A Clear Diagnosis: Dr. Richard Jackson On Health and Oregon Communities 

The most important messages aren’t always the easiest to hear.

Dr. Richard Jackson, chair of Environmental Health Sciences at UCLA’s Fielding School of Public Health, came to Oregon in June to share a difficult but crucial message: the nation is getting sicker. Many of our ailments, like obesity and diabetes, are largely preventable. And these problems are getting worse.

Today, nearly 34 percent of U.S. adults are obese. Children, 17 percent of whom are obese in America, are afflicted with health problems that were almost entirely unknown in their population just a couple of decades ago. Pediatricians are grappling to figure out how to treat a child who is extremely overweight and at risk of heart disease, or worse. Some even face a lower life expectancy than their parents. The nation’s spending on medical care is skyrocketing, and there is seemingly nothing to stop it.

Oregon is doing slightly better than the national average, but even here, the challenge is real and staggering. Obesity has risen from ten percent of the population in 1991, to 25 percent in 2010. Diabetes has risen from four percent in 1994 to more than seven percent in 2007. The costs in medical care are ballooning right alongside.

Jackson can show a multitude of graphs and maps that make clear just how frightening this trend is. But rather than leave his listeners in despair, Jackson knows a way out of this crisis.

And it doesn’t begin with developing new pills, surgeries, or treatments.

It begins in the neighborhood, in the street, and in our homes.

That’s the message that Jackson brought to nine talks around Oregon in one week, speaking at events in Salem, Eugene, Roseburg, Medford, Bend, and Portland. All told, over 650 people around Oregon heard Jackson’s talks in person, while thousands more heard him on OPB or other media outlets, or read about his message in local papers.

1000 Friends joined several partners to co-sponsor Jackson’s tour. We worked to get him before elected officials, planners, citizen advocates, businesspeople, and ordinary Oregonians in a variety of venues, all for one purpose—to recognize the serious challenge we face, and to identify how we can confront it. In the end, it will mean working together and learning to see and plan our communities in a new light.

Confronting the Challenge

Jackson, who previously headed the CDC’s environmental health center and was also one of California’s top health officials, doesn’t mince words when he describes our challenge, and the error of the approach we’ve been using to try to fix it.

At the City Club of Portland Friday Forum luncheon that capped his week in Oregon, Jackson described an all-too-common scenario: a ten-year-old boy that’s extremely overweight, facing adult problems like high blood pressure and cholesterol, and even depression. A typical medical approach might be to just tell the kid to be more active, and when that doesn’t work, prescribe hundreds of dollars of medicines to help treat all his side effects. 

But that approach is what’s costing our nation billions, and worse, it’s not working. “Over the last 25 to 30 years, we have medicalized what are in essence environmental problems,” Jackson told the audience of 200, with hundreds more listening on OPB or watching on local media. “But the environment is rigged against this child and his family. It’s rigged against the doctor, and it’s rigged against all of us.”

When Jackson says "environment," he means the shape of the neighborhoods and communities where we live, the food that is available to us, and the quality of the air and water we share. Far too many Americans live in places where each of these elements is stacked against them. And this has got to change, Jackson says.

Jackson proceeds to describe a revolution in public health that is working to assess how each of these areas plays a role in our health. “The purpose of public health is to ensure conditions where people can be healthy,” Jackson said at City Club. Later, he added: “Public health is about the causes of the causes of death. We’ve got to move upstream.”

Moving upstream, Jackson says, means assessing the way most Americans live: in communities with little choice but to drive; where physical activity is either rare or unsafe; where air quality causes millions of people, especially children, to suffer from asthma and respiratory problems. It means knowing whether healthy food is available and affordable, whether people are safe from worry about being killed while trying to cross a street or ride a bike, and whether stressful commutes in personal cars deny residents the much-needed mental health benefits of community and connection.

Those are the themes that Jackson has dedicated his career to exploring, as he did in a recent four-part series for PBS, Designing Healthy Communities, which has reached millions of Americans.

The Best Solutions: Solving Multiple Problems, Requiring Multiple Actors

We all have a role to play in improving health, but many of us don’t see our jobs that way. Jackson would like to change that. "Those of you who are builders and developers, you are health officials,” Jackson said at City Club. “Those of you who oversee transportation plans or urban plans are health officials. So much of the health issue is determined in your world, not in the medical world."

Other actions may seem more individual—for example, the decision to walk to the store instead of driving, or to eat an apple instead of a bag of chips. But if people’s environment makes those options difficult, as it does for tens of millions of Americans, it’s hard to blame them for doing things that are unhealthy.

Jackson believes that if we all work on ways to give people better options—for instance, providing safe ways to walk or bike to the store or to work, or providing efficient transit service, or improving access to healthy food—then many Americans would see their health, and their quality of life, improve very quickly.

In some places, that means building on what is already there: retrofitting existing neighborhoods and reviving walkable downtowns, a trend which smart Oregon communities are already doing. (Jackson had fine things to say about Roseburg and Redmond in particular.) In other places, it means designing well from the start. Almost everywhere, Jackson says, it means incorporating a full analysis of health impacts—a "Health Impact Assessment"—into the how we make decisions as a society about infrastructure, development, and priorities.

It's a daunting challenge, but here’s the really good news: when it comes to the built environment, transportation, and health, solving one problem often means solving multiple problems, which is exactly what we need to be doing.

Jackson cites a new light rail line in Charlotte, where a concurrent health study discovered by accident that people taking the new line were 80 percent more likely to meet the Surgeon General’s health targets than their counterparts who did not ride the line. On average, they had lost 6 ½ pounds, without even trying. Or there’s the new Cooper River Bridge in Charleston, South Carolina, where officials finally agreed to include a bike and pedestrian trail after strong citizen advocacy. That bridge is now one of Charleston’s most popular tourist attractions, and provides thousands of area residents with a safe, healthy way to commute and recreate.

 “In the 21st century we need to come up with solutions that can solve more than one domain at a time,” Jackson said at City Club, noting that this belief is spreading far across the medical community. "Land use" and "the built environment" are increasingly common topics at health conferences, and the nation’s most esteemed doctors have identified community form and routine physical activity as key factors in improving the nation’s overall health.

The benefits of creating healthier communities ripple out far beyond personal health. More walkable communities lead to higher real estate values, attracting additional investment and talent. Better health means less waste of our money on medical care (individually and through taxes), and more money to do things we enjoy. Less driving means less money going to foreign energy producers, less risk of violent death from car accidents, and more quality time with family and friends.

Most of all, it means leaving a better world for our children, which is a special concern of Jackson’s. “Every child has a right to be able to walk or bike safely to school. When we take away that ability, we’re taking away some of their lifespan. We’re taking away their freedom,” Jackson said at City Club. “We need to focus on changes that really impact our children.”

Jackson's tour also shows that interest in better health isn’t limited to urban areas. Case in point: the 80 people who showed up in Roseburg for a lunchtime talk and downtown tour with Jackson, which led the local paper to publish an editorial urging local leaders to heed his message. 

Indeed, health is a concern that’s common to us all, with extraordinary impacts on our personal well-being as well as our society’s. If we make the connection between healthier places and healthier people, we can get on the right track to solve many of the most pressing problems we face. Hopefully Dr. Jackson’s message, told firmly and heard clearly, will help Oregon communities connect the dots and work to create healthier places, for everyone.

More Info and Resources:

Download an mp3 of Jackson's presentation before the City Club of Portland.

Watch a video of Dr. Jackson's presentation in Eugene, courtesy of the City of Eugene.

Read a Roseburg News-Review article about his visit and talk there. Click here to read the paper’s follow-up editorial.

Learn more about where you can watch or purchase Dr. Jackson’s groundbreaking PBS series, Designing Healthy Communities.

1000 Friends believes that land use is a key contributor to health, as well as many other areas that impact our quality of life and community. Visit friends.org/LandUseIs to learn more about the role of land use planning in your daily life.

1000 Friends is extremely grateful for the efforts of our co-sponsors of Jackson’s statewide tour, including the Oregon Chapter of the American Planning Association, Oregon Environmental Council, and the Oregon Transportation and Growth Management Program, as well as many local partners who helped sponsor events in each community Jackson visited. For a full list of Jackson’s appearances and local partners, please visit friends.org/DesigningHealthyCommunities.