You are on page 1of 4


Public Policy
Information Sheet

Urban sprawl and health

Bigger doesn’t necessarily G Need for extensive road and transportation
infrastructure, resulting in transportation
mean healthier
networks biased towards automobile travel
Cities bring many of the things that we associate and with limited potential for multi-modal
with good health together in one locale – transportation and active transportation such
employment and educational opportunities; as public transit, walking, biking, and wheeling.
accessible, nutritious foods; hospitals, clinics, and
other healthcare facilities; cultural and economic Population densities and automobile dependence
diversity; and adequate housing. But when it in major Canadian metropolitan areas 2
comes to the physical size of a city, bigger doesn’t Percent of
always mean healthier. Sprawling cities with low population aged
population densities can have a negative impact 18 years and older
Census Population making all trips
on health. Metropolitan Density by car (as driver
Area (CMA) (persons/km2) or passenger)
Edmonton 109.9 77
What is urban sprawl?
Winnipeg 131.0 72
There are many definitions of urban sprawl, but
most suggest that sprawl is a development Ottawa-Gatineau 197.8 71
pattern characterized by the following features: Calgary 211.3 75
G Low-density development, with new growth Quebec City 218.4 74
appearing primarily on previously Vancouver 735.6 69
undeveloped or agricultural land
Montreal 853.6 65
Toronto 866.1 66
G Outward development at the city edge, in
contrast to a process of densification within
the city’s existing boundaries.
Impact of urban sprawl on health
G Emphasis on separation of major land uses
Sprawl is associated with at least four major
(residential, commercial, industrial) and on
categories of population health risks,3 including
single-use development (in contrast to mixed-
physical inactivity, reduced air quality, increased
use development).
motor vehicle collisions because of widespread
G Disconnected residential development where automobile travel, and mental health issues. These
new subdivisions are not contiguous with each risks can contribute to a range of negative health
other or with the rest of the city (sometimes outcomes, from chronic and debilitating
referred to as “leapfrog” development). conditions to fatal and non-fatal injuries.

April 2009 / For more information contact:

Impacts of sprawl on the health of the population
Elements of sprawl k Population health risks k Health outcomes (examples)

G Heart disease
G Diabetes
Low density development Physical inactivity
k G
Colon cancer
k G Respiratory disorders
Separation of residential
and commercial areas
Reduced air quality
k G Heart disease
G Some cancer types

Development on greenfields
at edges of urban areas
Motor vehicle collisions
k G Fatal injury
G Non-fatal injury

k Social isolation
Transportation infrastructure
biased towards automobiles
Loss of natural areas
Commuting stress
k G Mental health impacts

Source: Prepared by Population Health, Population Health and Research, Capital Health, 2008.

Physical inactivity. The link between physical complex factors that contribute to mental health.12
activity and health is well-established.4,5 Key We do know that sprawl can contribute to feelings
elements of sprawl – including separation of of social isolation, stress and disconnection from
residential areas from other land uses, high levels the natural environment, which have been
of automobile use and long commuting times – associated with mental health conditions.12
can make it difficult for people living in areas
characterized by sprawl to get sufficient daily
physical activity. Addressing the negative health
Air quality. There is an abundance of evidence effects of urban sprawl
linking air pollution to increased rates of illness and The negative health effects of sprawl can be
premature death in populations.7,8,9 In Canadian reduced through effective planning and
cities, vehicle emissions such as nitrogen oxides, development decisions. This requires collaboration
carbon monoxide, volatile organic compounds, across sectors and between groups—such as
and fine particulates are an important factor in planning and health—that often work in isolation
local air quality. By creating neighborhoods far from each another. We need an adequate supply
from the city core that necessitate automobile of compact, sustainable urban neighbourhoods
travel, sprawl contributes to poorer air quality and that support active transportation, complemented
its related health impacts. by economic reforms so that land and housing
Motor vehicle collisions. People who live in prices better incorporate the full health,
sprawling neighbourhoods spend more time in environmental, public infrastructure, and
automobiles than do those who live in more transportation costs of urban sprawl.
compact neighbourhoods. This simple fact puts Planning and development processes to reduce
them at greater risk for injury and even death from sprawl’s negative health impacts can be guided by
automobile collisions.10 research, which has found that:
Mental health risks. Making a direct link between Neighbourhood features such as high street
sprawl and mental health is difficult because of the connectivity, relatively high population density and

April 2009 / For more information contact:

mixed (residential, commercial, retail) land use Traffic-related deaths, “smart growth” cities and
have been linked to increased physical activity.3 sprawling cities, United States, 2000
Compact cities with more extensive public transit I Smartest growth I Most sprawled
systems often have dramatically lower automobile Per 100,000 population
fatality rates than do more sprawling cities.11
New York City, NY 4.42
Reduced auto travel and increased active
Kings County, NY 4.46
transportation can reduce the vehicle exhaust that
contributes to asthma, other respiratory Bronx County, NY 4.20
conditions, and cardiovascular disease.13 Queens County, NY 4.58
There is already considerable demand for San Francisco County, CA 6.31
compact, mixed-use communities that support
Hudson County, NJ 5.91
active transportation. Many people who currently
live in automobile-dependent neighbourhoods Philadelphia County, PA 8.04

would prefer to live in Suffolk County, MA 4.49

communities Richmond County, NY 5.63
supportive of active
Baltimore City, MD 7.68 7.68
“Sprawl impacts transportation.14
negatively on well-being Stokes County, NC 15.66
With political
by eroding social capital, Miami County, KS 38.80
will, public
robbing people of all ages of the
support and Davie County, NC 25.84
opportunity to have a balanced
creative Island County, MN 12.78
healthy lifestyle, degrading the
planning, we
surrounding natural environment, Walton County, GA 19.77
and increasing the stress of
can make our
major urban Yadkin County, NC 38.52
commuting, which not
only impacts mental centres Goochland County, VA 35.58
health but also physical healthier, safer
Fulton County, OH 28.01
health.”13 and more active
places to live. Clinton County, MI 16.99

Geauga County, OH 20.9

Source: Ewing, Scheiber, and Zegeer, 2003

Find out more

G Johnson SA, Marko J. Designing healthy places: G Smart Growth Canada Network.
land use planning and public health. Edmonton,
Alberta: Population Health – Capital Health;
G Sightline Institute.
G Ontario College of Family Physicians Report on
G Canada Mortgage and Housing Corporation
Public Health and Urban Sprawl in Ontario.
(CMHC) Comparing Neighbourhoods for
Environmental Health Committee, Ontario
Sustainable Features.
College of Family Physicians; 2005.
G Victoria Transport Policy Institute.

April 2009 / For more information contact:

1. Altshuler A, Gomez-Ibanez JA. Regulation for revenue: the
political economy of land use exactions. Washington, DC:
Brookings Institution; 1993.
2. Turcotte M. Dependence on cars in urban neighbourhoods.
Ottawa, Ontario: Statistics Canada; 2008. Available from
3. Johnson SA, Marko J. Designing healthy places: land use
planning and public health. Edmonton, Alberta: Population
Health – Capital Health; 2007.
4. United States Department of Health and Human Services.
The Surgeon General’s call to action to prevent and
decrease overweight and obesity. Rockville, MD: United
States Department of Health and Human Services, Public
Health Service, Office of the Surgeon General; 2001.
5. Magnusson P, Torp-Pedersen CT, Backer V, Beyer N,
Andersen LB, Hansen I-LK et al. 2004. Physical activity
and chronic disease: epidemiology, biological mechanisms,
practical recommendations and future research. III: the
musculoskeletal system and the lungs. Ugeskrift for Laeger
6. City of Edmonton Planning and Development. Monthly
Economic Review. Edmonton: City of Edmonton; February
2006. Available from URL:
7. World Health Organization. Health aspects of air pollution:
results from the WHO project “Systematic review of health
aspects of air pollution in Europe. Denmark: WHO
Regional Office for Europe; 2004.
8. Toronto Public Health. Toronto air quality index: health
links analysis. Toronto, Ontario: Toronto Public Health;
9. McKeown D. Air pollution burden of illness from traffic in
Toronto: problems and solutions. Toronto, Ontario: Toronto
Public Health; 2007.
10. Sightline Institute. Cascadia Scorecard. Seattle,
Washington: Sightline Institute; 2006.
11. Ewing R, Schieber RA, Zegeer CV. Urban sprawl as a risk
factor in motor vehicle occupant and pedestrian fatalities.
American Journal of Public Health 2003; 93(9):1541-1545.
12. Sturm R, Cohen DA. Suburban sprawl and physical and
mental health. Public Health 2004;118(7):488-496.
13. Ontario College of Family Physicians. The health impacts
of urban sprawl: social and mental health. Toronto: Ontario
College of Family Physicians; 2005.
14. Frank L, Chapman J and Levine J. Transportation and Land
Use Preferences and Atlanta Residents’ Neighbourhood
Choices. Atlanta GA: Georgia Tech Research Institute;
March 2004.

April 2009 / For more information contact: