Issue 30: Healthy Communities Part I - Michigan Society of Planning

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Issue 30: Healthy Communities Part I - Michigan Society of Planning

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Issue Number 30:

Healthy Communities - Part I

A Chapter of the American Planning Association

Two-part healthy

communities

examination

Welcome to the 30th installment of Smart Growth

Tactics. Each issue of Smart Growth Tactics

covers land use topics, tools, techniques, and

step-by-step instructions which can empower

local municipalities to create clear policy visions

to make real change happen.

To make communities sustainable and more

livable places, in 2003 the Michigan Land Use

Leadership Council (MLULC) created a “vision”

that embodied 23 statements about land use in

Michigan. Among these statements the MLULC

articuated that land use is about “creating

communities where community design promotes

healthy lifestyles.” Healthy communities enable

people to maintain a high quality of life and

productivity; have roads, schools, playgrounds

and other services to meet the needs of the

people in the community; and have a healthy and

safe environment.

This issue of Smart Growth Tactics is the first of

a two-part examination of healthy communities

written by Birchler Arroyo Associates, Inc. Vice

President Rod Arroyo. This first installment will

explore several factors related to planning for

healthy communities. The article is designed

to provide community leaders with a broad

perspective of trends relating to poor health

and obesity; possible causes for obesity and

inactivity; a definition of “healthy;” and the

connection between health and community

design. Issue 31 will provide more in-depth

information on the ways to design for healthy

communities including site specific design

concepts, policies, and techniques. Case

studies of several Michigan communities will be

highlighted. We hope that you find the two-part

examination valuable.

Planning for healthy communities

By Rodney L. Arroyo, AICP

The evidence is overwhelming - the

United States population

is getting fatter and

less healthy. Is poor

community planning

partially to blame?

The facts reveal many

unhealthy trends in

the eating and exercise

habits of our country’s

population. People are

eating more calories and

eating out more often;

children are walking

and biking to school less

and schools are being

built farther away from

children; the pricing and

marketing of soft drinks

has led to a massive

increase in consumption

that closely parallels the

increase in obesity in

the U.S.; and the per

capita consumption of

milk, which was almost

four times that of soft

drinks in 1947, is now

less than half that of soft

drinks. Almost twothirds

of Americans are

overweight, and obesity

rates in children and adults are way up

over the last 20 years.

The effects of the trend towards obesity

and inactivity are felt at every level of

society. Businesses see increased costs

and less productivity, governments and

institutions spend more on health care

Planners can play a significant role in the creation of healthy

communities. By simply performing a “walkable audit,”

a review of walking conditions along specified streets,

a community can identify assests and liabilities that can

provide a basis for future “healthy” community planning.

and must compensate for lost work days,

and individuals experience monetary,

social, physical, and emotional costs.

Experts are now saying that this may

be the first generation of children who

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Percent of Adults

40

35

30

25

20

15

10

5

0

Figure 1. Obesity in Adults and Per Capita Calories Consumed Per Day of

High Fructose Corn Syrup (HFCS), United States, 1970-2002

Obese, 20-74 years

HFCS Consumption

1961 1970 1973 1978 1979 1983 1990 1991 1994 2000 2001 2002

Sources: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Examination Survey and National

Health and Nutrition Examination Survey, and USDA Economic Research Service.

50

45

40

35

30

25

20

15

10

5

0

HFCS: Per Capita Calories Consumed Per Day

will not outlive their parents due to the

impacts of excessive weight.

Planners can play a significant role

in addressing this crisis. This article

will explore several factors related to

planning for healthy communities.

It begins with an overview of trends

related to health, followed by a

discussion of possible causes including

lack of exercise, excessive weight, and

poor overall health. Next, in order

to study and draw conclusions about

planning for healthy communities,

the term “healthy” must be defined.

The connection between health and

community design shows how planning

impacts community health. In the final

part of the article, ways to design for

healthy communities are explored,

including specific site design concepts,

policies, and techniques.

Gallons per Capita

HOW ARE THE TERMS “OBESITY” AND

“OVERWEIGHT” DEFINED?

Overweight is defined as someone with a

Body Mass Index (BMI) of over 25. Obese

applies to someone with a BMI over 30.

BMI is calculated as follows: 703.07 times

a person’s weight in pounds, divided by

the square of the person’s height in inches.

Unfortunately, this type of index does not

2

60

50

40

30

20

10

0

Figure 2: Per Capita Consumption of Beverage Milk and Carbonated Soft Drinks,

United States, 1947-2001

Carbonated Soft Drinks

Beverage Milk

1947 50 53 56 59 62 65 68 71 74 77 80 83 86 89 92 95 98 2001

Source: USDA Economic Research Service, Amber Waves, April 2004.

distinguish between pounds from fat and

those from muscle. Therefore, a body builder

with little excess fat and a significant amount

of muscle will likely have an overweight or

obese rating. But for most of the population,

BMI is the best indicator of excess weight in

relationship to height.

Health of the

nation and the

state – trends

and facts

Following is a list of some of the factors

that have signaled a cause for alarm by

many health professionals:

• Adult men and women are roughly

one inch taller than they were in

1960, but are nearly 25 pounds

heavier on average as well. 1

• Among 6-11 year old children,

average weight increased from

approximately 65 pounds in 1963-65

to almost 74 pounds in 1999-2002. 2

• Among 12-17 year old teens, the

average weight of boys increased

more than 15 pounds (to 141) and

the average weight of girls increased

approximately 12 pounds (to 130)

during the same time period. 3

• As illustrated in Figure 1, the

percentage of obese adults increased

from 13.3 percent (1960-1962)

to 31.1 percent (1999-2002). The

percent of children considered

overweight increased from 4.2

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percent (1963-65) to 15.8 percent

(1999-2002). 4

• An estimated 64.5 percent of

Americans are overweight. Excess

weight and physical inactivity are

reported to account for over 300,000

premature deaths each year, second

only to tobacco-related deaths among

preventable causes of death. 5

• People who live in the most

sprawling areas are likely to weigh six

pounds more than people in the most

compact United States counties. 6

• The number of students (5 to 18 years

old) walking or biking to school has

dropped from 42 percent in 1969

to 16 percent in 2001. In 1969, 52

percent of children lived less than two

miles from school versus 35 percent

in 2001. 7 In comparison, over 70

percent of adults surveyed said they

walked or rode a bike to school when

they were children. 8

• According to the United States

Department of Agriculture’s

Continuing Surveys of Food Intakes,

milk intake is down and soft drinks

intake is up among teenagers (See

Figure 2). In 1977-78, boys consumed

more than twice as much milk as soft

drinks, and girls consumed 50 percent

more milk than soft drinks. By 1994-

96, both boys and girls consumed

twice as much soft drinks as milk, and

20-29 year olds consumed three times

as much soft drinks. 9

• The average American consumes

over 43 pounds of high fructose corn

syrup (HFCS) and over 44 pounds of

refined sugar per year. 10 The average

American now consumes over 400

percent more HFCS than they did

in 1979 (See Figure 1). During the

1980s, HFCS became the number

one sweetener in soft drinks.

• While obesity rates are up worldwide,

comparing the United States to

Europe provides some significant

contrasts. Housing density is three

times higher in European cities than

United States cities. In Europe, 33

percent of daily trips are made by foot

or bicycle compared to 9.4 percent

in the United States. Bicycle trips

comprise 11 percent of daily trips in

Europe, compared with one percent

in the United States. Obesity rates

in the Netherlands, Denmark, and

Sweden are one-third of the United

States rate; Germany’s rate is one-half

the United States rate. 11

The costs to society from the obesity

epidemic are staggering. An estimated

27 percent of United States health care

costs are related to physical inactivity,

overweight levels, and obesity rates. 12

Michigan’s Surgeon General, Dr.

Kimberlydawn Wisdom, noted that an

unhealthy lifestyle, with obesity as one

result, accounts for 36 percent of health

care costs and a total of $8.6 billion each

year. 13 Research from the University

of Detroit Mercy finds that the state of

Michigan spends $400 million per year

on obesity and the federal government

spends $1.3 billion per year on obesity

in Michigan (Medicare, Medicaid);

employers lose $9 billion per year

on related sick days and replacement

worker training in Michigan.

Causes of obesity

It is generally recognized that obesity

is not caused by just one factor. There

have been many changes in our society

concurrent with the dramatic upward

trend in obesity rates. Following are

some of the major factors that are

generally recognized as contributing to

high obesity rates in the United States: 14

FOOD CHOICES & RELATED

CHANGES

This category includes many separate

food-related sub-factors including the

following:

Higher caloric intake. People are

eating over 300 more calories a day

than they did in the 1980s.

Portion size and pricing.

Restaurants are encouraging the

consumption of larger portions

through advertising and pricing.

Patrons can receive more food at

a lower cost per ounce when they

size up. Another example is soft

drink portions. In the 1950s, Coca-

Cola’s 6½ ounce bottle was the

typical serving (60 calories). During

the 1960s, the 12 ounce can was

popular (110 calories). Today, the

20 ounce bottle is taking hold of

the market (183 calories). For the

very thirsty, a 64 ounce Double Big

Gulp provides 586 calories.

More eating outside the home.

Spending in fast food restaurants has

grown 18 times in the past three

decades (from $6 billion annually

to $110 billion). The number of

fast food restaurants in the United

States grew from 30,000 in 1970 to

222,000 in 2001. Children ate out

at fast food and other restaurants

nearly three times as frequently in

1996 as they did in 1977. 15

High fructose corn syrup

(HFCS). First introduced in

the 1960s, HFCS is a sweetener

that is made from corn starch

that many consumers say tastes

sweeter than refined sugar. The

average American consumes over

43 pounds of HFCS and over 44

pounds of refined sugar per year.

When all types of caloric sweeteners

are combined, the average annual

consumption is over 100 pounds. 16

HFCS is less expensive to produce

than refined sugar and is now

found in everything from soft

drinks to baked goods. Some

researchers argue that the body

treats HFCS differently than refined

sugar or cane syrup, which leads

to more consumption of HFCS

beverages. There is evidence that

when sweeteners like HFCS are

in a liquid form, it leads to more

overconsumption than sweeteners

in solid food, and this may play a

role in obesity. 17

A compelling reason for the

additional consumption of HFCS is

pricing. When HFCS was added to

soft drinks in the 1980s, soft drink

consumption increased dramatically

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Elements of

a Healthy

Community

A. A clean, safe physical environment of

high quality

B. An ecosystem that is stable and

sustainable

C. A strong, mutually supportive, and nonexploitative

community

D. A high degree of participation and control

by the public over the decisions affecting

their lives, health, and well-being

E. Meeting the basic needs (food, water,

shelter, work, income, safety) for the

community’s entire population

F. Access to a wide variety of experiences

and resources, with the chance for a

wide variety of contact

G. A diverse, vital, and innovative local

economy

H. The encouragement of connectedness

with the past

I. An optimum level of public health and

sick care services

J. High health levels and low levels of

disease

Source: Hancock, T. and Duhl, L. (1986), “Healthy

Cities: Promting Health in the Urban Context.”

4

(40 percent increase from 1980

to 2000). During the time period

of increased consumption, the

inflation-adjusted price of soft

drinks declined by about one-third

according to the Bureau of Labor

Statistics. 18 For example, the price

of Coca-Cola sold in 1968 was

about $0.01 per ounce. 19 Adjusted

for inflation, this would equal about

$0.06 per ounce today. The 64

ounce Double Gulp from 7-Eleven

sells for $1.39 or $0.02 per ounce

(33 percent of the inflation-adjusted

price of Coca-Cola from 1968). If

a patron gets a refill for $0.99, the

cost per ounce drops to $0.015 per

ounce (25 percent of the inflationadjusted

price of Coca-Cola from

1968). 20 This type of pricing makes

soft drinks cheap and encourages

consumption of greater quantities.

Trans Fats. Trans fatty acids

(trans fats) are formed when

manufacturers turn

liquid oils into solid

Urban Sprawl

fats through a process

called hydrogenation.

This process increases

the shelf life of the fat

and it can be provided

to the food industry at a lower price

than traditional fats.

Research has shown that trans

fats contribute to clogged arteries

by raising the level of lowdensity

lipoprotein (LDL) or

“bad” cholesterol. Researchers

also suspect that trans fats increase

blood levels of other clogging

compounds, including triglycerides

and lipoprotein. Trans fats may also

increase the risk for developing

diabetes. 21

Manufacturers are starting to

voluntarily stop or reduce the use

of trans fats in some products.

Voluntary actions are also

impacting corporate culture. In

October 2006, new policies were

announced by the Walt Disney

Company that “call for Disney to

use its name and characters only

on kid-focused products that meet

specific guidelines, including limits

on calories, fat, saturated fat, and

sugar.” Disney also announced

“nutritionally-beneficial changes in

the meals served to children at all

Disney-operated restaurants in its

Parks and Resorts” and unveiled a

“company-wide plan to eliminate

added trans fats from food served

at its Parks by the end of 2007 and

from its licensed and promotional

products by the end of 2008.” 22

Sprawl. According to the American

Journal of Public Health, “the current

obesity epidemic has many causes,

but there is an association between

urban sprawl and obesity.” 23

Association is not equivalent

to causation, but it suggests the

following potential pathway:

Increased Automobile Use

Decreased Physical Activity Obesity

Increased Cardiovascular Disease Diabetes

and Other Health Problems

McCann and Ewing’s research on

sprawl, which compared compact

counties with sprawling ones,

had the following findings: every

50 point increase in the degree

of sprawl (county sprawl index)

corresponded to a weight gain of

over one pound. People in the

most sprawling areas are likely to

weigh six pounds more than people

in the most compact counties. Odds

of having hypertension (high blood

pressure) are six percent higher

for every 50 point increase in the

degree of sprawl. 24

Researchers for the University of

Detroit Mercy found that people

living in cities spending over $200

per capita on public transit are four

pounds lighter than people living in

cities spending $200 per capita or less.

They also found that the typical user

of the City of Detroit’s transit system

walks 0.8 miles per day, equivalent

to the 30 minutes of exercise per day

Leading

Health

Indicators

A. Physical Activity

B. Obesity/Weight

C. Tobacco Use

D. Substance Abuse

E. Responsible Sexual Behavior

F. Mental Health

G. Injury and Violence

H. Environmental Quality

I. Immunization

J. Access to Health Care

Source: Healthy People 2010, www. health.

gov/healthy people/LHI

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The desire to address health issues in urban areas emerged from the 1893

Columbian Exposition (World’s Fair) in Chicago.

that many experts recommend. They

opine that if everyone in Michigan

walked this distance every day, they

would lose five pounds each and

obesity would drop by 25 percent in

the state. 25 Based on this connection,

the following research hypothesis is

being explored: increased spending

on public transit would lead to

significant reductions in expenditures

for health care and lost time at work

(due to illness).

Social Changes. Social changes

contributing to the rise in obesity

rates include: 1) the electronic culture

- increase in popularity of video

games, internet use, and television

watching, 2) reduction in the amount

of physical education and recreation

time for children, and 3) longer

commutes and longer work hours.

What does

“healthy” mean?

The term “healthy” goes far beyond just

physical health or the absence of disease.

The concept of an individual’s wellness

has six key components: 26

1. Physical (health and development of

the body)

2. Intellectual (learning and creativity)

3. Emotional (awareness of feelings

toward self and others)

4. Spiritual (quest for meaning and

purpose)

5. Social (contributions to the human

community)

6. Vocational (growth at work)

Community planning can influence

all of these components in one way

or another. Communities, just like

people, can be healthy or unhealthy.

Physical health can be promoted

through many actions and facilities

including quality recreation facilities and

programs, walkable communities, and

bike paths. Intellectual health can be

promoted by social planning, including

working with the disadvantaged to

find access to good schools, healthy

food, safe and comfortable housing,

and safe neighborhoods. It can also be

achieved by economic development

programs to lure research programs

and higher education programs to a

community. Emotional health can be

promoted through community design

that encourages social interaction and

physical exercise and by planning for

mental health facilities and programs

to serve those in need. Spiritual health

can be fostered by working with the

religious community to identify sites

for new facilities and incorporating

quiet places for reflection in public

parks and plazas. Social health has a

strong linkage to the built environment.

Important components include a welldesigned

core gathering area (typically

in a downtown area) and other places

to interact, play, and recreate that

are welcoming, well-maintained,

and properly designed. People tend

to congregate and energize the civic

core of the community, providing

opportunities for social interaction.

Recreation programs and communitywide

playscape construction projects can

also foster social interaction. Vocational

growth can be provided through an

economic development program that

brings jobs to the community or works

to retain employers. Programs to assist

small businesses with building expansion

The European

Model

Europe is characterized by a much stronger

emphasis on compact development, walkable

communities, transit, and bicycle facilities.

This is reflected in statistics related to

walking, biking, and obesity. Transportation

systems in European cities encourage

walking. Housing density is three times higher

in European cities than United States cities,

which makes transit a more affordable and

practical option compared to the automobile.

The pricing structure, which penalizes use

of the automobile by high fuel pricing and

high taxes, also encourages other forms of

transportation. The following summarizes

some of the positive impacts of this type of

system:

• In Europe, 33 percent of daily trips are

made by foot or bicycle compared to 9.4

percent in the United States.

• Bicycle trips comprise 11 percent of daily

trips in Europe compared with 1 percent in

the United States.

• Obesity rates in the Netherlands, Denmark,

and Sweden are one-third of the United

States rate; Germany’s rate is one-half the

United States rate

• Denmark has effectively banned trans

fats and other countries are considering a

similar ban.

Source: McCann, Barbara and Ewing, Reid (2003),

Measuring the Health Effects of Sprawl.

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foot travel, bicycles, trains, and horses.

The widespread use of the automobile

provided an ability to travel farther and

faster without the need for walking.

The development of the Interstate

Highway System further improved

mobility, but reduced the need for foot

travel even more.

The interstate highway system, a network of freeways or expressways, has a total

of 46,837 miles. Serving all major United States cities, the highway system has

had a major influence on land use patterns.

Suburban dwellers drive twice as far,

walk and bicycle one-third less often,

consume twice as much energy, and

produce twice as much air pollution

as their urban counterparts where land

uses are mixed. 28 It becomes apparent

that the traditional suburban design

model is automobile-dominated and

often pedestrian-unfriendly. It is not

surprising that obesity rates are higher in

sprawling communities than they are in

more compact walkable ones.

plans and helping guide developers

through the plan review process can

lead to a spirit of cooperation that

encourages new growth.

Community health

and design – How

are they linked?

In the 19th century, overcrowding

of city centers, poor sanitation,

air pollution from factories, and

similar environmental factors caused

widespread infectious disease and poor

health for many Americans. 27 The desire

to move to the suburbs or to rural areas

was often born out of self preservation

– seeking out a healthier place to live

and work.

The City Beautiful Movement, which

emerged from the 1893 Columbian

Exposition (World’s Fair) in Chicago,

and the desire to address health issues

in urban areas, led city planners to alter

the physical environment. Incompatible

land uses were separated, improved

water and sewer treatment systems were

built, and health effects were realized.

The effort to separate land uses was

further bolstered by the landmark

United States Supreme Court case,

Village of Euclid v. Ambler Realty. It

granted localities the freedom to set

their own zoning regulations (including

separation of incompatible land uses) so

long as the ordinances served a “rational

relation to the health and safety of the

community.”

The separation of low-density uses

without pedestrian and other nonmotorized

connections discourages

healthy forms of transportation

and consumes open space without

consideration of historic settlement

patterns. Lower densities do not support

the use of public transit and rely on

increased use of the automobile.

Another key defining moment that

influenced community design was the

passage of the Federal Aid Highway

Act, which was signed into law on

June 29, 1956, by President Dwight D.

Eisenhower. This Act established the

Interstate Highway System and has had

a major influence on land use patterns.

Mobility is related to available modes

of travel. Prior to the popularity of the

automobile, urban dwellers relied on

Designing

and planning

for healthy

communities

The American Planning Association

(APA) recently identified a fivepoint

strategy for intervention and

collaboration between planning and

public health: 29

1. Visioning and goal setting

2. Plans and planning

3. Implementation tools

4. Site design and development

5. Public facility siting and capital

spending

There are many policies, ordinances,

design criteria, and other actions that

can be put in place to address the issue

of increased obesity, low exercise rates,

and the high cost of these factors to

society. After all, this issue appears to

clearly fall under government’s authority

to protect the public health, safety,

and welfare. The APA report notes

that planners can become involved in

public health by addressing issues such

as 1) non-point source pollution of

6

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surface water and groundwater, 2) air

quality planning, 3) crime and safety, 4)

pedestrian safety, 5) hazardous materials

planning, and 6) mental health.

The following techniques and concepts

to promote healthy communities may

be appropriate for the practicing planner

to pursue. In many cases these actions

will take place in conjunction with the

planning commission and/or legislative

body. The list is not exhaustive,

but it addresses key foundations and

techniques that can serve as a starting

point for action. Acting on one or two

will not yield the lasting results that are

possible with a more comprehensive

approach. Also, not all of these possible

actions are appropriate for every

community or every part of every

community. Each community and every

individual must make unique choices

that reflect individual character, goals,

and desired outcomes.

Barriers and solutions for

improving walkablity

BARRIER

Wide, unshaded streets with no

sidewalks

SOLUTION

Narrow, shaded streets with sidewalks

INCORPORATE COMMUNITY

HEALTH INTO LONG-RANGE

PLANNING AND POLICY

DEVELOPMENT

Planning provides the foundation for

community action. Promoting active

community design is no different

than any other planning issue that

communities face. If a community can

build strong support with its citizens and

businesses and create a long-range plan

built upon this support, the action items

have a greater chance of happening and

achieving the desired result.

To effectively plan, it is critical to

understand and document community

assets and liabilities. For example,

conducting a walkability audit may

identify assets and liabilities that can

provide a basis for future planning. It is

important to raise awareness and build

coalitions that can assist in the process

all the way from problem definition to

goal and policy formulation to planning

and action. A visioning and goal setting

process can help to build community

support for plans and action items.

Congested, unattractive arterial roads

with no landscaping or pedestrian

facilities

Blank walls, lack of street furniture,

no on-street parking, and narrow

sidewalk do not encourage strolling or

shopping

Arterial roads with landscape buffers,

wide sidewalks, and street level retail

and restaurants

Landscaping, on-street parking,

storefronts with windows, signage,

and streetscape promote strolling and

shopping

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Next Issue

Issue 31 will continue to identify

concepts that promote healthy

communities including: universal

design principles in planning; new

urbanism; retrofitting suburbs; ordinance

amendments; the development of

Safe Routes to School and school

siting; investment in transit oriented

development; street connectivity;

safety issues; business participation and

involvement; traffic and road funding

alternatives; access to fresh foods in

urban cities; and community health

issues. Additionally two “Promoting

Active Communities” will be

highlighted.

Rodney L. Arroyo, AICP, is vice president

of Birchler Arroyo Associates, Inc., a

community planning and traffic consulting

firm in southeast Michigan. Mr. Arroyo is

recognized as an expert in land use planning,

participating in the American Planning

Association’s Growing Smart focus group

and providing input to the Michigan Land

Use Leadership Council on ways to enhance

planning and zoning activities in the state.

Resources

1 Ogden, Cynthia L., Cheryl D. Fryar, Margaret D. Carroll, and

Katherine M. Flegal (2004). Mean Body Weight, Height, and Body

Mass Index, United States 1960-2002. Advance Data from Vital

and Health Statistics, No. 347, p. 2. Centers for Disease Control

and Prevention (CDC).

2 Ibid.

3 Ibid.

4 National Center for Health Statistics (2005), Health, U.S.

Department of Health and Human Services

5 Allison, D., K. Fountaine, and J. Manson (1999). Annual deaths

attributable to obesity in the United States. JAMA. 1999;282,1530-

1538.

6 McCann, Barbara and Reid Ewing (2003). Measuring the Health

Effects of Sprawl, Smart Growth America Surface Transportation

Policy Project, September 2003,13.

7 Centers for Disease Control and Prevention – CDC (2006). Kids

Walk-to-School: Then and Now — Barriers and Solutions. U.S.

Department of Health and Human Services.

8 Surface Transportation Policy Project (2003). American Attitudes

Toward Walking and Creating Better Walking Communities.

Surface Transportation Policy Project, April 2003.

9 Jacobson, Michael (2005). Liquid Candy, How Soft Drinks Are

Harming American’s Health. Washington, DC: Center for Science

in the Public Interest.

10 White, John S. (2005). High Fructose Corn Syrup and

Sucrose: Reassuring Similarities and Complementary Differences.

White Technical Research. www.hfcsfacts.com and USDA

Economic Research Service

11 McCann, Barbara and Reid Ewing (2003). Measuring the

Health Effects of Sprawl, 19.

12 Anderson, Louise et al (2005). Health care charges associated

with physical inactivity, overweight, and obesity. Preventing

Chronic Disease. 2005;2(4).

13 Warbach, John (2005). Bringing America back in sync with

its values: designing healthy livable communities conference.

Planning & Zoning News. 2005;23(3),6.

14 Putnam, J., J. Allshouse, and L. Kantor (2002). U.S. per capita

food supply trends. Food Review. Winter 2002, U.S.D.A.

15 Levi, J., C. Juliano, and L. Segal (2006). F as in Fat: How

Obesity Policies are Failing in America. Trust for America’s Health.

www.healthyamericans.org. 21.

16 White, John S. (2005). High Fructose Corn Syrup and

Sucrose: Reassuring Similarities and Complementary Differences.

17 Bray, George, S. Nielsen, and Barry Popkin (2004).

Consumption of High Fructose Corn Syrup in beverages may play

a role in the epidemic of obesity. American Journal of Clinical

Nutrition. 2004:79:537-43.

18 Warner, Melanie (2006). A sweetener with a bad rap. New

York Times. July 2, 2006.

19 www.foodtimeline.org

20 www.wikipedia.org

21 Groch, Judith (2006). Trans Fats Judged Major Villain

in Cardiovascular Disease. MedPage Today and Dariush

Mozaffarian, et al, “Trans Fatty Acids and Cardiovascular

Disease,” New England Journal of Medicine 2006; 354:1601-

1613.

22 Walt Disney Company Press Release – October 16, 2006.

23 Lopez, Russ (2004). Urban sprawl and risk for being

overweight or obese. American Journal of Public Health.

2004;94(3), 1574-79.

24 McCann, Barbara and Reid Ewing (2003). Measuring the

Health Effects of Sprawl, 13.

25 Hoback, Alan, Scott Anderson, Utpal Dutta, Pamela Nelson,

and Judith Mouch (2005). Link Between Transit Funding and

Obesity. Unpublished. University of Detroit Mercy.

26 American Journal of Health Promotion. 1989,3,3,5 (source for

wellness items 1 through 5)

27 Healthy Places, Healthy People (2000). Report of an Experts’

Meeting, November 27-28, 2000. Sponsored by the Robert Wood

Johnson Foundation.

28 Ibid.

29 Morris, Marla, ed. Integrating Planning and Public Health:

Tools and Strategies to Create Healthy Places. (2006). Planning

Advisory Service Report 339/540, American Planning Association.

SmartGrowthTactics

This publication was produced by the Michigan Association of Planning.

Photo and graphic credits: page 1, Dan Burden; page 5, www. wikipedia.org; page 6,

www.wikipedia.org; page 7, Dan Burden (top two photos) and Rodney L. Arroyo.

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