Cities

The U.S. Census Bureau estimates that approximately 80 percent of the country's population reside in urban and suburban settings. As the largest consumer of energy, American cities are responsible for a great portion of greenhouse gases and pollution through energy consumption to support industrial, commercial, residential, and transportation needs. On a human scale, they are places of social, environmental, and physical patterns and behaviors affecting population health.

As cities grow in size and population, more attention is being paid to infrastructure needs as well as to the environmental impacts of urbanization. Within cities, much of the conversation and action centers on the concept of sustainability. Urban planners are increasingly engaged in the conversation about population health. They are working with organizations and industry to create programs and interventions to reduce the negative effects of urbanization.

A concise definition of sustainability has not been developed, and a variety of principles have been adopted by cities and organizations. It is not a matter of disagreement about [Page 106]what needs to happen with the built and social environments; it is a matter of disagreement about what sustainability will ultimately create. For example, Chicago, which touts itself as America's greenest city (among others that do likewise), emphasizes economy in its discussion of sustainability. Seattle aims for environmental protection. Portland seeks to limit growth. Sonoma County recognizes the link between the economy, society, and the environment and the need to manage resources for current and future generations. This last sample may best summarize the concept of sustainability. Basically, the driving force is being responsible to the Earth's ecosystems and creating places where practices reduce the negative effects of consumption. These principles include designing streets for increased physical activity, development that reduces environmental impact, neighborhood economies to reduce travel, urban gardening, and influencing stewardship through the creation and purchase of renewable energy sources. Environmental efforts are inextricably linked to health, such as reducing pollution outputs, building green space, and creating economies and specialized workforces to remediate harmful environmental factors to reduce exposure to hazards.

It is impossible to measure the number of efforts under way for creating sustainable cities, and the long-term effects on population health are yet known. Cities are increasingly involved in public health initiatives, including banning smoking in public places, promoting farmers markets, and restricting fast food establishments near schools. Cities are instrumental in these efforts through community and economic development programs, revitalization efforts, urban development practices, and program design. Some efforts can potentially have multiple positive effects on population health. For example, creating safe parks and streets can reduce violence and injury, promote physical activity, mitigate urban heat, and combat carbon output of surrounding buildings.

The role of the city in green health is one that is emerging as initiatives are implemented and as programs expand. Many cities are making efforts to remediate what currently exists; other cities are passing regulations to proactively intervene with future development. For example, some cities have passed ordinances or created tax incentives for new building standards to incorporate green principles that aim to increase the efficiency of resource use. Remediation might include redevelopment of brownfields (cleaning up contaminated property), reuse of abandoned or historic buildings, and removal of lead from older housing stock. Other efforts might serve community and individual needs, such as partnering with neighborhood groups and schools to turn empty lots into community gardens.

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