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Healthy Is as Healthy Lives

Designing Heart-Healthy Communities

We've had enough of good advice. The real secret to fitness is to live in an environment that encourages it.
By Geoffrey Cowley and Karen Springen
Newsweek

Oct. 3, 2005 issue - Forecasting heart disease is becoming an ever-finer art, as researchers learn more about the risk factors. But here's a predictor you may not have heard about: street address. In a study published last year, scientists at the RAND Corp. scored 38 metropolitan areas on the "sprawl index"? basically a measure of their dependence on cars. When the researchers tallied disease rates for the same areas, an interesting pattern emerged. Other risk factors aside, people in densely populated places graced with sidewalks and shops had the lowest rates of diabetes, hypertension, heart disease and stroke. And the rates rose steadily as communities became more spread-out and less walkable. Statistically, a person living in Boston or San Francisco was healthier than an identical person in Atlanta or San Bernardino. Without even trying, the folks in those more-compact communities were apparently exercising enough to ward off chronic illness. As the RAND team deduced, "suburban design may be an important new avenue for health promotion."

In fact it may herald a whole new approach. Personal behavior may hold the secret to long-term health, but as researchers are now discovering, behavior is not just a matter of choice. Every aspect of our lifestyles?what we eat, whether we smoke, how much we exercise?is shaped by our surroundings. If you live in a subdivision, work in an office park and can't buy a stamp without getting on the interstate, going with the flow is enough to make you sick. Staying fit in such places has long been a lonely act of resistance. But as many communities are now discovering, people surrounded by walkways and bike paths tend to use them. When smoking is barred in restaurants and workplaces, people tend to quit. And when fresh, whole food is as accessible as the processed kind, people often prefer it. "We've spent years making the healthy choice the most difficult choice," says Ross Brownson, an epidemiologist at St. Louis University. "We need to make it the easy choice."

If good advice were enough to keep people healthy, Americans would have few worries. We've been hectored for 30 years about the rules of heart-healthy living: don't smoke, maintain a healthy weight, get 30 minutes of moderate exercise each day, eat five servings of fruit and vegetables. Yet studies suggest that only 3 percent of us follow all those recommendations. More than half of all U.S. adults are inactive; two thirds are overweight or obese. And it's not for lack of awareness. "Stop 10 people in the street," says University of Colorado nutritionist James Hill, "and all 10 of them will say, 'I wish I were more active.' The trouble is, we've engineered the physical activity out of daily life."

If you doubt that, consider some of the changes the past half century has wrought. Physically active jobs were the norm in 1950, but sedentary employment is now twice as common. The percentage of Americans living in suburbs has more than doubled during the same period (from roughly 20 percent to 50 percent), prompting dramatic increases in car travel and a sharp decline in walking. According to the U.S. Department of Transportation, only one child in eight now walks or bikes to school each day, and the average adult spends an hour a day behind the wheel. Couple those trends with the rise of television and a surge in commercial food production (a daily surplus of 1,000 calories per person), and you've got the ingredients for a health crisis?no personal lassitude required.

But change is possible. Public agencies are now teaming up with foundations, universities and private companies to launch a new kind of health campaign?one that focuses on improving people's options instead of reforming their behavior. The goals range from updating restaurant menus to restoring mass transit, but the most visible efforts focus on making the "built environment" more conducive to walking and cycling. "We're trying to create communities where people can once again spend at least part of their lives on foot," says Marya Morris of the American Planning Association. The planners' ideal is a densely populated community where the blocks are small, the streets are on a grid (no curlicues or cul-de-sacs), residential neighborhoods are enlivened by street-front shops and services, and the sidewalks are safe and attractive. "Sidewalks help people take small steps toward being active," says Allen Dearry, associate director of the National Institute of Environmental Health Sciences. "Walking even a thousand extra steps each day improves health?and people will do it if they're given the chance."

Even a car-based community can take steps to create a more foot-friendly environment. Nashville is now three years into a 10-year, $260 million project that will expand parks and create a citywide network of bike lanes and walking paths. The initiative, seeded by a $200,000 grant from the Robert Wood Johnson Foundation's Active Living by Design program, also includes bike-safety classes for kids and a "walk to shop" program to get seniors out in groups. In Michigan, meanwhile, the state government is using loans, grants and tax credits to encourage "active community policies," and local officials are discovering that even modest investments, such as a painted crosswalk or an asphalt bike path, can help lure people out of their minivans. When the town of Jackson held a "smart commute" day to show off some newly opened routes last May, some 86 percent of the people who left their cars home from work were doing it for the very first time.

One of them was Hoyt Skinner, a 52-year-old aerospace engineer who stands 5 feet 9 inches and weighed 232 pounds. Skinner actually missed the event itself due to a bout of bronchitis. But the surrounding publicity inspired him to dust off the bike he hadn't touched in seven years and try pedaling it three miles to work. He still got there in less than 20 minutes?and the ride was so invigorating that he was soon biking for fun as well as efficiency. He logged 900 miles over the summer and will top 1,000 this fall. And though he didn't set out consciously to lose weight or improve his health, he has shed 28 pounds and brought his type 2 diabetes under control. "I love riding," he says. "You're cutting across the city blocks, going where there's no traffic. If they hadn't built these trails, my bike would still be collecting dust!"

As communities race to expand people's exercise options, many are working to improve food options as well?especially the ones that schools create for kids. Congress recently revised the national school-lunch law to require that participating schools create nutrition-and-exercise policies, and 40 states have introduced their own bills. In California, Gov. Arnold Schwarzenegger is pushing a measure to extend a ban on soda sales to high schools. And New Jersey has adopted a sweeping plan to restrict fat, sugar and portion sizes for any food served in its schools. But it will take more than rules and restrictions to steer kids toward heart-healthy lifestyles. The larger challenge is to create environments where kids discover for themselves the pleas-ures and benefits of fresh whole foods. "If kids are just told 'No more soda in the schools,' they say 'OK, I'll smuggle soda in'," says Danny Gerber, codirector of the Urban Nutrition Initiative at the University of Pennsylvania's Center for Community Partnerships. "We need to engage them in the planning."

That's what chef Alice Waters had in mind 10 years ago when she founded Berkeley, Calif.'s now famous Edible Schoolyard. The enterprise started in a garbage-strewn square-acre lot near the city's King Middle School. Waters organ-ized the students and their parents to tear up the old asphalt, and then persuaded the city to donate 100 tons of municipal compost to restore life to the soil. Kids who had grown up on Twinkies were soon growing their own tomatoes, corn and collard greens?and savoring the harvest. The garden is still thriving, and it has inspired similar efforts in such unlikely places as Cleveland, Philadelphia and Newark, N.J. The urban farms aren't all as big as Berkeley's, but they're having similar impacts. "On any scale," says Dearry, "gardening helps kids form a closer connection to what food is, what a proper diet is, what a proper portion is."

And even small gardens can nurture big ideas. Gerber's Urban Nutrition Initiative helped launch a middle-school vegetable plot the same year that the Berkeley program was born. During the past decade, it has spawned a citywide network of school- and church-based gardens. The student gardeners have created a co-op, whose 200 members qualify for discounts, and they recently retrofitted an old ice-cream truck so they could peddle fresh, local produce in inner-city neighborhoods. The kids themselves have become savvy entrepreneurs. More important, they and their families have become lovers of good food. "McDonald's was my downfall," says Brandon Taylor, a high-school senior who has spent three years working on the project. "Now I eat more things like collards and kale." His mom does, too, and the changes in her diet have left her 20 pounds slimmer than she was in the pre-garden days.

It takes more than a bike path or a vegetable truck to create a healthy community. But when people unite behind such initiatives, living well stops being the right thing to do and becomes a source of delight. "People get inspired," says Hill, the University of Colorado psychologist. "Everyone wants to take a role. They get this feeling of success, and they want to do more." Wanting to do more. That's the secret to a long and vigorous life?and unlocking it sometimes takes a village.

© 2005 Newsweek, Inc.
© 2005 MSNBC.com
http://www.msnbc.msn.com/id/9466932/site/newsweek/

The Changing Definition of Affordable Housing

The New York Times

September 29, 2005
Cut-Rate Homes For Middle Class Are Catching On
By DEAN E. MURPHY

NOVATO, Calif. - Janice Quinci likes nice things: fashionable clothes, dinner out with her husband, a private school for her daughter. With a household income in the six figures, Ms. Quinci can pretty much enjoy it all.

With the notable exception, until now, of a home of her own.

"We figured we would rent our whole lives," Ms. Quinci said. "We didn't really think that we could afford to have a place to ourselves."

Ms. Quinci, 29, was speaking from the front porch of her three-bedroom townhouse here in suburban Marin County, north of San Francisco. She and her husband, Vito, a salesman for a wine distributor, bought it new from a developer last November with no money down and at a steep discount. Inside, the refrigerator was pushed aside as workers laid a new kitchen floor - at no cost to the Quincis - because the original one was not up to snuff.

The Quincis might not look the part, but they are the beneficiaries of an unusual form of public housing that is gaining popularity in real-estate-obsessed America.

Some middle-class families are buying homes at budget prices made possible by government agencies, private developers, not-for-profit groups and employers.

Affordable housing, once shorthand for low rents for the poor, is being stretched like never before to include homeownership for people who are more likely to have Starbucks cash cards than food stamps in their wallets. These middle-income earners, priced out of homes from Burlington, Vt., to Santa Fe, N.M., are being offered financial breaks to live in hot real-estate markets and near their jobs.

"Our thinking is that a healthy middle class is important to the city," said Geoffrey Lewis, assistant director of policy at the Boston Redevelopment Authority, which has overseen the building of hundreds of units reserved for middle-income earners. "We want to keep these people in Boston; they are the glue in the neighborhoods and the glue in the economy as well."

Sometimes called low-cost, work force or inclusionary housing, the cut-price units are most popular in places "suffering from success," as one study described the cities where real estate costs outpaced incomes and where government officials, businesses and housing advocates were struggling to increase homeownership for all but the rich.

Unlike traditional government programs intended for the most disadvantaged, the emphasis is on people with full-time jobs who earn too much to qualify for federal assistance but too little to obtain a conventional mortgage, at least not in the cities or neighborhoods where they want to live.

Typically, those household incomes are 80 percent to 120 percent of the median income, which, in expensive metropolitan areas like San Francisco, Boston and New York, can extend into six figures for a family of four.

Nicolas P. Retsinas, director of the Joint Center for Housing Studies at Harvard, said, "In many places where housing costs have escalated, that historical social contract appears to have been voided, the contract that if you work you can find a decent place to live."

The price breaks are usually not achieved through direct subsidies but a range of cost-cutting programs, including cities making zoning changes for developers, providing land at reduced cost, expediting approvals of building plans and allowing the construction of bigger and more expensive homes elsewhere.

In some programs, like that of Burlington Community Land Trust in Vermont, the units are subsidized with state property transfer taxes. Elsewhere, employers and lenders offer financing packages direct to buyers.

Even in New York City, where efforts to reach out to the squeezed middle class began decades ago with construction of Mitchell-Lama buildings, the ever-growing affordability problem has led to a flurry of new programs, city officials said.

About 200 blocks in the Greenpoint and Williamsburg neighborhoods of Brooklyn were rezoned in May to include incentives for developers to build housing for a range of incomes, including households earning as much 125 percent of the median, something that had previously been reserved for high-priced Manhattan.

"By creating ownership, you are giving moderate income residents a financial stake in their neighborhoods, so they benefit from the improvement rather than be hurt by it," said Shaun Donovan, the housing commissioner in New York.

The spread of the phenomenon is too new and dispersed to be quantified, government officials and housing advocates say, and so far it occupies only a small piece of the nation's affordable housing pie. Still, it is catching the attention of home builders, city planners, educators and business people across the nation, leading to workshops and seminars on the subject as well as a spate of local laws that make it simpler for developers to offer the units.

Public and private investors are also discovering the trend. Investment funds totaling $190 million have been created in the past year in Los Angeles and San Diego Counties for the purpose of building middle-income housing in so-called urban infill areas that have access to public transportation.

The funds' manager, the Phoenix Realty Group, expects to finance more than 3,000 homes in the next five years. As in many work force projects, the builders will be allowed to construct more units than typically permitted under zoning laws. The "density bonuses" enable the developer to make up the lost profit on each unit by selling more of them.

"It's an unserved niche," said Tammy Harpster, Phoenix's vice president for acquisitions in San Diego.

Conrad Egan, president of the National Housing Conference, an affordable housing advocacy group in Washington, said the stepped up focus was due in part to a "turnaround on the part of political leaders and office seekers" that the market cannot provide affordable housing for many Americans, even those who are financially secure.

"The picture has shifted because more and more constituents of these local and state leaders are affected," Mr. Egan said.

A lottery is under way for condominiums in a seven-story building on the harbor front in East Boston, with all 30 units reserved for people earning 80 percent to 120 percent of the median income, or as much as $99,000.

More than 550 other subsidized homes have been built in Boston over the past few years - some in buildings where other units sell for millions of dollars - that have been reserved for middle-income earners at prices as low as $190,000 for three bedrooms.

In South Burlington, Vt., a 60-unit condominium project opened in February, with half of the units reserved for people earning up to 140 percent of the area median income. The Burlington Community Land Trust provided a direct subsidy of $25,000 on the homes, which sold for $119,000 to $169,000.

As in most of the arrangements around the country, the Vermont buyers agreed to restrictions on the resale of the homes, including how much profit they could make in order to keep the units affordable.

"There are seven teachers in there, and a couple of them are college professors," said Brenda Torpy, executive director of the land trust. "The gap between what people earn and what they can afford is really creeping up. These people are not who you would think of as low income."

In Lincoln Heights, a neighborhood just north of downtown Los Angeles, families making double the county's median income, or about $100,000, are eligible for reduced-price condominiums now under construction. Without even advertising, the developer, AMCAL Multi-Housing Inc., has compiled a list of 2,000 hopeful buyers a year before the homes will be available.

"It's not surprising," said Percy Vaz, the company's president. "The alternative is for people to go out to Riverside, Palmdale or Lancaster and spend two and a half hours on the freeway."

Not so long ago here in Novato, a bedroom community in Marin County about 30 miles north of San Francisco, the Quincis' household income of roughly $111,000 would have disqualified them from any housing breaks. But in Marin County the median sale price for houses in June was about $925,000. The Quincis would need to triple their income to afford that.

Under a complex formula devised by Novato city officials, some new housing on the former Hamilton Air Force Base is being offered at reduced prices to people with household incomes up to 120 percent of the median.

The Quincis are at the top end of that scale, meaning they had to pay more for their townhouse than families that earn less, but they qualified just the same. The couple paid $390,000, about 30 percent below market value; while single-family houses on the former base not part of the program sell at market value, recently as much as $1.8 million, real estate agents say.

"Often in our culture, it is the middle class that gets left out of everything," said Roderick J. Wood, the city manager in Beverly Hills who held the same post in Novato when the Hamilton project was conceived. "We wanted to help that group."

Ms. Quinci, who grew up in Novato but had been living out of town with her husband at his grandmother's house, said the special housing was the only way she could afford to move back home. A high school friend lives a few doors away, as does a high school science teacher.

"We see deer out back and wild turkey, and there are rabbits in the morning," said Ms. Quinci, a stay-at-home mother, her year-old son cuddled on her shoulder and her 3-year-old daughter rubbing her eyes after an afternoon nap.

Preferences in Novato were offered to police officers, firefighters, teachers and other public employees, but some of the 351 affordable homes are also available to the general public through lotteries, the most recent one in August.

On lottery day, it is a lot like Christmas, said Laura Levine, the Hamilton project manager for Northbay Family Homes, a nonprofit housing company that has overseen the sales.

"If you're over 18," Ms. Levine said, "come on down. It's a beautiful place."

Copyright 2005 The New York Times Company