Earlier this month pediatrician Neal Kaufman, M.D., and TPR publisher David Abel, with the support of Majestic Realty, brought professionals from across the civic spectrum together to address the relationship between the built environment & public health. In two excerpts from this "Unhealthy by Design?" Conference, California Endowment CEO Dr. Robert Ross & L.A. Planning Director Gail Goldberg address how dense, well-designed cities can be more livable-and more healthy.
Director, L.A. City Planning
Planners by nature are sort of environmental determinists. We really believe that you are where you live. And that is a powerful concept with enormous responsibility. I have to tell you that because of that enormous responsibility, I felt really guilty when I saw the title, "Unhealthy by Design?" It made me think about what kinds of neighborhoods we have created in the past and what the unintended consequences were.
I think the unintended consequences have been dire, mostly because in the past we spent a lot of time planning for cars instead of for people. I was struck by something Peter said that we apparently still, when we can, are building sprawl. It's probably good news for some of us who are running out of room that we can't build sprawl.
Today, I'd like to talk about possibilities, because planning really is about creating possibilities. Plans can't make things happen, but they can make things possible. And they can also make things likely.
I came to Los Angeles three months ago because a very charismatic mayor spent an hour of his time one day talking to me about the possibilities in Los Angeles. He convinced me that this was an exciting opportunity in the history of our city and that many things were possible that have not been possible before.
When I came to Los Angeles I found by talking to the planning commissioners, councilmembers, that they too shared this excitement. Neighborhoods are ready to sit down and talk about how they can, and will, grow over the next 20 years. I think we are beginning to come to terms with the fact that no matter what we do, we are going to grow.
There is nothing we can do to shut down that growth unless we are willing to shut down the growth of jobs and to contain our economic growth. So far I've seen no appetite for that, so I think we have to conclude that growth is going to happen.
How can it happen in a way that will create a higher quality of life for the people who live here? From every discussion I've had in every community, communities are willing to talk about revitalization and growth, but they are not willing to have that discussion unless they believe that accommodating greater density will result in a better quality of life for the people who live in that neighborhood today. They have no interest in simply taking care of our growth problems, but they have a huge interest in making their neighborhoods better places to live.
One of the discussions that has to happen very early on is, what are the missions in those neighborhoods? It depends on the quality of the discussions that go on in neighborhoods.
We can create plans with support from the mayor, the City Council, and the planning commission. But their potential for implementation is very small unless the community really embraces it and believes that the plan captures their aspirations for their neighborhood. And that demands a level of dialogue that we in this city have never had before. It demands a certain trust that we have with the community to listen to their issues. It demands recognition that if smart growth is really so smart, the neighborhoods will see that too.
I have seen in my career communities who have been totally opposed to any kind of growth, over months of real dialog, transform themselves and agree to transform their neighborhoods. So I know it is possible. When you talk about the kinds of things Peter showed, and it's even more powerful to show people images of their own ideas. And a real discussion of urban design is seriously lacking in Los Angeles, as are discussions of public space and the pedestrian environment.
But if neighborhoods begin to hold discussions about urban design-about what their street might look like with wonderful street trees or places for people to sit, an environment where walkers are not only comfortable but where they want to be. You have to talk to neighborhoods about how to create the mix of uses that make an interesting and useful environment to walk around in.
Are there places where we can take care of many of our daily needs? Can we get to the dry cleaner? Can we find a doctor? Is there a school nearby? Is there a variety of housing types? Can our children get an apartment in that community if it's a wonderful place to live? Can our parents move to their single-family house to a smaller condominium in that place? Have we provided them with all the opportunities to stay?
And planning should say that these are important concepts and we need to make that possible in our neighborhoods. So the mix of the uses, the places that we can walk, the environment that we create, and the potential for us to get to places we need to go without getting in our cars. And we need to give people other opportunities for mobility: Can people find a transit station nearby? Can they get to work and back?
When we talk about our ability to accommodate growth and to create a livable environment, I think we can all see that that is not only possible but actually likely that we can accommodate the million or half-million people that will move to Los Angeles with good planning.
What we cannot do in Los Angeles and in most other American cities is to accommodate the millions of cars that those people will bring. At the current rate of car ownership, that's about 675,000 cars. At the current rate of parking we produce about for or five parking spaces for every car – one at home, one at work, and others around the city in the places where we go.
In order to accommodate those 675,000 cars we would need to provide 37 square miles of parking. That is simply impossible. So we need to recognize that we have to give that up. We have to think about an environment not with no cars but fewer cars. And fewer cars can make a remarkable difference in our future and our neighborhoods and in our cities in terms of quality of life.
We have to figure out what we're going to provide in the neighborhoods – I don't think it's a lot of parking lots, and I don't think it's parking at the current standards. But we do have to produce the amenities and the public infrastructure that will support growth. We have to be able to talk to communities about open space, parks, and recreational opportunities, and we have to be creative.
As I drive around Los Angeles, I don't see those wonderful green spaces and ample parks. You might ask, "where are we going to get them?" Many cities have come up with very creative ways.
Cities are capping freeways and putting in parks. Cities are building parking lots underground and covering them with parks. People are building roof gardens. And we have to be enormously creative about how we build open space. And it can be done if we think outside the box. When I look around at the opportunities we have with freeways-and that's one thing we have a lot of-the opportunity to build and knit this city back together by connecting things and build on top of freeways.
Los Angeles has the most creative people in the country, and I think we have the potential here to come up with new and better ideas. But again, I think we're talking about possibilities. It is possible for all of us in the public arena to partner with the communities to make wonderful plans.
And we have to have the implements to make it happen. We need the codes, the regulations, and the ordinances, but we need to make the right things happen. The better and the more consensus we have around planning, the more likely it will be that wonderful neighborhoods will happen.
I am committed. I believe strongly in the organizational structure of the city of Los Angeles and in the volunteer commissions, which are absolutely committed to wonderful neighborhoods where people can lead happier, healthier lives. I hope that next year we can come back to this conference and show some wonderful examples, because we need that desperately in this city.
Dr. Robert Ross
President and CEO
I want to give you a bit of the relevant public health history of this site where the California Endowment now sits in Downtown Los Angeles.
Someone who came to our grand opening told me that in 1923 there was significant outbreak of bubonic plague in Los Angeles, and the epicenter for that outbreak was nearby. This neighborhood was populated largely by poor Mexican-American families, and the reason for the outbreak of plague was because of rats-and poverty. The combination of those factors and the lack of a public health infrastructure led to a number of deaths, virtually all of them among the lower classes.
It was curtailed when the Chamber of Commerce and Los Angeles business leaders literally passed the hat to raise money to raze some homes and put others up on bricks. So that was the intersection of place, health, public health, and poverty that is the history behind this site. The owner of a downtown hotel summarily fired all of his Mexican-American employees because he didn't want "those people" spreading plague to his guests.
I was looking at the list of the attendees of this conference, and I want to acknowledge Neal Kafuman and David Abel. I encourage you to flip through this guest list, which includes urban planners, transportation professionals, public health, university officials and academics, architects, community development people, RAND, policymakers, developers, homebuilders, and community-based organizations. That is quite an unlikely gathering of professionals. At most conferences you see the same people over and over again. This kind of gathering is critically important to identifying where we are in public health.
People have referred to the "third revolution" in public health. In the first revolution, we addressed diseases, such as meningitis, polio, smallpox, etc. Then the second revolution was when, based on prevalence of vaccines and more modern healthcare and sanitation practices, we succeeded in reducing diseases.
So now what creeps up among the top-ten killers are chronic diseases – heart diseases, cancer, stroke, diabetes, etc. And these are very expensive to treat. Studies report that 1 percent of the population is consuming 22 percent of health care costs. The less healthy 50 percent of America are consuming 97 percent of health case costs. So the healthier portion is consuming only 3 percent of the $1.7 trillion that is spent annually on health care.
Those chronic diseases are influenced by how and whether you exercise, what you eat, whether you smoke or not, whether you have violence in your neighborhood, whether you have toxic fumes, or brownfields-those things are having an increasingly disproportionate burden on health and productivity of this country, and even more disproportionately on low-income communities. So we are shifting focus to chronic diseases.
The third revolution in public health is how to produce health. The shift will be from thinking about health as a transaction, between doctor and patient and patient and hospital, to thinking about health more holistically-from the standpoint of root causes. Seventy percent of what influences your health has nothing to do with the heath care you can buy.
You can have the best insurance and the best doctors in the world, but if you live in a poor-quality neighborhood, if you smoke or drink, if you're not getting exercise and not getting five servings of fresh fruits and vegetables, you are doing yourself no good.
How do you make that shift to a more holistic, community-based construct? It is a hard shift for us, but we need to have these kinds of cross-sectional conversations where we get together. We have not mastered how to do this at our foundation. We are interested in it. We are interested in preventing diabetes, obesity, and asthma and influencing the design of great neighborhoods.
The traffic and housing affordability issues provide an opportunity to rethink what we're doing. And I think in Los Angeles we're seeing the "Villaraigosa factor"-someone who brings a sense of dynamism, energy, and charisma that took Gail Goldberg from San Diego. That's the power of this mayor and others, including Eric Garcetti and Ed Reyes, who are thinking about a better Los Angeles. We have to take advantage of that political capital and apply it.