Chensheng Alex Lu came to Emorys Rollins School
of Public Health from the University of Washington
in Seattle last summer, he and his wife, Lii Chu,
began searching for the best schools for their two
young sons. The excellent public schools were the
primary reason for their decision to settle in Alpharetta,
a suburb some twenty miles north of Atlanta.
is about the same distance from Emory as the Lu
familys former home, a suburb north of Seattle,
was from the University of Washington campus. But
he soon discovered that a comparable commute takes
him about three times as long.
Seattle, Lu left his house at about eight in the
morning and drove a short distance to a bus park-and-ride
lot, where he left his car for free. He then boarded
a comfortable bus and read a newspaper or work-related
articles for the next thirty-five minutes, until
the bus deposited him on campus. He was always in
his office before nine.
(left), who is conducting research on exposure to
toxic chemicals, quickly learned that this civilized
schedule wouldnt work in Atlanta. He would
like to take public transportation to Emory, but
he would have to drive about fourteen miles on Georgia
400, one of the metro areas most heavily traveled
arteries, to the northernmost MARTA stop in Sandy
Springs and board the southbound train; take it
to Lindbergh Station in town; then switch to a bus
that would bring him to the Emory campusnot
a practical option. So he tried various driving
routes and departure times until he learned that
to reach his office in under an hour, he had to
leave home by 6:45 a.m. to beat the heaviest traffic.
think my record is an hour and forty minutes,
he says of his morning drive. Its not
just the time I mind, its the stress, because
driving is very dangerous here. Its a nightmare.
I was warned about the traffic issue here, but I
was really surprised to see that the congestion
is so bad.
Riederer, who also joined the Rollins faculty last
summer as senior research associate, didnt
own a car when she moved to Atlanta. As a native
of Washington, D.C., and then a graduate student
in Boston, Riederer relied on urban public transport,
as well as her bicycle and her feet.
have kind of a rule of thumb that I will never live
more than four miles from work if I can help it,
she says. That way I can always walk if I
Boston, Riederer found that her bike was the most
efficient way to get around. She rode four miles
each day from Cambridge to Harvards medical
campus. It was a beautiful ride down the Charles
River, through city park land, she says. I
was getting exercise while enjoying the river and
she came to Emory, Riederer (left), who is studying
the effects of childrens exposure to pesticides,
tried to duplicate the experience by renting a carriage
house 3.4 miles from campus in Atlantas stately
Inman Park neighborhood. She does plan to ride her
bike to Emory every day, although without the security
of the dedicated bicycle lanes that Boston offered.
When the weather is poor, she says she will likely
take the MARTA bus, despite the fact that the convoluted
bus ride (which frequently runs late) takes longer
than it does to walk.
the most dramatic change for Riederer: she bought
a cara hybrid Honda Civic.
warned me, you have to get a car, she says.
And its true. You just cant get
around without it. I could probably have survived
six months or so, but it would have been very frustrating.
infamous dependence on gas-guzzling cars is one
symptom of a serious sickness widely known as urban
sprawl. Both Lu and Riederer, University newcomers
who are already experiencing the ill effects of
the citys ugly traffic and lack of practical
public transportation, are keenly aware of these
problems, thanks in part to the stark contrast between
Atlanta and their previous urban homes.
and Riederer also happen to work in offices just
a few doors down from one of the nations foremost
authorities on urban sprawl: Howard Frumkin (right),
chair of environmental and occupational health at
Rollins School of Public Health. Frumkin recently
published Urban Sprawl and Public Health: Designing,
Planning and Building for Healthy Communities with
two colleagues, Lawrence Frank and Richard Jackson.
Frank, a former faculty member at Georgia Tech,
is the Bombardier Chair in Sustainable Transportation
Systems in the School of Community and Regional
Planning at the University of British Columbia;
Jackson, previously director of the CDCs National
Center for Environmental Health, is the state public
health officer for California.
is urban development gone wild, spreading like kudzu
from the edges of the city proper out into the surrounding
landscape. Its generally defined as areas
where homes and buildings are spread out and large
parcels of land are used for only one purposeentirely
commercial or entirely residential, as opposed to
the mixed-use development of urban areas. Connectivity,
or the ability to get from place to place easily,
is low, turning even a short distance into a long
sprawl has worried environmentalists for some time
because of its relentless encroachment on the countrys
natural resources and green space, Frumkin and his
colleagues are approaching it from a relatively
new angle: its impact on public health. According
to Frumkin and many others, this kind of development
spawns myriad health issues, from respiratory illness
to obesity to car accidents. And while sprawl affects
some groups more than others, its everybodys
is not a problem of special categories of people,
Frumkin says. If it is true that certain types
of development actually undermine our sense of community,
every one of us is affected.
is frequently consulted by urban planners, developers,
and civic leaders about the impact of sprawl-type
growth. He works with a number of Atlanta-area organizations
that are addressing issues related to sprawl, including
the Institute for Georgia Environmental Leadership
and the Clean Air Campaign.
has a longstanding connection with the Georgia Clean
Air Campaign, formed in 1996 to educate the public
about metro Atlantas air quality problem and
encourage solutions to traffic congestion and air
pollution. In 2000, former Emory President William
M. Chace won the Clean Air Campaigns Pacesetter
Award for helping develop specific initiatives at
Emory to improve air quality, including the launching
of a fleet of alternative-fueled shuttles; encouraging
more than 1,200 employees to participate in a MARTA
subsidy program; and getting more than 400 employees
involved in carpools or vanpools.
number of other Emory experts are studying problems
related to sprawl. Rollins faculty members Paige
Tolbert and P. Barry Ryan have studied the effects
of air pollution on a variety of health problems;
Karen Mumford is looking at the benefits of public
park use and physical activity. Charles Raison of
the psychiatry department has studied modernitys
effect on mental health and happiness, including
factors such as increased traffic and suburban living
helped found a collaboration among the CDC, Georgia
Tech, and Emory: the Healthy Places Research Group.
He hopes the group will help create the next
generation of thinkers about urban design
we hope to have joint training in urban planning,
architecture, and public health, Frumkin says.
It really needs to be a collaborative process
with groups working together and making health considerations
part of the planning process.
a scholar of urban sprawl, Frumkin is perfectly
situated: Emorys hometown is what he has called
one of the nations great laboratories
of sprawl. In a recent study by Smart Growth
America, a Washington, D.C.-based advocacy group,
Atlanta ranked number four on the list of metro
areas with the greatest sprawl, after San Bernardino,
California; Greensboro-Winston Salem-High Point,
North Carolina; and Raleigh-Durham, North Carolina.
(New York ranked number one for lowest sprawl.)
metro Atlanta keeps expanding, spreading over and
beyond its ten counties like a triple-decker ice
cream cone that has been dropped onto hot pavement
and lies melting in the Georgia sun. With more than
4.1 million residents, metro Atlanta is one of the
fastest-growing areas in the country, according
to the Georgia Humanities Councils New Georgia
Encyclopedia, adding more than 40,000 residents
annually. According to another study by the Brookings
Institute, the vast majority of the citys
explosive population growth is occurring in its
is perhaps the most consistent, recognizeable characteristic
of sprawl is also one of the most troublesome: the
car reigns supreme. Atlantans are well-known for
their car codependency, and particularly their unhealthy
attachment to big, air-polluting SUVs. The metro
area is stitched together by more than sixteen thousand
miles of road, the second-highest number of miles
per capita of any city in the nation, according
to the New Georgia Encyclopedia, and millions of
drivers keep the asphalt hot twenty-four hours a
day, seven days a week.
Lu says he was running errands recently on a stretch
of strip malls in Alpharetta with his older son
when suddenly his son burst out, Dad, Ive
seen six Hummers on this road! He was so impressed
at spotting half-a-dozen of the colossal, $55,000
SUVs (reputed to get gas mileage in the neighborhood
of nine miles per gallon) that when he got home,
he called a friend back in Seattle to tell him.
emissions release noxious gases, including ozone,
into the air, which may explain why the American
Lung Association ranks Atlanta sixth among metropolitan
areas in ozone pollution. While ozone serves as
a protective blanket high in the earths stratosphere,
its more like a suffocating fog near the ground.
High ozone levels make it harder to breathe, worsening
rates of asthma, emphysema, and bronchitis, especially
among children and the elderly. A recent study by
the Centers for Disease Control and Prevention reported
a 37 percent increase in emergency room visits for
respiratory problems after ozone alerts were issued;
Tolbert and her colleagues continue to study the
effects of air pollution on respiratory health.
poor air quality isnt the only by-product
of heavy traffic. Automobile-related injuries and
fatalities are 50 percent higher in sprawling areas,
according to Smart Growth America.
relates mostly to the fact that if you spend more
time in a dangerous situationa moving caryour
risk for injury or fatality is higher, Frumkin
drivers arent the only ones at risk. Sprawl
tends to produce commercial areas made up of strip
malls and vast parking lots bordered by wide, clogged
roads, built with no thought to sidewalks and pedestrian
in Atlanta, I feel like Im always in danger
as a pedestrian, says Riederer, who walks
places as often as she can. Sometimes youll
be walking on the sidewalk and it just stops, so
you have to walk on the street.
2000, metro Atlanta was named the second-most dangerous
area for pedestrians in the nation by the Surface
Transportation Policy Project, with fifty to seventy
pedestrian fatalities a year. In 2002, however,
the city dropped to number twelve in the rankings,
thanks to increased focus on sidewalks and crosswalk
safety. The majority of pedestrian victims are Hispanics
and African Americans who live in communities where
not everyone can afford to own a car.
we build our roads for cars, that doesnt protect
walkers and bikers, Frumkin says. So
you see more injuries and fatalities there too.
In a car-dependent society, people who cant
afford cars become disenfranchised.
problem, Frumkin says, is that suburban development
tends to attract high-income families, while inner-city
neighborhoods become run-down and undesirable. In
a complementary trend, city communities may be revitalized
or gentrified, also becoming too expensive
for poorer residents. As socio-economic groups become
more sharply delineated and geographically spread
out, it becomes harder for wage-earners to live
near where they work.
we spread the region out, each enclave becomes pretty
homogeneous in terms of income, Frumkin says.
When neighborhoods become unaffordable, people
get pushed out and may have difficulty finding a
place to live. They end up driving long distances
to work, and guess what? They are driving the oldest,
most air-polluting cars.
number of legal structures conspire to encourage
sprawl. Zoning laws, first created to separate residential
and industrial areas, now promote sprawl by segregating
land use; bank regulations and practices also divide
mortgage from business lending.
to Urban Sprawl and Public Health, Suburban
communities have misused zoning to exclude low-income
and minority families, most effectively by limiting
multifamily and other affordable forms of housing,
creating one of the principal legal devices for
segregation by income, race, and ethnicity.
cities like New York and Boston where its
a high-cost headache to park and store vehicles,
its common for even white-collar workers not
to own a car. On any given block, there might be
an apartment building, a grocery store, restaurants,
a dry cleaner, and a coffee shop. No one has to
walk for miles to take care of basic needs. When
greater distances must be covered, the subway and
bus systems offer relatively efficient transportation
to everywhere in the city, with convenient stops
every few blocks.
high connectivity and sound infrastructure that
are a hallmark of well-planned cities result in
a more active lifestyle for residents. Rather than
getting in a car every time they need to go somewhere,
urban dwellers frequently walk or bike, as Anne
Riederer did in Boston.
dont like to drive, she says. Its
a very two-dimensional view of the world.
contrast, in the suburbs of sprawling cities, most
residents walk out their doors, get into their cars,
and drive just about everywhere they need to go,
as Alex Lu finds himself doing these days. Destinations
are simply too spread out to travel there any other
lack of physical activity and sedentary lifestyle
common in our suburbs lead to a number of health
probems, including obesity, heart disease, cancer,
gall bladder disease, and high blood pressure,
Frumkin says. It may also contribute to depression.
Physical activity is very good at helping to control
there is substantial evidence that urban sprawl
affects physical health, most notably by fouling
the air and water and limiting residents physical
activity, the connection between sprawl and mental
health is less obvious. But Frumkin believes the
tie is a strong one that should be investigated
common hypothesis suggests that spending long hours
alone in a car, sitting in traffic or trying to
drive safely on a fast, busy highway, may fuel feelings
of anger, hostility, and problems with impulse control.
this issue of road rage, Frumkin says. Nobody
has ever heard of sidewalk rage. It doesnt
exist. Walking is a situation where youre
making contact with others and often exchanging
a friendly nod, in contrast with shaking your fist
out of a car window.
rage has erupted with increasing frequency in high-traffic
areas across the country, sometimes with tragic
results. In 2000, a driver on I-75 south of Atlanta
got into a dispute with another motorist and became
so incensed that he jumped out of the car and ran
toward the other, who shot and killed him, according
to Urban Sprawl and Public Health.
is a disaster psychologically. . . . Theres
data that commuting time is related to anger, hostility,
and unhappiness, says Raison, who studies
mental health and happiness.
metro Atlanta and sprawling cities like it could
be conceived as being constructed of a childs
small, plastic toy houses, Lego buildings, and Matchbox
cars, one solution would be to gather it all up
into a box, give it a good shaking to mix it up,
and put it down again, grouping and stacking all
the elements neatly in about one-third of its original
this kind of community is called smart growth. The
idea is to use less land for more purposes, more
like European cities where buildings cluster thickly
together right up to the edge, then green countryside
begins. Rather than sweeping suburban lawns where
only one family can relax or play, the biggest stretches
of grass are public space available to everyone.
design strategy would focus on higher-density, compact
development, Frumkin says. At the same
time its preserving green space and park land
so people have access to those amenities. Its
a whole different strategy of developing land. Mixed-income
neighborhoods with plenty of affordable housing
are a very important part of this story.
immediate advantage would be that people could live
closer to where they work and shop, which would
mean less driving. Sidewalks and walkable business
and commercial districts are critical to smart growth,
as found in the secondary downtowns
that are beginning to form in suburban areas.
hopeful trend on the horizon is whats called
the new urbanismthe attempt to build developments
that more resemble small towns with distances between
houses and local retail areas accessible by foot,
neighbor Decatur, a small town on the outskirts
of the city, offers a picturesque square with shops
and restaurants, churches, a public library, even
public buildings such as the courthouseall
within walking distance of residential neighborhoods.
People are eager to move to places where they
can walk around, Frumkin says.
lives in the Druid Hills neighborhood close to Emory
so that he can ride his bike to work every day.
He owns a gas-electric hybrid car that emits less
pollution for the trips he does have to make by
car. The unhealthy effects of sprawl can be diminished
by active citizens, he saystaking one step
at a time.
to take as many trips as you can on foot or bike,
Frumkin advises. If you dont have the
facilities, push for bike paths and good sidewalks.
Patronize stores near where you liveit creates
strong neighborhood economies and undoes some of
the worst effects of sprawl. Work hard to create
and take care of good parks. If you have a park
nearby, you have less need of a huge backyard. And
try to live near where you work. It really is pleasant
to do that.