5
Human Health and the Built Environment

In the United States, the “built” environment—the environment designed and constructed by humans—has been greatly influenced by the rapid population growth in this country in the last 50 years. During that time, the U.S. population has increased by 83 percent, and a result is an enormous growth in the number of large metropolitan areas throughout the country (U.S. Census Bureau, 2000b). Land area has expanded much faster than population in many metropolitan areas, demonstrating the land-intensive nature of this pattern of growth. Similarly, the population outside the central cities has grown faster than the population in the central cities, demonstrating a shift of population to suburban areas.

From 1990 to 1998, the metropolitan population in the South grew by 5.3 percent inside the central cities and 18.4 percent outside the central cities (U.S. Census Bureau, 2000b). Metropolitan Atlanta’s population grew rapidly from 1970 to 1999, increasing by 114 percent throughout the entire region, but decreasing by 14 percent within the city’s borders. The area of metropolitan Atlanta has also grown, from “only” 65 miles from north to south in 1990 to its current size of 110 miles. This pattern of sprawl, typical of the Sunbelt cities, results in low population density across metropolitan areas. Older cities such as Washington, D.C., and Boston tend to have higher density (3,465 and 2,610 people per square mile, respectively), whereas the density of Atlanta and Dallas is only 1,400 people per square mile (Brookings Institute, 2002a).

Rapid population growth is a worldwide phenomenon. In another 50 years, by 2050, about 10 billion people will share this planet, compared with about 6 billion today. About 7.5 billion people will be living in urban areas. Many will live in megacities with populations of more than 10 million people. Many participants agreed that this burgeoning of the population worldwide is a central driving force in environmental problems and has serious ramifications for health that will worsen in the next few decades. Some anticipated consequences are water shortages, increased air and water pollution, overcrowding, increased sprawl and



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 29
Health and the Environment in the Southeastern United States 5 Human Health and the Built Environment In the United States, the “built” environment—the environment designed and constructed by humans—has been greatly influenced by the rapid population growth in this country in the last 50 years. During that time, the U.S. population has increased by 83 percent, and a result is an enormous growth in the number of large metropolitan areas throughout the country (U.S. Census Bureau, 2000b). Land area has expanded much faster than population in many metropolitan areas, demonstrating the land-intensive nature of this pattern of growth. Similarly, the population outside the central cities has grown faster than the population in the central cities, demonstrating a shift of population to suburban areas. From 1990 to 1998, the metropolitan population in the South grew by 5.3 percent inside the central cities and 18.4 percent outside the central cities (U.S. Census Bureau, 2000b). Metropolitan Atlanta’s population grew rapidly from 1970 to 1999, increasing by 114 percent throughout the entire region, but decreasing by 14 percent within the city’s borders. The area of metropolitan Atlanta has also grown, from “only” 65 miles from north to south in 1990 to its current size of 110 miles. This pattern of sprawl, typical of the Sunbelt cities, results in low population density across metropolitan areas. Older cities such as Washington, D.C., and Boston tend to have higher density (3,465 and 2,610 people per square mile, respectively), whereas the density of Atlanta and Dallas is only 1,400 people per square mile (Brookings Institute, 2002a). Rapid population growth is a worldwide phenomenon. In another 50 years, by 2050, about 10 billion people will share this planet, compared with about 6 billion today. About 7.5 billion people will be living in urban areas. Many will live in megacities with populations of more than 10 million people. Many participants agreed that this burgeoning of the population worldwide is a central driving force in environmental problems and has serious ramifications for health that will worsen in the next few decades. Some anticipated consequences are water shortages, increased air and water pollution, overcrowding, increased sprawl and

OCR for page 29
Health and the Environment in the Southeastern United States traffic congestion, deforestation and soil erosion, vanishing open spaces, and destruction of wildlife habitats. A panel of speakers and respondents discussed approaches to making the built environment safer, healthier, and more environmentally friendly. Many participants acknowledged that, particularly in light of expected population growth, the decisions made today, and the solutions devised and implemented in the coming decade, will have profound effects on our environment and the health of the human family generation after generation. TRANSPORTATION AND HEALTHY ENVIRONMENTS A close relationship exists between transportation, the design of the built environment, and health, according to Ricardo Martinez, Safety Intelligence Systems.* Modern transportation, particularly the automobile, has become a vital resource for our society and our economy and has given us tremendous mobility. At the same time, it has changed every aspect of our lives—how we behave, how we build houses, how we shape our communities, how we work, and how we play—everything. In the United States, the automobile is among our greatest health hazards, particularly for young people. Automobiles now claim more than 40,000 lives each year in the United States (National Highway Traffic Safety Administration, 1999) and are the leading cause of death among persons 1 to 24 years of age (CDC, 1999b). These fatalities affect African Americans disproportionately. Among men, national rates are highest for African Americans (32.5 deaths per 100,000 people per year), next highest for whites (19.5), and lowest for Hispanics (10.2). Among women, the rates are highest for African Americans (11.6) and roughly equivalent for whites and Hispanics (8.5 and 9.1 per 100,000, respectively) (Cubbin et al., 2000). Yet too often we consider transportation only in terms of the freedom it provides and fail to see how closely it is linked with the environment, public health, and safety. Ricardo Martinez Automobile crashes also account for 3.4 million nonfatal injuries each year in this country at an estimated cost of $200 billion (CDC, 1999b). The rates of automobile fatalities and injuries per driver, and per miles driven, have decreased substantially in recent decades as a result of safer cars and roads, laws that discourage drunk driving, and other measures; yet because of the increased number of cars and miles driven, the absolute toll from automobile crashes remains high. The automobile also poses a serious health risk for pedestrians in our soci- *   Former National Highway Traffic Safety Administration administrator.

OCR for page 29
Health and the Environment in the Southeastern United States FIGURE 5–1 Pedestrians are at risk of injury and fatality from automobiles. SOURCE: Richard J. Jackson. Reprinted with permission. ety (Figure 5–1). Each year, automobiles cause about 6,000 fatalities and about 110,000 injuries among pedestrians nationwide (Cohen et al., 1997; McCann and DeLille, 2000). These fatalities disproportionately affect members of minority groups. In Atlanta, for instance, annual pedestrian fatality rates from 1994 to 1998 were 9.74 per 100,000 for Hispanics, 3.85 per 100,000 for African Americans, and 1.64 per 100,000 for whites (Hanzlick et al., 1999). Similar patterns are seen across the country (Marosi, 1999; Morano and Sipress, 1999). The reasons for this disproportionate impact are complex and may involve the probability of being a pedestrian (perhaps related to low access to automobiles and public transportation), road construction in areas where members of minority groups walk, and behavioral and cultural factors such as being unaccustomed to high-speed traffic. An automobile injury or an auto-pedestrian accident can be considered a disease process, suggested Martinez. Like any disease process, it can be separated into three parts: host, agent, and environment. The host is the human, the agent is the energy transmitted to the body (beyond what the tissues can tolerate), and the environment is what brings the two together in the crash. The design of the automobile environment can help keep host and agent—human and energy—apart and greatly increase safety. Environmental design is an integral part of automobile injury prevention. For example, controlled-access freeways and turnpikes have the lowest fatality rates of our roadways, even though cars travel at high speeds, because deadly head-on and side-impact crashes are avoided (Martinez, 1990). Interstate highways are designed to provide a relatively safe environment for the automobile. Traffic proceeds in one direction, and there is no cross-traffic. These roadways have guard rails, breakaway poles, wide shoulders, and

OCR for page 29
Health and the Environment in the Southeastern United States few distractions. In contrast, the typical state highway has oncoming and cross-traffic, narrow shoulders, many distractions—and higher fatality rates. Incorporating safety features, such as broad median strips and wide shoulders, into the design of state highways can potentially lessen injury rates. “Traffic-calming” design features, such as narrowing roadways to reduce automobiles speeds, may also decrease injuries. Martinez suggested that proper environmental design can also protect pedestrians. Because a pedestrian always loses in a contest with an automobile, a primary rule is to keep the two separated with sidewalks, overpasses, fences, and pedestrian-friendly intersections. Pedestrian routes that need special attention are those within a community, particularly the routes that children take to reach each other’s homes, their school, or a nearby park. Safe pedestrian routes that connect communities with one another are also needed, as are routes leading to and from public transportation and the buildings in which we work and shop. A serious impediment to pedestrian safety is the absence of sidewalks in many developments in suburban America. Requiring sidewalks in new developments and retrofitting sidewalks in existing communities are possible solutions. Providing incentives for sidewalk construction may be an effective way to bring about community cooperation, suggested Lawrence Frank, Georgia Institute of Technology. Safety education and traffic law enforcement are important ways of changing driving and pedestrian behavior and promoting safety. Yet the design of the transportation environment can have an even greater effect on safety because it is a preventive measure that does not rely on the public’s compliance with safety measures, stated Martinez. The federal government can assist in the design of a safer transportation environment and in funding construction costs. Regional and state approaches to transportation design may provide a unifying perspective. However, much of the work to be done is dictated by the particular circumstances of the locality and often must be addressed at the local level. THE BUILT ENVIRONMENT AND HEALTH PROBLEMS Reliance on the automobile, and the environmental and behavioral changes that accompany automobile use, have contributed to many serious public health problems in this country, according to Wayne Alexander, Emory University School of Medicine. The growth of our urban areas has led to decreased physical activity as driving has replaced walking and bicycling. A sedentary life-style, in turn, is a well-established risk factor for cardiovascular disease, stroke, and allcause mortality (NIH Consensus Development Panel on Physical Activity and Cardiovascular Health, 1996; Pate et al., 1995; U.S. Department of Health and Human Services, 1996; Wannamethee et al., 1998, 1999). Men in the lowest quintile of physical fitness have a two- to threefold increased risk of dying over-

OCR for page 29
Health and the Environment in the Southeastern United States all, and a three- to fivefold increased risk of dying of cardiovascular disease, compared with men who are more fit (Wei et al., 1999). Physical activity prolongs life (Lee and Paffenbarger, 2000; Wannamethee et al., 1998). Among women, walking 10 blocks per day or more is associated with a 33 percent decrease in the risk of cardiovascular disease (Sesso et al., 1999). Many chronic diseases involve the cardiovascular system, and it is now understood at the cellular and molecular level why stimulating blood flow in vessels by walking contributes to the health of the cardiovascular system. From the perspective of cardiovascular health alone, an environment that hinders walking and other forms of exercise is an unhealthy one, concluded Alexander. Obesity resulting from overeating and underexercising is an epidemic that is growing at an alarming rate in this country. Jackson stated that the increase in obesity in this country during the past decade is dramatic (Figure 5–2). The average 11-year-old boy in the United States today is 11 pounds heavier than a boy of the same age in 1973 (CDC, 1999a). Being overweight increases the overall risk of death by 250 percent; it carries a fourfold increase in the risk of heart disease and death and a fivefold increase in the risk of type II diabetes (Willet et al., 1999). Obesity also increases the risk of high blood pressure, gallbladder disease, and some cancers (NIH, 1998). According to Alexander, air pollution is another serious health consequence of our dependence on the automobile. Air pollution is an umbrella term for a series of distinct contaminants that may be found in air. In general, there are nine kinds of air pollutants: ozone, NOx, CO, particulates, hydrocarbons, lead, SOx, air toxics, and allergens. The first five of them are produced by so-called mobile sources—cars and trucks—noted Jackson. In Atlanta, ozone is the leading air pollutant of concern (Table 5–1). Because ozone is a secondary product of hydrocarbons and NOx, it demonstrates a characteristic daily pattern. On a typical August day in Atlanta, the day starts with very low ozone levels and with a busy TABLE 5–1 Atlanta’s Leading Pollutant Concern: Ozone Respiratory Effects (ozone > PM) Cardiovascular Effects (PM > ozone) Immune Effects Airway inflammation Increased mortality Increased susceptibility to infection Decreased air flow     Increased symptoms, emergency department visits, medication use, hospitalizations     NOTE: PM = particulate matter.

OCR for page 29
Health and the Environment in the Southeastern United States FIGURE 5–2 Prevalence of obesity among U.S. adults: 1991, 1993, 1995, and 1998. Obesity defined as >30 kg/m2 body mass index. Data from the CDC’s Behavioral Risk Factor Surveillance System. SOURCE: Mokdad et al., 1999. Reprinted with permission. rush hour. The second rush hour occurs in late afternoon, fueling the process, so that by the time school athletes are outside practicing, bicycle commuters are peddling home, and afternoon joggers are getting their exercise, the air is dangerous to breathe. Air pollution, like so many health hazards, does not affect everyone in society equally. Poor people and people of color are disproportionately affected for two reasons: (1) they are disproportionately exposed, and (2) they are more

OCR for page 29
Health and the Environment in the Southeastern United States likely to have underlying diseases that increase their susceptibility (Wernett and Nieves, 1992). There is compelling evidence that air pollution contributes to chronic lung disease and asthma, said Alexander. The epidemic of asthma is growing in our country and is of particular concern in children. As asthma continues to increase, its prevalence and mortality remain higher in minority group members than in

OCR for page 29
Health and the Environment in the Southeastern United States whites (Litonjua et al., 1999; Metzger et al., 1995; National Heart, Lung, and Blood Institute Working Group, 1995; Persky et al., 1998). An important function of health professionals and environmentalists is to educate the public about the strong links between unhealthy life-styles and the environments that promote them. Kerr noted that although protecting the environment against unhealthy influences is difficult and expensive, it may be more expensive to deal with the consequences of not protecting the environment, particularly increased medical costs. Odum further reflected that an unhealthy environment not only is responsible for disease, but also affects the social health and well-being of the entire community—what the Constitution calls “domestic tranquillity.” ENVIRONMENTALLY FRIENDLY BUILDINGS The “sick building syndrome” is familiar to many and represents inadequate building design and construction practices. However, building design and construction need not adversely affect the environment or our health. The Southface Energy Institute of Georgia is a research and educational organization that, among other things, promotes environmentally friendly buildings that bring health benefits to their occupants. The Southface building, which serves as a model to reflect the organization’s principles, was designed with four goals in mind, according to Dennis Creech, Southface Energy Institute: to promote health, to conserve energy, to improve water efficiency, and to demonstrate the use of low-impact environmental materials (Figure 5–3). In the Southface building, moisture is controlled to avoid mold and dust mites that can cause health problems such as asthma and allergies. Materials are chosen wisely to avoid substances that can affect health adversely; for example, all paints used in the building contain no volatile organic compounds. The Southface building reduces the impact of one of our most environmentally damaging activities—energy production and use—by using about 60 percent less energy than the typical building in Atlanta. This energy efficiency is achieved through sound building and insulating techniques and the use of solar electric roof shingles. Water efficiency is achieved by using less water and preserving water quality. For example, the driveways adjacent to the Southface building are constructed from porous concrete, which allows the rainwater to percolate into the soil to help protect the watershed. Throughout three years of drought, a butterfly garden next to the building has been irrigated with gray water from the laundry. Low-impact environmental materials are those that require minimal natural resources. The entire shell of the Southface building—the roof and outer walls— is made with insulating panels that use 25 percent less wood than standard construction methods. These materials not only reduce the burden on our forests, but also provide better insulation.

OCR for page 29
Health and the Environment in the Southeastern United States FIGURE 5–3 The Southface building was built to promote health, conserve energy, improve water efficiency and demonstrate the use of low-impact environmental materials. SOURCE: Neal Dent. Reprinted with permission from Southface Energy Institute. The lessons learned from the Southface building, and others like it, can be applied directly to residential housing. Homes built according to these principles not only save their owners money in energy costs and maintenance—typically a 30 percent saving over a traditional home—but also cause fewer allergy problems, stated Creech. Many traditional homes are energy inefficient, as can be determined by examining heat loss (Figure 5–4). Windows are a major source of energy loss, but loss from other areas may also be substantial and can be more easily and inexpensively corrected. Caulking wall-to-floor joints and around window and door frames is inexpensive and can make a large difference in stemming energy losses (Georgia Environmental Facilities Authority, 1999). Another area of substantial heat loss is heating ducts. In a typical home, 10 to 30 percent of the

OCR for page 29
Health and the Environment in the Southeastern United States FIGURE 5–4 Infrared image of heat loss. SOURCE: Dennis Creech. Reprinted with permission from Southface Energy Institute. heating bill is attributable to leaks in the ducts (Georgia Environmental Facilities Authority, 1999). Creech noted that energy losses not only inflate our heating bills but also cause health problems. When energy escapes through a leak, that area of the home cools down, creating condensation. The moisture encourages the growth of toxic mold and dust mites, which cause allergies in many people. Leaky heat ducts create pressure imbalances in the home that cause cold air to be drawn in

OCR for page 29
Health and the Environment in the Southeastern United States from the crawl space underneath the home—a space that is ripe with mold and other biological contaminants. Fixing leaks in heating ducts not only conserves resources but also enhances health. A tightly sealed house requires that homeowners take care with combustion appliances and cars, both of which can produce lethal levels of carbon monoxide. Unvented combustion appliances have no place in the home. The biggest health risk from combustion in the home is not the water heater, the furnace, or the fireplace—it is the automobile, suggested Creech. In many homes, the leakiest wall is between the home and the attached garage. For that reason alone, the car’s engine should never be run inside the garage. Any wind that blows into the open garage when the car’s engine is running carries carbon monoxide into the house through the smallest crack. Installing carbon monoxide detectors in all homes that have attached garages would minimize the risk of carbon monoxide poisoning. PARTNERSHIPS WITH ACADEMIA Fifty years ago, a research scientist’s work typically involved investigating a specific topic in isolation in a university laboratory. The work was generally conducted within a single discipline and was unconnected to other disciplines and to the needs of society. Today’s research is often conducted along interdisciplinary lines, and the university now functions as an integral part of the community, making connections with other research organizations and with society as a whole, according to Charles Liotta, Georgia Institute of Technology. Research universities must become a major intellectual force in rebuilding the unity of health and the environment through a holistic approach, rather than through fragmented initiatives. Charles Liotta Scientists, engineers, and architects must become health and environment leaders and decision makers rather than just technical problem solvers. Liotta noted that achieving this goal requires new kinds of partnerships. Universities must adopt a more comprehensive view of how students and faculty learn and how they conduct research, and they must promote the changes necessary for scientists, engineers, and architects to be able to create more sustainable technologies. One way of promoting sustainable technologies is through partnerships— among departments within universities, between universities and other academic research institutions, and between these institutions and industry, federal laboratories, and other government organizations, suggested Liotta. An example of a useful collaborative technology that is currently being developed is a new type of photovoltaic cell that will allow relatively high efficiency conversion of sunlight into electricity at little cost. Georgia Institute of Technology has fostered multidisciplinary research by

OCR for page 29
Health and the Environment in the Southeastern United States locating centers representing separate but related disciplines in close proximity to each other. For example, the Georgia Center for Advanced Telecommunications Technologies and the Micro-electronics Research Center collocate science, engineering, and social science disciplines so that collaborative efforts can be undertaken to solve real-world problems. Such partnerships create a holistic approach to teaching and learning by giving students and faculty exposure to many different disciplines while furthering in-depth study in their primary discipline. PARTNERSHIPS WITH INDUSTRY: CREATING TRUST The existing model of government-generated environmental regulation is “command and control.” The goal is to control “end-of-pipe problems” by commanding and enforcing regulations, according to Linda DiSantis, United Parcel Service. Until recently, much of the regulatory work on environmental impacts has been necessary, and the regulatory and compliance process has generally worked well for most industries. Today, however, new kinds of challenges are arising from different kinds of industries and different kinds of impacts, and the traditional model of environmental regulation no longer always works well for the service sector. An answer is to seek creative solutions, such as incentives, for reducing unhealthful impacts on the environment. All major players in the process—government regulators, business and industry, environmental groups, and the research community—appear to favor a holistic approach to improving environmental quality, but a key impediment is the lack of trust among these groups. Although creative solutions are often sought in negotiations between representatives from government and from business and industry, government regulators often revert to the old approach—rule making—primarily because they do not trust business and industry to do the right thing unless penalties are threatened, according to DiSantis. For the holistic approach to work, participating groups must develop mutual trust, and old patterns of behavior must be put aside. Regulators need to reserve rule making for instances when other avenues do not work. Environmental groups play an important part in raising awareness of environmental problems and holding business and government accountable for the role each is supposed to play in solving them. Lack of trust amongst major players creates obstacles to achieving a consensus on needed solutions. Linda DiSantis Some industries often find themselves dealing with two juxtaposed concerns: (1) economic realities and the ability of companies to deliver a fair return on investment, on one hand, and (2) environmental protection and minimization of health risks, on the other, according to Charles Goodman, of Southern Company. Such is the case with implementing the Clean Air Act, which was a mile-

OCR for page 29
Health and the Environment in the Southeastern United States stone piece of environmental legislation that affected virtually every business— from large energy companies to the local dry cleaners. Most large utilities are significantly affected by clean air regulations, and they recognize the need to control emissions and waste. These companies must deal with the challenge of complying with regulations of all kinds, meeting customer needs, and at the same time satisfying their investors. Most electricity sales are still subject to price regulation, and this means that utilities must deal with some regulators who determine what they can charge for their product and other regulators who try to limit the effects of energy production on the environment. Electricity that is sold on the open market, like other products not subject to price controls, must still face competitive pressure that can limit recovery of the full cost of additional environmental requirements. Goodman noted that industries may have to incur significant expenses and modify their operations to meet federal standards for air quality, but from an economic vantage point, industries may question what represents good enough. Achieving the last few percentage points of improvement in air quality costs disproportionately more than obtaining the first percentage point. While acknowledging that there are no easy answers to the question, “How clean is clean enough?” some participants suggested that having an increased dialogue would be helpful. BUILDING HEALTHIER CITIES The “American dream” has always been to have a good home, a good job, good education, and a safe neighborhood. Achieving this dream in today’s society typically means living in the suburbs and relying on the private automobile to drive long distances to work, shop, and play. What are the costs of the pursuit of this goal for individuals, society, and environmental quality? They are well-known—urban sprawl, traffic congestion, long commute times, lack of open space, stress, lack of a sense of community, and poor air quality, according to Michael Kilgallon, the Pacific Group. Atlanta is one of the least densely developed (i.e., fastest-sprawling) cities in the United States. Atlanta’s residential lots are, on average, three times the size of lots in any other large city in the South. As the Atlanta area grows by an anticipated 600,000 people in the next decade, continuing to achieve the American dream will mean greatly increasing sprawl and its ill effects. Allowing our society to grow in this manner places us in danger of creating an environment that we will want to “get through” as opposed to an environment that we will enjoy, said Lawrence Frank, Georgia Institute of Technology. What new direction can we take to accommodate this growth? Across the country, many cities and counties are exploring new policies that would reconfigure urban growth by aiming for higher-density, mixed use development in some areas and preservation of green space in others. Many in the housing industry, in

OCR for page 29
Health and the Environment in the Southeastern United States Box 5–1 Regional Development and Smart Growth Features A desirable pattern of regional development: Protects and improves the quality of life for all citizens, Permits and promotes healthy behaviors, Minimizes or eliminates hazards to people, and Protects, preserves, and restores the natural environment. Smart growth is likely to feature the following: Higher-density, more contiguous development Preserved green spaces Mixed land uses with walkable neighborhoods Limited road construction balanced by transportation alternatives Architectural heterogeneity Economic and racial heterogeneity Development and capital investment balanced between central city and periphery Effective, coordinated regional planning government, and in environmental groups are promoting the concept of “smart growth” as a better way for society to grow (Box 5–1). From a health standpoint, the features of smart growth are highly attractive. They offer the potential of more walking, less driving, fewer car crashes and pedestrian fatalities, and more livable regions with enhanced social capital—all important health benefits. To improve the built environment, we need to understand the process that shapes it, said Elliott Sclar, Columbia University. Urban planners, engineers, and developers face community barriers, political barriers, and regulatory barriers, stated Kilgallon. Because political and regulatory barriers flow from the community, a useful course of action is to focus on community barriers. Sclar noted that too often, community policy reflects the short-term needs of the few, not the long-term needs of the many. However, as much as most people oppose the effects of sprawl, they also tend to oppose changes that increase density, stated Frank. As is often said, people hate density, and they hate sprawl. The probable solution is to find a middle ground. A means of combating sprawl that is advocated by many people, although they tend not to specify how to achieve it, is to slow growth or halt it altogether. Kilgallon noted that the only way to slow or halt growth voluntarily in an area is to let the quality of life deteriorate to the point that people no longer want to live there. An alternative, proposed by some participants, is to convince local politicians to stop the growth of existing communities through regulation. However, Kilgallon asserted that halting growth in some communities may merely push the growth out further.

OCR for page 29
Health and the Environment in the Southeastern United States How do we facilitate the adoption of middle-ground concepts such as smart growth in our communities? We must educate each other and the general public about their benefits to health and well-being and convince people of their worth. Many groups and partnerships—among industry, environmental groups, regional governments, and state government—are working toward this goal. Yet because the involvement of local government is missing in most of them, progress is slow. The goal of building healthier cities must be achieved through consensus because voters will not allow regulations to be forced upon them. Thus, the challenge is to show the public the deep connection between smart-growth concepts and a healthier, more productive, and more enjoyable way of living.