When Chensheng Alex Lu came to Emory’s 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.

Alpharetta is about the same distance from Emory as the Lu family’s 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.

In 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.

Lu (left), who is conducting research on exposure to toxic chemicals, quickly learned that this civilized schedule wouldn’t 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 area’s 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 campus–not 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.

“I think my record is an hour and forty minutes,” he says of his morning drive. “It’s not just the time I mind, it’s the stress, because driving is very dangerous here. It’s a nightmare. I was warned about the traffic issue here, but I was really surprised to see that the congestion is so bad.”

Anne Riederer, who also joined the Rollins faculty last summer as senior research associate, didn’t 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.

“I 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 have to.”

In Boston, Riederer found that her bike was the most efficient way to get around. She rode four miles each day from Cambridge to Harvard’s 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 the trees.”

When she came to Emory, Riederer (left), who is studying the effects of children’s exposure to pesticides, tried to duplicate the experience by renting a carriage house 3.4 miles from campus in Atlanta’s 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.

But the most dramatic change for Riederer: she bought a car–a hybrid Honda Civic.

“Everybody warned me, you have to get a car,” she says. “And it’s true. You just can’t get around without it. I could probably have survived six months or so, but it would have been very frustrating.”

Atlanta’s 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 city’s 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.

Lu and Riederer also happen to work in offices just a few doors down from one of the nation’s 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 CDC’s National Center for Environmental Health, is the state public health officer for California.

Sprawl is urban development gone wild, spreading like kudzu from the edges of the city proper out into the surrounding landscape. It’s generally defined as areas where homes and buildings are spread out and large parcels of land are used for only one purpose–entirely 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 drive.

While sprawl has worried environmentalists for some time because of its relentless encroachment on the country’s 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, it’s everybody’s problem.

“This 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.”

Frumkin 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.

Emory has a longstanding connection with the Georgia Clean Air Campaign, formed in 1996 to educate the public about metro Atlanta’s air quality problem and encourage solutions to traffic congestion and air pollution. In 2000, former Emory President William M. Chace won the Clean Air Campaign’s 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.

A 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 modernity’s effect on mental health and happiness, including factors such as increased traffic and suburban living conditions.

Frumkin 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 and planning.

“Eventually 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.”

As a scholar of urban sprawl, Frumkin is perfectly situated: Emory’s hometown is what he has called “one of the nation’s 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.)

And 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 Council’s New Georgia Encyclopedia, adding more than 40,000 residents annually. According to another study by the Brookings Institute, the vast majority of the city’s explosive population growth is occurring in its suburbs.

What 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.

Alex 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, I’ve 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.

Car 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 earth’s stratosphere, it’s 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.

But poor air quality isn’t the only by-product of heavy traffic. Automobile-related injuries and fatalities are 50 percent higher in sprawling areas, according to Smart Growth America.

“This relates mostly to the fact that if you spend more time in a dangerous situation–a moving car–your risk for injury or fatality is higher,” Frumkin says.

And drivers aren’t 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 safety.

“Here in Atlanta, I feel like I’m always in danger as a pedestrian,” says Riederer, who walks places as often as she can. “Sometimes you’ll be walking on the sidewalk and it just stops, so you have to walk on the street.”

In 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.

“If we build our roads for cars, that doesn’t protect walkers and bikers,” Frumkin says. “So you see more injuries and fatalities there too. In a car-dependent society, people who can’t afford cars become disenfranchised.”

Another 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.

“As 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.”

A 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.

According 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.”

In cities like New York and Boston where it’s a high-cost headache to park and store vehicles, it’s 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.

The 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.

“I don’t like to drive,” she says. “It’s a very two-dimensional view of the world.”

By 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 way.

“The 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 depression.”

While 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 more thoroughly.

One 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.

“There’s this issue of road rage,” Frumkin says. “Nobody has ever heard of sidewalk rage. It doesn’t exist. Walking is a situation where you’re making contact with others and often exchanging a friendly nod, in contrast with shaking your fist out of a car window.”

Road 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.

“Sprawl is a disaster psychologically. . . . There’s data that commuting time is related to anger, hostility, and unhappiness,” says Raison, who studies mental health and happiness.

If metro Atlanta and sprawling cities like it could be conceived as being constructed of a child’s 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 space.

Life-size, 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.

“The design strategy would focus on higher-density, compact development,” Frumkin says. “At the same time it’s preserving green space and park land so people have access to those amenities. It’s a whole different strategy of developing land. Mixed-income neighborhoods with plenty of affordable housing are a very important part of this story.”

One 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.

“One hopeful trend on the horizon is what’s called the new urbanism–the attempt to build developments that more resemble small towns with distances between houses and local retail areas accessible by foot,” says Raison.

Atlanta’s 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 courthouse–all within walking distance of residential neighborhoods. “People are eager to move to places where they can walk around,” Frumkin says.

Frumkin 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 says–taking one step at a time.

“Try to take as many trips as you can on foot or bike,” Frumkin advises. “If you don’t have the facilities, push for bike paths and good sidewalks. Patronize stores near where you live–it 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.”



© 2005 Emory University