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Placemaking builds stronger, livelier, more livable communities – but that’s just part of the story. Numerous medical leaders have also shown that Placemaking can play a huge role in promoting better health for all Americans.

It was big news last month when a group of retired U.S. generals published a report highlighting a little-known threat to national security: our kids are not healthy enough to fight.

Even in Minnesota, where people pride themselves on being hardy, two-thirds of young people are too obese or unhealthy to meet the military’s fitness requirements, the report states.

According to a delegation of public health experts meeting with Minnesota citizens during the 4th annual Placemaking residency, little exercise and poor diets pose a serious problem not only on foreign battlefields, but also here at home for people of all ages. The event, which sparked discussion of looming health issues across the Twin Cities, was sponsored by the St. Paul Riverfront Corporation in partnership with more than 50 local organizations.

“We are facing in the 21st Century a situation comparable to December 7, 1941–and we must work with the same single-minded purpose,” explained Dr. Richard Jackson, chair of UCLA’s Environmental Health Sciences Department and former Environmental Health Director at the US Centers for Disease Control (CDC).

The crisis has been caused in part by the way we’ve designed our communities since World War II, he said. “This building of America for the benefit of cars is starting to backfire. We should put people first.”

Jackson, a pediatrician, agreed with the generals’ recommendation to build more biking and walking trails. “Every child ought to be able to walk or bike to school. We’ve gone from 66 percent of kids to 12 percent in a generation.”

Over the same period, the number of middle-aged Americans who say they get “no regular physical activity” has skyrocketed from 17% to 52%. Seven percent of Americans now have Type-II diabetes, which consumes 2% of our entire GDP, according to Jackson. We rank 49th in global life expectancy, tied with Costa Rica, “which spends seven times less on medical expenses.”

“Changing the physical environment [in our communities] changes our health and well-being,” he told more than 1000 people on May 14 at the Annual Great River Gathering, offering examples of ambitious trail projects in Indianapolis and Atlanta, which boosted people’s physical activity. “This makes the healthy choices easy, so doctors don’t have to wag their fingers at patients to take a walk.”

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“Is your zip code more important than your genetic code [for determining health]?” asked Dr. Anthony Iton, former Alameda County [California] Health Commissioner and now Vice President for Healthy Communities of the California Endowment during a Placemaking symposium at Metropolitan State University.

He noted that in Alameda County (which includes inner city Oakland as well as wealthy enclaves), “we have areas where people live shorter lives, substantially shorter, 20 years shorter than in other areas.” Even in the Twin Cities, he reported, there is an 8-year life expectancy gap between richer and poorer neighborhoods.

In addition to the lack of wholesome food and opportunities for exercise, people in low-income areas “live in a fog of stress,” Iton explained, which elevates long term levels of cortisol hormones that cause diabetes and other diseases, “regardless of what you eat and how much you exercise.”

“We spend $3 trillion a year on halting the consequences–and little on the conditions and inequities that make them happen,” he said. “You can’t solve these disparities with antibiotics and MRIs.”

Minnesota’s Commissioner of Health Dr. Ed Ehlinger added, “To make a difference, we have to challenge the narrative that health is all individual [choices].”

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The Placemaking Residency hit the streets across Minneapolis, St. Paul, and suburbs, engaging people to brainstorm innovations in their own backyards. Gehl Studio led a workshop to imagine how the South Loop–an emerging development clustered around three light rail stops near the Mall of America in suburban Bloomington–could grow into a thriving city center.

Acknowledging that the area was different than urban neighborhoods, Gehl Studio’s Team Leader Blaine Merker noted that despite different cultures and physical surroundings, “the way people inhabit and use space is universal…we are not all that different.” His colleague Anna Muessig added, “People walk anywhere it’s interesting.” The audience envisioned the South Loop as a pedestrian-friendly zone full of architectural details to delight people’s imaginations, and as a place that takes full advantage of the adjacent wild, green space of the Minnesota Valley National Wildlife Refuge.

There’s nothing new about linking public health and urban planning, explains Patrick Seeb, who was a nurse before he became the head of the St. Paul Riverfront Corporation. “A century ago they were the same thing, as city planners built sewer lines and parks to eliminate the diseases that made cities so unhealthy at the time,” he says.

He points to a shining local example, Dr. Justus Ohage, who was both a surgeon and Commissioner of Health in St. Paul in the early 1900s. Concerned about the state of hygiene in the Twin Cities, Ohage mortgaged his home to purchase Harriet Island, where he built public baths and swimming beaches, which he donated to the city to become a park where people could enjoy fresh air and clean water.

“Our issues are different today but one thing remains the same: how we build cities that make a difference for people’s health,” notes Seeb.