Six Epidemics in American History Show How Urban Design Affects Our Health

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07/30/19 – BOSTON, MA. – Sara Jensen Carr, professor at the School of Architecture, poses for a portrait outside the ISEC building on July 30, 2019. Her research focuses on how our communities and the buildings we live in affect our health, and conversely how we react to health and disease by building certain structures and designing certain urban amenities. Photo by Matthew Modoono/Northeastern University

By Emily Arntsen

Northeast News

Cities organized on grids are more than practical. They are also good for your health, according to Sara Jensen Carr, Assistant Professor of Architecture. Americans learned this the hard way in the 1800s during cholera epidemics, when infected water pooled in twisting, unpaved streets.

“During this time, there was a coordinated movement to remove all litter from the streets and bring fresh water to homes,” says Carr. “The net effect is that we have straighter streets to accommodate long pipes underneath to move water and waste more safely.”

Carr is write a book, The Topography of Well-Being, which chronicles six health crises throughout the history of the United States and how these epidemics have influenced the design of our cities. In addition to infectious diseases like cholera, yellow fever, and tuberculosis, Carr focuses on “social diseases” like crime and chronic illnesses, such as battling weight loss and self-image, and how these influence or are influenced by changes in American cityscapes.

“The city was really seen as an incubator of disease for much of American history,” says Sara Jensen Carr, assistant professor of architecture at Northeastern. Photo by Matthew Modoono/Northeastern University

“The city was really seen as an incubator of disease for much of American history,” Carr says. This was especially true in the early 19th century, when people believed in a theory called miasma, the idea that diseases floated aimlessly through air and water.

“It really terrified people,” Carr says. During the Industrial Revolution, when cities became densely populated, people began to worry about overcrowded housing conditions for fear of catching “bad air”. As a result, says Carr, towards the end of the 19th century there was a huge push to design buildings and outdoor spaces that brought in fresh air and sunlight.

Around this time, landscape architect and public health officer Frederick Law Olmsted began designing public parks, such as the Emerald Necklace in Boston and Central Park in New York. “Even though he didn’t have a lot of scientific knowledge to prove it, he inherently knew that we needed room to breathe,” Carr says.

Public parks became even more popular when tuberculosis swept across the United States at the turn of the 20th century. “The interesting thing about TB is that the air and the sunlight were actually very healing,” Carr says.

Photos of early 1900s ‘consumer’ hospitals designed to treat tuberculosis patients show people lying outside in beds, exposure to the sun, as a form of treatment. Wealthier patients could afford set up their beds in “window tents” sleep in the open air without leaving the comfort of their room.

These disease-inspired designs continued into the 20th century. “TB influenced a lot of architecture and urban planning until about the 1960s, especially in modern public housing,” Carr says.

The mid-20th century also marked the beginning of the Urban Crisis in American cities, during which racial tensions ran high and wealthy white citizens began to move to the suburbs, taking business with them.

“Cities were in ruins,” Carr says. “There was this fleeting boogey man of blight in the cities.” But instead of fearing miasma and “bad air,” people now feared things like violence and drugs. “There was a lot of confusion between poor neighborhoods and disease,” she says.

“People were cutting off large swathes of the city and building federal highways, building literal walls around poor neighborhoods, essentially quarantining immigrant and minority populations through housing clauses,” Carr says.

Essentially, these covenants were contracts that stayed with the land, regardless of ownership, that prohibited non-whites from buying or renting that property. And many of these alliances actually used health as an excuse to exclude owners by race.

“There’s a history of covenants going back to the 1960s that say homeowners shouldn’t sell their properties to African Americans because they have higher death rates than white homeowners,” Carr says.

But whereas the white flight movement to the suburbs in the mid-twentieth century originally excluded people of color, Carr says we are now seeing the opposite trend. “There’s actually a trend now of minority and immigrant populations moving to suburbs further away from jobs.”

The latest health crisis Carr has researched for her book is the connection between suburbia and obesity. “The inhabitants of the suburbs have to spend more time in the car to get around. They don’t have time to exercise. They can’t walk to the grocery store,” Carr says. “Suburban sprawl is not the cause of the obesity epidemic, but many people agree it is definitely a contributor.”

These are some of the consequences that Carr hopes designers will consider more seriously in the future. “We have to start addressing the health needs of our communities and consider the unintended fallout from what we’ve done in the past,” she says.

(Reproduced with permission from the News at Northeastern.)

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