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Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities, by Howard Frumkin, Lawrence Frank, and Richard Jackson, is reviewed.

Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities Howard Frumkin, Lawrence Frank, and Richard Jackson. Island Press, Washington, DC, 2004. 288 pages. $60, $30 (paperback).

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The Fannie Mae Foundation sponsored a survey of top urban planners and historians in 2000, asking them to list the top 10 influences on the American metropolis over the past 50 years. A notable absence from the "Top 10" list that resulted from this survey was any mention of human health [Robert Fishman, 2000, "The American Metropolis at Century's End: Past and Future Influences," Housing Policy Debate, 11(1), 199-213].

This absence is not surprising since public health considerations are not commonly taught in planning schools. Nor are they high on the list of issues most contemporary planners work on and worry about in their day-to-day duties. However, public health is poised to play a meaningful role in how communities are planned and built. In Urban Sprawl and Public Health, the authors build a thorough, compelling, and overdue case that how and where growth occurs has both direct and indirect impacts on human health. They also argue that urban planning and public health can no longer afford to exist in separate worlds. That argument is gaining traction, attention, and funding support from many government entities and foundations. Planners who want to understand the emerging fusion of planning and public health would do well to read this book.

Until recently, the American public health community had not weighed in on broad patterns of growth in a clear and coherent way. In the latter half of the 2oth century, as sprawl became the dominant land use paradigm, public health professionals ceded the shaping of the built environment to planners and engineers, as well as to government policies unrelated to human health concerns. The authors point out that this is a marked change from the legacy of the 19th and early 20th centuries when there was a rich tradition of collaboration between public health and urban design professionals.

A robust and expanding body of research supports the central theme that sprawl is not good for public health. The authors provide a well documented and well written summary of recent development patterns in the U.S., and an account of the evolution of urban health from the 17th century to the present. This is essential background for planners interested in the relationships between urban form and health. It also sets the stage for the book's main topic-the evidence linking adverse health outcomes with sprawling development.

The authors examine each of the following topics in the context of sprawling development: air pollution and related illnesses, the decline in physical activity, obesity and its attendant diseases, injuries related to auto dependence, threats to water quantity and quality, mental illnesses, and the erosion of social capital. The state of research on these topics is not uniform. Some, such as air pollution, are conclusively linked by the literature to land use patterns. Research on others, such as mental health, is less conclusive. But the authors acknowledge these gaps and raise questions rather than reaching conclusions when empirical evidence is lacking.

Urban Sprawl and Public Health is not an op-ed piece. It is a carefully researched and documented examination of existing research. The term sprawl is not used in a pejorative sense, but as a descriptive term. The authors acknowledge that there is not yet adequate evidence to guide city design and planning in a way that will maximize human health. However, they do reach conclusions and suggest solutions. In doing so, they cite the "Precautionary Principle," which commonly guides public health measures where evidence is compelling but incomplete:

As articulated in the Wingspread Statement of 1998, this principle holds that "when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." (p. 220)

Based on this principle and the evidence they describe, Frumkin, Frank, and Jackson issue a call for rebuilding American communities using smart growth strategies such as mixing land uses, decreasing automobile dependence by providing more transportation choices, and increasing density balanced by preservation of open spaces. They leave planners with this message: You are public health professionals.