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About Healthy Places

Health and Healthy Places

According to the World Health Organization, health is a state of complete physical, mental, and social well-being and not merely the absence of infirmity. A healthy community as described by the U.S. Department of Health and Human Services Healthy People 2010 report is one that continuously creates and improves both its physical and social environments, helping people to support one another in aspects of daily life and to develop to their fullest potential. Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders — where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.

CDC’s Built Environment and Health Initiative (also known as the Healthy Community Design Initiative) works to improve public health by:
  • Linking public health surveillance with community design
  • Improving community design decisions through tools such
    as Health Impact Assessment;
  • Educating decision makers on the health impact of community design;
  • Building partnerships with community design decision makers and
    their influencers;
  • Conducting research to identify the links between health and
    community design; and
  • Translating research into best practices.

Healthy community design can improve people’s health by:

Healthy Environments

Broadly defined, the environment includes all that is external to an individual — the air we breathe, the water we drink and use, the land and built structures that surround us — all of the natural as well as human-formed conditions that influence the quality of our lives. Our interactions with the environment are complex and not always healthy.

A healthy community environment encompasses aspects of human health, disease, and injury that are determined or influenced by factors in the overall environment. Examining the interaction between health and the environment requires studying not only how health is affected by the direct pathological impacts of various chemical, physical, and biologic agents, but also by factors in the broad physical and social environments, which include housing, urban development, land use, transportation, industry, and agriculture.

Since 1900, life expectancy in the United States has increased by approximately 40 years. Only seven of those years can be attributed to improvements in disease care while the rest are the result of improved prevention efforts (such as immunizations) and improved environmental conditions, including sanitation and water. The link between the nation’s health and the environment is unmistakable.

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Poorly Planned Growth

Poorly planned growth that fails to consider regional implications is often referred to as “sprawl.” Sprawl is a complex pattern of land use, transportation, and social and economic development. Traits associated with the concept of sprawl include–

  • The disappearance of farmland, fields, and natural woodland as cities expand outward and consume once-rural or natural areas
  • Large tracts of land converted into low-density housing, commercial settlements, or paved parking lots
  • Widespread strip commercial development along major transportation corridors
  • Low-density residential and commercial developments
  • Sporadic (or “leapfrog”) developments with large spaces of vacant land between them
  • No centralized planning of land uses
  • Zoning laws that segregate land uses into isolated categories, separating housing from schools, businesses, and recreational areas
  • Dominance of the automobile as the primary means of transportation
  • Extensive road construction to accommodate the automobile — development that either ignores or eliminates the social integrity of neighborhoods
  • Increased traffic congestion, poor air quality, contaminated water and land, and scarce affordable housing
  • Less safety for pedestrians, bicyclists, and automobile occupants

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Healthy Community Design

In April 2002, the American Planning Association (APA) adopted a definition of smart growth, with one of the six critical elements being to promote public health and healthy communities. APA defines smart growth as using comprehensive planning to guide, design, develop, revitalize and build communities for all that:

  • Have a unique sense of community and place;
  • Preserve and enhance valuable natural and cultural resources;
  • Equitably distribute the costs and benefits of development;
  • Expand the range of transportation, employment, and housing choices in a fiscally responsible manner;
  • Value long-range, region-wide sustainability rather than short- term, incremental, or geographically isolated actions; and
  • Promote public health and healthy communities.

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CDC Promotes Healthy Community Design

CDC is committed to forming new partnerships and seeking solutions to community-wide public health problems. Every person has a stake in environmental public health. As the environment deteriorates, so does the physical and mental health of the people within it.

In a commentary appearing in the Journal of the American Medical Association (Vol 284, Oct 4, 2000), Jeffrey Koplan, MD, MPH, then director of CDC, stated that in spite of earlier progress,

“The environment will be increasingly challenged by toxic exposures, population growth, continued urbanization, and urban design that hinder healthy behaviors, such as physical activity.”

The former director of CDC’s National Center for Environmental Health, Richard Jackson, MD, MPH in the preface to the monograph Creating a Healthy Environment (2001), stated:

“We must be alert to the health benefits, including less stress, lower blood pressure, and overall improved physical and mental health, that can result when people live and work in accessible, safe, well-designed, thoughtful structures and landscapes.”

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Healthy Places Envisioned

Since World War II, the American landscape has changed. The growth of suburbia was fueled in the 1950s and 1960s by a growing trend in automobile ownership and government-subsidized road-building projects. Soon residential areas were well separated from commerce and industry. Education and recreation had distinct locations within a community. Shopping moved from the center of town to suburban shopping centers and malls. Rarely could residents get from one place to another without first getting into an automobile. And before long, pedestrian walkways, tree-lined streets, and older neighborhoods were often demolished to make way for wider roads and interstate highways.

Today, typical suburban homes sit in cul-de-sac subdivisions that empty onto high-volume roads. Zoning laws encourage the separation of residential areas from schools and shopping malls by long and often dangerous travel distances. Elementary school bicycle racks stand empty as parents fear for their children’s safety on narrow or traffic-laden roads. Pedestrians take risks as they cross dangerous intersections in communities where safe crosswalks are all but nonexistent.

But just as there are characteristics of the environment known to create unsafe conditions or foster disease, certain aspects of the environment may promote health and well-being. For example, designing walking trails and safe bicycle paths throughout our communities can promote increased physical activity. People can educate themselves about these aspects of the environment that can lead to healthier communities and healthier people. CDC has created this web site to help people do just that.

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American Planning Association Policy Guide on Smart Growth, April 2002. Available from URL:

Andersen G, Borton J, Curran C, Dietrich A, Donlin J, Farquhar D, et al. The built environment: is there a connection between sprawl and health? State Health Notes 2002 May 6:3-5.

Jackson RJ. What Olmsted knew. Western City 2001;March. Available from URL:

Koplan J, Fleming D. Current and future public health challenges. JAMA 2000;284:1696-8. Available from URL: [PDF – 262 KB]

U.S. Department of Health and Human Services. Healthy People 2010. Part 7: Educational and community based programs. Washington, DC: U.S. Government Printing Office 2000 Nov. Available from URL:

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948. Available from URL:

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