Lawrence Frank, Peter Engelke, Thomas Schmid,

2003. Health and Community Design: The Impact

of the Built Environment on Physical Activity.

Island Press, ISBN: 1559639172, 253 pp.

The introductory chapter opens with a quotation

from Aristotle about health being the first factor to

consider when planning for the ideal city. It then

summarises the problems people face in enjoying

good health in the automobile-dependent suburbs

typical of North America and many other parts of

the world. The second chapter—Public Health and

Urban Form in America—traces the path which

produced the current situation in these suburbs.

Chapters 3–5 analyse physical activities by their

implications for health, by types and patterns, and

by their different impact on children, the elderly and

the poor. Chapters 6–9 examine the built environment,

transportation systems, land-use patterns and urban

design characteristics. Chapter 10 applies these

principles of urban design to case studies in Seattle

and Atlanta, while the last chapter draws some general

conclusions.

The authors are not explicit about their target

audience but the book appears to be written for an

interdisciplinary mix of planners, engineers and health

practitioners, both professional and academic.

In the authors’ words, dThis book is about how our

communities influence one important type of behav-

ior, physical activity, and the health outcomes that are

associated with itT (p. 1). To which they add, dourphysical environment inhibits many forms of activity,

such as walking, and has become a significant barrier

to more active lifestyles.T In this part of the book, dourcommunitiesT means dAmerican communitiesT. Laterthey explain, dChapter 2 provides background for

understanding how the built environments in which

Americans live and work have come to existT, andthey observe dthe reader will note that two cities,

Atlanta and Seattle, receive the greatest amount of

attentionT (p. 9).At this point, this reviewer was thinking that the

book should have been subtitled dCase studies of

Atlanta and SeattleT to make the context clear.

However, Chapters 4, 5 and 7 contain extensive

comparisons with data from European cities that

provide some very interesting contrasts. This con-

fusion about the implied context of statements persists

throughout the book. It would have been easier to

follow if it had been presented as a book about urban

design and health in America, with the European

material placed in a comparative chapter. There is no

mention at all of the vastly different problems of cities

in the poorer countries of the world, where an

increasingly large majority of the world’s urban

dwellers live. This narrow focus on the health

implications of the layout of American suburbs could

have been better captured in the title.

Overall, this is a very stimulating and thoughtful

work which highlights a problem of which citizens in

the richer countries of the world are becoming

gradually more aware. We have known for a long

time that dlong-term patterns of behaviors—in partic-

ular, tobacco use, poor nutrition, and lack of physical

activity—play significant roles in the onset of four

main chronic diseases (cardiovascular disease, cancer,

diabetes, and chronic obstructive pulmonary disease)

and, thus, in premature mortalityT (p. 43). The authorspresent data which show that ddiet and activity

patternsT were responsible for 14% of total deaths in

the United States (1990), second only to tobacco

(19%) and ahead of alcohol (5%) and motor vehicles

(1%). They are careful to point out that physical

inactivity alone is not responsible for these outcomes.

Rather it is the association of physical inactivity with

sedentary lifestyle and improper diet that should be

blamed.

These general relationships have been known for

some time. The value of this book is that the authors

explain how this situation was abetted by the

proliferation of low-density suburbs in twentieth-

century America. They explore the deep irony in the

situation. People—encouraged by planners—escaped

from the high density, unhealthy nineteenth-century

manufacturing town for the cleanliness of ex urbia in

the countryside, high-jacking Ebenezer Howard’s

dgarden cityT and transforming it into a garden suburb.

Howard would have been appalled—but then he did

not anticipate the transforming power of the automo-

bile as a means of mass transportation.

The authors examine the typical (American)

decentralised suburb, built around winding cul-de-

sacs, designed to prevent incursions by through-

traffic. These suburbs also discourage journeys by

foot and bicycle because journeys become much

longer than they would be in a grid-based system of

Book reviews258

streets, or the organic patterns of pre-industrial

European streetscapes. The suburbs and the city are

linked by multi-lane expressways, which are likewise

hostile to walkers and cyclists. We are confronted

with the chilling observation that the poor are

threatened by far worse fates than obesity: da study

of pedestrian fatality rates in four metropolitan

Atlanta counties. . .found that the rates for African

American and Hispanics were two and six times

greater, respectively, than rates for whitesT (p. 96).

We cannot escape the conclusion that settlements

designed for people with automobiles are designed

against those without them.

The European comparisons show that this evolu-

tion of suburbs, automobiles, obesity and pedestrian

slaughter was not inevitable. Data on the modal split

for 14 OECD countries show that only Canada and

Norway come close to the United States. Italy has the

smallest percentage of trips by car, and the highest for

public transport, cycling, and walking. The authors

analyse the implications of age for the future of

human health in rich countries. They point out,

ominously, that children are as car-dependant as their

parents. Childhood obesity is already a major public

health concern. It could be very different. In the

Netherlands, no less than 25% of trips for the 65–74

age group are by bicycle. Nor does that figure drop

much (24%) for the 75+ group. The comparable figure

for the United States is 0.2%.

The authors conclude that the North American

suburb is not only wasteful of environmental resour-

ces (land, air, water), it is also wasteful of human

lives. They suggest that urban plans should incorpo-

rate a dhealth impact statementT. Generally, they do

not see—perhaps realistically—a ready solution to

this problem. The book might have ended on a more

optimistic note if they had concluded with observa-

tions from those communities where successful

innovations have broken the link between life in the

suburbs and automobile dependence.

Although it would be difficult to see this book as a

text for a course, it would certainly be a useful and

stimulating reference for the range of courses which

deal with this interdisciplinary problem area, such as

environment and health, urban design, and trans-

portation planning.

Rodney R. White

Department of Geography, and Institute for

Environmental Studies, University of Toronto,

ONT, Canada M8V 2S4

E-mail address: rodney.white@utoronto.ca.

doi:10.1016/j.ecolecon.2004.07.014

Book reviews 259