3 nearly 400% (Pratt et al. 2011). Our aging population will confront more health challenges. Health care costs—now at $2.5 trillion each year, or nearly 18% of GDP—continue to rise. These two domains—the built environment and human health—are linked. Mounting evidence shows that where we live, work, study, and play affects health and well-being in many ways. As we understand these connections better, we can design and build sustainable, resilient, and health-promoting places. This is serious business. It is vital that we get it right. While the
Report on the State of Health + Urbanism
is a deeply flawed document, we can learn much from it, in both positive and negative senses, as we work to advance human health and well-being through design. The major lessons, we submit, are the need for collaboration, the need for careful scholarship, the need to confront and manage complexity, and the need for balanced public discourse.
The need for collaboration
The intersection of the built environment and human health is highly interdisciplinary. It requires that built environment professionals—architects, urban planners landscape architects, developers, builders, and others—collaborate with health and social science professionals—physicians, epidemiologists, sociologists, and others. How did the MIT report do in this respect? The report’s editor was Alan Berger, Professor of Landscape Architecture and Urban Design at MIT and Director of Research at that institution’s Center for Advanced Urbanism, “with” Andrew Scott, an Associate Professor of Architecture at MIT. The other contributors are listed in two locations, on the acknowledgments page (page 1) and under “contributors” (page 10) (with considerable non-overlap between the two lists). But nearly all contributors other than professors Berger and Scott appear to have been MIT urban planning and architecture students. One contributor, Aparna Keshaviah, has a master’s degree in biostatistics, but her professional experience (judging by her publications) is limited to cancer and psychological ailments, with no background in the built environment, social epidemiology, or broader issues of public health. There are no authors with expertise in epidemiology, medicine, environmental health, or other relevant health sciences, and no indication of pre-publication review by anybody with such expertise. As expected, a team this one-dimensional runs into trouble. Many statements are inconsistent with current knowledge in public health and biology. For example, on page 14, in the chapter entitled “Health + Urbanism Primer,” we read that “Pythogenic theory (or ‘filth theory’) made it clear that disease was caused by the decomposition of organic matter.” What? The filth theory was put to rest at more than a century ago (Chapin, 1902), along with bloodletting and leeches. On page 16 we read that “infectious disease is no longer a major problem in developed countries.” Really? Pneumonia and influenza kill over 50,000 Americans and cost the nation $40 billion each year, more than 1.1 million Americans are living with HIV, recent outbreaks of diseases such as SARS, Ebola, and West Nile virus have threatened the U.S. and dozens of other nations, and an estimated 1.7 million hospital-acquired infections occur each year in the United States. And on page 22, the section on air pollution begins with the declaration that “High levels of carbon dioxide is [sic] linked to asthma-related deaths.” Not only is this claim incorrect (carbon dioxide isn’t linked to asthma mortality), but the reference cited to support