for other forms of life. This increases biodiversity and can add value to
communities. Natural resources such as trees, watersheds, and aquifers help protect public health
by providing clean air and water. Urban parks such as Philadelphia’s Wissahickon Park or
Washington, D.C.’s Rock Creek Park provide clean water for the public by absorbing and
101
Berman, M. G., J. Jonides, and S. Kaplan. 2008. “The cognitive Benefits of Interacting with Nature.”
Psychological Science 19 (12): 1207-12.
102
Wells, N. M., and G. W. Evans, 2003. “Nearby Nature: A Buffer of Life Stress among Rural Children.”
Environment and Behavior 35: 311-30.
103
Ibid., 42.
104
Hüttenmoser, M. 1995. “Children and their Living Surroundings: Empirical Investigations into the Significance of
Living Surroundings for the Everyday Life and Development of Children. “ Children’s Environments 12: 403-13.
44
purifying polluted run-off water from impervious surfaces. These parks also mitigate stream
erosion by maintaining the flow of the water through steady water absorption.105
Parks also provide affordable means to participate in physical activities for those that are
economically disadvantaged and can’t afford fee-based recreation activities. It’s also important
to consider age groups, ethnicity, and socioeconomic status that may have different attitudes and
different needs when it comes to physical activities.
What are the benefits of open spaces?
There are many benefits of open spaces. However, this report will not discuss in-depth all
the tangible benefits of open spaces that are directly related to obesity. Open spaces provide:
•
Health and physical benefits
•
Social benefits
•
Environmental benefits
•
Economic benefits
Parks provide many environmental benefits. City parks reduce water pollution and
reduce storm water management by protecting underground water sources. They provide a
natural habitat, and provide ecosystem services such as carbon sequestration that traps
greenhouse gases. This can contribute to climate change. The Trust for Public Land (TPL), a
national nonprofit land conservation organization that promotes the conservation of open spaces
such as parks, community gardens, and natural places has developed an evaluation tool that
105
“How Cities Use Parks to Improve Public Health.” City Parks Forum Briefing Papers. American Planning
Association, 2013. Web. <http://www.planning.org/cityparks/briefingpapers/physicalactivity.htm>/.
45
measures the economic value of city parks. The seven attributes the TPL quantifies are property
values, tourism, direct use, health, community cohesion, clean water, and clean air.106
Access to public parks is one of the most effective solutions focused on public health and
obesity. Studies have shown that people who experience their natural surroundings enjoy
medical benefits. These include “lower blood pressure and cholesterol levels, enhanced survival
after a heart attack, more rapid recovery from surgery, fewer minor medical complaints, and
lower self-reported stress”.107 Certain features in parks can predetermine abundant physical
activity. These features include “accessibility, proximity, good lighting, toilets, and drinking
water. Other features are well-designed, well-maintained paths, and attractive scenery.108
It’s also important that cities provide different types of parks because of the different
ways to use public spaces. Research has shown that more people are likely to use trails and
greenways when there is a mix of views, good lighting, solid trail conditions, and restrooms.
Lower usage contributes to litter, noise, and poor maintenance of trails.109 Public parks are great
options for physical activity because they provides opportunities to increase fitness and reduce a
sedentary lifestyle.
What is the problem?
Research has shown that there is a lack of physical activity in the United States. This is
among the most pressing health concerns. A report by the Healthy People 2010 “indicated that
only 15 percent of adults reported physical activity for five or more days per week for 30
106
Harnik, Peter, and Ben Welle. Measuring the Economic Value of a City Park System. Rep. Chicago: Trust for
Public Land. 2009. Web. <http://cloud.tpl.org/pubs/ccpe-econvalueparks-rpt.pdf>.
107
Ibid., 45.
108
Frumkin, 2003 “Healthy Places: Exploring the Evidence.” American Journal of Public Health Vol. 93 No. 9.
109
Reynolds KD, Wolch J, Byrne J, Chou CP, Feng G, Weaver S, Jerrett M. Trail characteristics as correlates of urban
trail use. Am J Health Promot. 2007;21(suppl 4):335–345.
46
minutes or longer, and another 40 percent of adults reported that they did not participate in any
regular physical activity”. These alarming rates pose health risks contributing to obesity. About
80 percent of adult obese people in the US already have diabetes, high blood pressure, coronary
heart disease, high blood cholesterol, osteoarthritis, or gallbladder disease. About 40 percent
have more than one of these conditions.
Lack of open space
A study by the TPL has shown that the most populous cities in the United States don’t
offer much parkland space for city residents. There is a median average of 12.9 acres of city park
spaces available per 1000 residents. Cities such as New York averages 4.5 acres, Chicago
averages 4.2, Los Angeles averages 6.2, Seattle averages 9.1, and Philadelphia averages 7.1 acres
per 1000 residents. Many of these cities have designated park spaces within their city but the city
itself has such a high population density that open spaces appear scarce. For example, New York
has 38,019 acres of park spaces in the city that has a total of 195,072 acres of city space,
including the park space. This park space makes up about 19.5% of the total, which is significant
compared to most major cities, even though it has a population of over 8 million from FY
2009.110
Violence
Violence is a factor that plays a role when people decide whether or not to walk in
neighborhoods that are considered unsafe. A study showed that people were three times more
likely not to be physically active during leisure time in neighborhoods that were classified “not at
110
Rogers, Will. 2010 City Parks Facts. Rep. Chicago. Trust For Public Land. 2010. Web.
<http://cloud.tpl.org/pubs/ccpe_CityParkFacts_2010.pdf>.
47
all safe” than in neighborhoods classified as “extremely safe”. This may also affect people’s
decisions about where to go shopping for food. Some might decide to shop at a local “safer”
convenience store that contains higher-priced unhealthy food than shop at a grocery store that
has better options, but is in an unsafe area.
Poor sanitation and inaccessibility
The quality and aesthetics of parks, trails, and open spaces are important determinants of
whether people will likely use them for physical activity. Children living in unsafe
neighborhoods or with the presence of garbage on the streets “had an approximately 30-60%
higher chance of being obese or overweight than children living in better conditions”.111 Also,
the same study showed that children had a 20 to 45 percent higher chance of becoming
overweight or obese if sidewalks and walking paths were not accessible. Users are more attracted
to parks when they are well-maintained, equipped with infrastructure and provide park facilities.
Parks that have lighting capabilities, restrooms, and drinking fountains are known to have higher
rates of physical activity by their users.112 Parks and trails that demonstrated lots of litter,
excessive noise, heavy vegetation, drainage channels, and tunnels were associated with lower
levels of park usage.113 Also, having pedestrian friendly features such as maintained sidewalks
and street-crossing facilities helped provide more walking opportunities. Studies have shown
111
Singh, G.K., M. Siahpush, M. D. Kogan. 2010. “Neighborhoods Socioeconomic Conditions, Built Environments,
and Childhood Obesity.” Health Affairs 29: 3 503-512.
112
Kaczynski, A.T., and K.A. Henderson, 2007. “Environmental Correlates of Physical Activity: A Review of Evidence
about Parks and Recreation.” Leisure Sciences 29: 315-54.
113
Reynolds, K.D. J. Wolch, J. Byrne, C. Chou, G. Feng, S. Weaver, and M. Jerrett. 2007. “Trail Characteristics as
Correlates of urban Trail Use.” Health Promotion. 21: 335-45.
48
people who live in neighborhoods with sidewalks tend to walk more than in neighborhoods
without them.114
Distance
Living in close proximity to open spaces such as parks, trails, and playgrounds is
correlated to more physical activity.115 A recent study showed that people living a quarter of a
mile or less from a park were the most common users (43 percent) compared to those that lived
more than a mile away (13 percent).116 Studies also have shown that people living near outdoor
features such as lakes, beaches and coastal areas are associated with higher physical activities.117
In addition to having local open spaces available, access to indoor recreational centers also helps
meet the physical activity recommendations.
Solutions
Urban open spaces offer options cities can incorporate into communities that need help
addressing obesity while adding beautification and greenery into cities. To address obesity in our
cities, it is important to make sure there is available open space for people to rejuvenate their
minds and bodies while also promoting physical activities. How open spaces are utilized depends
114
Troped, P.J., R.P. Saunders, R.R. Pate, B. Reininger, and C. L. Addy. 2003. “Correlates of Recreational and
Transportation Physical Activityin a New England Community.” Preventive Medicine 37: 304-10.
115
Bauman, A.E. , and F.C. Bull. 2007. Environmental Correlates of Physical Activity and Walking in Adults and
Children: A Review of the Reviews. London: National Institute of Health and Clinical Excellence.
http://www.nice.org.uk/nicemedia/live/11679/34740/34740.pdf .
116
Cohen, D.A., D. Golinelli, S. Williamson, A. Sehgal, T. Marsh, and T.L. Mckensie. 2009. “Effects of Park
Improvements on Park Use and Physical Activity: Policyand Programming Implications.” American Journal of
Preventive Medicine 37: 475-80.
117
Owen, N., N. Humpel, E. Leslie, A. Bauman, and J.F. Sallis, K.J. Calfas, and K. Patrick. 2004. “Understanding
Environmental Influences on Walking: Review and Research Agenda.” American Journal of Preventive Medicine 27:
67-76.
49
on the needs of the community and the ability for government to finance development and
maintenance costs.
Diversity of open space recreational activities
Cities should provide a variety of different uses for the existing park spaces. Since people
have different attitudes and health needs, it’s important for cities to consider the different choices
and amenities that people can use. Different ethnicities have been considered when choosing
parks and the type of activities designed for park users.118 For example, “African Americans
were more likely to use facility-based urban recreational parks while whites were more likely to
use woodland parks for such activities as camping and hiking.”119 A study of Chicago’s Lincoln
Park showed that:
Asians, Latinos, blacks, and whites all valued certain park attributes, such as the lake,
ponds, and zoo. However, the natural environment was the most frequently mentioned favorable
attribute among Asians, Latinos, and whites, while cultural facilities were most favored among
blacks. In this study, whites exhibited higher participation rates in active individual pursuits,
such as biking, walking and jogging in the park, while black, Latino, and Asian park users
exhibited higher participation rates in passive activities such as sitting and relaxing. Asians and
Latinos participated more heavily in group social activities such as picnicking.120
118
Hutchinson, R. 1987. "Ethnicity and urban recreation: Whites, Blacks and Hispanics in Chicago's public parks."
Journal of Leisure Research,19:205-222.
119
Dwyer, J. F., and P. H. Gobster. 1997. "The implications of increased racial and ethnic diversity for recreation
resource management, planning, and research." In Kuentzel, W. F., ed., Proceedings of the 1996 Northeastern
Recreation Research Symposium. General Technical Report NE-232. Radnor PA: USDA Forest Service, Northeastern
Forest Experiment Station, pp 3-7.
120
Gobster, P.H. 2002. "Managing urban parks for a racially and ethnically diverse clientele." Leisure
Sciences,24:143-159.
50
Reclaim and reuse abandoned or vacant spaces
Cities around the country may have abandoned lots that are under-utilized or are
abandoned. Depending on the location, size of lot, and environmental factors, opportunities for
urban renewal can be realized. Successful renewal often requires input from the community,
private development and government planning. Philadelphia, for instance, has developed a
framework that organizes all the vacant properties located in the city with the purpose of
redevelopment, as it is estimated to have as much as 60,000 vacant and abandoned properties in
the city. The report suggests that the city “develop[s] a vacant property reclamation strategy for
managing the acquisition, disposition, and reuse of vacant properties” by “conducting a citywide
property inventory to determine the true extent of the problem”.121 They also suggested
determining the value of vacant properties and developing a simplified vacant property database
accessible to interested parties such as “community groups, private developers, and
neighborhood residents.” The city would create a centralized land banking government program
which is responsible for the acquisition and disposition of vacant or abandoned properties.122
In poorer communities that might suffer from property neglect, high crime, and poor
access to food, certain types of abandoned spaces could be used for urban farming or park space:
places where the community can come gather while adding value to the surrounding
neighborhood.
121
“Philadelphia City Council Approves Land Bank Legislation.” Building Sustainable Communities in Philadelphia.
Philadelphia. LISC, 12 Dec. 2011. Web. <http://philadelphialisc.wordpress.com/2013/12/12/philadelphia-citycouncil-approves-land-bank-legislation/>.
122
“The Impact of Community Development Corporations on Urban Neighborhoods.” Urban Institute. 2005.
Retrieved from http://www.urban.org/UploadedPDF/311217_CDCs.pdf.
51
Build community gardens
Community gardens are considered a great use of open space especially in communities
that have poor access to healthy and affordable food. Cities around the country have embraced
the idea of community gardens and urban farms in order to increase food security and address
problems such as obesity, exercise rated, a lack of a sense of community, and economic
inequities. While space for community gardens might be limited and expensive, the benefits
often outweigh any costs that go into it. Benefits include forging a stronger community,
opportunities for recreation, exercise, therapy, and education. Community gardens have the
power to stimulate social interaction with people in the local community. Food often has the
power to bring people together and community gardens are a great catalyst. They also provide
other great human skills such as self-reliance, conservation of resources, green space
preservation and the creation of opportunities for monetary gain. Reducing the cost of food for
cash-strapped families and providing highly nutritious food is another huge benefit. They also
have environmental benefits such as reducing city heat from streets and parking lots.123
Walkable areas
An overlooked aspect of open spaces is the creation of walkable areas between
destinations. Mthat any communities across America simply do not walk because of street
connectivity issues, unsafe roads, or destinations are too far apart or too time-consuming to
travel. A national survey showed that 25 percent of pedestrian trips occur on roads without
123
“Home – American Community Garden Association.” American Community Garden Association. N.p., 2013.
Web. <https://communitygarden.org/>.
52
sidewalks and 95 percent of bicycle trips occur on roads without bike lanes.124 People living in
high-walkable neighborhoods get more physical activity than people in low-walkability
neighborhoods. Adults that live in more walkable communities get, on average, forty-one more
minutes of physical exercise per week than people in low-walkable communities.125 This
explains clear benefits of having walkable communities.
Having walkable communities requires clear design and planning. There are various
tools that urban designers and planners can use to improve the quality of walkable areas. There
are quantitative and qualitative factors that focuses on sidewalks.
The first is the sidewalk experience. This focuses on the experience of the individual and
seeks to identify what they look for in a positive sidewalk experience. The first factor that an
active sidewalk experience considers are the natural features of sustainability in a sidewalk such
as trees, air quality, and storm water management. Other factors include safety, connectivity,
accessibility, and variety. The second factor is the physical space. This factor examines the
physical elements that contribute to the character of the sidewalk. One of the primary
methodologies that designers use is develop a three-dimensional perspective also known as the
‘sidewalk room’ is to map how a pedestrian perceives a sidewalk.
The sidewalk breaks down into four planes: the ground plane, roadside plane, building
wall plane, and the canopy, or what is above the ground. Each plane has typical physical
elements that affect the experience of the pedestrian. The typical elements of the ground plane
includes green strips (planters), width, slopes, street trees, pavement material, street furniture,
124
NHTSA (National Highway Traffic Safety Administration) and Bureau of Transportation Statistics. 2003. National
Transportation Statistics 2003.
http://www.bts.gov/publicatioons/national_transportation_statistics/2003/index.html/
125
Sallis, J.F., B.E. Saelens, L.D. Frank, T.L. Conway, D.J. Slymen, K.L. Cain, J.E. Chapman, and J. Kerr. 2009.
“Neighborhood Built Environment and Income: Examining Multiple Health Outcomes.” Social Science &Medicine
68: 1285-93.
53
fire hydrants, and waste bins. The roadside plane mostly examines what is on the immediate
edge of the sidewalk. Typical elements include parked cars, bike racks, street vendors, street
trees, and lighting or signage poles.
The building wall plane typically is the opposite side of the road where buildings occupy
the space. It’s also typically where the private property line meets the sidewalk. The position of
the building affects the experience whether buildings are set back from the sidewalk or occupy
the edge of the property line. Elements of this plane often include entrances, signage, awnings,
plantings, building setbacks, windows, lighting, and buildings.
The canopy plane is what the pedestrians perceive overhead. Physical elements of the
canopy include signage, balconies, fire escapes, building walls, street trees, landmarks, and
lighting.
The final factor that shapes how sidewalks are used is the policies. Policies play a role in
regulating what is allowed and also influences the outcome of the physical environment. City
planners often have to decide what will work best for the present and in the future. Planners use
zoning code terms such as ‘allow’, ‘incentivize’, ‘mandate’, ‘relieve’, ‘remove impediment’, and
‘guide’ to regulate the land-use.
There are a number of considerations in which zoning ordinances can promote or hinder
the design of active walkable communities. The appropriate approach to maximizing the most
physical activity opportunities often depends on not just the location but also how the land can be
used. Another important consideration is evaluating each area’s context. This is the approach to
each area based on the local, social, economic, and environmental conditions.
Below is a list of common regulations for the physical elements of sidewalks:
-Minimum standards for sidewalk length, levelness, and accessibility so that there is necessary
54
space for foot traffic. The average width of a pedestrian is about 2.5 feet not including other
things they might carry.
-Some cities require a planting strip along with width considerations. For example, in New York
City, it’s mandated that in certain districts, trees must be provided every 25 feet and trees must
be planted at approximately equal intervals of the street.
-Some cities such as New York are encouraging the use of street swales and other stormwater
management strategies for stormwater runoff. Cities such as New York, Portland, and San
Francisco have guided policies on the regulated uses. The city of Portland, Oregon has
mandated a green streets policy to incorporate green street facilities for certain types of
development. San Francisco has city regulations that allow for on-site stormwater-retention and
infiltration that emphasizes water conservation.
-allowing retail and service-based establishments to be near residential districts that is designed
to promote convenience for shoppers and to create stability for retail establishments. Some
districts in New York City has a policy guide that tries to ‘incentivize’ specific neighborhoods to
use certain spaces for special arts and entertainment.
-City districts that promote mixed land-use zoning are often used to encourage walking in
convenient locations. Often cities try to incorporate a variety of building and zoning codes to
have more diversity in a walkable area. For example, zoning ordinances might allow a certain
amount of residential use and retail use or public uses in a given area. For example, the city of
Portland, Oregon allows mixed commercial/residential uses on single sites. Businesses are on
the ground level while upper stories are intended for residential stories. This kind of zoning
promotes development on busier streets and discourages a strip commercial appearance.
-The city of Louisville, Tennessee has a mandate that requires clear markings or delineations on
55
public sidewalks that are interrupted by curbcuts. This is to promote public safety and required
by the ADA.
There are other dynamic factors to be considered when designing or planning walkways
that seek to promote more activity. Other considerations include the scale of buildings, how the
roadbed is distributed, car traffic, local policies, and projections for pedestrian use. Sidewalks are
often considered a part of a larger network that connects to other destinations such as schools,
parks, public transit stops, libraries, stores, homes, and office spaces. It is important that the
pedestrian experience fits the need for different uses.
Sidewalks should be designed to be safe, attractive, interconnected, and diverse. This
needs the support of designers, planners, city leaders, and advocates who all care about their
communities. Finally, improving public spaces like sidewalks can improve both the built
environment and public health.126
Built Environment Conclusion:
Cities should continue to develop more compact and dense cities that require increased
transit service. Providing friendly transit service near residential areas and business districts will
encourage people to use public transit and could discourage people from driving their personal
vehicles. Local and state government should designate priority funding in areas that are planning
compact development. This would promote higher use of transit and also share the burden of
paying for transit services.
There also should be a higher priority placed on the investment in transit, bicycling, and
walking infrastructure rather than road expansion. This can reduce commute times and
126
Burden, A., Burney, Washburn, A., et al. 2013. “Active Design: Shaping the Sidewalk Experience.” NYC
Department of City Planning.
56
congestion, and give people opportunities for physical activity while travelling home, to work, or
to other destinations. This is one of the best strategies to combat urban sprawl; by dis-investing
in road expansion and investing more into existing communities.
57
Chapter 3: The Food Environment
Overview of the Food Environment
A complex food environment shapes and influences the food choices and eating
behaviors that people make. A food environment is defined as “the availability and selection of
foods in a particular setting, such as a school or a neighborhood; availability and selection affect
people’s intake and their health”.127 There’s a strong relationship between people’s behaviors
and eating habits with the food environment provided. This relationship suggests that changes to
the built environment can be made to improve people’s food choices to reduce the rates of
obesity. While food choices can be improved, other problems persist. Access to healthy and
nutritious food is lacking in some areas. Another significant problem is that millions of people
can’t afford healthy food on a daily basis and have get food assistance to make ends meet. In this
section, we will analyze these problems that affect the health of millions of Americans and then
focus on some of the solutions.
What is the problem?
Recently, research on the obesity epidemic has shown a connection between the built
environment and the role it plays on human health. More specifically, there is a connection of the
impact of the food environment on human health. Research has shown that our eating
environment contributes to the obesity epidemic more than individual factors such as our
personal choices, knowledge, motivation, and our capabilities.128
127
Ibid., 42.
Story, M., K. Kaphingst, R. Robinson-O’Brien, and K. Glanz. 2008. “Creating Healthy Food and Eating
Environments: Policy and Environmental Approaches.” Annual Review of Public Health 29: 253-72.
128
58
Socio-Ecological Model
There is also another way to look at our current food and physical environment, which is
through a Socio-Ecological Model. It simply illustrates the factors that contribute to our choices
and influences based on individual and external factors. Below is an example of a SocioEcological Model:
Figure 1: Social-Ecological Model
Source 1: USDA
The Social-Ecological Model is an approach to help us understand the various factors
which influences choices we make in our everyday lives. For many, choices are not always wellinformed and forces such as the media and cultural values can determine the decisions we make.
59
For some, well-informed choices don’t exist because of the environmental surroundings that
some people are in. For example, some children don’t go to school on a daily basis and therefore
might receive less education about what healthy choices to make. The Social-Ecological model is
also used as a tool in obesity prevention programs by breaking down different levels of influence
that can be used to support long-term healthy life-style choices. The different levels of influence
or factors often are:
1. Individuals
This level addresses people’s behaviors that can relate to eating and physical activities by
changing their knowledge, attitudes, and beliefs. It does have a relationship to other levels as it
requires social support to help sustain long-term changes. Social relationships include families,
schools, community, and government.
2. Interpersonal groups
Interpersonal groups can be family, group of friends, a club that a person is affiliated with,
membership group, or any group that someone belongs to. It’s important because a person can
encourage others to make healthful behaviors by giving them support and knowledge they need
to make good choices.
3. Organizational
Organizations are those where large groups of people get together on a regular basis to serve a
purpose. These include schools, employment centers, faith-based organizations, sports teams,
and volunteer groups. Organizations can help members make more healthful choices by planning
organizational policies or initiatives that address better eating, physical activity, or providing
health information.
4. Community
60
Communities have the power to influence on a local level. It can influence city government to
make more healthful communities by improving parks and recreation facilities, implement
community gardens, spur development of farmers’ markets, encourage schools to adopt higher
nutrition standards, and work with organizations to improve nutrition or physical activity.
5. Society
This level, as a whole, captures all the previous levels of influence working together to change
problems such as obesity. In this case, policies in nutrition, physical activity, school health,
media campaigns, and partnerships with government, private enterprises, or non-profit
organizations can work together to address the challenge of obesity.129
Environmental Barriers
For the most part, research has shown that access to fresh food is limited in low-income
neighborhoods and rural communities which is one of the reasons obesity rates are higher in
those areas. Supermarkets provide a variety of healthy food that are readily available in
communities that are dense or have wealth. Areas that often lack supermarkets are in rural
communities that don’t have large population densities. Poor urban communities also lack
supermarkets.
Approximately 23.5 million Americans and 6.5 million children are living without
supermarkets in close proximity.130 One of the main barriers for rural and small-town areas is
poor transportation infrastructure while people who live in areas with limited healthy options
129
“CDC’s State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases:
Social-Ecological Model.” 2013. U.S. Department of Health & Human Services. Retrieved from:
http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/Health/Health.htm.
130
“USDA ERS – Food Environment Atlas.” USDA ERS – Overview. USDA, 2013. Web.
<http://www.ers.usda.gov/data-products/food-environment-atlas.aspx#.U2KtFfldUMs>.
61
have to spend on average 19.5 minutes traveling to a supermarket, significantly more than the
national average of about 15 minutes.131
Many poor communities offer limited healthy food options. Instead of offering a variety
of healthy food options, many communities instead offer an abundance high calorie, higher fat,
and nutrient-deficient food made for convenience. Examples of these are fast food restaurants
and convenient stores.
Food Insecurity
There is also a strong association between Americans who are low-income and that are
food insecure. Also known as food insecurity, which is the inability to acquire enough food often
due to financial constraints.132 Food insecurity is defined as “the availability of nutritionally
adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is
limited or uncertain.” Food insecurity is different from hunger. Hunger is defined as “the uneasy
or painful sensation caused by lack of food.133
According to a report from the Economic Research Service (ERS) under the USDA,
about 14.5% or 17.6 million households were affected by food insecurity in 2012. This comes to
an equivalent of 49 million people or 1 in 6 Americans that lived in food-insecure households.
About 33.1 million adults and 15.9 million children were food-insecure.134 The prevalence of
food insecurity has essentially remained unchanged since 2008. Research has shown that low131
Ver Ploeg, M., V. Breneman, T. Farrigan, K. Hamrick, D. Hopkins, P. Kaufman, B. Lin, M. Nord, T. Smith, R.
Williams, K. Kinnison, C. Olander, A. Singh, E. Tuckermanty, R. Krantz-Kent, C. Polen, H. McGowan, S. Kim. “Access
to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences” 2009. US
Department of Agriculture, Economic Research Service.
132
Rose D, Oliveira V. Nutrient intakes of individuals from food-insufficient households in the United States. Am J
Public Health. 1997: 87(12): 1956-1961.
133
Anderson, S.A., ed., “Core indicators of nutritional state for difficult-to-sample
populations,” Journal of Nutrition, 120(11S) (1990):1557-1600.
134
Coleman-Jensen, A., M. Nord, A. Singh. “Household Food Security in the United States, 2012. Economic
Research Report No. ERR-155.
62
income families are forced to sacrifice some food expenditures to pay for other non-discretionary
items such as housing/shelter, transportation, and utilities. Even low-income families who
receive government food benefits have been found to struggle acquiring enough food. 52 percent
of households that received Supplemental Nutrition Assistance Program (SNAP) benefits were
food insecure. 48 percent of the recipients of the National School Lunch Program and 46 percent
of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were
found to be food insecure.135
These numbers are reported to be conservative; food insecure households without hunger
have adults skipping meals or cutting the size of meals and making other adjustments; including
reducing the quality of diets for themselves and their children. A number of families are
“reluctant to state that they don’t have enough money to buy food, and are especially reluctant to
admit to interviewers that their children are hungry.”136
Rates of food insecurity were found to be much higher than the national average with
incomes near or below the Federal poverty line. Food insecurity is more likely to occur in large
cities and rural areas than in suburban or exurban areas around large cities. Rates in metropolitan
areas were measured at 16.9 percent while food insecurity was measured at 12.7 in suburban
areas.137
135
Ibid., 62.
Hamilton, W.L., J.T. Cook, W.W. Thompson, L.F. Buron, E.A. Frongillo, C.M. Olson, and
C.A. Wehler, Household Food Security in the United States in 1995: Summary Report of
the Food Security Measurement Project, U.S. Department of Agriculture, Food and
Consumer Service, Alexandria, VA, September 1997.
137
Ibid., 62.
136
63
Food Insecurity and Health
Food insecurity has been associated with poor physical and mental health. In most cases,
being food-insecure and living in poverty has been associated with stressful life conditions and
not having consistent sources of food. In this case, there are often social and environmental risk
factors such as domestic violence, job or housing insecurity, all that affects a person’s health
status.
Cross-sectional studies have shown that people who are food insecure and have poorer
health tend to lack sufficient education, low employment status, and exposure to stressful
situations.138 People that are aware of their low social standing have feelings of shame and
distrust that can have negative biological consequences through physiological responses to
environmental stress.139 Long-term psychological stress “can have adverse effects on various
organ systems, leading to disease”.140
In families that are food insecure, children are found to have problems learning, which
results in lower grades and test scores. They are also more likely to be anxious and irritable in
the classroom. Adolescents are likely to have psychological problems and adults are likely to
experience depression or have an anxiety disorder.141
138
Siefert, K. C. Keflin, M. Corcoran, and D. Williams. 2001. “Food Insufficiency and the Physical and Mental Health
of Low-Income Women.” Welfare, Work, and Well-Being. 159-177.
139
Lynch, J., Smith, G.D, Kaplan, G.A. & House, J.S. 2000. “Income Inequality and Mortality: Importance to Health of
Individual Income, Psychosocial Environment, or Material Conditions.” BMJ Vol. 1200-1204.
140
McEwen, B.S. (1998). “Protective and Damaging Effects of Stress Mediators.” New England Journal of Medicine.
Vol. 338, 171-179.
141
Casey, P,. Goolsby, S., Berkowitz, C., Frank, D., Cook, J., Cutts, D., Black, M., Zaldivar, N., Levenson, S., Heeren,
T., Meyers, A., and the Children’s Sentinel Nutrition Assessment Program Study Group. (2004). “Maternal
Depression, Changing Public Assistance, Food Security, and Child Health Status.” Pediatrics. 113(2), 298-304.
64
Obesity and Mental Health
People who are obese and food insecure have among the highest rates of depression.142
The psychological and social effects for those who are obese are significant. Obese people often
have the stigma from a societal context that their weight is caused by a lack of self-discipline or
moral weakness. These attitudes often manifest themselves when employers discriminate against
job candidates who are overweight or obese. Obese people often choose not to go out in public
because they feel self-conscious or can’t enjoy activities due to spatial constraints. Isolation can
lead to depression, anxiety, low self-esteem, eating disorders, and distorted body image.143
There is some evidence that poor mental health can lead to unhealthy lifestyle choices
and increased appetite. In addition, other factors such as stress, poor weight management,
negative thoughts, low expectations, low social support, and using food as a coping strategy can
make it difficult to treat people with mental health disorders with obesity.144
Eating Habits
The eating habits of Americans have changed significantly from the 20th century when
food portions were smaller. American’s consumption of calories, fat, and sugar has gone up
since the 20th century. American’s average daily calorie intake went from 1955 calories in 19711975 to 2239 per day in 2003-2004. This is close to a 300 calorie increase. These rates have
142
Gariepy G, Nitka D, Schmitz N. 2010. “The Association between Obesity and anxiety disorders in the population:
a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry. 67(3): 220-229.
143
Collingwood, J. 2007. Obesity and Mental Health. Psych Central. Retrieved on October 25, 2013, from
http://psychcentral.com/lib/obesity-and-mental-health/000895.
144
Markowitz, S., Friedman M.A., Arent S.M. 2008. “Understanding the relation between
Obesity and Depression: Causal mechanisms and implications for treatment.”
Clinical Psychology: Science and Practice. 15(1):1-20.
65
declined to about 2195 calories per day in 2009-2010.145 Americans consumed an average of 640
calories of added fat per day in 2008.146 Sugar consumption has decreased from 100 grams in
1999-2000 to 76.6 grams in 2007-2008 but it’s still nearly two times the recommended amount
by USDA standards.147
Among other findings are increased rates of eating outside the home. Food consumed at
restaurants typically contain more fat, saturated fat, less fiber, calcium, and iron than food
prepared at home.148 This is due to convenience, food marketing, time-constraints, and lack of
skills to prepare meals. 63 percent of children ages from 1-12 ate at a restaurant one to three
times per week.149 Normal or underweight adults consumed about 9.2 percent of calories from
fast food while obese adults consumed about 13.2 percent of their calories from fast food.150
According to an USDA report, most people who are obese or overweight need to reduce
consumption of added fats, refined grains, sodium, added sugars or sweeteners, and increase
consumption of fruits, vegetables, whole grains, low-fat milk or milk products.151
A special note: Food Marketing
America’s food environment is the subject of food marketing. Marketing of food
products has been prevalent for a number of years; especially food that is not necessarily
145
Ford ES and Dietz WH. Trends in energy intake among adults in the United States: Findings from NHANES.
American Journal of Clinical Nutrition, 97(4): 848-53, 2013.
146
Loss-Adjusted Food Availability: Spreadsheets – Calories. US Department of Agriculture, Economic Research
Service.
147
Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States.
American Journal of Clinical Nutrition, 94(3): 726-34, 2011.
148
Lin B, Frazao E, Guthrie J. 1999. “Away-from-home foods increasingly important to quality of American diet.”
Economic Research Service/USDA.
149
Guthrie JF, Lin BH, and Frazao E. "Role of Food Prepared Away from Home in the American Diet, 1977-78 versus
1994-96: Changes and Consequences." Journal of Nutrition Education and Behavior, 34(3):140-50, 2002.
150
Fryar CD and Ervin B. Caloric intake from fast food among adults: United States, 2007-2010. NCHS data brief, no
114. Hyattsville, MD: National Center for Health Statistics, 2013.
151
Wells HF and Buzby JC. Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005. Economic
Information Bulletin No. 33. Washington, D.C.: Economic Research Service, U.S. Department of Agriculture, 2008.
66
conducive to our well-being and personal health. There are serious concerns over misleading
advertisements that market unhealthy food products as healthful. There are also serious concerns
over potential conflict of interests of health organizations siding with major food companies that
are arguably contributing to the obesity epidemic. This section will briefly touch on the issues of
food marketing.
Food marketing targets children, promoting food that is high in fat, calories, and sugar
while low in healthful nutrients. Scientific research has shown that food marketing has profound
lifelong effects on eating behaviors and health.
Marketing of food products typically occurs in media sources such as broadcasting,
internet, mobile media sources, print, and the radio. Companies are starting to utilize more nontraditional media sources to market their products such as video games, online advertising
games, and other digital media sources.
In 2009, the fast-food restaurant industry spent about $4.2 billion advertising their
products using “TV, digital, mobile, outdoor, radio advertising, and other media marketing to
children and adults.”152 Companies also personalize their marketing through local communities
through billboards, stores, restaurants, and schools.153 There are concerns over digital marketing
techniques influencing youths to buy their products. Some food promoters have developed
marketing techniques that reduces attention and triggers emotional arousal that fosters impulsive
behavior. Another technique is that social media can capture users’ online behaviors without
152
Harris JL, Schwartz MB, Brownell KD, et al. Fast food F.A.C.T.S.:
“Evaluating fast food nutrition and marketing to youth.” Rudd Center for Food Policy and Obesity. 2010. Retrieved
from: http://www.fastfoodmarketing.org/media/FastFoodFACTS_Report.pdf.
153
Harris, J. and Graff, S. “Protecting Children From Harmful Food Marketing: Options for Local Government to
Make a Difference.”
67
notifying them which can be used for personalized marketing to individuals without prior
knowledge.154
Exposure to TV advertising has been shown to influence food and beverage purchasing
patterns; even five years after the initial exposure.155 A study showed that children who are
exposed to TV marketing of food consumed 45 percent more food than children exposed to TV
content that doesn’t show food marketing regardless of the food advertised, food brand, or
characteristics of the child.156 Research reports that youth who watch years of food
advertisements will purchase fewer fruits, vegetables, and whole grains. On the other hand,
youth were reported to increase their purchases of fast foods, fried foods, and sugar-sweetened
beverages.157
Young consumers who are at risk for obesity are often the biggest consumers of media
advertising. Current proposals to attempt to reduce the number of unhealthy food advertisements
are growing. The Federal Trade Commission (FTC), the CDC, the FDA, and the USDA have
combined efforts to address food marketing to children. They have attempted to formulate
nutrition standards that must be met to try to restrict unhealthy foods from being marketed.
However, those proposals never worked.158 Other proposals include public pressure efforts that
include letter-writing campaigns to food companies or broadcasting companies, and to adopt
nutrition standards that promote better health.
154
Montgomery K and Chester J. “Digital Food Marketing to Children and Adolescents: Problematic Practices and
Policy Interventions.” National Policy & Legal Analysis Network to Prevent Childhood Obesity, October 2011.
155
Barr-Anderson DJ, Larson NI, Nelson MC, Neumark-Sztainer D, Story M. “Does television viewing predict dietary
intake five years later in high school students and young adults?” International Journal of Behavioral Nutrition and
Physical Activity. 2009; 6:7.
156
Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior. Health
Psychol. 2009;28(4):404–413.
157
Ibid., 68.
158
Nestle, M. 2012. “Shouldn’t Nickeloden adopt better nutrition standards for the products it advertises?” Food
Politics. Retrieved from: http://www.foodpolitics.com/tag/iwginteragency-working-group/.
68
The state of Maine became the first state to implement a statewide law that prohibits
unhealthy food. However, 85 percent of Maine high schools failed to comply with the law.
Possible solutions are to require more assistance from the state government to help schools
comply with the laws.159
Solutions to improve our food environment
Strategies to improving our food environment require a variety of efforts and goals. For
one, there needs to be short-term goals to improve people’s health by providing healthier food
choices, with long term goals to systematically improve the food system. There are a number of
considerations that must be made to determine if efforts can be achieved. Determining the social
fabric of a community is an important consideration. People might not be able to afford healthful
food or they have to overcome other social and environmental limitations that prevent people
from making healthier choices. For people who have poor health because of food insecurity, a
change to social conditions is needed. Some changes can be made with political action at the
local level, while other changes would need higher levels of influence. An agenda that includes
social welfare and economic policy initiatives would be necessary steps to improve the lives of
people that can’t access the means to healthy food.160
Providing solutions to reduce obesity rates through the food environment will also require
comprehensive strategies that include policy changes, community action, personal responsibility,
and redesigning our living environment. We have already seen action taken by government at all
levels and non-profit organizations aimed at lowering obesity rates through policy alterations,
159
Polacsek M, O’Rourke K, O’Brian L, Blum JW, Donahue S. “Examining Compliance With a Statewide Law
Banning Food and Beverage Marketing in Maine Schools.” Public Health Reports, 127: 216-223, 2012.
160
Link, B. and J. Phelan. 1995. “Social conditions as fundamental causes of disease.” Journal of Health and Social
Behavior. 80-94.
69
physical activity programs, and educating the public about the issues. Below are examples of
environmental interventions that government and other special interest groups have taken to
improve public health.
Food Financing Initiatives
This approach can work in a number of different ways. In addition to instituting
community gardens and establishing farmer’s markets into areas that are lacking enough fresh
food, a relatively new strategy in bringing fresh and healthy food to communities is
implementing a Fresh Food Financing Initiative. Originally spearheaded by the state of
Pennsylvania, it works to invest in new supermarkets in underserved and low-income
communities.
Already, there are federal and state investments made to support poor urban and rural
communities that lack fresh food. In addition to providing access to fresh food, its mission is to
also improve economic conditions by providing economic opportunities and raising land values
by adding a social benefit to the community.
The Fresh Food initiative is a public-private partnership that was developed by The Food
Trust, a non-profit organization aimed to improve health and nutrition, and The Reinvestment
Fund which is a community development financial institution.
This initiative has invested $85 million dollars into supermarket development in
underserved areas. The initiative has provided funding for at least 88 fresh-food retail projects. It
70
expects to create, as well as preserve, more than 5,000 living wage jobs in poor areas.161 It will
also help improve access to more than 500,000 people.162
The success of the Food Financing Initiative model from Pennsylvania has spurred the
national government to adopt a similar model and states such as New York, New Jersey, Illinois,
Louisiana, and California have taken steps to use them.163 The federal government has already
instituted the $400 million Healthy Food Financing Initiative which is used to “promote a range
of interventions that expand access to nutritious foods, including developing and equipping
grocery stores.”
The initiative works through a partnership between the US Department of Agriculture
(USDA), Department of the Treasury, and the Health and Human Services (HHS). The Treasury
Department creates incentives for the private sector to develop more options for healthy food by
providing $250 million in tax credits to the New Markets Tax Credits and $25 million to
community development financial institutions devoted to financing healthy food in their local
communities.
The USDA effort is to help improve access to healthy food through their nutrition
assistance program, promote business opportunities for farmers, and expand economic
development in rural areas. The HHS acts to promote community economic development by
awarding grants to Community Development Corporations to finance grocery stores, farmers
markets, and other healthy food options. 164
161
The Reinvestment Fund: Capital at the point of impact. 2012. “Pennsylvania Fresh Food Financing Initiative.”
http://www.trfund.com/financing/Healthy_food/FreshFoodFinancing.html/
162
The Food Trust. 2012. “Pennsylvania Fresh Food Financing Initiative: Encouraging the development of food
retail in underserved Pennsylvania communities.” http://www.thefoodtrust.org/php/programs/fffi.php/
163
The Reinvestment Fund: Capital at the point of impact. 2012. “Food Access.” <http://www.trfund.com/TRFfood-access.html/.>
164
U.S. Department of Health & Human Services. 2010. “Obama Administration Details Healthy Food Financing
Initiative.” <http://www.hhs.gov/news/press/2010pres/02/20100219a.html/.>
71
Local Food Programs
There are a number of food programs across the country that focuses on increasing access
to food, giving people opportunities to have careers in urban agriculture, educating people to eat
healthier, and providing a means for people to stay out of jail or being homeless. There are a
number of local organizations/institutions and farms that seek to empower youth, low-income
individuals, previously incarcerated individuals, people of color, and immigrant families with
viable economic opportunities.
In Boston, The Food Project created a vision that engages young people in sustainable
agriculture, and teaches them the values of self-efficacy and social change while gaining
knowledge in farming as well as business experience. The program works with hundreds of
teenagers and thousands of volunteers that serve the local population. Food is distributed from
various farm sites totaling 40 acres of farmland in the greater Boston area. The distributed food
supports their efforts to serve community supported agriculture programs, low-income farmer’s
markets, and hunger relief organizations. The Food Project grows over 250,000 pounds of fresh
vegetables, fruits, flowers, and herbs using sustainable farming practices. Sustainable agriculture
is the practice of growing food for consumption but also to farm in a manner that preserves and
enhances the environment.165
A non-profit and self-empowerment program called Seattle Tilth educates people how to
grow food, , raise urban livestock, and conserve natural resources. They also offer programs that
hire young, underprivileged individuals to learn about sustainable agriculture and invaluable
business skills such as marketing produce items at farmer’s markets through their Seattle Youth
Garden Works program. Lastly, they also offer a program that provides business training to
underprivileged immigrants and refugees outside the Seattle area. Seattle Tilth gets funding from
165
165. “Seed Crew.” The Food Project. The Food Project, 2013. Web. <http://thefoodproject.org/about/.>
72
a variety of sources in addition to obtaining revenue from selling food at farmers markets,
donations for their work, and offering their educational services. They received a $483,160 grant
from the USDA’s Beginning Farmer and Rancher Development Program to train immigrants to
become small farmers and learn how to market their products.166
Other organizations around the country fulfill similar missions. The Added Value Farm in
New York City provides year-long training to teens about business practices in farming. They
develop skills in leadership, help operate the Red Hook Farmers’ Market, and engage in
educational advocacy around issues in food justice.167
Growing Home, an urban agricultural organization, operates a number of urban farms.
They sell their food through their CSA’s in Chicago, and train formerly incarcerated and
homeless individuals on its farms around the city. Of those that had been incarcerated, 95 percent
did not go back to jail. 90 percent of the formerly incarcerated or homeless participants were able
to find stable housing. Over two-thirds of those that were trained, were either able to find fulltime jobs, or participate in further job training.168
The Seattle Market Gardens Program focuses on selling local produce through its CSA
gardens as well as its Farm Stand operations in low-income neighborhoods. One of its aims is to
provide resources and the necessary skills needed for the refugee and immigrant farmer
population that reside in Seattle. Many immigrants and refugees bring their farming skills from
their native lands but need assistance in understanding the local conditions and also need
166
Seattle Tilth. “About Us.” 2013. http://seattletilth.org/about/.>
“Added Value/Red Hook Community Farm” Retrieved from
http://www.slowfoodnyc.org/program/snail_approval/awardee/added_value_red_hook_community_farm.
168
“Growing Home.” Retrieved from www. http://growinghomeinc.org/.
167
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financial assistance to grow and sell their food.169 Much of their work is also done with Seattle
Tilth.
In short, many food programs aim to empower individuals and also endorses community
development. They provide individuals with the necessary job training and skill development
that’s needed in order to succeed in their future career endeavors. Through urban agriculture,
people have opportunities to be productive that can have lasting effects on future generations.
Urban Agriculture
Many Americans today are part of the growing trend of producing food for themselves
and others as a way sustainable to revitalize and improve the physical and economic health of
their community.
Communities that have greater access to fresh produce consume healthier diets and have
lower rates of diet-related diseases than communities lacking access. Urban agriculture is an
approach that can help communities, otherwise lacking access to healthy choices, meet the health
needs of its people. Further, strategies to distribute healthier food choices through urban
agriculture include selling food at farm stands, farmer’s markets and through community
supported agriculture (CSA). There are a number of urban farmers that offer sliding price scales
and accept EBT (Electronic Benefit Transfer) cards to help low-income families afford nutritious
and healthy food. In addition, families that participate in urban agriculture are typically able to
offset 30 to 40 percent of their produce needs by eating food grown in their gardens.170
Urban farming also supports healthier ethnic food diets and help people grow culturally
appropriate food for their families. Studies have shown that diet quality has decreased from first
169
“Seattle Market Gardens.” Retrieved from http://www.seattle.gov/neighborhoods/ppatch/marketgardens/.
170. “P-Patch Community Gardens |Department of Neighborhoods.” Seattle Department of Neighborhoods.
City of Seattle, 2013. Web. <http://seattle.gov/neighborhoods/ppatch/aboutppatch.htm>.
170
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generation to second generation ethnic groups. First generation Hispanic women who
immigrated to America had diets that were similar to white non-Hispanic women. However,
second-generation Mexican America women stand to have much higher risk of eating a poor diet
than the first-generation women.171 Another example showed that Type 2 diabetes was higher for
second-generation Japanese American men and women than their predecessors.172 With
communities that are linked closer, they are more likely to grow food that they desire for their
health that otherwise might not be readily available in their communities.
Case studies for urban agriculture
There are a number of case studies of urban agricultural projects that have helped
Americans live successfully. Immigrants in America have the opportunity to grow culturally
appropriate food for their families and communities. These projects include the The Detroit
Black Food Security Network, Nuestras Raices (Holyoke, Massachusetts), and the East New
York Farms!; all of which seek to connect younger residents with elders in their communities
who can share their skills and perspectives on food.
With the increasing demand for healthier food choices, economic opportunities present
themselves for local communities. Urban agriculture can improve the economic health by
stimulating job opportunities, providing job skills and training, attracting new businesses, and
saving money for families.
In Cleveland, Ohio an urban-agricultural enterprise called Green City Growers
Cooperative is growing leafy greens and herbs in a five-acre hydroponic greenhouse to be sold to
171
Guendelman S., and Abrams B. (1995). “Dietary Intake among Mexican-American Women: Generational
Differences and a Comparison with White Non-Hispanic Women.” American Journal of Public Health: 85(1): 20-25.
172
Fujimoto, W., Leonetti, D., et al. (1987). “Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance
among 2nd generation Japanese-American men” Diabetes 36: 721-29.
75
grocery stores, wholesale produce businesses, and other institutions. This new business expects
to employ around 40 living wage jobs with benefits.173 The city also has created a land-use grant
program that turns vacant land into community gardens. There are now over 30 urban farming
projects to date.174
A collaborative effort to launch urban farms in Detroit called Self-Help Addiction
Rehabilitation (SHAR) involves over 50 organizations and seven universities to start growing
produce on approximately 30 acres of vacant land. It involves using an efficient, three tier
system that will have three growing seasons. The effort is expected to have between 2,500 to
3,500 permanent living wage jobs for low-income residents and recovery addicts.
There are a few other large-scale urban agriculture projects in Detroit that aims to
revitalize the city through urban agriculture. One is a non-profit called RecoveryPark, which
seeks to create 18,000 new jobs over the next two decades. It hopes to create opportunities
through indoor/outdoor urban farms on 2,475 acres, a food processing center, and an indoor fish
farm.175 Another related urban agricultural projects in Detroit is Hantz Farms, which seeks to
plant trees on approximately 140 acres of blighted vacant lots as a beautification project. 176
Urban agriculture projects are often placed in locations that previously were vacant or
underused. Then they are transformed into attractive, safe, and productive sites that create a
positive effect on human health. They can also foster a sense of community and create safer
neighborhoods. They do this by connecting people of all ages, ethnicity, and socioeconomic
173
Snook, D. 2012. “Green City Growers to plant first winter crop in large Cleveland greenhouse.” retrieved from
http://www.cleveland.com/taste/index.ssf/2012/12/green_city_growers_to_plant_fi.html.
174
“Urban Agriculture and Community Gardens.” PolicyLink.
http://www.policylink.org/site/c.lkIXLbMNJrE/b.7634267/k.C841/Policy.htm.
175
Sands, D. 2013. “RecoveryPark, Detroit Urban Agriculture Project, Would Create Jobs For Ex-Offenders,
Addicts.” Retrieved from http://www.huffingtonpost.com/2013/06/03/recoverypark-detroit-urban-agriculturejobs_n_3379029.html.>
176
“Council Oks sale of 1,500 lots for urban farming project.” 2012. Detroit Free Press. Retrieved from
http://www.freep.com/article/20121211/NEWS01/121211061/.
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background, with the goal of producing healthful food. Neighborhoods with community gardens
often report lower rates of crime, trash dumping, fires, and violent deaths.177
Some urban farmers have come across some challenges in urban agriculture. One is
establishing land-use protections for urban agriculture. The second is securing land that has been
used for urban agriculture when the land is not owned outright.
The following are strategies that city governments and organizations can use in creating
or maintaining the viability of urban agriculture projects in cities.
Land-Use strategies for Urban Agriculture:
Adopt Zoning and General Plan language
Strategies for securing long-term use of land often require the support of local
government policies and land trusts. Local governments can adopt language that allows the use
of urban agriculture in its general plans and zoning codes. The cities of Berkeley, CA; Seattle,
WA; Cleveland, OH; San Francisco, CA; Oakland, CA; Washington DC; Portland, OR;
Madison, WI and Chicago, IL are among the few cities that have explicit language in its city
codes that support the efforts of urban agriculture through its community garden programs.
These cities have policies in place such as special zoning designations, Bylaws, or are inclusions
to their General Plans.178
Adding an urban agricultural zoning designation would be beneficial for urban farmers as
it recognizes and legitimizes the use of growing food in urban spaces. These land-use codes
177
Hagey, Allison, Solana Rice, and Rebecca Flournoy. Growing Urban Agriculture: Equitable Strategies and Policies
for Improving Access to Healthy Food and Revitalizing Communities. Rep. Oakland: PolicyLink. 2012. Web.
<http://www.fairfoodnetwork.org/sites/default/files/UrbanAg_FullReport.pdf.>.
178
“Land Use and Planning Policies to Support Community and Urban Gardening.” Urban Tilth. Public Health Law
and Policy, 31 July 2008. Web. <http://www.urbantilth.org/wpcontent/uploads/2008/09/communitygardenpolicyinventory-2.pdf>.
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allow people to grow food in their backyards and sell it, allow greenhouses on buildings,
increases the number of chickens allowed, and reduces fees related to urban agriculture. Also,
they ensure that the farming space is to be protected from other development. There are a
number of urban agricultural locations that are not regulated or permitted to practice farming.
Adding specific language in city plans and zoning ordinances can be used to support the use of
community gardens.
Many state laws require counties and cities to adopt comprehensive/general plans that
oversee the physical development of a city or county. Also, zoning ordinances simply carry out
the policy regulations of the comprehensive/general plan. Zoning is simply a government land
division regulatory mechanism that separates spaces into districts. Each district has different
land-use regulations within each district. Zoning “determines what can and cannot be built, and
what activities can and cannot take place, on the parcels of land throughout a community.”179
Urban agriculture spaces such as community gardens are not usually addressed in zoning
codes which is partly why many of them are closed down as illegal or are displaced by other
types of development. In the following sections, we will examine two options modeled after the
Public Health Law and Policy (PHLP) toolkit that’s designed for cities or counties to adopt
community gardens as part of an amendment to their community’s existing zoning laws. 180
Permitted Use of Community Gardens
The first option is an ordinance that establishes community gardens as an approved use of
land in residential, multifamily, industrial, or any other approved district in which a community
179 General Plans and Zoning: A Toolkit on Land Use and Health, available at:
www.healthyplanning.org/toolkit_gpz.html.
180
“Establishing Land Use Protections For Community Gardens.” Change Lab Solutions. National Policy & Legal
Analysis Network to Prevent Childhood Obesity, June 2010. Web.
<http://changelabsolutions.org/sites/phlpnet.org/files/CommunityGardenPolicy_FINAL_Updated_100608.pdf>.
78
garden would be appropriate. This designation allows citizens to develop and maintain
community gardens in the enumerated districts without requiring the sponsor to obtain a permit,
finding, variance, or other government approval.
The following is an example of the language a city or county can use in their zoning
codes in order to permit the use of community gardens:
Community Gardens shall consist of land used for the cultivation
of fruits, vegetables, plants, flowers, or herbs by multiple users. The land
shall be served by a water supply sufficient to support the cultivation
practices used on the site. Such land may include available public land.
Community gardens are a permitted use in the following zones:
residential, multifamily, mixed-use, open space, industrial
____________ [ add other zoning districts ] subject to the following
regulations:
Comment: Some communities may permit community gardeners to keep bees and raise
chickens on garden sites. If so, this definition can be amended to allow these uses.
(a) Site users must provide a Phase I Environmental Site Assessment (ESA). Any
historical sources of contamination identified in the ESA must be tested to
determine type and level of contamination; appropriate remediation procedures
must be undertaken to ensure that soil is suitable for gardening.
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Comment: Funds and grant for environmental site assessments, testing and cleanup procedures
may be available from a variety of state and federal sources. Site users should coordinate with
their local economic development and redevelopment agencies, as well as their local/regional
Department of Toxic Substances Control.
(b) Site users must have an established set of operating rules addressing
the governance structure of the garden, hours of operation, maintenance
and security requirements and responsibilities; a garden coordinator to
perform the coordinating role for the management of the community
gardens; and must assign garden plots according to the operating rules
established for that garden. The name and telephone number of the
garden coordinator and a copy of the operating rules shall be kept on file
with the City [insert department name] Department.
Comment: To function effectively, a community garden must have established operating rules
and a garden coordinator. In this ordinance, a municipality could (1) require that gardens have
rules, as the model language does above, (2) provide a complete listing of rules; or (3) give
authority for a particular city or county department or officer to establish community garden
rules and require each community garden to adhere to those rules. A municipality could also
choose to address some or all of the requirements for operating a community garden in this or an
accompanying ordinance.
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(c) The site is designed and maintained so that water and fertilizer will
not drain onto adjacent property.
(d) There shall be no retail sales on site, except for produce grown on the
site.
Comment: Community gardens can be a needed source of income to low-income residents, as
well as a source of produce for neighbors who do not grow their own food. The model language
allows gardeners to sell the produce they have grown, but permits no sales of other items.
Because the model ordinance permits community gardens to be established in a variety of use
districts, including residential districts, a municipality may be reluctant to allow major retail
operations on garden sites. If the municipality chooses, it may allow more expansive sales at
garden sites. Alternatively, it could permit gardeners to sell produce at a different site. The model
ordinance addresses land use issues when permitting sales, but does not address other regulations
that may affect sales, such as health and sanitation laws or business license regulations. Before
permitting sales of community garden produce, the municipality must ensure that those sales are
permitted under other state and local laws.
(e) No building or structures shall be permitted on the site; however, [
sheds for storage of tools limited in size to [ _______ ] or subject to the
requirements of section ____ ], greenhouses that consist of buildings
made of glass, plastic, or fiberglass in which plants are cultivated, [
chicken coops ], benches, bike racks, raised/accessible planting beds,
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compost or waste bins, picnic tables, seasonal farm stands, fences,
garden art, rain barrel systems, [ beehives ], [ barbeque grills, outdoor
ovens ] and children’s play areas shall be permitted. The combined area
of all buildings or structures shall not exceed [ 15 percent ] of the garden
site lot areas. Any signs shall comply with applicable [ city/county ]
ordinances.
Comment: Some communities may wish to allow community gardeners to erect sheds for the
storage of tools on garden sites. The municipality should make sure that any provision regarding
sheds conforms to other municipal code provisions regarding storage sheds on property.
Additionally, if communities permit the cultivation of beehives and chickens in their community
gardens, structures for the care of these animals should be included. Local laws vary on the
keeping of farm animals in different use districts.
(f) Fences shall not exceed [ six feet ] in height, shall be at least [
fifty percent ] open if they are taller than [ four feet ], and shall be
constructed of wood, chain link, or ornamental metal. For any garden
that is [ 15,000 square feet in area or greater ] and is in a location that is
subject to design review and approval by the [ City Planning
Commission or Landmarks Commission ], no fence shall be installed
without review by the [ City Planning Director, on behalf of the
Commission ], so that best efforts are taken to ensure that the fence is
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compatible in appearance and placement with the character of nearby
properties.
Comment: Municipalities usually have requirements regarding fences in their zoning or building
codes. If the municipality has existing regulations, it may not need this provision. Communities
may wish to impose additional regulations on community gardens, including:

Prohibiting connections to electricity or sewers without a permit or other permission from
the municipality or a particular department;

Imposing specific regulations regarding maintenance of the site, such as frequency of
waste collection;

Requiring a community garden to have a nonprofit entity or neighborhood group as a
sponsor or to act as garden coordinator; or

Requiring particular landscaping or setbacks outside of the garden within the public rightof-way.
Open Space Protections for Community Gardens
The second option for establishing legitimacy for community gardens on city land is to
designate an area to be zoned as a sub-district or sub-use within an open space zoning district. By
enacting this policy, a community can protect and preserve community gardens as an open space
use. An example of the language that can be used is as follows:
Community Garden open space sub-districts shall consist of land divided into multiple plots
appropriate for and limited to the cultivation of fruits, vegetables, plants, flowers or herbs by
various users. Such land may include available public land.
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Additional Plans of Action cities can implement
It is important to consider land-use policies for urban agriculture because it can help
ensure their long-term ability to operate on a site and preserves the land for certain uses.
There are other actions that cities can adopt to facilitate the creation and maintenance of
community gardens and urban farms. They can provide financial support, technical assistance,
and education. Civic leaders and planners can also promote urban agriculture by encouraging
interim or temporary use of underutilized land for gardens, assist in land acquisition for gardens,
and help manage and program community gardens.
The City of Escondido, California, has an “Adopt-a-Lot” policy allowing community
gardens to be operated as an interim use on both publicly and privately owned vacant land. A
city employee works with landowners and the community to develop an agreement for the
conditions and tenure of use of the land as a garden.181
Seattle has been able to purchase land, maintain garden plots, support urban agricultural
programs, and other efforts through bond monies, public housing funds, and neighborhood
matching grants.182
A number of communities have created partnerships with nonprofit organizations to
acquire land for and operate community gardens. An example of this is NeighborSpace, a
Chicago nonprofit that works with the Chicago Park District and Forest Preserve District.
NeighborSpace receives funding from the agencies to purchase space for urban agriculture. The
181 “Cultivating Community Gardens: The Role of Local Government in Creating Healthy, Livable Neighborhoods.”
LGC. Local Government Commission, 2012. Web.
<http://www.lgc.org/wordpress/freepub/community_design/fact_sheets/community_gardens_cs.pdf>.
182
www.seattle.gov/neighborhoods/ppatch/.
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organization also has agreements with local groups to use and maintain the spaces.183 Another
example is The City of Seattle’s P-Patch Community Garden Program which works with the
nonprofit Friends of P-Patch and the City Housing Authority to acquire, build, protect, and
advocate for the gardens.
Plan Language for Community Gardens
Some states require each county and city to adopt a comprehensive plan that envisions
the future goals and development of the area. Language that aims to protect and expand
community gardens needs to be tailored to the needs of the individual community and can be
incorporated into their city plans in a number of ways.184 Below are some specific examples of
General Plan language that was highlighted in the PHLP:
• Encourage the creation and operation of one community garden of no
less than [one] acre for every ____ [ 2,500 ] households. Identify
neighborhoods that do not meet this standard and prioritize the
establishment of new gardens in neighborhoods that are underserved by
other open space and healthy eating opportunities.
Comment: This standard matches closely the National Recreation and Park Association’s widely
used “best practice standards” for a neighborhood park or tot lot (1/2 acre: 2500 households for a
183
183. “Land Use Guidelines for Community Projects on NeighborSpace-protected Land.” NeighborSpace
Community Managed Open Space. N.p., 2012. Web. <http://neighbor-space.org/wpcontent/uploads/2012/10/NBSPguidelines_site.pdf>.
184 How to Create and Implement Healthy General Plans, “Section III: Writing a
Healthy General Plan.” Available at: www.healthyplanning.org/toolkit_healthygp.html.
85
tot lot; 1 acre: 5000 households for a neighborhood lot185). Communities that are more or less
urban will need to assess whether this standard is appropriate for them.
• Identify existing and potential community garden sites on public
property, including parks; recreation and senior centers; public
easements and right-of-ways; and surplus property, and give high
priority to community gardens in appropriate locations.
• Adopt zoning regulations that establish community gardens as a
permitted use in appropriate locations. Community gardens are
compatible with the [ insert names (e.g., Commercial, Public Facility,
Open Space, Multifamily Residential) ] land use designations shown on
the General Plan land use map.
• Encourage [ or require ] all new affordable housing units to contain
designated yard or other shared space for residents to garden.
• Encourage [ or require ] all [ or some, such as multifamily residential,
commercial, institutional or public ] new construction to incorporate
green roofs, edible landscaping, and encourage the use of existing roof
space for community gardening.
• Community gardens shall count towards park and open space
allocations required by local Quimby Act ordinances for new
subdivisions and multifamily development.
185 1990 Recreation, Park and Open Space Standards and Guidelines, and the 1996 Park, Recreation, Open
Space and Greenway Guidelines and Tables D1.2, D1.3, D1.4, D1.5, and D1.6.
86
Comment: The Quimby Act is a California policy that authorizes cities and counties to pass
ordinances requiring developers to dedicate land or pay in lieu fees, or a combination of both, for
park or recreational purposes as a condition to approving a tentative map application. Dedication
of land associated with the Quimby Act requires setting aside between 3 to 5 acres of
developable land for every 1,000 population generated by the proposed development.186
• Create a Community Gardening Program within the [ Parks and
Recreation Department ] to support existing and create additional
community gardens.
• Increase support for community gardens through partnerships with
other governmental agencies and private institutions including school
district(s), neighborhood groups, senior centers, businesses, and civic
and gardening organizations.
• Secure additional community garden sites through long-term leases or
through
ownership as permanent public assets by the City, nonprofit
organizations, and public or private institutions like universities,
colleges, school districts, hospitals, and faith communities.
• Encourage local law enforcement agencies to recognize the risk of
vandalism of and theft from community gardens and provide appropriate
surveillance and security to community gardens.
186 The formula to calculate a proposed development’s Quimby requirement is as follows: (persons per household)*
X (number of units in development) X 3 to 5 acres**1,000* Estimates for
“Person’s per household” can be found in the Housing Element of a City or County’s General Plan or via
the census website, available at: www.census.gov.
87
Lease Agreements
An effective strategy that a number of local governments have done to demonstrate their
commitment for urban agriculture is to authorize leasing agreements with other organizations. A
resource by the National Policy and Legal Analysis Network to Prevent Childhood Obesity
(NPLAN) has created a legal toolkit that can be used for local governments and other
organizations that provides a basic structure on how to operate a community garden.
The first step is a lease between a landowner and a non-profit organization (NPO) that is
allowed to use the property as a community garden. The NPO is responsible for overseeing the
operation of the garden, to uphold the conditions of the lease, and often relinquishes certain
rights such as the right to sue for property damage or injuries. The second step involves a model
gardener’s agreement. This agreement is made by the sponsoring NGO and the individual
gardener. The NGO allows for the individual gardener to use the community garden but they
must abide certain rules and they give up certain rights such as the right to sue if they are injured.
The third step involves model community garden rules. The rules stipulate how the garden will
be used, as well as the responsibilities and privileges that the gardeners have. Rules are designed
to maintain safety for individuals and property, to minimize disputes, to have a fair dispute
resolution process, and prevent disturbances from neighbors.
Creating a lease agreement between landowners and other parties ensures that
landowners have certain rights to protect themselves. For example it protects landowner’s
damage to their property or liability in the event that a gardener might injure themselves. Also
there often is little incentive for landowners to allow community gardens in their space since
they are not likely to receive much economic return and the potential costs to have a community
garden may lower the desire to have them. There are considerations to make for leasing
88
community gardens. One is determining the suitability of the property. Questions to ponder
might include:
1) Is there sufficient space to make the endeavor worthwhile?
2) Does the space have access to water, sufficient sunlight, and appropriate soil suitable for
growing food?
3) Is the soil safe to grow food? Additional testing might need to be done beforehand before
committing to such a project.
Another consideration that often needs to be addressed is the duration of the community
garden. Some landowners need to have flexibility in terms of duration in order to make the land
available. Some community gardens might have a long-term use or a short-term use depending
on the expectations of the landowner. This is an important consideration because it could
determine how much time and money that is invested into the space.
Farmers Market
A major local institution that has grown in recent years to serve the local community is
the farmers market. These points of sale have grown dramatically in just a few years due to
heavy promotion, distinctive products, low prices, and a unique shopping experience. In 1994,
there were approximately 1,755 farmers markets in America. In 2012 more than 7,800 farmers
markets thrive across the country.187 There are more than 130,000 vendors that sell their
products at farmers markets and sales are over $1 billion nationwide.188
187
United States Department of Agriculture: Agriculture Marketing Service. 2012. “Farmers markets and Local
Food Marketing.” http://www.ams.usda.gov/AMSv1.0/
188
Farmland Report: American Farmland Trust. 2011. “Farmers Markets by the Numbers.”
http://blog.farmland.org/2011/04/farmers-markets-by-the-numbers/.>
89
Some cities have multiple farmers markets which provide more opportunities to buy local
products. For example, New York City has over 100 farmers markets and Los Angeles has over
80 farmers markets.189 Farmers feature their products to consumers at a retail market. Markets
are typically characterized by multiple booths or tables located either indoors or outdoors. They
typically sell food items such as fresh vegetables, fruit, dairy, and meat items to name a few.
Farmers’ markets provide a number of benefits. First, farmers keep most of the money
from consumer sales rather than selling to supermarket wholesalers. Farmers are often forced to
receive low prices for their produce even though supermarkets mark-up the prices. Farmers are
left to get a marginal share and some are even forced to go out of business because of such poor
returns.190 Consumers benefit from buying fresh food and being offered a variety of unique
products while building a relationship with farmers.
Farmers markets are considered to be a community experience that puts the consumers in
touch with the people that produced the products and gives consumers an opportunity to learn
about how the food was grown. Also, money spent at farmers markets tends to be circulated
locally and supports the local community. According to a study, for every dollar that a consumer
spends in their local community retailer, 30 to 45 cents stays locally circulated compared to 15
cents when spent at a large chain.191 Also prices at farmers markets are often comparable or
even lower depending on the items and location. One sample study concluded that various
farmers markets in multiple Southeastern states had produce items that were less expensive than
189
Department of Agriculture & Markets. 2012. “New York State Farmers’ Markets.”
http://www.agriculture.ny.gov/AP/CommunityFarmersMarkets.asp/.>
190
Friends of the Earth. 2000. “The Economic Benefits of Farmers’ Markets.”
http://www.foe.co.uk/resource/briefings/farmers_markets.pdf/.>
191
Mitchell, Stacy. Independent Business. Key Studies on Big-Box Retail and Independent Business. July 2012.
http://www.ilsr.org/key-studies-walmart-and-bigbox-retail/#1/.>
90
in supermarkets by an average of 22 percent. Also, 88 percent of the communities with farmers
markets had organic items that were cheaper by an average of 16 percent.192
Finally, one of the most unseen benefits of farmers markets is the creation of jobs for
farmers and the preservation of farmland. The number of farmers markets increased by 9.6
percent in 2012 from 2011.193 Supporting local farmers ensures that farming will remain a viable
option. Despite the growth of farmers markets, there still is room for improvement. There are
3,143 counties in the US that enjoy a farmers market. Of all counties, 33 percent of them do not
have a farmers market while 5 percent had 10 or more farmers markets. The counties with more
than 10 markets are located in high population counties with a high customer base. Most of the
counties without a farmers market are located in the Midwest and with a low population base.194
Many small farmers rely on farmers markets for their income because many wholesalers and
mass markets will only contract with high volume producers.
Low-income people who receive SNAP benefits can expect to be able to use their
benefits at farmer’s markets. In 2012, the Food and Nutrition Service (FNS) received $4 million
to increase availability of point-of-sale (POS) equipment in farmer’s markets that are not
currently participating in SNAP.195
192
Flaccavento, A., 2011. “Is Local Food Affordable for Ordinary Folks? A Comparison of Farmers Markets and
Supermarkets in Nineteen Communities in the Southeast.” Scale, Inc. Print.
193
United States Department of Agriculture: Agricultural Marketing Service. 2012. “Farmers Markets and Local
Food Marketing.” <http://www.ams.usda.gov/AMSv1.0/farmersmarkets/.>
194
United States Department of Agriculture: Economic Research Service. 2012. “Farmers’ Markets Concentrated in
Metro Counties.” http://www.ers.usda.gov/amber-waves/2012-december/on-the-map-farmers-marketsconcentrated-in-metro-counties.aspx/.>
195
“Farmers’ Market Equipment Funds: A Funding Opportunity for Certain Farmers’ Markets and Direct Marketing
Farmers.” 2012. United States Department of Agriculture. Retrieved from:
http://www.fns.usda.gov/sites/default/files/FM-update.pdf/.>
91
Policy and Pricing Interventions in restaurants and schools
Studies have shown that eating away from home is associated with higher calories and
lower diet quality which might contribute to the prevalence of obesity. However, restaurants can
incorporate healthier choices to help mitigate the rise of obesity and improve the diets of many
Americans.
Studies interviewing major restaurant executives that plan menus have shown that there
are barriers to introducing healthier options on a large scale. The barriers includes shorter life
span for certain food items, increased preparation time, low sales, and high labor costs. Also,
there isn’t a strong demand for healthier food options in some major restaurants. The restaurant
industry needs to have strong consumer demand for them to incorporate more healthy food
choices.196
Despite the challenges of incorporating healthier food options in restaurants, optimism
exists in increasing healthier food options in restaurants. Many major restaurant chains report
that they expect to provide more healthy and fresh food as part of a strategy to be innovative and
forward thinking.197 Surveys have shown that consumers claim to want healthier options but
indulge on unhealthier food when they eat out.198
There are programs and initiatives to try to encourage consumers to eat more fruits and
vegetables that are beyond the focus of vegetarian meals. Some ideas include providing
convenient containers for leftover fruits and vegetables meals. This would encourage consumers
196
Glanz, K., Resnicow, K., Seymour, J., et al. 2007. “How Major Restaurant Chains plan their menus: The Role of
Profit, Demand, and Health.” American Journal of Preventive Medicine. 32: (5).
197
Glanz, K., Hoelscher, D., “Increasing fruit and vegetable intake by changing environments, policy and pricing:
restaurant-based research, strategies, and recommendations.” American Journal of Preventive Medicine. 39: S8893.
198
Bowman, S., Vinyard, B. 2004. “Fast Food consumption of U.S. adults: Impact on energy and nutrient intakes
and overweight status. Journal of the American College of Nutrition.23: 163-168.
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to eat them later for snacks or other meals. Institutional policies would be needed to promote
implementation.199
The next effort includes restaurants adding menu labels showing the number of servings
of fruits and vegetables in food products. Food menus that have labels like a “5-A-Day” sticker
that shows how many fruits and vegetables servings it contributes to the total daily
recommended servings. In cafeterias, stickers would ideally be placed at the point-of-purchase.
Other suggestions include making ‘value meals’ using fruits and vegetables instead of French
fries, chips, or other high-calorie snacks. This would encourage higher consumption and would
subsidize prices when you buy more. The restaurant chains McDonald’s and Subway offer some
of these strategies.200
Next, we will discuss federal programs available to help meet the food needs of
individuals who otherwise can’t afford it. Below two examples of specific programs and the
impact they have on America.
Federal Program Example 1: WIC (Women, Infants, and Children)
The WIC is a nutritional assistance program aimed at low-income pregnant women, new
mothers, infants, and children providing nutritious food, nutrition education, and access to food
related health care. It was founded in 1974 in response to the realization that hunger among
mothers and their children was widespread. The program provides assistance to more than 9
million Americans. The program has recently focused its outreach efforts to underserved diverse
communities as many qualified poor Americans are not educated about the nutritional programs
available to help them achieve nutritional goals.
199
199. Natow, Annette B. and Jo-Ann Heslin. Eating out Food Counter: Restaurant, Takeout, and Snack Foods.
New York: Pocket, 1998. Print.
200
Ibid., 92.
93
The WIC program has used extensive social marketing campaigns to increase
participation in underserved communities. An effective tool they’ve implemented for outreach is
using foreign languages in their marketing materials. State WIC departments have distributed
materials translated to many different languages focused on specific cultural needs such as
Spanish, Mandarin, French, Portuguese, Russian, Somali, and Vietnamese. Many of the
outreach efforts include distribution of outreach materials like flyers and brochures, attendance
to conferences or community events, collaboration with the media, implementation of the
automated WIC hotline, sponsorship of local health fairs, and referrals.201
Federal Program Example 2: Supplemental Nutrition Assistance Program (SNAP)
The SNAP program is the largest nutrition assistance program in the United States. It
serves over 45 million people, about 1 in 7 Americans.202 The federal program is designed to
reduce food insecurity and help people with low-incomes have the ability to buy nutritious food.
Benefits are provided through an electronic benefits transfer (EBT) card that is similarly used
like an ATM card. A person who qualifies can use the card to purchase food and beverages. The
amount of monetary benefits a person or family receives depends on factors such as income and
family size.
The program has been shown to significantly reduce the rate of food insecurity for the
poor. However studies have also shown that SNAP participants are disproportionately obese and
201
“Making WIC Work for Multicultural Communities: Best Practices in Outreach and Nutrition Education” 2009.
Food Research and Action Center. Retrieved from: http://frac.org/newsite/wpcontent/uploads/2009/09/wic_multicultural_communities.pdf#page=6.
202
“Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program.” 2012. USDA: Food
and Nutrition Service & Office of Research and Analysis.”
http://www.fns.usda.gov/sites/default/files//BuildingHealthyAmerica.pdf.
94
have poorer diet quality in comparison to those who are eligible but don’t participate in it.203
Also diets of SNAP participants are similar to that of higher-income Americans.204 The graph
below compares the health index of those who use SNAP and those who don’t.
Table 1: Healthy Eating Index Scores by Subgroups: 1999 to 2004
Source 2: USDA
There are practical solutions that can be implemented to minimize the possible negative
health outcomes. Some proposed ideas to strengthen SNAP with regard to obesity and other
nutritional concerns include the following:
-Providing program participants a discount (lesser amount deducted from EBT card) for
purchasing more nutritious food items such as fruits and vegetables.
-Providing coupons for fruit and vegetable purchases.
-Increasing the program benefit levels so that more money is available for purchasing more
nutritious food items.
203
“U Experts analyze Supplemental Nutrition Assistance Program (SNAP).” 2013. University of Minnesota School of
Public Health. Retrieved from: http://sph.umn.edu/u-experts-analyze-supplemental-nutrition-assistance-programsnap/.>
204
“Diet Quality of Americans by Food Stamp Participation Status: Data from the National Health and Nutrition
Examination Survey, 1999-2004.” Report submitted to the U.S. Department of Agriculture, Food and Nutrition
Service. Cambridge, MA: Abt Associates, Inc., July 2008.
95
-Prohibiting the purchase of less nutritious food items with SNAP benefits. Foods that are high in
discretionary calories such as soft drinks, sweet baked goods, and candies have been proposed as
prime targets for exclusion.
-Strengthening SNAP-Ed, the nutrition education component of SNAP.
-Expanding availability of wireless technology in farmers markets so that SNAP EBT cards may
be accepted at more of these markets.
-Bi-weekly rather than monthly deposits onto the EBT card to reduce episodic food insecurity
which may lead to overeating.
-Encouraging other marketplace changes such as allowing food retailers to offer discounts to
SNAP participants for the purchase of more nutritious foods. A key concern is that proposed
policies improve health without being detrimental to program participation.205
The USDA, through the 2008 Farm Bill, has created a pilot program called Healthy
Incentives Pilot that will provide financial incentives to buy fruits, vegetables, and other
healthful foods using SNAP cards. SNAP participants receive 30 cents for every dollar spent on
eligible fruits, vegetables, and other goods back into EBT cards. The pilot is currently done in
the state of Massachusetts. Results of the program are still unknown in terms of data on food
purchases, but implementation of the program had numerous technical challenges as it required
extensive system changes for large supermarkets. Also, some retailers noted it would be more
likely to participate in the program if the pilot program was a permanent program and not just for
a 14 month period.206 However, the initiative has been considered a success because state
officials in Massachusetts were able to get the program running throughout the entire state in
205
Ibid., 95.
“Healthy Incentives Pilot (HIP) Early Implementation Report — Summary.” USDA: 2013. USDA: Food and
Nutrition Service, Office of Research and Analysis.
<http://www.fns.usda.gov/sites/default/files/HIP_Early_Implementation_Summary.pdf/.>
206
96
only 15 months. Future initiatives should consider offering more incentives to encourage people
to buy more fruits and vegetables.
These are just a few strategies that leaders can implement to help improve the food
choices in people’s communities. Other strategies include bringing grocery stores to
communities that don’t have access to them, bringing more farmers markets to fruition,
encouraging the use of urban agriculture, and encouraging restaurants to bring more healthy
choices for people to make.
The Food Environment Conclusion:
A person’s food choices are often determined by what’s available in their food
environment. It also is determined by socio-economic factors such as income, education, family
background, and the cultural expectations that people are exposed to themselves. In this sense,
strong government and community interventions is necessary to bring healthy change to people’s
lives. People that are obese often live in areas where food access is limited. Therefore, providing
access to healthy food in poor areas is a necessary step to address food access. There are a
number of different ways to provide food access. It often depends on the community’s needs and
what options are available to provide assistance. Options range from providing grocery stores in
poor neighborhoods where there is perceived risk to the grocery store’s bottom line; other
options include creating community gardens that is shared by the community’s residents. It’s
also important to note that many people struggle to afford healthy food which often requires the
support of the government and the local community. The government can provide financial
assistance while local communities can provide local food programs that provides access to
healthy food.
97
Chapter 4: Education
Issues of K-12 Education on health
One of the prevalent problems in addressing obesity is the lack of useful education to
inform people about proper nutrition, dieting, and physical exercise. Nearly one in three children
and adolescents in America is overweight or obese. These concerning stats suggest that policy
intervention on all scales is a necessary strategy to inform people about what they can do to
improve their health. A number of actions are underway to address the problems of childhood
obesity. There are a number of K-12 schools around the country that are taking strong initiatives
to improve the health and well-being of school children. Examples of these efforts include lunch
programs to include healthier menu options, creating more time for schoolchildren to participate
in physical exercise and in physical education, promoting walking/biking to school programs,
and using community gardens as part of the classroom to promote better diets.
We are already seeing initiatives at all levels aimed at reducing obesity. At the national
level there are two major initiatives with the goal to reduce childhood obesity as well as prevent
future obesity related diseases. The first is the Let’s Move campaign led by Michelle Obama
which strives to alleviate childhood obesity through physical activity and proper nutrition. The
second is the Communities Putting Prevention to Work (CPPW) initiative to promote health and
prevent chronic diseases attributed to poor nutrition and lack of physical exercise. States have
implemented legislation to tackle obesity and are putting preventive measures in place to curb
future children from getting too obese.
The results of many of these initiatives are still not in yet, but we are already seeing
promising results. There are signs that the national childhood obesity rate has leveled off since
the early 2000’s despite some disparities. A number of cities around the country such as
98
Philadelphia and New York City have reported declining obesity rates. States such as Mississippi
and California have also reported declining rates. Many of these changes are the result of strong
initiatives and policies set by local and state government along with strong community
support.207
This chapter will focus on a few questions concerning nutrition and physical education.
Then it will address the current solutions that leaders have implemented and also examine other
practical solutions that communities can use to reduce obesity rates in America’s children.
What is nutrition and how can it apply to obesity?
Nutrition is an essential element of obesity because it has a direct impact on a person’s
health. Nutrition “is the intake of food, considered in relation to the body’s dietary needs.”208
Poor nutrition can serve significant health risks such as reduced immunity, increased
susceptibility to disease, reduced productivity, and impaired physical and mental health. These
health risks can be minimized by focusing on nutrients that are essential for the body to function.
The essential nutrients for life include carbohydrates, proteins, lipids, fiber, vitamins, minerals,
and water.209 Many Americans don’t get enough of these nutrients to live a full healthy lifestyle.
Most Americans consume too much sodium, calories from solid fats, added sugars and refined
grains.210 Nutrition can help people make smart choices about the foods people should eat to
develop good health as part of a healthy lifestyle. The graph below shows how little the average
207
“Declining Childhood Obesity rates−where are we seeing the most progress?” 2012. Robert Wood Johnson
Foundation. <http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf401163/.>
208
“Nutrition.” WHO. World Health Organization, 2013. Web. <http://www.who.int/topics/nutrition/en>.
209
”What is Nutrition?” What is Nutrition? Tips For Healthy Living. 2013. http://whatisnutritiontips.com/.
210
“Executive Summary” Dietary Guidelines For Americans, 2010.
<http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/ExecSumm.pdf.>
99
American consumes of vital nutrients compared to the excessive amount of unhealthy nutrients
the same average American consumes.
Source: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter5.
The Dietary Guidelines for Americans which is issued by the USDA and Department of
Health and Human Services (HHS) is the authoritative measure when it comes to nutrition and
health. It also is the basis for nutrition education programs, Federal nutrition assistance
100
programs, and dietary advice provided by health professionals.211 The Dietary Guidelines
recommend managing total calorie intake and increasing physical activities. It also states that we
should reduce the following food components:212
1) Reduce daily sodium intake as many Americans have hypertension, diabetes, and chronic
kidney disease.
2) Consume less calories from saturated fatty acids by substituting them with
monounsaturated and polyunsaturated fatty acids.
3) Consume less dietary cholesterol
4) Reduce the intake of calories from fats and added sugars
5) Limit consumption of refined grains, especially refined grain foods that contain solid fats,
added sugars, and sodium.
6) Minimizing the consumption of trans fatty acids as low as possible such as hydrogenated
oils and other solid fatty foods.
The foods and nutrients that the Dietary Guidelines suggests that Americans should follow as
part of a healthy diet are:
1) Increasing vegetable and fruit intake.
2) Eating a variety of vegetables, including those with a variety of colors such as those with
dark-green, red, and orange vegetables.
3) Replacing refined grains with whole grains
4) Increase consumption of seafood and lower consumption of red meats
211
“USDA and HHS Announce New Dietary Guidelines to Help Americans Make Healthier Food Choices and
Confront Obesity Epidemic.” USDA Press Release.
<http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PressRelease.pdf/.>
212
“Executive Summary” Dietary Guidelines For Americans, 2010.
<http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/ExecSumm.pdf/.>
101
5) Replace protein foods that are higher in solid fats with choices that are lower in solid fats
and calories
6) Use oils to replace solid fats where possible
7) Higher consumption of foods that contains more potassium, dietary fiber, calcium, and
vitamin D which are nutrients of concern in American diets. These foods include
vegetables, fruits, whole grains, and milk products.
It is important to understand the role of nutrition as it regulates how our bodies function.
Having a nutritious diet that is low in solid fat, sodium, and added sugars not only gives
people a natural weight, it also gives people the energy they need to succeed. Below is a
resource list that provides website information about nutrition and tools to help people adopt
healthy choices.
102
Source: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter6.pdf.
Nutrition in K-12 schools
More than 31 million children are served school lunches each day, at a cost over $10
billion which fulfills about 35 percent of children’s daily food requirements.213 A long-term
study concluded that the National School Lunch Program (NSLP) was contributing to the obesity
213
Briefel, R. R., M. K. Crepinsek, et al. (2009). "School food environments and practices affect dietary
behaviors of US public school children." Journal of American Diet Association 109(2 Suppl): S91-107.
103
epidemic. The NSLP funds meals to about 30 million children in about 100,000 schools and the
School Breakfast Program provides financial assistance to more than 10 million children. The
study, which analyzed data on more than 13,500 elementary school children around the country
showed that children who participated in the meal program were more likely to become
overweight than those who were not in the program.214 The study cites data from the National
Health and Nutrition Examination Survey that was taken between 1971 and 1974 and again from
2003 to 2004. The results showed that the prevalence of overweight preschool children jumped
from 5 percent to 13.9 percent. For school-aged children, the prevalence jumped from 4 percent
to 18.8 percent for children ages 6 to 11. Those who were between ages 12-19, the prevalence
jumped from 6.1 percent to 17.4 percent.
The research also showed that children who eat both the breakfast and lunch sponsored
programs where less overweight than those who didn’t participate in either program. Breakfast
choices were shown to be healthier and more nutritious than lunch choices.
These problems are the result of the challenge of budgeting healthy and appealing meals
for students. School districts have to meet certain nutritional standards, but they get to choose the
specific foods they want to serve. The school programs reimburse meals to students but it may
not cover the full cost of meals which is why schools often sacrifice meals that are cheaper and
have lower nutritional quality. While schools have to follow certain nutritional standards, some
foods are not subjected to the same standards. These foods, often known as a la carte, may
include meal-type items but are most commonly snacks such as potato chips, cookies, or ice
cream. It is noted that some schools are not in compliance with school lunches which could
result in a loss of funding from the NSLP.
214
Millimet, D., Tchernis R., et al. “School Nutrition Programs and the Incidence of Childhood Obesity.” Journal of
Human Resources. (45): 3. pg. 640-654.
104
There are also concerns that children’s eating habits and choices change over time. A
small study done in Minnesota showed that as students move from elementary to middle school,
their consumption of breakfast, fruits, vegetables, and milk decreased. Specifically, consumption
of fruit fell by 41 percent and consumption of vegetables dropped 25% from 3rd to 5th grade.
Also consumption of soft drinks rose. The proportions of soda drink consumption more than
tripled between the 3rd and 8th grades while there were significant reductions of milk and juice
consumption.215
These findings concluded that efforts at the local level to the national level are needed to
promote healthful food choices for children. Specifically, nutrition education needs to be a
higher priority. Promoting healthy eating must be encouraged in all environments, not just in
schools. Findings have shown that many students get more of their fruits and vegetables contents
from school than outside of school.216
The state of physical activity and physical education in schools
Over 95 percent of school-aged youths in America attend school and that is where the
majority of school children spend their time, besides home.217 In this sense, policymakers at the
national, state, and local levels have powerful roles in contributing to the prevention of childhood
obesity, including the provision of opportunities for physical education before, during, and after
school.
215
Leslie A. Lytle, Sara Seifert, et al. 2000. “How Do Children's Eating Patterns and Food Choices Change Over
Time? Results from a Cohort Study.” American Journal of Health Promotion. (14): 4 pp. 222-228.
216
Ishdorj A., Crepinsek M., et al. 2013. “Children’s Consumption of Fruits and Vegetables: Do School Environment
and Policies Affect Choices at School and Away from School?” Applied Economic Perspectives and Policy. (35): 2
pp. 341-359.
217
Ehrlich G. 2011. Physical Activity in Schools is a ‘Win-Win’ from an Academic and Health Perspective. Retrieved
from ‘F as in Fat: How Obesity Threatens America’s Future 2011”.
105
Fortunately, there is growing evidence of the academic as well as health benefits
attributed to children’s physical activity. A CDC literature review noted that increased time in
physical education classes were linked to higher achievement test scores. Having short classroom
physical activity breaks of about 5 to 20 minutes such as recess improved the attention span and
concentration of students and also improved student behavior and test scores. Other notable
conclusions have shown that participation in team sports and physical activity clubs have shown
positive effects on student grade point averages and their likelihood of graduation. These reports
make an argument that schools should continue to invest in physical education and physical
activity to improve student performance and reduce poor behaviors and lack of concentration.
According to the CDC, fewer than ten percent of middle schools and fewer than five
percent of elementary schools and high schools offer physical education on a daily basis. Of
schools that do offer physical activity opportunities, approximately one-third are fee-based
programs, which reduces access for low-income students. The most notable barriers for youths in
accessing physical activity programs are time, resources, and staff capacity. The percentage of
high school students who attended physical education classes on a daily basis decreased from 42
percent in 1991 to 25 percent in 1995 and remained at those levels until 2011 when it rose to 31
percent. In 2011, 41 percent of 9th-grade students attended physical education classes but only 24
percent of 12th-graders attended physical education classes.218
Most youths and teenagers in this country are not as physically active as they should be.
According the CDC, among 9-12th graders, only 11 percent of females and 24 percent of males
said they were physically active every day.219 Also in 2007, only 30 percent of 9-12th graders
218
CDC. The Association Between School-Based Physical Activity, including Physical Education, and Academic
Performance. Atlanta, GA: U.S. Department of Health and Human Services; 2010.
219
Centers for Disease Control and Prevention‘s National Youth Risk Behavior Surveillance—United
States, 2007. Unpublished data.
106
reported attending physical education classes every day.220 Among 9-13 year olds, only 39
percent were reported to participate in organized physical activity.221 Other concerns showed that
in 1969, 41 percent of students walked or biked to school. Those numbers dropped to 13 percent
in 2001.222 Instead of engaging in physical activity, 35 percent of 9-12th graders were reported to
spend 3 or more hours watching television every day.223
These concerning facts demonstrate that schools and parents need to do a better job in
encouraging students to be more active. They also need to encourage schools to implement a
comprehensive school physical activity program. The following are ideas in providing practical
solutions parents and schools can use to encourage their children to engage in more physical
activities.
Let’s Move! Campaign and the Taskforce on Childhood Obesity
The Let’s Move! initiative, launched by Presidential First Lady Michelle Obama in 2010
is dedicated to raising awareness about childhood obesity and promoting comprehensive
solutions. The initiative encourages access to healthier food in schools, providing parents with
information and tools to make good choices about food and physical activity, and to get more
physical activity for children.
The campaign spurred the development of the White House Task Force on Childhood
Obesity which seeks “to develop an interagency action plan to solve the problem of obesity
220
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2007.
MMWR. 2008;57(No.SS-4):1-131.
221
Ibid., 107.
222
McDonald MC. Active transport to school: trends among U.S. schoolchildren, 1969-2001. American
Journal of Preventive Medicine 2007;32(6):509-16. Print.
223
Ibid., 107.
107
among our Nation’s children within a generation.”224 The Task Force has presented 70 specific
recommendations. The ultimate goal of the taskforce is to reduce the rate of obesity to 5 percent
by 2030.
The Federal agencies that are part of this taskforce include the Human and Health
Services (HHS), the Department of Agriculture (USDA), Federal Trade Commission (FTC), the
Treasury Department, the Department of Transportation (DOT), the Department of Education,
and the Environmental Protection Agency (EPA).
HHS has released new guidance standards for physical activity and nutrition. The USDA
has updated the Dietary Guidelines and Food Pyramid that is aimed to help provide information
about nutrition. The USDA also is promoting their Healthier US School Challenge which is a
voluntary initiative to help schools participating in the National School Lunch Program to
promote healthier school meals and encourage physical activity. Monetary awards are available
based on measureable improvements in nutrition and physical activities.225
The FTC has monitored how food is marketed to children. In 2008, the FTC
recommended to companies that market food or beverage products “adopt meaningful, nutritionbased standards for marketing their products – standards that extend to all advertising and
promotional techniques…and should improve the nutritional profiles of products marketed to
children and adolescents.”226
224
“Presidential Memorandum – Establishing a Task Force on Childhood Obesity” 2010. The White House.
http://www.whitehouse.gov/the-press-office/presidential-memorandum-establishing-a-task-force-childhoodobesity/.>
225
"United States Department of Agriculture Food and Nutrition Service: HealthierUS School Challenge".
November 26, 2010.
226
Federal Trade Commission. FTC Report Sheds New Light on Food Marketing to Children and Adolescents. Federal
Trade Commission: Protecting American’s Consumers. N.p., 29 July 2008. Web. <http://www.ftc.gov/newsevents/press-releases/2008/07/ftc-report-sheds-new-light-food-marketing-children-adolescents>.
108
The DOT and EPA has promoted walking and biking to school. The DOT has provided a
best practices guide for their National Safe Routes to School program. The EPA has proposed
voluntary school siting guidelines. The Department of Education has supported the initiative by
granting $35 million to physical education programs that support the Successful, Safe, and
Healthy Students initiative.227
Healthy Schools Program
The Healthy Schools Program, which was created by the Alliance for a Healthier
Generation is the nation’s largest program that focuses on school-based obesity prevention. The
program currently works in more than 20,000 schools in every state.228 Their effort focuses on
schools that are predominately low-income and have minority students as they are at higher risk
for obesity.
The program provides training and technical assistance to schools for four years at no
cost. The program focuses on eight areas:
1) Policies and systems
2) School meals
3) Competitive foods and beverages
4) Health education
5) Physical education
6) Physical activity outside of physical education
7) Before-and-after-school programs
227
“Childhood Obesity Task Force Unveils Action Plan: Solving the Problem of Childhood Obesity Within a
Generation.” 2010. The White House. <http://www.whitehouse.gov/the-press-office/childhood-obesity-task-forceunveils-action-plan-solving-problem-childhood-obesity/.>
228
“Our Approach.” The Alliance for a Healthier Generation. American Heart Association. 2012. Web.
<https://www.healthiergeneration.org/about_childhood_obesity/our_approach>.
109
8) School employee wellness
The program has worked effectively for schools that participated in them. About 50
percent of the schools in the program have improved the nutritional value of the school meals
and over 50 percent of their schools have dedicated 20 percent of afterschool program time to
physical activity.229
Schools can apply for the program but have to follow a framework that works with
school children and teenagers to acquire the knowledge about health and work to become
healthier. Each of the program areas has a checklist in order to pass the requirements to be in the
program.
For policies and systems, some criteria that must be met are providing drinking water free
of charge to students during the school day, having schools track student’s body mass index and
reporting the results to the district, having the school’s wellness goals integrated into the overall
school improvement plans, and having school grounds open to students, families and the
community for access to physical activities. In addition, there are awards which stipulate that the
school in question is implementing the district wellness policies and is providing feedback to the
district. Other awards have members of the school community provide input into wellness policy
activities during meetings.
There are a number of criterion that the school must meet for school meals. Some
examples are having the school engage in the marketing of healthy food options during breakfast
and lunch by using posters, table tents, or the use of creative names for healthy options. Schools
can have a system in place where students or parents can preselect breakfast and lunch. There
can be annual training to cover basic nutrition and healthy eating concepts such as handling
229
“Schools” The Alliance for a Healthier Generation. 2013. American Heart Association. 2013. Web.
<https://www.healthiergeneration.org/take_action/schools/.>
110
fresh food, or knowing how to reduce fat and sodium in food preparation. There should always
be at least one serving of fruit and vegetables for breakfast as well as multiple meal options
served every day.
The criterion for competitive foods and beverages is based on a standard that the school
sets for itself. Competitive foods is a term defined as foods or beverages that are sold at school
that are not part of the National Breakfast or Lunch meals program. Schools can meet the ‘Gold
Level Award’ by setting school policies that restrict branding and marketing competitive foods
that meet the Alliance guidelines. Entrees that are served as competitive foods are a la carte, in
school stores, and in vending needs and meet nutritional standards of foods that are low in fat
and sodium. There are other standards that explain other school policies and practices.
The criteria for health education states: comprehensive health education is required for all
students. This includes skills-based lessons on healthy eating, benefits of physical activity, and a
minimum of 30 minutes per week of instructional time. High schools can take a step further and
require student take health education for high school graduation. Another criteria is that teachers
who teach health education receive annual professional development on effective practices and
are licensed or certified in health education. Districts can use the CDC’s Health Education
Curriculum Analysis Tool (HECAT) which monitors and works to improve eating habits and
physical activities.
School employees such as teachers and administrators are expected to participate in
programs themselves to ensure that they provide children opportunities to participate in physical
activities and healthy eating programs.
One of the criteria for physical education in the program is the requirement of elementary
school children to participate in a minimum of 60 minutes of physical education per week, 90
111
minutes for middle school students, and a minimum of one-half year or more of physical
education with the option to enroll in additional education if students desire. Schools are to
provide fitness education, conduct, health-related fitness assessments, and create individualized
physical activity/fitness plans that include goal-setting and monitoring.230
The basis for the Healthy Schools Program is to give students and educators the best
opportunity to achieve healthful goals. The program recognizes that obesity is a top concern and
focus on efforts to reduce or prevent obesity in schools is the best way to battle it now and in the
future.
Communities Putting Prevention to Work (CPPW)
The Communities Putting Prevention to Work (CPPW) initiative is a national campaign
led by the CDC that addresses chronic diseases such as obesity and tobacco in all 50 states. CDC
has awarded $373 million in grants to various local communities around the country. 28 states
have received $230 million in funding to address obesity.231 The grants fund obesity prevention
efforts and improve health behaviors by changing community environments. Strategies include
improving nutritional standards, increasing physical activity, and implementing nutrition
education.232
230
“Healthy Schools Program Framework: Criteria for Developing a Healthier School Environment.” Alliance for a
Healthier Generation. 2013. American Heart Association.
<https://schools.healthiergeneration.org/_asset/l062yk/07-278_HSPFramework.pdf.>
231
“American Recovery and Reinvestment Act Prevention and Wellness Initiative: Communities Putting Prevention
to Work.” Centers for Disease Control and Prevention.
<http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/communities/profiles/pdf/
HHS_CPPW_CommunityFactSheet.pdf./>
232
“Obesity.” Centers for Disease Control and Prevention.
<http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/program/obesity.htm./>
112
Legislation for Healthy schools - meal options through policy changes
Studies have shown that school-based programs, policies, and initiatives can help prevent
or reduce obesity rates.233 States like Mississippi and California have set their own nutritional
standards for foods and beverages sold in vending machines.234 California prohibited its public
schools from selling sugar-sweetened beverages in high schools. A study noted that in 2012,
students were consuming 158 fewer calories per day than in states with weaker standards.235
Case Study: Philadelphia
The city of Philadelphia, which has diverse racial demographics, has reported a 4.7
percent decline in childhood obesity for grades K-12 between the years 2006 to 2010. Much of
those drops were contributed by strong changes in the school environment. Philadelphia did the
following in relation to school policy:
1. Provided nutrition education to students who qualified for the federal Supplemental
Nutrition Assistance Program (SNAP)
2. Removed all sodas and sweetened beverages from public school vending machines
3. Implemented a wellness policy that includes guidelines for school meals, snacks, physical
activity, and nutrition education
4. Banned deep fryers in school kitchens
5. Switched 2 percent milk to 1 percent and skim milk
233
Veugelers PJ and Fitzgerald AL. Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel
Comparison. American Journal of Public Health, 95(3): 432-35, 2005.
234
“Declining childhood obesity rates—where are we seeing the most progress?” 2012. Robert Wood Johnson
Foundation. <http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf401163./>
235
“California High School Students Consuming Fewer Calories at School.” RWJF. Robert Wood Johnson
Foundation, 14 May 2012. Web. <http://rwjf.org/en/about-rwjf/newsroom/newsroomcontent/2012/05/california-high-school-students-consuming-fewer-calories-at-scho.html>.
113
The city also worked to provide funding to attract grocers in low-income communities. Since
2001, Philadelphia has added 18 newly renovated or new supermarkets that are part of their
Fresh Food Financing Initiative. The city also requires chain restaurants in the city to provide
nutritional information on menus.236
States can create incentives for districts to follow their policies such as attaining compliance
to receive state funding. For example, school districts in New Mexico that fail the academic and
performance standards will result in a loss of funding for the following school year.237 Schoolbased efforts that relate to obesity have focused on improving the quality of food served in
cafeterias, in vending machines, school stores, limiting sales of less nutritious foods and
beverages. Schools are also focusing on efforts to improve physical education and physical
activities. Next we will examine the various government policies that have been put in place that
attempt to improve higher quality standards in food and physical education.
Healthy, Hunger-Free Kids Act
This is part of the National School Lunch and Breakfast Program that provides more
financial resources for schools to comply with higher food standards. The USDA is required to
oversee a transition to healthier school meals. Schools that comply are eligible for increased
federal reimbursements for school meal programs. The USDA will also establish nutritional
standards that state what foods and beverages can be sold at school. This includes vending
machines, school stores, and cafeterias. Local education agencies will be required to report on
236
“Philadelpha: Signs of Progress Toward Reversing the Childhood Obesity Epidemic.” 2013. Robert Wood Johnson
Foundation. <http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/07/philadelphia--signs-ofprogress.html.>
237
“Elementary Physical Education Program Units.” Nmlegis. New Mexico Legislature, 24 May 2011. Web.
<http://www.nmlegis.gov/Sessions/07%20Regular/final/HB0208.pdf/.”>
114
nutritional quality, participate in nutrition assistance programs, and influence food policies.238
Before the law was implemented only four states (Arkansas, South Dakota, Tennessee, Texas
had school meal standards that were more strict than the USDA requirements. Now over 20
states have stricter standards set by the USDA.
As part of the Healthy Hunger-Free Kids Act to provide nutritional standards, the USDA
created the Smart Snacks in School to provide students healthier food options while still offering
the opportunities to enjoy food options that aren’t as healthy. As school districts are working to
improve the quality of breakfast and lunch meals, the policy sets new minimum nutritional
standard for snacks. Students can still buy snacks that have saturated fat, sugar, and sodium, but
the policy is promoting products that have whole grains, low-fat dairy, fruits, vegetables, or
protein foods that are the primary ingredients. For example, student can still purchase chips, but
they will come in healthier versions such as baked tortilla chips, reduced-fat corn chips, or baked
potato chips. The policy does not prevent students bringing snacks such as cookies or other treats
from home, it only restricts food that is sold at school during the school day.239
Some school districts say that even as they increase the number of healthy options,
students continue to choose unhealthy foods. Last year, the USDA awarded $2 million to
researchers to examine the best ways to encourage kids to pick fruits and vegetables instead of
cookies and french fries. The scientists will examine marketing and placement techniques to see
which work best to make the healthier options more available and/or appealing. Some options
238
“Competitive Foods in School.” Adolescents and School Health. Center for Disease Control and Prevention. 06
Sept. 2013. Web. <http://www.cdc.gov/healthyyouth/nutrition/standards.htm>.
239
“Smart Snacks In School Nutritional Standards Interim Final Rule Questions and Answers” 2013. USDA.
<http://www.fns.usda.gov/cnd/governance/legislation/allfoods_QandA.pdf>.
115
that are being considered include: hiding chocolate milk behind plain milk, putting the salad bar
near the checkout, placing fruit in pretty baskets, and accepting only cash for desserts. 240
This law is in place to help schools meet higher food quality standards while providing
financial incentives to participate.
School Breakfast Program
This program was established by the US Congress as a pilot program in 1966 and became
a permanent entitlement program in 1975. The program is important because about 12.5 million
students who qualify for reduced or free breakfast were served on a daily basis. Many families
live on limited budgets and can’t provide breakfast meals everyday or live busy lives that they
don’t have time to make a nutritious meal. Eligibility is determined by household income. To
receive a free breakfast, household income must be at or below 130 percent of the federal
poverty level. To qualify for a reduced breakfast, family income must be between 130 and 185
percent of the poverty level.
Research has shown that children who consume school breakfast eat more fruit, more
milk, and consume a wider variety of foods than those who don’t eat breakfast or have breakfast
at home. School breakfast participation is associated with a lower body mass index, lower
probability of being overweight and lower probability of obesity.241 School breakfast has been
240
Martin, Rachel. “School Cafeterias to Try Psychology in Lunch Line.” The Huffington Post. The
HuffingtonPost.com, 13 October 2010. Web.
<http://www.huffingtonpost.com/2010/10/13/school-cafeterias-to-try-_0_n_760839.html>.
241
Gleason, P. M. & Dodd, A. H. (2009). School breakfast program but not school lunch program participation is
associated with lower body mass index. Journal of the American Dietetic Association, 109(2 Supplement 1), S118S128.
116
shown to eliminate disparities between food secure and food insecure children.242 It also protects
against other negative health outcomes. Adolescents that skip breakfast are more likely to have
higher rates of: blood cholesterol and insulin levels, smoking, alcohol use, physical inactivity,
disordered eating, and unhealthy weight management practices.243 244
Other studies have shown that students who eat school breakfast increase their math and
reading scores as well as improve their memory in cognitive tests over those who don’t. Also
research shows that children who eat breakfast at school perform better on standardized tests
than those who skip breakfast or eat breakfast at home.245 School breakfast participation, even
when offered for free, has a positive impact on student’s mental health, which also includes
reductions to behavioral problems, anxiety, and depression.246
These facts demonstrate a clear need for school breakfast. However some challenges
persist. Many middle and high school students are affected by the perception that school
breakfast is for the poor which has deterred many poor students from participating in the
program. There are new strategies to help students deal with the stigma of being poor and giving
them a meal to combat hunger and other negative health outcomes.
One strategy is to offer free breakfast to all students. This ‘universal’ free meal can boost
participation and eliminate the burden of collecting fees. Students are still free to not participate.
242
Khan, S., Pinckney, R. G., Keeney, D., Frankowski, B., & Carney, J. K. (2009). “Prevalence of food insecurity and
utilization of food assistance program: an exploratory survey of a Vermont middle school.” Journal of School
Health, 81(1), 15-20.
assistance program: an exploratory survey of a Vermont middle school. Journal of School Health, 81(1), 15-20.
243
Cohen, B., Evers, S., Manske, S., Bercovitz, K., & Edward, H. G. (2003). “Smoking, physical activity and breakfast
consumption among secondary school students in a southwestern Ontario community.” Canadian Journal of Public
Health. 94(1), 41-44.
244
Keski-Rahkonen, A., Kaprio, J., Rissanen, A., Virkkunen, M., & Rose, R. J. (2003). “Breakfast skipping and healthcompromising behaviors in adolescents and adults.” European Journal of Clinical Nutrition, 57(7), 842-853.
245
Child Nutrition Fact Sheet: School Breakfast Program. Rep. Washington, D.C.: Food Research and Action Center.
2009. Web. <http://frac.org/wp-content/uploads/2009/09/school_breakfast_program_fact_sheet.pdf>.
246
Murphy, J. M., Pagano, M. E., Nachmani, J., Sperling, P., Kane, S., & Kleinman, R. E. (1998). The relationship of
school breakfast to psychosocial and academic functioning: cross-sectional and longitudinal observations in an
inner-city school sample. Archives of Pediatrics and Adolescent Medicine, 152(9), 899-907.
117
Schools that have a high percentage of free or reduced-price eligibility of students are often able
to make up for lost revenue from paid meals with more participation through economies of scale.
There are other considerations to be made such as labor costs, food costs, school size, and
reimbursement amounts.
Schools can implement other strategies to encourage participation in the breakfast
program in order to improve students’ school performance and personal health. An alternative
breakfast service plan that meets the needs of the school can be used. For example, schools can
adopt a Breakfast in the Classroom service where students eat breakfast in the first 15 minutes of
the school day, which can increase participation dramatically. Meals can be delivered to each
classroom or picked up on the way to class. This strategy can reduce the stigma of school
breakfast being only for low-income students and provides social bonding time for students and
teachers.247
The second option that schools can implement is the Grab and Go Breakfast service in
which schools serve breakfast from carts in the hallway or cafeteria that is to be eaten on the way
to the class. This provides flexibility for schools to encourage students to participate in the
program. Some students might have difficulty getting a breakfast meal before school starts and
this provides an option to eat breakfast right before school starts.248
The last option that schools can use to provide breakfast to their students is the Second
Chance Breakfast. Breakfast is served from the cafeteria or carts after the first period during a
morning break, which allows students who arrive late or not hungry to still get a breakfast. This
247
“How it Works: Breakfast in the Classroom.” FRAC. Food Research and Action Center. 2012. Web.
<http://frac.org/pdf/how_it_works_bic_fact_sheet.pdf>.
248
“How it Works: Grab and Go Fact Sheet.” FRAC. Food Research and Action Center. 2012. Web.
<http://frac.org/pdf/how_it_works_grabandgo_fact_sheet.pdf>.
118
option often works best in middle or high schools that can reduce the social stigma associated
with school breakfast. It also does not reduce lunch participation.249
School breakfast is an important strategy to combat the problems associated with
childhood obesity and student-based performances. Schools need to strengthen their efforts in
improving the quality of school meals. More importantly, schools must make sure that all
students have access to breakfast.
After School Snacks and Meals
The federal government has an afterschool Nutrition Program that serves meals and
snacks to children after school, on weekends, and during school holidays. It is a federallysubsidized program to help children be active, engaged, and safe while parents are busy. The
program provides a reimbursement for each meal served. The program recently revised its
nutritional standards in response to the prevalence of childhood obesity.
The nutritional guidelines for afterschool meals are:
-
1 serving of milk
-
2 servings of fruits and/or vegetables
-
1 serving of grains
-
1 serving of protein
Meals can be hot or cold. Snacks have to include two of the four components to qualify.
The programs are designed for schools interested in serving meals, local government agencies,
and afterschool programs run by nonprofits such as the Boys and Girls Club or YMCA’s.250
249
“How it Works: Second Chance Breakfast Fact Sheet.” 2013. FRAC. Food Research and Action Center. 2012.
Web. <http://frac.org/pdf/how_it_works_2ndchancebreakfast_fact_sheet.pdf.>
250
“Afterschool Nutrition Programs” FRAC. Food Research and Action Center. 2012. Web.
<http://frac.org/federal-foodnutrition-programs/afterschool-programs/.>
119
Schools and other community services have the ability to serve high quality food which
can attract children to afterschool programs and give students the energy to benefit from
educational or enrichment activities. These students are often low-income students who are at a
higher risk of consuming less healthy food. Promoting healthy snacks and meals reinforces
positive eating habits and ensures that children have access to fresh fruits, vegetables, and whole
grains instead of high fat foods or soda. Afterschool programs often provide opportunities for
physical activity. This contributes to better health and reduces the risk of obesity.
Schools and other programs that serve afterschool meals and snacks can strive to go
above and beyond serving the minimum standards for nutritional quality. Through the Food
Research and Action Center, an evaluation can be done to monitor how it’s doing. The criterion
include:
1) Offering fresh fruits and/or vegetables five days a week
2) Offering whole-grain foods two or more times a week
3) Serving low-fat milk and/or skim milk
4) Serving food at the right temperature (serving cold foods cold, not frozen. Serving hot
foods hot, not burnt or overcooked)
5) Offering alternative menu items for children based on religious observances or food
allergies
6) Serving culturally sensitive food for the population of children
120
Figure 2: Example of Afterschool Snack Menu
Source: Food Research and Action Center
Providing high quality food over lower quality food can attract children to eat healthier and
participate in programs that depend on funding from grants.251
Afterschool programs that want more information on how to participate can contact state
child nutrition programs through the USDA’s Food and Nutrition Services or at
http://www.fns.usda.gov/cnd/Contacts/StateDirectory.htm.
Summer Food Service Program
The USDA’s Summer School Service program provides free meals and snacks to lowincome children 18 and under when school is out. Meals served in the program must meet
federal nutritional standards. When school is not in session, millions of low-income children lose
access to school meals and this program fills the gap. Local government programs such as parks
and recreation summer programs, school districts, and nonprofits can sponsor summer food sites.
Food sites may be located at schools, parks, recreation centers, housing projects, summer camps,
faith-based places of worship, and other places where children congregate when school is out.
251
“Food Research and Action Center: Afterschool Nutrition Standards of Excellence” FRAC. Food Research &
Action Center. 2009. Web. <http://frac.org/newsite/wp-content/uploads/2009/06/afstandards.pdf.>
121
Currently, the program is underutilized. Only 1 out of 7 children who receive free or
reduced-priced meals during the school year continue to receive meals outside of the school
months. Sites qualify either as an open or enrolled site. Open sites are located in low-income
areas where 50 percent or more of the children are eligible for free or reduced-priced school
meals. It then is open to all children in the community. Enrolled sites provide meals to children
who are only enrolled in the program. The sites must also be located in low-income areas where
at least half of the children enrolled are eligible for free or reduced-priced school meals.
The program is beneficial because many low-income children do not eat healthy during
the summer months when school is out. This program is aimed at providing healthy meals while
enabling children to learn and be safe. It also helps parents stretch their food dollar at home when
their children are involved in these programs.252 Below is an example of a four week supper
menu used in the summer program.
252
“Fact Sheet: The Summer Food Service Program” FRAC. Food Research & Action Center. 2013. Web.
<http://frac.org/pdf/sfsp_fact_sheet.pdf.>
122
Figure 3: Lunch or Supper Menu
Source: Food Research and Action Center
123
Fresh Fruit and Vegetable Program
The Fresh Fruit and Vegetable Program (FFVP) is a federally assisted program that
provides fresh fruits and vegetables for free to qualified elementary schools. The “goal of the
FFVP is to improve children’s overall diet and create healthier eating habits to impact their
present and future health.”253 FFVP was created through the 2002 Farm Bill as a pilot program
and has demonstrated its success through an evaluation report. It stated that students who
participated in the program consumed more fruits and vegetables than those that didn’t and had a
positive influence on families’ eating habits. Students were reported to have improved cognition,
longer attention spans, were less hungry throughout the school day, had fewer behavioral
problems, and visited the nurse less.254 Since 2008, it has become a permanent program and has
expanded to all 50 states and more than 3 million students benefit from the program. The
program encourages students to consume healthy snacks at times other than breakfast or lunch.
Eligible schools apply for grant funding from the state. The state gets their funding
through a federal allocation process. Schools are selected by the state and receive funding that
ranges between $50-75 per student per year to provide fresh fruit and vegetables.255
Schools struggling to meet their students’ nutritional needs can apply for funding, so
students can eat healthier and do better in school.
Physical exercise and physical education
According to the Physical Activity Guidelines for Americans set by the U.S. Department
of Health and Human Services, youths should get at least 60 minutes of physical activity every
253
“Fresh Fruit and Vegetable Program” 2013. Food and Nutrition Service. USDA. Sept. 2013. Web.
<http://www.fns.usda.gov/sites/default/files/FFVPFactSheet.pdf>.
254
“Fresh Fruit & Vegetable Snack Program for Schools” FFVP. N.d. Web.
<http://www.ciaprochef.com/wohf2011/pdf/FreshFruitandVegetableSnackProgram.pdf>.
255
Ibid., 124.
124
day. More specifically, there should be a focus on aerobic physical activity, musclestrengthening, and bone-strengthening. All of these activities should be done at least 3 days a
week.256
Schools should require daily physical education for students K-12. It is recommended
that they get 150 minutes per week for elementary schools and 225 minutes per week for
secondary schools.257 Examples of moderate or vigorous-intensity aerobic activities include bike
riding, walking, running, dancing, and team sports like soccer or basketball. Musclestrengthening activities for younger children include gymnastics, playing in a jungle gym, and
climbing a tree. Activities for adolescents include weightlifting, rock-climbing, push-ups, and
pull-ups. Bone-strengthening activities include jumping, running, and sports like gymnastics,
basketball, and tennis.258
Parents can advocate improving the quality of their children’s physical activity programs
by pushing stronger programs that encourage more physical activities. These can include higher
quality physical education classes, more recess time, walk-and bike-to-school programs, and
school staff wellness programs. They can also organize special events like walk-a-thons, dances,
and bike-a-thons. For parents who want to be more involved, they can volunteer to help with
after-school physical activity programs or sports teams.259
Families should encourage physical activity by making it a lifestyle. Families should set
time aside for physical activities. Families can use free places like public parks, sports fields,
256
“Youth Physical Activity Guidelines Toolkit.” Adolescents and School Health. Centers for Disease Control and
Prevention. 19 Feb. 2013. Web. <http://www.cdc.gov/healthyyouth/physicalactivity/guidelines.htm>.
257
National Association for Sport and Physical Education. Moving into the future: national standards for physical
education, 2nd ed. Reston, VA: National Association for Sport and Physical Education; 2004.
258
“Physical activity guidelines for Americans.” Physical Activity Guidelines. US Department of Health & Human
Services, n.d. Web. <http://www.health.gov/PAGuidelines/>.
259
“Comprehensive school physical activity Programs.” National Association for Sport and Physical Education,
2008. Web. <http://www.wheresmytype.org/downloads/Comprehensive-School-Physical-Activity-Programs22008.pdf>.
125
hiking areas, or bicycling routes to be active. Walking or riding bikes to nearby destinations
instead of driving a car is encouraged. Parents need to get their children to participate in team or
individual sports as well as noncompetitive activities such as bicycling, hiking jogging, and
swimming. Parents can be supportive by taking children to and from activities or helping them
find other ways to get there. In addition, parents should talk to their children about the physical
activities they participate in and how much they enjoy it.260
Parents can also limit how much time their children can watch television, play video
games, or use computers. The American Academy of Pediatrics states that children should not
spend more than 2 hours a day watching television, playing video games or using a computer.
Some strategies to limit screen time are to put a TV or computer in a common area instead of a
child’s own bedroom.261
Safe Routes to School Program
City leaders should be mindful about how most children get to school. Presently, more
than half of America’s children arrive to school through automobiles. One in sixth school trips
are made through walking or bicycling and only a quarter of school trips are made on a school
bus.262 Efforts have been made by various organizations to fund, promote, and organize efforts to
offer alternative routes for children to get to school. The Safe Routes to School program started
as an effort to reduce the amount of children killed from walking and bicycling to school and has
since focused on increasing physical activity, community involvement, and increasing choices
260
“Youth Physical Activity: The Role of Families.” CDC. Centers for Disease Control and Prevention. Aug. 2009.
Web. <http://www.cdc.gov/healthyyouth/physicalactivity/toolkit/factsheet_pa_guidelines_families.pdf>.
261
“American Academy of Pediatrics. Committee on Public Education. American Academy of Pediatrics:
Children, adolescents, and television.” Pediatrics 2001;107(5):1043-8.
262
Ewing, R., W. Schroeer, and W. Greene. 2004. “School Location and Student Travel: Analysisof Factors Affecting
Mode Choice.” Transportation Research Record no. 1895: 55-63.
126
for parents to get their children to school. The program, funded by the federal government,
appropriatd more than $1 billion to states during the period of 2005 to 2012. The money is used
to organize events, educate the public, develop mapping tools, and improve transportation
infrastructure.
There is the National Bike to School Day that is held at the local level. Schools and city
leaders organize programs aimed to educate parents and children about pedestrian and bicycle
safety. Cities can also apply for funding to build new pedestrian friendly infrastructure such as
sidewalks and bicycle paths. A new web-based walking and bike route mapping tool was
developed to share walking and bicycling routes. A peer to peer program was created to organize
local events aimed to increase awareness while also developing best practices of the program.263
264 265
Nutrition education
Approximately 75 percent of schools require nutrition education as part of the
requirement for health education. However, the time spent on nutrition education and dietary
behavior has declined in recent years and funding has been limited.266 Also many educators are
not qualified with the necessary knowledge and skills to promote nutrition education. Research
has shown that well-designed education interventions can improve dietary behaviors.267
263
“History of SRTS.” National Center for Safe Routes to School. US Department of Transportation, 2012. Web.
<http://www.saferoutesinfo.org/about-us/mission-and-history>.
264
Safe Routes to School. Raleighnc.gov. City of Raleigh. 14 Mar. 2014. Web.
<http://www.raleighnc.gov/home/content/PWksTranServices/Articles/SafeRoutesToSchool.html>.
265
“2011-2012 Summary Annual Report.” National Center for Safe Routes to School. US Department of
Transportation, 2012. Web. <http://www.saferoutesinfo.org/data-central/national-progress/federalreports/2011-2012-annual-report>.
266
Lee, S M , Burgeson, C R , Fulton, J E , Spain, C G (2007) Physical education and physical activity:
results from the School Health Policies and Programs Study 2006 Journal of School Health, 77, 435-63.
267
Luepker, R V , et al (1996) Outcomes of a field trial to improve children’s dietary patterns
and physical activity The Child and Adolescent Trial for Cardiovascular Health CATCH Collaborative Group
127
It is recommended that the USDA and the U.S. Department of Education work together
to improve nutritional standards and requirements for nutrition education. Educators can take
interdisciplinary approaches to incorporate healthy diets in the school curriculum with subjects
such as math, history, or foreign language. For example, in math, you could calculate how much
calories a person needs, in history you can have a lesson on historical diets, and foreign language
students can design a cultural food menu. Other educational programs such as Teach for America
and Head Start can promote nutrition education.
An effective educational tool as part of a nutrition education strategy is the use of school
gardens. Research has shown that a school garden, as part of a nutrition education program,
improves student knowledge of fruits and vegetables and influences behavior change among
them.268
Farm-to-school opportunities
In 1997, the USDA began efforts to launch the ‘Farm-to-school’ (FTS) initiative which is
now operated by the Food and Nutrition Service. It was an effort to connect farms to school meal
programs and educate students about where their food came from while providing farmers an
opportunity to market their food to schools. The term farm-to-school “encompasses efforts that
bring local or regionally produced foods into school cafeterias; hands-on-learning activities such
as school gardening, farm visits, and culinary classes; and the integration of food-related
education into the regular, standards-based classroom curriculum.”269
Journal of the American Medical Association, 275(10), 768–776.
268
Parmer, S et al (2009). “School gardens: an experiential learning approach for a nutrition education
program to increase fruit and vegetable knowledge, preference, and consumption among second-grade
students.” Journal of Nutrition Education and Behavior, 41(3), 212-7.
269
“Farm to School.” Food and Nutrition Service. United States Department of Agriculture, 19 Feb. 2014. Web.
<http://www.fns.usda.gov/farmtoschool/farm-school>.
128
The USDA supports FTS programs through a few initiatives. One is through the Healthy,
Hunger-Free Kids Act, in which the USDA grants funds to schools and other organizations. The
USDA’s grant program supports schools and non-profit organizations by providing technical
assistance, supporting operations, purchasing equipment, developing school gardens, planning
partnerships, and implementing farm to school activities.
The USDA has provided more than $350 million dollars to provide local food to 13,000
schools and 2.8 million students. About 45 percent of the projects devoted to the program are in
rural communities. They provide much needed economic support by creating jobs and
partnering with school districts.270
Schools can apply for grants up to $100,000 to help them launch programs. In 2013, the
USDA announced 71 grant projects spanning 42 states and the District of Columbia that connect
schools with local agricultural producers. One school district in Massachusetts will develop a
district-wide farm to school program that focuses on creating youth jobs, healthy eating, and
physical education. Another school district, in Olympia, WA will partner with local farms.
Students will apply biology, history, and horticultural skills towards farming management. The
farms will grow organic food for the school district and serve as an educational space.271
The USDA has also established an initiative called Know Your Farmer, Know Your
Food. The initiative focuses on helping students understand where food comes from and the
journey it takes to get to our plates. Schools also focus on providing food from their locality or
region to improve sustainability, improve their local food economy, and give students an
opportunity to meet the farmers that provide their food.
270
“USDA Announces Additional Support to Help Schools Buy Local.” Food and Nutrition Service. United States
Department of Agriculture. 19 Nov. 2013. Web. <http://www.fns.usda.gov/pressrelease/2013/021813.>
271
Ibid., 129.
129
FTS initiatives tackle many of the challenges to student eating behaviors, childhood
obesity. They can change the school food environment and improve poor nutritional quality at
schools. They also educate students about sustainability, health, nutrition, and food systems.
There is also some evidence that farm-to-school programs have a positive effect on improving
student’s diets. Anecdotal accounts and unpublished reports have shown that dietary habits in
schools that implemented FTS programs have improved. School food assessments from two
different studies have shown increased consumption and preference for fruits and vegetables in
California, Oregon, and Massachusetts. This also includes an increased knowledge of where food
comes from.272 273 However, more studies are needed to show the effectiveness of FTS in
fostering eating behavior and attitudes for children. More research and methods of evaluation are
needed to show whether FTS is an effective model to reduce childhood obesity.274
Conclusion:
Education is one of the key factors in addressing obesity in the short-term but especially
critical for the nation’s future. Childhood obesity is higher than in the nation’s past and research
suggests that the current generation of young children may not live longer than their parents.
This can change if holistic approaches are taken in schools as well as in food programs outside of
schools that focuses on nutrition. Physical activity remains an important lifestyle factor that
many children don’t practice and special attention is essential to improve statistics in this area. In
272
US. US Department of Agriculture. Food and Nutrition Service. USDA Farm to School Team: 2010 Summary
Report. Washington, D.C.: USDA, 2011. Web. <http://www.fns.usda.gov/sites/default/files/2010_summaryreport.pdf>.
273
“Farm to school program Toolkit.” Centers for Health Promotion and Disease Prevention. University of North
Carolina at Chapel Hill, 2008. Web. <http://www.cias.wisc.edu/wp-contents/uploads/2011/09/8-evaluate-yourwork.pdf.>
274
Aftosmes, Alyssa. “Impact of Farm-to-School Programs: A Research Brief to the Massachusetts Food Policy
Council.” Harvard Catalyst: The Harvard Clinical and Translational Science Center.4 Nov. 2011. Web.
<http://catalyst.harvard.edu/pdf/chirp/Farm_to_School.pdf>.
130
short, physical activity and nutrition in each school district needs to be a top priority. Schools
must concentrate efforts and devote more time to physical activity and providing nutritious
meals during breakfast and lunch. Emphasis on nutrition education so that students know how to
make informed decisions about eating must be paramount if our nation is to remain a
superpower.
131
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