In what kind of community are you most likely to end up dead in a pool of blood?

The chief question of urban planning is, “How does our built environment affect our lives?” In some ways, however, the way we choose to structure our communities contributes to untimely death.

Environmental Health Researcher Richard Joseph Jackson, MD, MPH famously presents his audiences this provocative question, “In what kind of community are you most likely to end up in a pool of blood?”

When researchers added up deaths by vehicular collision and crime to generate an overall rate of violent death, they found that you’re 20 percent more likely to die in the suburbs. While violent crime is, indeed, worse in cities than suburbs, car crashes far outstrip those deaths in both areas. The risk of death by car crashes in rural counties is twice that of most urban counties. Density is the best predictor of this combined danger, with the least dense (and most car-dependent) areas being the most dangerous.

Living in a community where you can’t walk to do everyday tasks cuts down on the amount of exercise people are able to get, leading to a slew of other heath problems. “The modern America of obesity, inactivity, depression, and loss of community has not ‘happened’ to us. We legislated, subsidized, and planned it this way,” Jackson writes in his book Urban Sprawl and Public Health.

And vulnerable populations such as the elderly are the most affected. Car crashes are the third-leading cause of traumatic brain injury and the second-leading cause of associated deaths. Rates of TBI are highest for the elderly, and experiencing a TBI doubles the risk of dementia, according to the Amen Clinics blog. Dementia cases are only growing, and Alzheimer’s disease is the sixth leading cause of death in the United States.

Taken as a whole, our built environment is hurting public health. Doctors are commonly concerned with pathology: the direct, medical cause of a condition, but Jackson thinks doctors should have a wider field of concern. He spoke on the subject in a 2006 interview in Metropolis Magazine:

In July 1999 the head of the CDC invited his dozen directors to the central office to work on a paper about the ten leading diseases of the twenty-first century. I’m driving over there, and as always I’m thinking about pesticides, herbicides, cancer, and birth-defect clusters—you name it. I’m late, stuck in traffic on Buford Highway, voted one of the ten worst streets in North America. It’s a seven-lane road surrounded by garden apartments, mainly for poor immigrants, with no sidewalks and two miles between traffic lights. It’s 95 degrees out, 95 percent humidity. I see a woman on the right shoulder, struggling along, and she reminds me of my mother. She’s in her seventies, with reddish hair and bent over with osteoporosis. She has a shopping bag in each hand and is really struggling.

[…] This woman stayed in my mind during the whole discussion we were having about the future of public health. Afterward I e-mailed Howie Frumkin and said, “If that poor woman had collapsed from heat stroke, we docs would have written the cause of death as heat stroke and not lack of trees and public transportation, poor urban form, and heat-island effects. If she had been killed by a truck going by, the cause of death would have been ‘motor-vehicle trauma,’ and not lack of sidewalks and transit, poor urban ­planning, and failed political leadership.” That was the “aha!” moment for me. Here I was focusing on remote disease risks when the biggest risks that people faced were coming from the built environment.

Often, urban planning is painted as an issue for city-dwelling yuppies, but, in a country where most people in poverty live in the suburbs, mobility is an issue that should concern everyone.

h/t Jeff Speck, Walkable City via Metropolis Magazine

Photo: YoungToymaker via Flickr