The UCLA professor and host of the PBS series Designing Healthy Communities describes what it truly means to build a healthy community.
Dr. Richard Jackson, UCLA School of Public Health
Tavis: Each month this year we are pleased to bring you a conversation about health and healthcare issues as a part of our “Road to Health” series. Tonight we kick off this series with Dr. Richard Jackson.
He is the former director of the CDC’s National Center for Environmental Health. He now serves as the chair of the environmental health sciences department at UCLA. He is also the host of the PBS series called “Designing Healthy Communities.” So here now, a preview of “Designing Healthy Communities.”
Tavis: Dr. Jackson, good to have you on the program, sir.
Dr. Richard Jackson: Nice to meet you, Tavis.
Tavis: Let me start by asking a pretty simple question. When you say “designing healthy communities,” how does one go about designing a healthy community?
Jackson: We have essentially built because we’ve tried to meet economic needs. We build because an investor puts something somewhere. But for too long we really haven’t thought about what we build, does it make people healthy?
For a long time I was the director of the National Center for Environmental Health, and I worried about minute things – molecules and toxic substances. I worried about big things – climate change.
About 10 years ago I came to the conclusion that what really impacts people’s health is where they live, the home they’re in, the people they’re with, the community they’re in. For too long we’ve been worrying about things far away or very minute, and it was time to think about designing and building places that worked for people.
Tavis: I suspect – and I’m not naïve here – I suspect that there are certain places in this country that are better to live vis-à-vis health than other places.
Jackson: If you tell me where you live we can tell you how long you’re going to live. In Alameda County, which is Oakland, California, it’s a 15-year lifespan difference between the people in the poor parts of town and the people in the more favored parts of town.
Tavis: Fifteen years.
Jackson: Fifteen years, and we see this over and over again. Being poor, being in environments that have – in pollution, but being in environments that don’t have healthy places where you can buy food, that don’t have green spaces, that don’t have safe places to walk, that’s a risk for your wellbeing and for your lifespan.
Tavis: What is to be done about that? It takes resources to live in those places, I suspect, in Alameda County where you can get an extra 15 years on your life, and the persons who are living in the places where they are denied 15 years would go across the bridge, so to speak, if they could, if they had the resources.
Jackson: To do this series we visited about a dozen cities around the United States, and we visited one that was the healthiest city in the healthiest state, and that was Boulder, Colorado.
It has bicycle trails; it has a more favored population, in terms of economy and education. People live a long time. A lot of these people can go about their lives without actually getting in a car week in, week out, month in, month out. We visited places that were really challenged.
The huge city of Detroit has about a third the population it had 20 years ago. Until very recently, the city of Detroit did not have a single supermarket. So thinking about how a city that’s been devastated by partly the population, the wealthier population moving out, and partly by a whole series of other economic issues, including the economy largely moving overseas, in many ways, how do cities come back?
What’s interesting is in the repopulation of Detroit, one of the big things that happened was the farmer’s market, and it’s gotten bigger and bigger, the Eastern Market, that people can get healthier food.
They’re now putting bike ways into that, and they’re building community gardens around it. Those community gardens are owned by the community. It’s real work, people are generating income and they’re building community, and that’s how we’re going to have to turn it around.
Tavis: Why is Boulder such an exemplary example, and can that be scaled up?
Jackson: Boulder is in some ways lucky. It’s got a university there with a fairly stable income, and not everyone can be Boulder. But on the other hand, it has creeks and streams running through it that have bike trails or walking trails along it. The bike trails are put in place, and then going the other way, and then it brought people in town.
One of the cities that we visited was Elgin, Illinois. Elgin was your classic Rust Belt town. They used to make Elgin watches, and 30 years ago the Elgin Watch Company went out of business; downtown became essentially a superfund site. Everyone moved out and lived five, six miles from each other and shopped in big box stores.
They decided, “We need to rebuild a real downtown. We need to build a downtown around the library, with the bicycle routes around it.” They reclaimed the Fox River, with walking trails and parks along it.
Then they had to do something very important – they had to bring in people of diverse incomes downtown. This was not about so-called “gentrification,” you bring in people that are well-off and put only those people there. You have to have a real mix in that population to create a real community.
So what I tell my students in class is if you want to rebuild a community you have to have the hardware and the software. The hardware is you have to have the hardscape – the roads, the bike ways, the safe buildings, insulated, preferably energy efficient and sustainable.
But you have to have the software – you have to have community ownership, because a community often has a lot of wisdom about what works best there.
Tavis: This is my word, not yours, Dr. Jackson, but how do you – where we live is a very, very personal choice. People want to be empowered to have – they want to have the agency, if I can use that word, to decide where they want to live, and I get that. I wouldn’t want to be told where to live.
So how do you – again, my word, not yours – coerce people, how do you force people to live together in downtown Elgin or anyplace like it, and what are the benefits, what are the values of people of diverse backgrounds and diverse incomes living together? So one, how do you make it happen, and what’s the value of doing it anyway?
Jackson: I thought a lot about the word “organic.” When we think about organic plants or foods, they grow best if they’re adapted to the soil, the climate, the weather, the water patterns, the sun patterns and the rest, and what works in one place is not going to work in another.
So really, the community has to decide what they want in that place. When we say people decide where they live, that’s not really true. For a lot of us, we live where we live because that’s where we were born and that’s where our friends are.
For a lot of us, we live where we live because we would love to live closer to Manhattan or closer to Berkeley, California, but we can’t afford anything there and we end up driving 40, 50, 60 miles, and the real estate people say drive until you qualify. So it’s the economics that’s really determining where people live, it’s not that.
The other big driver is schools. People pick where they’re going to live, is it safe, can I afford it, and how good are the schools? Those are the biggest drivers. I would argue that actually we’ve removed people’s agency, their ability to have that choice, because your degrees – I might think oh, I want to have a yard, I want to have a lawn, I want to have this neighborhood, but if I move out to the central valley of California and all I’ve got are houses and there’s no walking trails, there’s no infrastructure, the library, the doctor’s offices, the community services, pretty soon it gets really lonely.
Think about a child growing up in a home where they need to ask for a ride every single time they want to go about their life’s work.
Tavis: So what’s the advantage, then – the second part of that question – the advantage of people in a place like Elgin living together where there is diversity in income, diversity in ethnicity, et cetera, et cetera? What’s the value of that?
Jackson: Probably tangibles and intangible values. One is the towns and cities that do best are the ones that attractive bright and creative people, and we see this over and over again. They just take off. People want to live there. So if you create a place that bright young people want to come to, the services there get better.
You begin to develop the tax base; you begin to develop the restaurants, the services. Poor people often don’t get the police services, the trash services, other kinds of services, so that diversity brings in the services and brings in the resources and the policing.
People say, “Oh, I don’t want to live in a crowded place,” and then they go on vacation to a place like Paris or other cities that are very, very dense, and they go, “Oh, I ate and ate and ate and I didn’t gain any weight.” Why? “Well, I walked all the time, it was so interesting being there.”
So I would argue that you have to have diversity in income, and this sounds cynical, but poor people need rich people, because that’s how the services come in, and rich people need poor people because somebody’s got to do the work.
There are cities; they talk about the Aspen syndrome – Aspen, Colorado. There’s this huge traffic jam coming in for all the people that do the work, and I’m not talking just day laborers, I’m talking nurses and teachers and police officers have to come into that town to provide the services, and go out.
What’s the advantage? Imagine what it’s like to grow up in a place like that, where the only people you see are very favored, very wealthy, trust fund, very secure folks. You don’t get any experience of the broader world.
Tavis: The flip side of an experiment in a place like Elgin, Illinois, where you have, again, this mixed living, is this – I’m hesitating because I want to refer to it as an old school notion, and yet it’s not that old.
I was about to ask about these sort of restrictive covenants back in the day, where neighborhoods wouldn’t let certain people live, and that they didn’t want people to live in their neighborhoods and they had these covenants to keep you out. I think of the wonderful play, “A Raisin in the Sun,” Lorraine Hansberry’s wonderful work that has an element of this restrictive covenant in the play itself.
Does that still happen? Because I recall just a couple of years ago the Obama administration, Eric Holder going after a particular community in the Northeast where they were still engaged in this practice of keeping people out of their neighborhoods.
So to what extent, if at all, is that part of the problem in the country today in certain areas?
Jackson: I think one would have to have one’s head in the sand if we didn’t think that racism didn’t play a large part in the depopulation of downtown Detroit, if it didn’t have influences in other parts of the country.
It took brave people to break down those barriers. It took smart attorneys and lawsuits to change it. It took the enforcement of the Civil Rights Act, and things aren’t perfect by a long shot.
There are still parts where it would be – parts of Los Angeles, for example, would be extremely difficult for people of certain racial and ethnic backgrounds to get in, unless they had a lot of money.
When I was state health officer for California, I lived in a development that was about one-quarter so-called “affordable housing.” I didn’t know which of my neighbors were section 8 housing people, and I was the state health officer for the whole state. We got along perfectly well.
I think actually one of the most foolish things we can do as a country is to isolate people of – put all the poor people in one place, warehouse them. It doesn’t work. We ended up tearing down entire housing developments because it doesn’t work for people. You don’t want children growing up in that kind of environment.
Tavis: Help me understand, then, with all of the urban sprawl that we have experienced in this country, why it is that what sounds to me like common sense – my grandmother might say it sounds too much like right, it just makes too much sense – but how is it with all this urban sprawl that we’ve seen in these top cities that these kinds of considerations have not been on the table?
Jackson: I’ve probably given a talk a week around the country for the last 10 years around this issue of built environment and health, and inevitably someone comes up to me and says, “This sounds like common sense. People ought to live in energy-efficient homes, they ought to be near transit, they ought to be able to meet their life needs.
“Every child ought to be able to walk or bicycle safely to school, and you ought to have parks nearby. Why, that’s common sense.” That’s true, that is common sense. Why aren’t we doing it? I think there are a lot of structural reasons.
We need to change the codes that decide what’s going to go where. Right now, we codify – make law – residential will be over here, light business will be here, heavy business will be here.
Well, in fact, there’s no reason that accountants’ offices and light retail can’t be mixed in with a community. That’s what we did 80 years ago in the United States; it worked very well. Now by separating it all it means you have to be in a car to do every single thing.
So we’ve got to change the laws and the codes. We’ve got to change the fundamental tax structure. We have a tax structure that makes it very difficult for people to do this, so there are small things and there are big things that have to happen, but I would argue, and this is really why we went forward with this television series, is maybe at the bottom we’ve got to change our mind-set and we’ve got to begin to realize, I would be very happy to be in a place where I didn’t have to sit white-knuckled, hanging on to a steering wheel 60 miles a day, and could spend that time with my children or with my church or with my friends.
Many people in Los Angeles, for example, the most stressful part of the day is their commute to work. It’s not their jobs. So we become so married to our cars we’ve forgotten what makes us happy in our lives.
Tavis: If what you’re saying makes such sense, and it does make such sense, and with all due respect, you can’t be the only person or even the first person saying this, what, then, are the barriers, or what do they say are the barriers, to elected officials changing these laws, changing the codes, doing the kinds of things that need to be done to help design healthier communities?
What do they suggest is the reason why they can’t or haven’t done this?
Jackson: A big obstacle in a state like California, for example, and I realize it’s bigger than that, is a lot of the tax revenue comes from big box stores, big car dealer lots, because the sales tax goes to the locality.
So changing tax policy is a big one. There’s a debate going on in northern New Jersey about a light rail that’s going to run along the Hudson River above the Palisades, and people in one of the towns don’t want it there. The people further along want it there.
Folks that already have it say we love it, but it’s a change, it’s new. Unfamiliar-looking people coming in there. We don’t want the change. So that’s the sad news. The good news is I look at our young people, it gives me real hope. What I’m talking about in this series is our young people are very worried about the world that we are handing them. They’re very worried about getting jobs, they’re worried about resources, they’re worried about climate change.
They don’t like the way things are going, and what gave me great hope towards the end is I looked at Detroit and it’s being repopulated with the most bright and young creative people. They’re mixing in with the African American folks that have been there, ran the barber shops and the other things, the restaurants, and people are getting along very well.
So I’m finding young people can accommodate to this new world far better than folks – the aging baby boomers, and maybe that’s the hope, because the shelf life of human beings is rather short, and this’ll take a generation to fix.
Tavis: I like the example you’ve offered of Detroit, and I’ve been hearing and reading about what’s happening, particularly in downtown Detroit, with this repopulation of all kinds of people, not just African Americans.
How do you, in those instances, though, guard against negative gentrification? That is to say, how do you guard against people feeling like that they are, in fact, being pushed out, and now that you can buy a home in Detroit for like five dollars, (laughs) that people are, again, being cast aside. How do you guard against that?
Jackson: At a practical level in Detroit, they’re going to have to take a fair number of the residual homes and cluster them together into a real community. You can’t have a community if you’ve got something that looks like a Scrabble board at the end, with little homes and isolated blocks here and there, number one.
Number two, what – and this is very interesting – in San Francisco there was an area that had about 200 very poor families living in substandard housing. A developer came in and said, “Oh, I’m going to build a thousand-unit, high-end housing for people,” and the city of San Francisco said, “Okay, we’d like that revenue from all those high-end folks, but you’re going to put 240 affordable homes in there, and you’re going to put the people that are in there already in decent housing while they wait to move in.
It was a battle going back and forth, but at the end that’s exactly what happened. So people’s rights, when these changes occur, have to be respected, and we’ve got to take care of them. They were the people in that community all along, before suddenly it became popular again.
Tavis: Who’s on the front line of this fight? Are these local officials, are these state officials, or this is something that the federal government needs to get engaged in?
Jackson: One of the reasons we did this series was the average citizen needs to begin to understand this. I would say that my physician friends, my son is an internist, and, “I’m sitting there, Dad, and if we see 20, 30 patients a day, between five and 10 have diabetes, they’re very overweight, they’re very out of shape. I write a prescription – and they’re depressed.
“I write a prescription for something for their cholesterol and something for their diabetes and I tell them to go out and exercise and eat sensibly. They live in neighborhoods where all you’ve got is a mom and pop store that sells beer and junk food, and they can’t eat fruits and vegetables. They live in a neighborhood where they can’t go for a walk and meet their life needs.”
So more and more of my physician friends feel like sitting at the end of the disease pipeline, trying to patch up the casualties of a lifestyle that’s really doing serious harm.
As we look at our young people, people born after 1980, they are three to four times more likely to be obese than the previous generations. Average adults gained 25 pounds on average from 30 years ago. Average 14-year-old, 14 pounds.
One percent of all the money in the United States went to diabetes 10 years ago. It’s now 2 percent of the entire GDP is going to diabetes. When I was a young pediatrician I never saw a child with type II diabetes – this is adult onset. It’s now more than the children we see with so-called “juvenile.”
We’re seeing kids 10, 15, 20 years old with diseases of 50, 60, 70-year-olds because of this obesity and lack of fitness. So the physicians are looking at this and they’re very worried. The generals of the U.S. military are very worried, because two out of every seven recruits now cannot get in because of obesity and lack of fitness.
Part of it is we’ve engineered healthy food out of people’s lives, and we’ve engineered physical activity, be it exercise, out of people’s lives.
Tavis: Let me close our conversation and move toward the close by asking this question, which is how you get traction on this issue with the right people. Obviously you have this wonderful series now on PBS. You’ve got space in “The New York Times,” you’ve got airtime on PBS, you’re talking to the right people about these kinds of issues, and yet I’m trying to juxtapose that against that old acronym, NIMBY, not in my backyard, or not in my front yard, for that matter.
So with the persons who really matter, with the persons who are in these safer spaces and where the good schools are and et cetera, et cetera, to your earlier point, they have to understand that these dots are connected, and what happens over there does and ultimately will impact them.
But how do you get traction on this issue, with all due respect to PBS and “The New York Times?”
Jackson: Well, in the 1890s we realized that you can’t be healthy if everyone around you is sick – tuberculosis and other things. In the year 2012, you can’t be healthy if everyone around you is unhealthy, and you can’t have an economy that’s spending 20 percent of all its money on medical care.
I think – there was an old line about the business of America is business. We’ve got to get the corporate interests to become very committed to this. I’m not just talking so-called “greenwashing,” where some corporate entity does some nice ads.
I’m talking about the folks that are funding the next set of houses, the next communities that are being built. They need to be built with quality density. Nobody wants to live in a cracker box that is not safe and is poorly heated and poorly insulated and the sound goes right through it.
We need to build quality neighborhoods. It’s a good business proposition. When I first started talking about this, the housing people said to me, “You’re ruining the America,” like, “You should be fired because you’re saying sprawl is bad.”
I said, “Look, I’m actually saying something that you ought to like, which is if you put 20 houses, well-developed, on an acre, you’re going to make more money than if you put one or two.”
Tavis: Let’s hope that message gets through. The work is called designing healthy communities. It is, thankfully, a PBS series by that name, “Designing Healthy Communities.” You’ll see on the screen there, there is also a companion text by the same name, “Designing Healthy Communities.”
His name is Dr. Richard J. Jackson, and I’m honored to have you on this program. Thank you for the work that you are doing, and all the best to you.
Jackson: Thank you, Tavis.
Tavis: Dr. Jackson, good to see you. That’s our show for tonight.
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