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Institute of Medicine (US). Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington (DC): National Academies Press (US); 2001.

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Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century.

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4Human Health and the “Built” Environment

The “built” environment, that is, the one designed and constructed by humans, presents as many opportunities as challenges to environmental health. It also raises some of the most difficult social and political tests, because it inevitably involves issues of commerce, social justice, and community.

Clearly it is at the community level that many of the most important aspects of environmental health are being addressed. According to several workshop speakers, academic scientists must learn to convert the concerns of the community into research that is responsive; that is, they must actually work with the community in doing the research, hiring local people, creating a citizen’s advisory panel, and developing a research agenda. Designers, besides taking a more responsible view of their work, have to consider human needs and health when planning the places in which we will live and work.


A modern American society has a tendency to design its environment as if the people who will live or work in it will eventually be leaving, said William McDonough of the University of Virginia. It is time to think of a new strategy where we assign a true value to building materials and embrace the notion that everything can be recycled. Design is the first signal of human intention (Figure 4.1), said McDonough. Designers should not be negligent; they should fully understand the environment in which they are creating designs and know what is in the materials that will be used in construction. A new vision of design is to accept responsibility for the consequences of construction, to create safe objects of long-term value, and to eliminate the concept of waste—even to consider the value of waste in producing new materials. Moreover, designers also have an obligation to object to work they find unethical or offensive, and regulations should increasingly be viewed as signals of design failure.

FIGURE 4.1. A bird flying over this GAP, Inc., office in San Bruno, California, would not know that a building is there.


A bird flying over this GAP, Inc., office in San Bruno, California, would not know that a building is there. Designers need to plan buildings so they are part of the environment. SOURCE: GAP, Inc. Reprinted with permission.

Waste is food—everything is a nutrient.

—William McDonough

Eco-efficiency in design should not be the goal, because efficiency is not always better. Rather, design should achieve eco-effectiveness. This means that natural laws should be engaged by designers to produce, for example, fabrics that are free of toxic chemicals; carpeting that is not embedded with polyvinyl chloride (PVC), fiberglass, and nylon; athletic shoes with uppers that are infinitely recyclable, and shower gels and cosmetics that go back into the water systems and start biodegrading.

Interior environments should be designed with human needs in mind. Corporate campuses should provide people with natural daylight and fresh air delivered directly to their breathing zone under their own control. Buildings can be designed that make more energy than they need to operate with solar collectors and a living machine waste treatment plant.


Many cities must work with what they have in order to build new businesses and create jobs because urban areas lack developable properties and green space. Reclaiming land can raise revenues without razing the environment, and it prevents further destruction of invaluable green space that is becoming a precious commodity in many cities.

Innovative designers can also contribute to “smart growth” in urban areas. Smart growth has many positive effects on the economy, attracting new businesses, encouraging development, and making health problems easier to address in the local community. For example, in New Jersey, brownfields development has actually enhanced environmental quality and saved local governments money by reserving fiscally beneficial open space. With the threat of urban and suburban sprawl, smart growth encourages retaining communities and enabling the preservation of selected open space, while allowing the development of urban centers. Vacant lots can become ballfields, and empty buildings can house much-needed grocery stores (Box 4-1).

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BOX 4-1

TURNING TRASH INTO CASH IN ELIZABETH, NEW JERSEY—A CASE STUDY. The city of Elizabeth, New Jersey, was an industrialized area up until the 1970s and 1980s, when manufacturing jobs were leaving the Northeast and the economy went dowhill. A 166-acre (more...)

While some urban areas are finding ways to better use the space within their borders, many cities such as Atlanta continue to spread outward, creating sprawl that not only increases environmental pollution and overtakes green space but creates an increasingly stressful environment for its inhabitants (Figure 4.2).

FIGURE 4.2. Atlanta’s heat island.


Atlanta’s heat island. NASA scientists have discovered that Atlanta’s sprawl development pattern is creating thunder storms. SOURCE: American Forests.

There is increasing recognition that our quality of life has been diminished by the intrusion of urban sprawl and unrestrained growth, said Robert Bullard, of Clark Atlanta University. For example, when a city like Phoenix chews up 1 acre per hour, there is something wrong. When we are sitting in traffic, when we have no opportunity to pass by a forest preserve or green open space, or when our children are being pushed into closer urban environments without the opportunities for play, something dire is going on. Some states are taking action.

California passed a $2 billion bond for new parks. New Jersey authorized $100 million to invest in open and green space. Georgia passed a bill that requires all counties to protect 20 percent of their land base for open and green space. At the federal level, the Conservation and Restoration Act builds on the President’s lands legacy, which proposes to set aside $900 million on a mandatory basis off-budget for land acquisition and protection of special land. Clearly, the momentum has swung toward reclamation and restoration of green space, but there is more work to be done.


When talking about healthy people, healthy homes, and healthy communities, the environmental justice framework is a good place to start. The environment is where we live, work, play, and go to school, as well as comprising the physical and natural world (Figure 4.3). The concept of environmental justice embraces the principle that all communities are entitled to equal protection of their environment, and health is at the forefront of environmental justice.

FIGURE 4.3. Hermineo taking clothes home to his mother in their cardboard shack.


Hermineo taking clothes home to his mother in their cardboard shack. Living in environments such as this wears people out. Neighborhoods like this one have problems with AIDS, drug addiction, increased mortality, and asthma. SOURCE: No Easy Walk. Photograph (more...)

Unfortunately, too often the search for environmental justices places the burden of proof on the victims, which has created a whole industry around risk assessment and risk management, where science is sometimes used as a tool to create a divide between the public and the scientific community.

In addition, merely conducting the proper scientific studies is not enough. After 30 years of studies documenting the toxicity of lead, for example, we still have childhood lead poisoning, because the major social justice issue—housing—has not been solved. In addition, false dichotomies are often constructed when trying to resolve environmental issues in the built environment—for example, jobs versus the environment or jobs versus health. What is really needed are efforts to identify and eliminate discriminatory policies and practices; ensure equal enforcement of laws, regulations, and policies; address disparate impacts; and involve the community early on and throughout the process (Figure 4.4).

FIGURE 4.4. Industry-induced relocation destroys communities and has profound effects on human health.


Industry-induced relocation destroys communities and has profound effects on human health. SOURCE: Environmental Justice Resource Center, Clark Atlanta University. Reprinted with permission.

Coherence in the built environment is fundamental to the health of communities, said Mindy Fullilove, Columbia University. When neighborhoods are torn down or destroyed, more than a community is at stake. For example, the spread of the AIDS epidemic in New York City can be linked to pockets of intense poverty in the South Bronx in which the demolition of housing, followed by the closing of city and municipal services, led to the relocation of intravenous drug users to other parts of the city. The resulting social disruption increased risky health behaviors. Moreover, these individuals were infected with the AIDS virus, which led to spikes of the infection rates in the communities to which they migrated.

A community is very hard to build up but easy to tear down.

—Mindy Fullilove

We often view the destruction of a poor community as destroying nothing of any social value, but a ghetto community is still a community and a home to real people, asserted Fullilove. Communities store things in their common memory and when the community is dispersed, all of this common memory of how to live together is lost and has to be rebuilt from scratch. A community is very hard to build up but easy to tear down, reflected Fullilove, in describing the intense effort it takes to rebuild a run-down neighborhood.

In the ideal world, good community life includes appropriate socialization of children to care for the environment and the promotion of pride. Community life in urban centers is often based on communication between and among the parts of the urban environment, perhaps from window to window or front porch to front porch. In a coherent environment, people understand and carry out behaviors related to neighboring friendliness. When buildings are torn down and high-rise housing projects are constructed, it is difficult for people to maintain group life, and individual well-being is destroyed. Buildings do not necessarily make homes.

Vacant, blighted lots separate people who then have to carry on daily life without the amenities and visual landscape that make daily life easy and meaningful. This wears people out, and it is under these conditions that increases occur in all kinds of diseases, including but not limited to AIDS, drug addiction, infant mortality, and most recently, asthma. A cycle begins of decay, disinvestment, abandoned housing, increased drug use, and violence.

Some cities have taken a new approach, that is, to ensure that every single lot is tidy and a part of the neighborhood (see Figure 4.5). Lots are not abandoned, and efforts are made to ensure that poor and working people who live in the area can remain residents in the neighborhood.

FIGURE 4.5. Manchester, New Hampshire, and other cities have taken a new approach to ensure that every single lot is tidy, green, and part of the neighborhood.


Manchester, New Hampshire, and other cities have taken a new approach to ensure that every single lot is tidy, green, and part of the neighborhood. SOURCE: M. Fullilove. Reprinted with permission.


“Although we cannot survive without the ecosystem services that make all life possible, we do not know how to produce most of them and there is no market in them,” said Amory Lovins, chief executive officer (research) of Rocky Mountain Institute. “Yet we can behave as if they were properly valued—without needing to know their actual value—and thereby make business far more successful, both economically and environmentally.”

We are not running out of mineral resources, such as copper and oil because powerful extractive technologies are keeping ahead of depletion. Yet we are running out of biotic resources and the services that ecosystems provide, so our prosperity is increasingly limited “by fish, not boats and nets, and by forests, not chainsaws,” said Lovins.

Natural Capitalism, the title of a book by Paul Hawken, Amory Lovins, and Hunter Lovins (1999), defines an environmentally and socially restorative way of doing business as if nature and people were properly valued. It calls for radically improved resource productivity; the redesign of production along biological lines with no waste and no toxicity; a business model that rewards both of these shifts; and reinvestment in natural capital.

Even today, when nature and people are valued at roughly zero, it is highly profitable to reduce and eliminate waste because there is so much of it. The flow of materials extracted, used, and disposed of in the U.S. economy averages 20 times our body weight per person per day; yet only 1 percent of this ends up in durable materials, and only one-fiftieth of that gets reused or recycled. The materials system is thus about 99.98 percent pure waste—a vast business opportunity. Energy is similar: our cars use only 1 percent of their fuel energy to move the driver, our buildings are a few percent as efficient as the laws of physics permit, and our power stations throw away waste heat equal to Japan’s total energy use for everything. Yet highly integrated design can make buildings 10-fold more energy efficient and usually cheaper to construct. Hypercar vehicles will ultimately eliminate the current version of the car: big, uncompromised versions getting more than 100 miles per gallon (Figure 4.6) will enter production by 2005 and ultimately will displace as much oil as the Organization of Petroleum Exporting Countries (OPEC) now sells, while decoupling road transport from climate and air quality. Each such vehicle is also a plug-in fuel-cell power plant that can earn back a third to a half of its ownership cost by selling power back to the grid when parked (normally 96 percent of the time).

FIGURE 4.6. In 10 years, these hydroelectric vehicles will save as much oil as OPEC now sells.


In 10 years, these hydroelectric vehicles will save as much oil as OPEC now sells. They will also help to avoid adverse climate effects and smog, which will lead to better quality of urban air. SOURCE: A. Lovins. Reprinted with permission.

Simple common sense applied to designing energy-efficient buildings can also make people happier and more productive, according to Lovins. For example, new office designs—in which people can see what they are doing because of high-quality and natural lighting, can hear themselves think because of good acoustics and the absence of mechanical noise, and feel more comfortable because of better thermal design—can yield as much as a 16 percent gain in labor productivity. Indoor air quality and daylight also make a big difference, contributing to health and reducing fatigue. Students in daylit schools do about 20 to 26 percent better on test scores. In factories, good day lighting reduces or eliminates lost-time accidents.

A second principle of natural capitalism, according to Lovins, is loop closing that eliminates the entire concept of waste. Instead, products that have been used get turned back into something useful via reuse, repair, remanufacturing, or recycling. Both biologically inspired, closed-loop, nontoxic design and radically increased resource productivity are rewarded by the “solutions economy” business model, which shifts from selling products to leasing a flow of services. Done right, this can align the interests of providers and customers, so that both make more money by doing more, better, with less, for longer. The resulting profits can then support reinvestment—as any prudent capitalist would do—in restoring and expanding the dwindling stocks of natural capital.

Where this is taking us is to a world in which successful businesses take their values from their customers, their designs from nature, and their discipline from the marketplace. By design, urbanists too can treat their cities’ formidable economic, social, and ecological needs not as competing priorities to be traded off, but rather as interlinked design elements with synergies to be captured. By using integrated design, early adopters of natural capitalist principles are finding striking gains in short-term profitability and competitive advantage—and the most exciting places to work.


Many workshop participants noted that environmental justice is clearly a central area of concern when considering human health and the built environment. There is no question that there is more environmental injustice in disadvantaged minority neighborhoods in the United States, and there is no question that there are more people in these environments who are unhealthy, said Mindy Fullilove. She added that experts can argue for a long time about cause and effect and the relationships between exposure and risk, but there is an undeniable truism that people who are unhealthy in general are more susceptible to environmental problems. Addressing the challenge of the built environment requires much more than just looking at chemical exposures and risks, it requires a holistic look at the entire built environment and the social issues involved with it. Lovins highlighted the need for multidisciplinary approaches that go beyond the usual boundaries of public health, urban planning, engineering, and design. Many speakers emphasized that government agencies can act to energize, inspire, and motivate integration of the various disciplines. Finally, there was discussion by several speakers that we must be more responsible about evaluating the consequences of our decisions in order to realign our thinking with each new effort to build health into the environment.

Copyright © 2001, National Academy of Sciences.
Bookshelf ID: NBK99591


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