Sprawl is a devastating national phenomenon marked by the economic and demographic shift from the city to surrounding rural areas as a place to live, work, shop, and attend school. (For a comprehensive discussion of sprawl, see Sprawl Overview.) Link to Sprawl Overview Section - coming - it was done but disappeared when my system started acting weird - took out the timed temp backup too - will have to reedit from the regular backup - you didn’t need to know all of this did you? Not only is sprawl damaging to the cities, the suburbs, and your pocketbook, sprawl also has dangerous consequences for your health.

In recent years, the public health and planning communities have come together to join in the fight against sprawl, as these professionals now recognize that sprawl induces significant health risks for Americans across the country. Just as environmentalists are now acknowledging the interconnected nature of concerns such as air and water pollution, ozone depletion, and dwindling open space and natural resources, public health and land use professionals are realizing that sprawl and its consequences cannot be studied in a vacuum.

Sprawl induces problems which extend far beyond the acknowledged consequences of water and air pollution, though these are indeed serious side effects. In short, urban sprawl creates communities which are heavily dependent on the automobile and inhospitable to pedestrians, a phenomenon which has led to the rise of American obesity and increase in automobile crashes and pedestrian and bicyclist deaths. Congestion interferes with sound mental health, and has been linked to increases in stress and depression. A sprawling area also disrupts a sense of community and shared identity for a locality. Clearly then, the health risks of sprawl may be greater than anyone could have possibly imagined at the dawn of the suburban movement more than half a century ago.

Water Pollution

With development comes the destruction of wetlands, which the Clean Water Act defines as:

“Those areas that are inundated or saturated by surface or ground water 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." (40 CFR 232.2(r))

Though largely unrecognized by the public as such, wetlands are nature’s water filters and extremely productive ecosystems. As state and federal agencies choose not to protect wetlands to the fullest extent possible, wetlands are being destroyed at an alarming rate with devastating consequences. The Sierra Club estimates that over 100,000 acres of wetlands are destroyed each year.

Wetlands often serve as the headwaters for streams and can serve as important components for ground water recharge. Also, wetlands act as natural filters for upland surface water, retaining excess nutrients and various types of pollutants as well as reducing sediment, all of which improve water quality. In fact, wetlands can remove up to 90 percent of pollutants in water.

When development destroys wetlands and changes the area into impervious surface (that which water cannot permeate, such as concrete), this conversion is done at a significant health risk. Pollutants such as pesticides, fertilizers, and metals enter into storm runoff water rather than being naturally absorbed into a wetland. When this runoff enters a body of water, which then becomes drinking water, residents of that area are exposed to polluted water. Wetlands are much more effective at halting runoff than are impervious surfaces; non-profit organization 1000 Friends of Washington report that runoff from an impervious surface such as a parking lot is 16 times greater than runoff from a wetland of the same size.

Another contributor to water pollution is the use of septic systems in low density suburban and rural housing development. A Virginia Tech study found that as many as half of all septic systems are not functioning properly, which can lead to wastewater reaching the surface and joining runoff. This filtration problem occurs when wastewater moves too quickly through the soil, and also when the soil is clogged with pollutants and does not allow for proper filtration of the waste.

Erosion and Flooding

Wetlands literally act as a sponge and serve as a depository for excess water during storm events and snow melts. By retaining surface water, wetlands help control the volume of water flowing downstream while the vegetation and topography of the wetlands serve to reduce the speed of the surface water running through them. The combination of reducing the volume and speed of storm water are critical components to reducing erosion and flood damage. In coastal areas, many states are now restoring wetlands to provide better buffering from tropical storms and hurricanes to reduce storm related damage and costs.

In areas with high rates of development, new buildings are often constructed on top of wetlands and floodplains, greatly increasing the risk of flooding. In the past eight years, the Sierra Club reports that over 850 people were killed by floods which caused $89 billion in property damage. This destruction is due in large part to the consequences of urban sprawl. Most would agree that this constitutes a pretty hefty health risk.

Air Pollution and Respiratory Problems

The suburban life is dependent on the automobile for transportation to work, school, shopping, and entertainment. Many suburban families even have multiple cars to accomplish these purposes. Whereas in the cities, jobs, schools, shops, movie theaters, and city government were all within walking distance, in the suburbs, a car is needed to get almost anyplace. A Federal Highway Administration report found that the national total vehicle miles of travel (VMT) increased by 59% between 1980 and 1995 alone. It is not a far stretch of the imagination to believe that this American love affair with the automobile has increased the amount of pollution in our air, leading to vast increases in the number of respiratory problems from which Americans suffer.

While Americans tend to think of traditional industrial waste as being the source of most of the country’s air pollution, it is instead vehicular emissions that are the culprit for many primary pollutants. Automobiles are also subject to fewer governmental regulations than are most industries, and the growing popularity of SUVs and other large, inefficient vehicles as the preferred mode of transportation in the suburbs has only increased the problem. Carbon monoxide, sulfur dioxide, hydrocarbons, and nitrogen oxides are all found in vehicular emissions and can be very damaging to one’s health.

One of the most severe air pollution problems in the United States is the prevalence of ground-level ozone, which is formed by the components of car exhaust. Over sixty urban areas across the country, including Philadelphia and large portions of Bucks County, do not meet EPA standards for carbon monoxide or ground-level ozone levels, and 25 percent of the nation’s children live in these areas. High ozone concentrations can lead to pulmonary and respiratory problems in otherwise healthy individuals, but are especially problematic for children, the elderly, and asthmatics.

The Sierra Club reports that automotive waste is responsible for twelve billion pounds of toxic chemicals each year, and is the number one cause of air-pollution related cancer. According to Mark Delucchi, an associate research ecologist with the Institute of Transportation Standards at the University of California at Davis, vehicle-related air pollutants cause 20,000-40,000 cases of chronic respiratory illness each year, and are also responsible for 50-70 million respiratory-related restricted activity days annually.

Children are the most vulnerable to air pollution, reports Smart Growth, a network of organizations dedicated to preserving community character and enhancing quality of life. In fact, children under the age of five have experienced a 160 percent increase in asthma rates over the last fifteen years alone. Asthma is the number one cause of hospitalization for chronic diseases and school absences for children. And, the problem is only getting worse: asthma rates in children more than doubled between 1980 and 1995, from 2.3 million to 5.5 million. (For more information on children and asthma, see “Asthma and the Environment: A Strategy to Protect Children” from the President’s Task Force on Environmental Health Risks and Safety Risks for Children.)

During the 1996 Olympic games in Atlanta, Georgia, city officials were able to drop peak morning traffic by 22.5 percent. The Centers for Disease Control (CDC) reported that ozone concentrations dropped a similar amount (27.9 percent), and asthma-related emergencies declined an amazing 41.6 percent. Interestingly, there was no decrease in other medical emergencies, which points to a clear connection between asthma and vehicular pollution. Another study in 1999 strengthened this link, finding that excessive ozone pollution is the cause of many thousands of cases of asthma each year in America’s cities, approximately 86,000 in Baltimore, 27,000 in Richmond, and 130,000 in Washington, DC.

To illustrate the magnitude of the asthma problem in the United States, consider that in 1998, the national cost of asthma (including medical treatment) was over $11 billion, and the CDC spent over $35 million in 2002 on their National Asthma Control Program, including asthma trackings, interventions, and partnerships across the country. The CDC estimated that in 2001, 31.3 million Americans had been diagnosed at one point in their life with asthma, 20.3 million were currently suffering, and 12 million had experienced an asthma attack within the last year. In 2002, asthma was responsible for 4,487 deaths, as well as 10.4 million outpatient visits, 1.8 million emergency department visits, and 465,000 hospitalizations. (For more information, visit the National Asthma Control website.)

According to the EPA, greenhouse gas emissions have increased greatly in recent years, forming smog and causing devastating problems for asthmatics, children, the elderly, and leading to respiratory disease in other individuals. Nitrous oxide emissions, a contributor to the greenhouse effect, increased by 44 percent between 1990 and 1996 according to 1998 Inventory of U.S. Greenhouse Gas Emissions and Sinks, an EPA report. Though carbon dioxide is a more plentiful vehicular emission, nitrous oxide is over three hundred times more powerful in capturing and retaining heat in the atmosphere. Scientists now agree that the greenhouse effect is causing climate changes around the world, the effects of which cannot be underestimated.

Another problem relating to sprawl is the creation of urban heat islands, which occur when natural vegetation is replaced by buildings, parking lots, roads, and other structures which absorb heat. Heat islands can raise air temperature by up to eight degrees, helping contribute to smog and heat-related illness and death.

What exactly is it about urban sprawl that contributes to such rampant air pollution? Originally, researchers believed that the increase in total vehicle miles traveled (VMT) for commuters between their homes in the suburbs and their jobs in the city was primarily responsible. However, researchers found that highway driving was not the major source of this new wave of air pollution, because emissions actually decrease with increasing speed. Also, fewer suburbanites actually commute to urban areas to work as more jobs are moving to the suburbs. Instead, researchers are now focusing on the number of trips made by automobiles rather than distance traveled, because over fifty percent of vehicular pollution occurs during ignition and then again when the car cools down. Planners use the estimate of ten trips per day per household; however, this is a nationwide average and this figure appears to be much higher in suburban America. The Sierra Club estimates that the average American spends 443 hours driving each year, the equivalent of eleven work weeks! The decentralized nature of the communities created by urban sprawl depend on making different trips for various activities rather than walking, or even driving to a central location such as a town square and then walking.

While most Americans are familiar with, if not concerned about, the crisis of air pollution, resulting respiratory problems, environmental damage and the hastening of climate changes, the link between these problems and urban sprawl has not been stressed nearly enough. The increase in automobile usage brought by sprawl can be held directly responsible for helping to cause this crisis, and steps must now be taken to help remedy the situation. Making public transportation easy, efficient, and affordable has emerged as a suggestion as to how to limit automobile use and dependence. Also, innovative community planning with emphasis on “walkable communities” can help turn the tide of air pollution.

However, air pollution is not the only unfortunate byproduct of increasing dependence on the autmobile...

Traffic-Related Accidents

Sprawling communities were designed for cars rather than walkers and bicyclists, making it difficult to get to schools, shopping, and places of employment without a car. This planning strategy has several disastrous consequences.

First, increased automobile use logically correlates to a higher rate of car accidents. A Smart Growth America report found that the top ten most sprawling areas across the country had an annual average of 15 fatal car accidents per 100,000 citizens each year, which is almost twice the rate of fatal accidents in the top ten least sprawling areas. Car accidents are also the leading cause of death for American children and teenagers.

Second, wide streets, few sidewalks, and dangerous intersections make many local roads extremely dangerous for pedestrians. Over 6,000 pedestrians are killed each year in accidents, more than half of which occur on neighborhood streets, according to a 1997 report from the Surface Transportation Policy Project (STPP).

High speed traffic and and infrequent crosswalks are the leading causes of these deaths, because pedestrians are not provided with a safe environment in which to cross roads. In order to improve pedestrian safety, the STPP recommends spending more state dollars in proportion to the number of pedestrian deaths, adding more sidewalks and crosswalks to existing roads, designing new roads with pedestrian safety in mind, and conducting more research in this field in order to better plan our communities.

Suburban design and dependence on the automobile has particularly devastating effects for the elderly and the disabled who may not be able to operate or afford a car. In the city, the elderly and disabled are more likely to live in a pedestrian-friendly neighborhood with grocery stores, doctors, entertainment, and even places of employment all within walking distance. Also, mass transit allows many to get around who would otherwise not be able to. In the suburbs, lack of mass transit, dangerous traffic situations, and the spread-out nature of the community prohibit many necessary activities (as well as healthy physical activity) for the elderly and disabled, having particularly devastating effects on these individuals.

Sedentary Lifestyle

Because of these poor walking conditions, Americans are walking less and less to reach their destinations, leading to the establishment of a more sedentary lifestyle, which contributes to the nationwide crisis of obesity and heart disease. It is virtually universally agreed that regular exercise is extremely healthy, with benefits including lower mortality rates, lessened chance of stroke and heart disease, weight loss and increase in muscle mass, and decrease of depression. We are truly setting ourselves up for disaster if communities are not built and strengthened with healthy outcomes in mind.

Professionals from a variety of fields, including public health, urban design, and planning have joined together to design strategies on how to create and improve communities to be more conducive to healthy lifestyles. The CDC has formed Active Community Environments Initiative (ACEI) in response to this goal. Public health improves as physical activity increases, and this interdisciplinary initiative identifies the link between public health, physical activity, and the consequences of sprawl. Specifically, the ACEI recognizes that planning which influences “proximity of facilities, street design, density of housing, availability of public transit and of pedestrian and bicycle facilities play a significant role in promoting or discouraging physical activity.”

Residents in congested areas spend much time sitting in their cars in traffic, which has dangerous health effects. First, by driving instead of walking or biking, one loses the health benefits of experiencing that exercise. Second, with long commuting times, the free time that would otherwise be available for exercise is not. Third, long hours in the car can lead to backpains and even ulcers and increased blood pressure caused by the stress of traffic.

Why do residents in sprawling communities not take the time to exercise? In addition to long commuting times and automobile dependence, a report by the CDC found that the greatest barriers to regular exercise are lack of sidewalks, trails, parks, and other places in which to exercise, and also perceived lack of safety in one’s community, both of which are effects of sprawl. The more spread-out a community becomes, the less exercise its citizens engage in, which has very poor consequences for public health, namely disease and obesity.

Smart Growth reports that nearly one in four Americans are obese, and 60 percent of the population is overweight. The percentage of overweight children has doubled in the past thirty years. This increase is largely due to changing lifestyles as brought on by the phenomenon of urban sprawl. For example, fewer children now walk to school because schools are widely spread out instead of being part of a neighborhood, and the traffic surrounding schools make the walk often unsafe. In a report for the Pew Oceans Commission, the South Carolina Conservation Commission found that students were four times as likely to walk to schools built before 1983 than those built after the early 1980s. According to the National Transportation Survey, there has been a 37 percent decline in the amount of trips children ages five through fifteen made by bike or foot between 1977 and 1995.

The American obesity epidemic is not only unhealthy; the effects of obesity and physical inactivity are costly as well. A recent study estimated the direct health care costs of obesity at approximately $70 billion, and the health care costs of physical inactivity at $37 billion.

Municipalities and states across the country are attempting to improve local conditions for pedestrians and bicyclists in order to offer more safe, efficient, and enjoyable transportation options and recreational opportunities. For example, New Jersey allocated over $9 million from its transportation budget to construct bike paths and make existing roads and bridges more bike-friendly. In Chicago over the past decade, 7,000 new bike racks were installed, 40 miles of bike paths were built or improved, and citywide biking events helped encourage bike riding. In Vermont, the Agency of Transportation Bicycle and Pedestrian Plan aims to improve biking and pedestrian access to roads and paths across the state. As evidence of the interdisciplinary approach necessitated by the plan, the advisory committee includes bicycle riders and tour operators, advocates of pedestrians and bicyclists, engineers, and transporation planners.

While initiatives such as these are making great strides toward improving pedestrian and bicyclist life in America’s sprawling communities, nationwide attention to the need for safe and healthy alternatives to vehicle-dependent transportation is still forthcoming.

Mental Health

One should never underestimate the health risks of sprawl, and declining mental health is one of the many adverse effects felt in sprawling communities. Sprawl brings with it increased traffic and longer commuting times, which are often very stressful. The onset of the “road rage” phenomenon is one such highly publicized effect of sprawl. Motorists become frustrated and angry with traffic conditions, and take these feelings out on other drivers, often creating dangerous traffic situations such as tailgating or harassment.

As discussed above, sprawl contributes to physical inactivity because of automobile dependence. Exercise has shown to be a great reliever of stress and depression because of endorphins released during physical activity, said to be the body’s natural “feel good” chemical. Several hundred scientific studies over the last 15 years have found that exercise can improve self-esteem, mood, and sleep patterns, and reduce anxiety, stress, and depression [ ]. When the conditions of sprawl routinely deny residents the benefits of exercise, the community’s collective mental health suffers.

Sprawling communities have fewer opportunities for human interaction, one of the cornerstones of mental health. People with strong interpersonal relationships have been found to live longer and happier lives than those who live in isolation, according to Dr. Howard Frumkin of Emory University’s Rollins School of Public Health. Long commute times leave fewer opportunities for socializing after work, and the use of cars rather than walking or biking to work, school, and errands decreases face-to-face contact with neighbors and others along the way.

Neighborhoods and developments are experiencing decreasing amounts of social involvement and identification, which is a far cry from the closely knit urban neighborhoods from half a century ago. There are also fewer “gathering points” in suburban communities today such as parks or even the town grocery store or pharmacy because of development and the subsequent mental separation from one’s community. Many studies have found that areas with a strong sense of community enjoy lower rates of violence and crime.

A particularly interesting study, Do Trees Strengthen Urban Communities, Reduce Domestic Violence? looked at public housing in Chicago and discovered that otherwise identical buildings with differing amounts of surrounding trees experienced varying levels of conflict and violence. Residents in buildings with more nearby trees found more nonviolent ways to deal with conflict, and also reported a better sense of community than those living in apartments without nearby trees.

Also, busy roads separate neighborhoods, and heavy traffic indicates a lower quality of life for residents. A British Medical Association report found that in a San Francisco neighborhood with varying degrees of traffic, social contacts decreased as traffic increased. A recent report concluded of sprawl and mental health that “face-to-face contact is a prerequisite for mental health, yet car dependence severely limits chance encounters.”

For Those Left Behind

Though increased water and air pollution, traffic accidents, sedentary lifestyles, and declining mental health are the most frequently discussed health risks of urban sprawl, they are certainly not the only negative consequences. Also, the health risks of sprawl are not just experienced by those living in the newly created suburbs. Indeed, urban residents are left to cope with the negative effects of suburban flight, including economic and social repercussions. For example, a frequently used strategy in urban America is the conversion of brownfields into school grounds because of low real estate cost. These lots are often abandoned after companies move their facilities from the city into the suburbs because of decreased cost. Brownfields are defined by the EPA as abandoned or underused industrial or commercial sites for which reuse is dangerous due to the possibility of hazardous waste contamination. Unfortunately, many urban communities are faced with the unenviable decision of whether to build a school in the face of possible contamination, or leave alone an unattractive and potentially dangerous lot.

Looking Toward the Future

Though the health risks of urban sprawl are many and severe, it is most certainly not a hopeless situation. Elected officials and the public health, planning, and engineering communities must continue to work together to foster multidisciplinary and creative approaches to help solve this devastating man-made problem. Many strategies have been proposed to limit the effects of urban sprawl, ranging from environmental improvements to engineering and planning design:

Though there is certainly reason to be optimistic regarding the future, one must not lose sight of the severity of the health risks that sprawl poses. Water pollution and poor sanitation, air pollution and respiratory problems, automobile dependence resulting in traffic accidents and an obesity crisis, declining mental health and increased violence and crime are all consequences that make one take pause at the stakes of sprawl. Perhaps just as the US Surgeon General labels cigarettes and alcohol with warnings, so too should America’s sprawling communities be labeled: “Warning: Sprawl is hazardous to your health.”

Links

Measuring the Health Effects of Sprawl – This is an excellent report by the Surface Transportation Policy Project and represents the first study to link the type of place that people live to their health

Smart Growth Network A discussion of the health risks of sprawl as well as a wonderful list of related links, ranging from pedestrian safety to parks to green building.

"The Specter of Sprawl” by Charles E. Schmidt - An article from Environmental Health Perspectives, the Journal of the National Institute of Environmental Health Sciences outlining the definition and causes of sprawl, the impact of the automobile, the effects of sprawl on rural areas, and possible solutions.

National Asthma Control Program A Centers for Disease Control (CDC) program website with a good overview of the asthma problem in the United States for children and adults, including specific data.

Surface Transportation Policy Project The Surface Transportation Policy Project is a “nationwide network of more than 800 organizations, including planners, community development organizations, and advocacy groups, devoted to improving the nation’s transportation system.” The website includes “Mean Streets 2000,” which clearly articulates the need for enhanced pedestrian safety across America.

"Caught in the Crosswalk: Pedestrian Safety in California.” Though a California-based report, the data contained in “Caught in the Crosswalk” has national implications for the health risks of sprawl. The report focuses on declining pedestrian safety as an effect of sprawl.

Active Community Environments Initiative Basic information on nutrition and physical activity, as well as news about special events (such as Kids Walk to School Day) and academic papers regarding land use and public health. A project of the Centers for Disease Control (CDC).

"Do Trees Strengthen Urban Communities, Reduce Domestic Violence?” A fascinating study of the effects of trees on communities which is discussed in this overview, and a convincing reason of the need to limit destruction of these resources.

Suburban Sprawl Adds Health Concerns This article is an Associated Press report, published in the New York Times, which details some of the findings of the findings of a major new study on the health impacts of sprawl.

"The Health Effects of Land Use and Transportation.” A brief (3 page) discussion from The Village Project of several of the health risk concepts contained in this overview, including heart disease, mental health, respiratory disease, and accidents. The Village Project is a North Carolina organization dedicated to creating walkable communities in their region.

"How Land Use and Transportation Systems Impact Public Health.” (Active Community Environments Initiative Working Paper) An extensive collection and analysis of existing literature on the relationship between land use and public health problems, focusing primarily on physical activity.

"Creating a Healthy Environment: The Impact of the Built Environment on Public Health.” A comprehensive report from Sprawl Watch which discusses important health risks relating to sprawl, including air pollution and respiratory disease, physical inactivity, pedestrian injury, quality of life problems for the elderly and disabled, and water pollution and sanitation. The report also includes recommendations for citizens, planners, architects, engineers, public health officials, and all those who wish to prevent or ameliorate these kinds of health risks in America’s communities.

"Asthma and the Environment: A Strategy to Protect Children.” (The President’s Task Force on Environmental Health Risks and Safety Risks to Children) Children are at a disproportionate risk for respiratory disease, and rapidly increasing rates of asthma in children should be reason enough to seek to limit air pollution in sprawling urban areas. This government report looks at a variety of causes of asthma in children, and seeks to prevent the disease or limit its effects through research and focused community outreach programs.

"Coastal Sprawl: The Effects of Urban Design on Aquatic Ecosystems in the United States” This report from the South Carolina Coastal Conservation League for the Pew Oceans Commission details the effects of sprawl on coastal regions, an effect which is not often considered. An interesting perspective on the devastating effects of sprawl.

Children at Risk: How Air Pollution from Power Plants Threatens the Health of America’s Children This report was prepared by the Clean Air Task Force and provides an interesting look at the potential impact that our nation’s power plants may have on the health of our children.