Land use can influence health outcomes positively by
presenting opportunities for healthy behavior or negatively by
restricting access to healthy options. Key land-use
characteristics that affect health include:
Patterns of land use within a community.
The design and construction of spaces and buildings within a
The transportation systems that connect people to places.
The industrial era of the 19th and early 20th centuries
created cities that provided economic opportunity to millions of
foreign immigrants and migrants from rural and small-town
America. But with so many people moving into cities,
overcrowding, poor sanitation, substandard housing and high
poverty rates contributed to widespread outbreaks of infectious
diseases, such as cholera and tuberculosis. The new professions
of public health and urban planning developed in response to the
desire to improve living conditions in growing urban centers.
Planning and community design can affect a community’s
health in a variety of ways including influencing physical
activity, food and nutrition, air quality, traffic safety, and
access to parks and open space.
As decision-makers, local officials can play a critical
leadership role in efforts to improve community health, because
there are so many ways that local decisions can affect residents’
health and well-being.
A wide array of local officials — those elected to serve on the
city council or county board of supervisors, residents serving on
advisory boards and commissions as well as local agency
administrators and staff — have many opportunities to integrate
health considerations into local programs and policy decisions.
Some of the most important types of local decisions with health
implications are outlined below.
How local officials choose to plan and lay out communities —
through the general plan, zoning and other land-use regulations —
For example, if homes, stores, schools and other places people
need to go are near one another and connected by safe and
convenient walking and bicycling routes, people are more likely
to walk or bike than if these amenities are located farther from
one another. Studies show that when residents take advantage of
these opportunities to increase their everyday activity, it
reduces their risks of obesity, diabetes and other chronic health
less time in cars gives people more free time to spend with their
families and communities, which can improve emotional
Decisions on how buildings are designed, constructed and
renovated have implications for health.
Many communities have established architectural standards, green
building requirements and other local policies that affect the
health and safety of residents and tenants. For example,
incorporating “universal design” principles into residential
construction — such as simply requiring that at least one entry
to each new or renovated residence be accessible for people with
disabilities — can make a neighborhood safer for people of all
ages and abilities.
Decisions on the type and character of public facilities and
infrastructure affect the health and safety of residents.
For example, neighborhood streets that carry fast auto traffic
can be modified through traffic-calming measures to slow vehicle
speeds. “Complete streets” programs can provide safe routes for
vehicles, bicycles, pedestrians and people with disabilities (for
more about complete streets, see “An
Overview of Planning Concepts for Health and the Built
Environment.”) These programs can help seniors and those with
limited mobility cross busy streets and make it easier for
children to safely walk and bike to school. As a result, the rate
of injuries and deaths from traffic accidents typically
Decisions about the programs that are funded through the city or
county budget can affect health.
This applies to decisions beyond those typically thought of as
health related, such as funding for clinics, senior meals and
other traditional health and social services. For example,
responding to a local budget crunch by closing parks or limiting
the hours they are open can make it more difficult for residents
to be physically active, even in neighborhoods where quality
recreational facilities can be safely reached by biking or
walking. This in turn can lead to declines in levels of health
Loss of farmland, wildlife habitat and natural resources as
low-density development spreads into formerly undeveloped areas.
Air-quality and climate-change issues associated with vehicle
emissions and energy use in buildings.
Inefficient water use and water-intensive plant selections in
Investments in infrastructure and services that can’t keep
pace with growth and the need for maintenance and replacement.
Changes in the nature and location of work, along with a
declining economic base in older urban neighborhoods and aging
suburbs as jobs and businesses shift to newer areas or leave the
As the field of urban planning has evolved, issues that were once
peripheral to planning have become more central. For example,
concern about the environmental consequences of land use spurred
policies and procedures to ensure that decision-makers and the
public understand the environmental effects of decisions and that
officials take steps to minimize or avoid environmental damage.
Demographic trends have also spurred changes in the types of
housing and neighborhoods that people seek at each stage of their
lives. These trends include changing family patterns, such as an
increase in the number of smaller households, growing numbers of
households with three or more generations under one roof and
“downsizing” by empty-nest couples and retirees.
In fact, the fastest population growth is occurring at both ends
of the age continuum, among young people and the elderly.
Squeezed in between these two growing groups is a busy “sandwich
generation” of middle-aged adults, many of whom are caring for
children, grandchildren or elderly parents. As a result of these
demographic changes, local communities have found that they must
plan for new patterns of land use and transportation and a wider
variety of types of development.
Concerns about the relationship between health and the built
environment are increasingly reflected in land-use planning.
Local communities are working to invigorate downtowns and main
streets, retrofit auto-oriented suburbs, find new uses for old
strip malls and shopping centers and build new neighborhoods that
work socially, economically and environmentally. Many efforts
like these are motivated in part by a desire to create healthier
and safer communities where residents have more opportunities to
be physically active and have access to a variety of nutritious
The leading causes of death in the United States have shifted
from infectious and communicable diseases to chronic diseases:
medical conditions that are long-lasting, persistent or
recurrent. Physical activity and proper nutrition can largely
prevent many chronic diseases, such as heart disease and Type 2
diabetes. In response to the rising rates of chronic disease,
many local agencies are adopting land-use measures that
facilitate healthy eating and active living.
Local authority to regulate land use derives from the police
power — the prerogative to act to promote the health, safety and
welfare of the community. Historically local agencies have
pioneered efforts to protect health and safety. For example,
beginning in the early 1900s, municipalities established sewer
systems and sanitation facilities to control waste and reduce
infectious disease.These local efforts eventually led to state
and federal sanitation and water-quality policies. More
recently, state restrictions on air pollution and smoking grew
out of local initiatives to protect public health.