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Zaheeda Darvesh Dr. Julie Cidell Transportation and Sustainability 465 12/10/2014

The influence of land use and transportation planning on obesity

Introduction

Obesity is a growing public health problem that has only recently attracted

widespread media attention. The dramatic increase in obesity has fostered interest among

researchers in analyzing whether and how individual behavior and the built environment

may have created an obesogenic environment. 1 Their research shows that in reducing

obesity, educating people on healthy lifestyles is not sufficient; the built environment must

enable and promote healthy behaviors as well.2 Within the built environment framework

land use and transportation planning components influence an individual’s opportunities

to food intake and physical activity. This research paper describes the impact of land use

and transportation planning on obesity prevalence.

Through this paper, as part of a larger overarching umbrella of the built

environment, I will explore the impact of land use and transportation planning on the

emerging obesity epidemic. Land use planning components--urban sprawl, street

connectivity, land-use mix and zoning--create surroundings that demotivate individuals to

be physically active, hence influence obesity. Likewise, transportation improvement

measures such as public transit, greenways and trails, pedestrian and bicycle facilities, and

efforts to manage car traffic can support or impede physical activity, hence impact health

outcomes. Land use and transportation planning components contribute to increasing

obesity prevalence which necessitates an emerging need to address interconnectivity

between the disciplines of urban planning, transportation planning and due to its

subsequent influence on obesity-public health. The following discourse entails the

evolution of research with respect to these disciplines.

1 The obesogenic environment comprises factors in our environment that support being obese. 2 (Perdue, Stone, & Gostin, September 2003)

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Figure1: Outline of the Research Paper

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Background

Obesity prevalence in adults has more than doubled from 1960 to 2010 from 13.4

percent to 35.7 percent.3 However as an emerging public health concern, it has only

recently garnered attention. The current high rates of obesity prevalence for children and

adults in the U.S. are primarily a result of genetics, individual behaviors and built

environment factors4 that lead to excess caloric intake and inadequate amounts of physical

activity.5 “Using the methods of inheritance studies, such as investigating pairs of twins,

researchers have concluded that inherited genes contribute about 40 percent and the

environment about 60 percent to whether a person becomes obese.”6 It can thus be

inferred that while obesity genes7 cannot be modified and altered, the built environment

components can be reformed to attenuate obesity prevalence.

Obesity is a national epidemic, causing higher medical costs and a lower quality of

life.8 It is a common manifestation of energy imbalance between energy consumed (by

food and drink) and energy expended through metabolism and physical activity.9 For

adults, overweight and obesity ranges are determined by using weight and height to

calculate a number called the "body mass index" (BMI)10 which correlates with the amount

of body fat.

• An adult who has a BMI between 25

and 29.9 is considered overweight.11

• An adult who has a BMI of 30 or higher

is considered obese.12

3 (National Institute of Diabetes and Digestive and Kidney Diseases, Overweight and Obesity Statistics) 4 Built environments-which are the totality of places, built or designed by humans, and include buildings, grounds around buildings, layout of communities, transportation infrastructure, and parks and trails, play an important role in affecting obesity, (Sallis, Floyd, Rodriguez, & Saelens, 2012) 5 (Factors Contributing to Overweight and Obesity, 2010) 6 (Genetics and Behavior, 2014) 7 (Echwald & Sørensen, 2001) 8 (Overweight and Obesity, 2012) 9 (Luma & Ahmad, May 25, 2011) 10 (Overweight and Obesity, 2012) 11 Ibid 12 Ibid

Table 1: BMI and Weight Status

BMI Weight Status

Below 18.5 Underweight

18.5 – 24.9 Normal

25.0 – 29.9 Overweight

30.0 and Above Obese

Source: Centers for Disease Control and Prevention

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Overweight and obese children and adults are at a higher risk for diabetes, high

blood pressure, high cholesterol, asthma, arthritis, and poor health status, thereby leading

to shorter life spans and increased medical costs.13 Hence it is very important to identify

and address the underlying factors that have resulted in increasing obesity prevalence.

Prior research on obesity in the 1970’s focused on physical activity as a means to

control obesity.14 The built-environment with its land use and transportation planning

measures were not included in this framework to mitigate obesity. Additionally, these

measures were independent of each other as either part of the urban planning or the

transportation planning realm. However new research from 2000 onwards suggests the

intertwinement between obesity and the built environment leading to emerging interests

on the convergence of public health, urban planning and transportation planning fields. By

coordinating efforts in land use and transportation planning, such as promoting compact,

mixed-use development, providing well-connected and walkable streets, efficient public

transit systems, reducing car dependency, providing designated bicycle paths, and more,

opportunities exist to increase physical activity, hence to mitigate obesity. Public health,

urban planning and transportation planning today must adopt policies and implement

projects that are symbiotic to each other in order to achieve desirable living conditions,

effective transportation systems and healthy public health outcomes.

How has the research concerning urban planning, transportation planning and

public health changed/evolved over time?

In the early 20th century, public health and urban planning were highly interrelated

fields. The spread of highly infectious diseases such as cholera in unsanitary and

inhabitable spaces during the industrial period reinforced the systemic linkages between

diseases and the organization of urban space. This reality led to the intersection of the two

fields. A general consensus among planners and architects of the industrial period was that

the industrial city was inherently unhealthy and incapable of being reformed.15 Hence

modernist planners and architects conceived the creation of an ideal city which had healthy

living and working conditions based on new, low-density and decentralized development.

13 (Causes and Consequences, 2012) 14 (Mann, August 1, 1971) 15 (Beauregard, 2002)

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Mass suburbanization seemed to be the solution to a host of problems, including those

involving health. Fordism--the industrialized and standardized form of mass production

and consumption of cars--supplemented by massive transportation infrastructure

developments through Roosevelt’s New Deal projects facilitated America’s

suburbanization. The suburban model seemingly eliminated the need to discuss public

health questions in the context of the built environment altogether and hence the period

from 1930 onwards marked the beginning of the divergence of the two fields.

During this time, transportation planning was isolated as well. Research connecting

the built form and travel behavior was mostly concentrated on the growing concern over

automobile traffic.16 For instance, walking and bicycling, like public transit, were mostly

considered to be alternative modes of transportation. However, automobile dependency

continued to escalate resulting in decreased use of these modes of transportation.

“Between 1977 and 1995, the number of all walking trips decreased by 32 percent, and

there was a similar decrease in trips made by adults walking to work.”17 Table 2 indicates

how his continues well into 2010. In light of this, researchers within the fields are now

suggesting the need to

reverse the declining rates

of walking and biking for

transportation, especially

for short trips, by viewing

these modes of

transportation as

opportunities for improving

health among children,

adolescents and adults.

Walking and biking now are not merely considered alternative modes of transportation,

but as a means to exercise. In combination with public health and urban planning

16 (Saelens & Handy, 2008) 17 (Active Transportation: Making the Link from Transportation to Physical Activity and Obesity, 2009)

Table 2: Journey to Work 2000 & 2010

Years

2000 2010

Car, Truck or Van 87.90% 86.30%

Public transportation 4.70% 4.90%

Motorcycle and other means 0.80% 1.20%

Bicycle 0.40% 0.50%

Walking 2.90% 2.80%

Worked at home 3.30% 4.30%

Source: United States Census Bureau, Census 2000 Summary File 3 (SF 3), Commuting Characteristics by Sex, 2010 American Community Survey 1-Year Estimates

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interventions, efforts to create walkable and bikeable communities and cities also have

social and recreational implications.18

Prior public health research, with respect to transportation implications, also mostly

focused on recognizing mostly asthma as a pressing health concern.19 Similarly, exercise

(e.g., walking) was considered primarily a mode of achieving the required physical

activity.20 Recently, however public health, like transportation planning, has embarked on a

multi-dimensional approach that conjoins efforts within the fields of urban planning,

transportation planning and public health.21

Modifying the built form and transportation systems is now seen as a means to

create environments that facilitate physical activity, hence curtailing obesity. Emerging

research suggests consistent associations between neighborhood design and walking and

cycling for transportation. 22 “Studies show that people who live in neighborhoods with

walkable designs spend an additional 30 minutes walking for transportation each week

and are more physically active than those who live in neighborhoods with less walkable

suburban designs.” 23

Prior to 2000 urban planning, transportation planning and public health were

distinct and disconnected. However, the plethora of research available now suggests the

need to unify efforts across these disciplines. Additionally, rapid increase in obesity

prevalence towards the end of the 20th century has provided researchers within these

fields the opportunity to explore the influence of the built environment and transportation

planning on public health outcomes. By collaborating to build synergism in research and

dissemination, public health, urban planning and transportation professionals can enhance

efforts to increase the number of communities that promote active living.24 Rather than

employing isolated, disconnected planning mechanisms like before, today urban planners,

transportation planners and public health planners can adopt mutual and conjoined

policies and projects that will achieve desirable living conditions, effective and efficient

18 (Southworth, 2005) 19 (A National Asthma Public Policy Agenda, 2009) 20 (Mann, August 1, 1971) 21 (Southworth, 2005) 22 (Frank, Engelke, & Schmid, May 23, 2003) 23 (Frank, et al., 2006) 24 (Hoehner, et al., September 2003)

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transportation systems and healthy public health outcomes.25 Two specific arenas for

intervention are discussed below.

Obesity prevalence and land use planning measures

Emerging views among public health and urban planning researchers demonstrate

the links between land use patterns and increase in obesity. Land use planning is a

mechanism within the built environment that controls, restricts and regulates land use and

development in an efficient and ethical manner. The following discussion throws light on

how land use planning components, such as urban sprawl, land-use mix, street

connectivity, zoning etc., can influence obesity.

Urban Sprawl influencing obesity

Today urban sprawl–a byproduct of land development–is a common feature of the

urban landscape in the United States. Urban sprawl can be defined as low density,

decentralized and automobile-centered development and is a result of a complex set of

interrelated socioeconomic and cultural forces. It can be attributed to three underlying

factors:

1) population growth resulting in the movement of people away from the urban

center,

2) rising income increasing the demand for space, hence facilitating this movement of

people to suburban areas where property values are lower, and

3) decreasing commuting costs and investments in transportation infrastructure that

facilitate this outward expansion of development.

Some of the consequences of sprawl are automobile dependent transportation,

decreased ability to walk to destinations, more infrastructure developments, increased

road space and decreased neighborhood cohesion. With respect to public health outcomes,

sprawl causes environmental degradation through greenhouse gas emissions which

increase asthma prevalence in adults and children. Sprawl also promotes a sedentary

lifestyle leading to physical inactivity and therefore exacerbates obesity.

25 (Green & Klein, 2011)

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Land-use mix influencing obesity

Land-use mix is a commonly used indicator to measure presence or absence of

different types of land uses in close proximity to each another. For example low density,

single-use developments reflect the unavailability of destinations to which residents can

walk or ride bicycles, and thus is likely to contribute to residents' inactive lifestyles that in

turn will influence their overall health and impact obesity. Furthermore, low density,

sprawled developments are not viable for public transit. Overdependence on automobile

leads to skyrocketing traffic flow and traffic congestion, resulting in more time being

consumed on travelling and very little available to exercise. The situation is further

worsened by limited accessibility to public parks and other recreational areas that create

environments not feasible for physical activity.

Street connectivity influencing obesity

Street connectivity can be defined as the number of intersections along a segment of

streets and connections between areas to create a well-connected grid network. Poor

street connectivity consists of fewer intersections and longer distances between different

points. It affects the directness of travel, making travel less efficient, resulting in longer

trips. As it makes other modes of transportation such as bicycling and walking unviable,

unsuitable and unsafe and decreases physical activity, it impacts obesity as well.

Zoning influencing obesity

Parking provisions as requirements to satisfy the city’s zoning codes also impact

obesity. It’s ironic how cities are trying to attract more people (centralize populations) by

urbanizing the city core, but have rigid rules pertaining to parking provisions. On one hand,

we want to facilitate mixed-use and encourage more public transit and pedestrian focused

use, but at the same time have stringent, less flexible parking rules and regulations that

focus on providing ample quotas of off-street or premise parking that worsen traffic and

demotivate the public to engage in walking and other forms of exercise, hence discourage

physical activity.

It can thus be inferred from all these urban planning components and more, that

land use planning influences obesity.

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What land use changes can reduce obesity prevalence?

1. Emerging research suggests that residents in denser, mixed-use areas are more

likely to engage in utilitarian physical activity (e.g., walking to shops) and are thus less

likely to be obese.26 In light of this fact, many communities today are turning towards

implementing mixed-use developments which allows mixing of residential and commercial,

as a means to promote walkability, reduce auto dependency, roadway congestion, and air

pollution. Studies suggest that a good land-use mix implies presence of “walkable

destinations” leading to increased physical activity, hence lower BMI.27

2. Street connectivity also impacts the walkability of a neighborhood, by promoting

walking and reducing car use. It therefore implies efficient and effective mobility and

accessibility.28 The Centers for Disease Control and Prevention (CDC) greatly emphasizes

the accessibility of recreational facilities to homes and schools by transit facilities to

encourage physical activity among people of all age groups. Benefits of better street

connectivity extend beyond improved mobility and accessibility. They facilitate shared-use

among pedestrians, bikers, transit and vehicle users, reduce congestion and inculcate

healthy behavior by promoting physical activity.

3. Zoning ordinances which require stringent parking for developments and buildings

must be relaxed. In line with the fact that zoning ordinances must be enacted in the interest

of public health,29 zoning can be used to restrict fast food outlets as a potential strategy to

combat obesity. 30Also, adopt zoning policies, such as allowing residential and commercial

uses near each other (mixed-use development), that promote active transportation to

destinations and make it easier to access physical activity and recreation areas

Obesity takes a tremendous toll on people’s health, and it costs the U.S. economy

billions of dollars. Hence, from a public health, financial as well as social perspective, it

becomes vital to address this distinct correlation between land use planning and increased

obesity through health-focused urban planning mechanisms.

26 (Lawrence D, Engelke, & Schmid, 2003) 27 (Brown & et al, December 2009) 28 Well-connected streets influence mobility which can be defined as the means (path) to an end (destination), hence make destinations accessible. 29 (Mair, Pierce, & Teret, October 2005) 30 Ibid

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Obesity prevalence and transportation planning measures

Automobile use has predominantly dictated the U.S. transportation scene. Along

with light truck, it has accounted for about 86 percent of passenger miles traveled in

2012.31 The dominance of an automobile-centered transportation system in the U.S. is

reflected in its current usage where the U.S. has less than 5 percent of the world’s

population, but 17 percent of the world’s cars. 32 To a user, cars represent freedom and

autonomy to operate on their own schedules without any time restrictions.33 Additionally,

automobile use facilitates economic and personal growth by widening the scope of job

opportunities, thereby increasing both mobility and accessibility. Furthermore, car reliance

shapes the social, spatial, temporal and technical conditions, and in so doing greatly

undermines other modes of transportation.34 These short-term benefits of car centered

transportation planning have in the long-term induced externalities such as pollution,

congestion, increased carbon footprint, increased infrastructure development, decreased

productivity and increased obesity.

Automobile dependency influencing obesity

Car centered transportation is sedentary as it displaces active forms of

transportation such as walking and bicycling. The U.S. Department of Health and Human

Services recommends that young people aged 6–17 years participate in at least 60 minutes

of physical activity daily.35 Also, it is recommended that adults partake in at least 150

minutes of moderate-intensity aerobic activity or 75 minutes vigorous-intensity aerobic

activity each week.36 However, less than half of all adults and less than 3 in 10 high school

students meet the physical activity requirements.37 Furthermore, research suggests that

each hour spent in a car results in a 6 percent increase in the likelihood of obesity and each

half-mile walked per day reduces those odds by nearly 5 percent.38 It therefore becomes

31 (Personal transportation, 2014) 32 Ibid 33 (Automobility, Car Culture and Weightless Travel: A discussion paper, 1999) 34 (Dixon & Hinde, 2005) 35 (Recommendations for Physical Activity, 2011) 36 Ibid 37 (Facts about Physical Activity, 2014) 38 (Stein, 2004)

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imperative to motivate people to use active forms of transportation such as biking and

walking rather than sedentary modes of travel such as cars and other automobiles.

Accessibility influencing obesity

Accessibility may act as a barrier to communities for living healthy lives. Some of

which are explained as below:

Food deserts

The proximity of individuals to nearby healthy food options and other heath related

goods and services influences health. One example is food deserts. Food deserts are defined

as urban neighborhoods and rural towns without ready access to fresh, healthy, and

affordable food. These communities have limited or no access to supermarkets and grocery

stores and are served only by fast food restaurants and convenience stores that offer few

healthy, affordable food options. The lack of access contributes to a poor diet and can lead

to higher levels of obesity and other diet-related diseases, such as diabetes and heart

disease. 39

Access to parks and recreational facilities

Some communities may not have access to recreational parks and facilities.

Proximity to parks and recreational spaces motivates individuals to partake in physical

activity. It has been suggested that access to parks, trails, open spaces, and recreational

facilities not only provides increased opportunities for children and adults to play and be

physically active, but these venues also influence other behaviors.40

Transportation infrastructure influencing obesity

Lack of resources allocated towards bicycling and walking infrastructure such as

designated bicycle paths and footpaths also demotivate people to use active forms of

transportation. Bicycling and walking-basic, fundamental forms of transportation-are

oftentimes overlooked due to over dependency on auto-centered development.

Transportation planning agencies should be proactive in investing in safe and adequate

biking and walking infrastructure that can reverse automobile dependency. A recent study

conducted to allocate funds towards biking infrastructure in Portland, Oregon suggests that

39 (Food Deserts) 40 (Blank, et al., October 2012)

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15 million spent on paving would save 50 million in the long-term. 41 Furthermore, this also

translates into higher rates of bicycling, hence increased physical activity, and reduced

obesity.

It is therefore important to implement transportation improvement programs such

as public transit, greenways and trails, pedestrian and bicycle facilities, and invest in efforts

to manage car traffic, as these measures can support or impede physical activity, hence

impact health outcomes such as obesity.

What transportation planning changes can reduce obesity prevalence?

1. Emerging research suggests that people who use public transit (buses, light rails,

subways etc.) are less likely to be sedentary than adults who don’t. 42 Additionally, physical

activity associated with transit use results in reduced medical costs and a higher quality of

life.

2. Walking and bicycling to school can help kids achieve their required physical

activity levels. However, road safety as well as increased car traffic has been pivotal in

demotivating parents to do so. Efforts promoted by programs such as the Safe Routes to

School, including building sidewalks, crosswalks and traffic-control devices around schools,

have been linked to both-increases in the percentage of students who walked to school and

reductions in the percentage of students being driven to school.43 Better quality of

sidewalks encourages pedestrian movement as well.

3. Building multi-use trails that connect population centers with desirable destinations

or recreation spaces can also be instrumental in inculcating a physically active lifestyle.

4. Cities that promote bicycling as a mode of transportation by providing allocated

bicycle lanes, exhibit higher levels of bicycle commuting. Additionally, facilities for bicycle

parking also motivate people to bicycle versus drive.

5. Often intersections are designed such that they facilitate speedy movement of cars,

which poses a threat to pedestrians and bicyclists. Hence, traffic calming and safety

measures such as curb extensions and speed bumps must be used to protect residents and

facilitate walking and bicycling.

41

(Anderson, 2014) 42 (Wener & Evans, 2007) 43 (Active Transportation: Making the Link from Transportation to Physical Activity and Obesity, 2009)

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Transportation improvement programs which promote walking, bicycling, and

reduce car use provide an opportunity to incorporate moderate physical activity as a daily

rhythm and a means to decrease physical inactivity for large segments of the population.

Through these transportation improvement programs, regular physical activity can be

incorporated as a life style change rather than a required chore. It can thus be an effective

mechanism in reducing the risk of obesity and can help people lead longer and healthier

lives.

Future implications of conjoined urban planning, transportation planning

and public health efforts.

The fields of public health and urban planning started as unified efforts, only to

bifurcate later and pursue individual and isolated goals. Urban planning started focusing

more on shaping the built environment whereas public health concentrated on disease

prevention and epidemiology. This resulted in complex wicked problems the effects of

which are visible today in the form of increased urban sprawl, segregated auto-oriented

development, increased infrastructure costs, congestion, poor air quality and increased

obesity prevalence. The past decade has seen a surge in coalescing efforts across urban

planning, transportation planning and public health disciplines to modify the built

environment to facilitate health. Various planning, transportation and public health

agencies are proactively pursuing endeavors to motivate individuals within these fields to

collaborate and work together in implementing policies and projects that will promote

health. The future seems promising. The federal government as well as private foundations

such as the Robert Wood Johnson Foundation and others are providing funds to state and

local communities to form coalitions consisting of urban planners, public health officials,

transportation planners and other diverse multi-disciplinary groups with assimilated goals

of building healthy communities. The focus of these funding outcomes is not restricted to

individual short-term project implementation but rather long-term systemic changes

through policy implementation that will be more sustainable going forward. The effects of

these long-term systemic policy level changes will be more valuable in how they affect

large population groups and communities by enabling them to adopt health enhancing

ways.

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Conclusion

The built environment affects health in a number of ways. Escalating obesity rates is

one of them. Recent research suggests that the built environment limits opportunities to

walk for utilitarian purposes, thereby contributing to this emerging obesity epidemic. It is

not sufficient to educate people regarding healthy lifestyles; the built environment must

promote, or at least allow for, engagement in healthy behaviors. There is definite

connection between obesity prevalence and land use and transportation planning

measures. Land use patterns and transportation investments collectively shape the desire

to walk, drive, or to travel via other means. In making conjoined efforts in land use and

transportation planning mechanisms such as promoting compact, mixed use development,

providing well-connected and walkable streets, efficient public transit systems, reducing

car dependency, designated bicycle paths, and more, opportunities exist to increase

physical activity, hence to mitigating obesity. Through these changes, the built environment

can be shaped to achieve healthy behavior. In order to address this global pandemic of

obesity, going forward urban planning, transportation planning and public health planning

must collectively adopt policies and implement projects that are symbiotic to each other in

order to achieve desirable living conditions, effective transportation systems and healthy

public health outcomes.

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