All right. So our guest interviewee this week is Dr. Kim Kinder, an Associate Professor of Urban and Regional Planning at the University of Michigan. I'm so glad to have a fellow geographer here in the room today, to hear more about your research on the social, cultural, and political aspects of urban landscapes and how that intersects with health and planning. Thank you so much for being here. Thanks for having me. Yeah. So to get us started, just give us a brief overview of the role of public health in neighborhood planning, and urban development. Yeah. So the role of Public Health and City Planning in city planning has changed significantly over a century. So public health and city planning are professions that grew up together if we think 100 years ago or the late 19th the early 20th century. There wasn't a sharp line between someone who would be involved in a city planning project and someone who would be involved in a public health project. It was really common for instance, for medical professionals to make prescriptions about what they thought healthy environment should be and for people who were involved in landscape architecture to read medical journals. So the two fields really started together and city planning has its roots in land use zoning. So separating industry, which in the 19th century was very heavily polluting, from the places where residents were living. So these were public health initiatives that were also city planning initiatives, that were used to create the city planning profession. Departments of Public Works, for instance, in order to build the water and sanitation systems. Then starting around the 1920s, 1930s the two fields really start to separate. At that point having essentially built a lot of infectious diseases out of existence, city planners started to pay less attention to those types of public health threats and more attention to building large-scale infrastructure for economic development, building parks and housing for real estate development, and went in that direction. Meanwhile, public health officials started to pay a little less attention to some of those environmental factors and started to pay more attention to educational initiatives, for instance, educating people on how to change their behavior to promote more health. For instance, that smoking was hazardous to your health for instance. Then they also focused on trying to increase people's access to healthcare facilities. For instance, the movement to try and get more neighborhood clinics in neighborhoods instead of far away in one large hospital. Right. So the two fields really separated at that point. Then it's only in the last decade or so that they've started to come back together again. In part, that's because of the growing awareness of not infectious disease but chronic disease. Chronic diseases where treatment options in your neighborhood health-based clinics have not really been very effective at reducing the rates of chronic disease, and where education alone also hasn't proven very effective at reducing the rates of infectious disease. Because all of the education in the world to say you should live somewhere where there's less air pollution, or you should eat a healthier diet, doesn't make a difference if you can't afford to live in an environment where there's less pollution or there aren't fresh fruits and vegetables for sale in your neighborhood. So public health officials have done a good job, I think, educating city planners about the environmental determinants of illness. City planners, our job is to shape the environments that people live and work and play in. So that's created an opportunity to bring those fields back together. Where instead of trying to retroactively address chronic health problems, f or instance through treatment which hasn't been effective, instead changing the environment that people are living to make it easier to live in a healthier environment or to get access to fruits and vegetables or physical activity opportunities or what have you. Yeah. That's really interesting how they grew apart and now they're starting to come back together you said about the last decade or so. You mentioned a few already, but just for students who might not be as familiar with this, can you give us some examples of some of these cross-disciplinary collaborations in this emerging healthy city planning? Yeah. So if public health folks are telling us that everyone needs to get a certain amount of physical activity every day, we have designed our cities in a way where we've designed physical activity out of our environments. It used to be that people walked everywhere and now we have neighborhoods that don't have sidewalks, where it's expected that you're going to drive from the garage attached to your house, to the garage attached to your office, to the elevator that takes you to your floor. So the normal physical activity that would have been embedded in an everyday routine has largely been designed out. So now we can try and encourage people to be more physically active. That's great, but there's a number of barriers. One barrier is if you decide you're going to be physically active, there's all the movement around, everyone has to get that 10,000 steps a day. But if you don't have a sidewalk where are you going to get those steps? Or if you have a mixed use environment, people are much more likely to walk because there's actually somewhere interesting to walk to. You're not just walking for walking sake. The same thing, if you do have a sidewalk and it's well maintained, it doesn't have cracks everywhere, you have street trees, you have shade when you're out walking in the summer and the sun hits you to warm you up in the winter, they're in those types of environments where walking is a pleasurable experience and it serves some other goal along the way. I am walking for fun with my dog because it's a pleasant environment, or I'm walking to the corner grocery store because I need something there, then people are much more likely to be physically active. Also, if we want people to be more physically active, right now compared to driving at least in the United States, walking and cycling is much more dangerous. So the statistics are per mile travel, that you're something like 12 or 13 times more likely to get hit if you're cycling, 23 times more likely to get injured during transportation if you're the pedestrian. So walking and cycling is a very dangerous thing to do. So we might say, go out, go walk, get your physical activity, but now people are showing up in the hospital because they've gotten hit by a car. Whereas if we develop protected bike lanes so that people can cycle safely, or if we develop different types of intersections that give pedestrians more protections when crossing, then you can both get that physical activity without incurring that new public health cost of those injuries. Yeah. So that's an example of where public health and city planners could come together. Just using physical activity as one example. Yeah, I know with my work with older adults, they talked a lot about, "I can't cross the street in time because the timer is so fast." They won't walk because they're afraid of getting hit by a car when they're struggling to cross the street, especially if there's ice or snow on the ground, or slippery puddles even. They've talked a lot about, "I need just something as simple as longer time crosswalks, will enabled me to walk." Which I had never thought about before. I know that they've also talked a lot about being more vulnerable to noticing every sidewalk crack, every bit of snow plowing, they get stuck at a corner when they're trying to cross. It's just so difficult sometimes to get out when their environment is not supportive to walking and being active. Yeah. Another example, thinking about US cities for instance compared to European cities, in European cities, I'm thinking for instance, in the Netherlands or in Germany, there's much stronger land use control in order to prevent cities from sprawling out. In the US, we don't have that. We allow sprawl, in fact, sprawl is the norm rather than the exception. Then the way that intersects with urban real estate markets is that we in the US tend to have large sections of the city experiencing significant disinvestment so that we can channel all of our investment to the area of the city that is growing, which creates these very inequitable landscapes. Then when you overlay on top of that histories of racial segregation, redlining, and we think about the way segregation concentrates poverty in place, that creates environments where some neighborhoods are very resource poor in terms of ability to raise money to pay for investments in the built environment, for instance. It's a group population that has very high social needs. Conversely, if you go out into the suburbs, you can have very low tax rates that raise very high amounts of resources for community that has very low need for those resources. So that mismatch between where needs are and where resources are is another place where city planners could get involved in public health. We could design policies that don't allow such systematic disinvestment. We could have policies that don't allow segregation on that extreme and through the environment, which is what we see in a lot of European cities. If we simply don't allow for that level of disinvestment in sprawl and instead we require, for instance, region-wide resource sharing, then there's a lot city planners can contribute not just to health of groups with resources, but to health equity in general. Yeah. So there's greater access to this healthy environments across a whole area and not just hotpots of concentrated affluence and supported development and then those zones of deprived areas that don't have that access. Exactly. Another example, for instance, would be city planners backing fair share laws. If you say that instead of having all of the low-income housing in one part of the city, it has to be spread throughout the city. Instead of having one area dump zoned industrial, where a lot of low-income residents live and putting all of the noxious land uses there and creating environments where maybe you have 60 times the normal air pollution levels in one neighborhood, that is a result of city planning decisions to site all of those noxious land uses in one site rather than spreading it out and having everyone to share a little bit but no one bearing all of the brunt of what's needed to make a city work. Yeah.
