Better measurement for healthier places

Abstract

In the second half of the 19th century, investment in sanitation,clean water, and housing infrastructure dramatically reduced the prev-alenceofcommunicablediseases,suchascholera,typhoid,andtubercu-losis. As a result, cities became healthier, especially in the developedworld. Today, the emphasis in the developed world has shifted fromcommunicable to non-communicable diseases, yet it is possible thatfeatures of the urban environment are once again a major culprit inmorbidity and mortality, this time by fostering behaviors that lead tosomeofthemostcommonchronicillnesses,suchascardiovasculardis-ease, diabetes, and cancer. There is an intense interest in such associa-tions, for example Powell et al.'s (2007) analysis of associationsbetween the food environment and individual behaviors is one of themost downloaded papers in Preventive Medicine.The idea that we have entered a new era of unhealthy cities ispredicated on the notion that many chronic diseases arise from un-healthy diet and lack of physical activity, which are in turn heavilyinfluenced by policy choices related to agriculture, commerce, trans-portation,and urban form. If the above is true, then the case for a pro-gressive policy response, such as the investment in sanitation thataccelerated in the 19th century in New York and other cities in theUnited States and Europe, would seem compelling. Such a policyresponse is already occurring in a number of US cities includingNew York, Washington DC, Salt Lake City, etc., with modest invest-ments in urban food and physical activity environments (e.g., bikelanes and bike share programs, complete street designs, and farmers'markets). Why hasn't this investment been as effective as the