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Institute for Local Government
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A Short History of Health and the Built Environment

Overview

A Short History of Health and the Built Environment

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.

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Sanitation Reform

The discovery of bacteria led to an understanding of the role of microbes in disease transmission. To stem the spread of disease, municipalities worked to create more sanitary conditions. Cities installed sanitary sewers and water-treatment systems. Local agencies cleaned streets and removed trash and contaminated waste. Establishing the most basic public health institutions — state boards of health and associations representing medical professionals — helped spur these sanitation reform efforts.

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Land-Use Regulation

The emerging planning and public health professions saw crowded urban communities as unsafe and unhealthy places. Neighborhoods with tall tenements and narrow crowded streets lacked trees and green spaces and didn’t allow fresh air and sunlight into homes. Disease was easily transmitted between individuals. Residents were exposed to noxious fumes, noise, chemicals and waste from nearby industries.

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Post-War Development

The post-World War II housing boom resulted in the rapid construction of low-density developments built on the periphery of pre-war suburban neighborhoods. Unlike the pre-war “streetcar suburbs” that were connected to urban centers by transit, these new neighborhoods were designed with widespread auto ownership in mind. As neighborhoods become less dense and expanded outward, traveling by car became the norm. Transportation investments favored auto travel over the needs of pedestrians, bicyclists and transit riders.5

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Where We Are Today

The land-use laws and regulations that created the contemporary landscape were instrumental in preventing factories from locating in residential neighborhoods and protecting residents from infectious diseases. Today, these same laws and regulations provide local agencies with powerful policy tools that can be employed to reverse the unintended consequences of traditional post-war planning and land-use practices. In the process, the fields of planning and public health are once again partners in creating healthier communities.

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