The Topography of Wellness: How Well being and Illness Formed the American Panorama
By Sara Jensen Carr; Charlottesville, Virginia:
College of Virginia Press, 2021; 288 pages, $34.50.
Reviewed by Pollyanna Rhee
In 2016, Karen DeSalvo, the performing assistant secretary for well being on the U.S. Division of Well being and Human Providers, famous that public well being was in a brand new period the place “one’s zip code is a greater indicator of well being than genetic code.” DeSalvo’s hyperlink between well being and place underscored a pervasive and uncomfortable reality about residing in the US right now: Racial and class-based segregation is each widespread and dangerous for individuals’s bodily and psychological well being.
Beneath these circumstances, well being is commonly a luxurious fairly than a part of our widespread good. On the similar time, our present period is marked by fixed knowledge gathering and quantitative evaluation of our cities: The place is probably the most livable place? Which is the healthiest metropolis? What’s the walkability index of this locale? We now have extra data than ever about our cities. However does all that knowledge really assist us? And the way did we get thus far?
Panorama and Public Well being
Sara Jensen Carr, ASLA, an assistant professor of structure at Northeastern College, tackles that remaining query in The Topography of Wellness: How Well being and Illness Formed the American Panorama. As an alternative of excited about well being as a matter resolved via a easy sure or no query—are you sick or not?—the guide examines how landscapes responded to and formed concepts about well being, wellness, and politics over the previous two centuries of American life.
Over the course of eight chapters that progress thematically and chronologically, Carr gives two associated interventions. The primary a part of the guide, titled “Infectious Terrains,” consists mainly of a revisionist historical past of the American constructed surroundings from the Nineteenth to the center of the Twentieth century. Acquainted and canonical figures comparable to Andrew Jackson Downing, Frederick Regulation Olmsted, Daniel Burnham, Le Corbusier, Frank Lloyd Wright, and Lewis Mumford endure reassessment via the lens of dominant concepts about well being and illness of their occasions. The second half, “The Chorography of Power Illness,” begins within the Fifties and presents a vital evaluation of latest work and initiatives linking public well being with the surroundings over the previous half century.
All through, panorama—parks, bike infrastructure, public housing initiatives, and suburbs—is interlocked with the historical past of public well being, together with lethal miasmas, germ principle, and our present deal with wellness and life-style selections, in addition to rising issues round local weather change.The Topography of Wellness’s narrative pinpoints city landscapes as a central platform for excited about the well being and wellness of the nation’s inhabitants, in addition to the plain political and social stakes of such endeavors. Clever landscapes, comparable to Olmsted’s parks, present leisurely and charming areas all through the nation. The designer additionally noticed them as lifesavers for the poor that allowed them to convalesce in city nature earlier than returning to productive labor.
At its core, Topography of Wellness argues that well being “was the medium via which cities had been formed and municipal governments imposed order.” In utilizing “wellness” as her central time period, Carr acknowledges its breadth, however explains the selection as one rooted in its current resonance as a time period connoting wholesome conduct and existence and her goal to interrogate its makes use of. Wellness and the related phrase “well-being” not solely suggest a person’s happiness however have taken off as phrases for advertising merchandise. The method of commodifying each landscapes and well being via wellness has a up to date really feel, however Carr desires to indicate its long-standing presence.
The Significance of Place
All through the historic and present examples, panorama emerges as an typically underexamined however ubiquitous presence in assessing well being. As cholera epidemics swept via the US at common intervals in the course of the Nineteenth century, sanitary surveys revealed stark disparities in demise fee by place. Some commentators noticed tenements as “perpetual fever-nests” because of their inhabitants’ behaviors, whereas others seen the poor as “victims of their surroundings.” Makes an attempt to develop entry to wholesome areas typically revealed attitudes that offered some segments of the inhabitants as extra deserving of well being than others.
The shifts Carr traces map onto bigger trajectories of American social and cultural historical past, particularly as residents, establishments, and governments have grappled (and proceed to grapple) with deep inequalities. Calling for interventions within the panorama within the identify of well being supplied a approach of advancing political aims. Responses to Nineteenth-century epidemics in quickly rising cities trusted assumptions that fashionable vices contributed to their unfold. City playgrounds furnished youngsters with devoted areas however had ethical justifications. Playgrounds inspired exercise fairly than idleness and saved youngsters separated from the affect of criminals and different unhealthy actors on metropolis streets. Even imaginary worlds showcased well being. Hygeia: A Metropolis of Well being, a utopian textual content by the British doctor Benjamin Ward Richardson in 1876, supplied detailed descriptions of a metropolis with “the bottom mortality” regardless of a scarcity of coaching in design. Notably, he omitted particulars about human actions. Realizing clear cities free from illness was such an aspiration that it might as effectively have been a fantasy.
Restricted Viewpoint
The second a part of the guide focuses on makes an attempt to mitigate the consequences of continual illnesses in Twentieth- and Twenty first-century city areas. As approaches towards well being turned extra technical and professionalized firstly of the Twentieth century, a equally restricted view of the connection between well being and cities emerged as effectively. Individuals got here to see epidemics and sickness on account of particular person selections fairly than a results of coverage and structural forces. Relatively than bettering one’s environment, the duty was now to enhance one’s personal self and free the physique from illness. These concepts knowledgeable critics through the midcentury period of city renewal, comparable to when Architectural Discussion board printed an article in 1951 titled “Slum Surgical procedure in St. Louis” and included pictures of blighted and so-called out of date districts that threatened to unfold throughout the town. In Victor Gruen’s 1964 The Coronary heart of Our Cities, he thought of the city core to be a coronary heart and advocated for the revival of the backyard metropolis to restore this “drained coronary heart.” Like a human physique, a metropolis may have its illnesses and pathologies within the type of blight surgically eliminated.
This restricted perspective resulted within the minimization of social and cultural issues. Writing in 1984, Kevin Lynch discovered the usage of medical terminology problematic as a result of it reassured individuals “residing exterior the town that their well being could be preserved by stopping the contagion of blight.”
No Single Answer
If there may be one overarching assumption, or maybe aspiration, in these initiatives over time, it’s the concept that a single intervention or design might be an easy resolution to the issue of well being with out regard for social, political, or ideological context. Presently common interventions comparable to incorporating panorama views in well being care settings, tree planting packages, and good cities designed with energetic livability in thoughts include elements of this assumption. This was the case even because the Facilities for Illness Management started to deal with “social determinants of well being” within the Eighties and Nineties. Carr seems to be particularly at analysis linking rising weight problems charges, elevated stress, and the rise of hypertension to low-density sprawl and life oriented across the automotive. However vilifying sprawl and providing an alternate may additionally take a neo-traditionalist and even regressive flip.
In a single of some reassessments, Carr examines the New Urbanist ideas of Andres Duany and Elizabeth Plater-Zyberk enshrined of their 2000 guide, Suburban Nation: The Rise of Sprawl and the Decline of the American Dream, written with the city planner Jeff Speck, Honorary ASLA. Along with dismissing the work of panorama architects merely as individuals who “prettify” fairly than enhance the panorama whereas leaning on their very own aesthetic preferences, Duany, Plater-Zyberk, and Speck reveal their very own restricted social imaginative and prescient. Of their rebuke of modernist cities, Carr contends that the trio “uncritically doubled down” on “defining their superior traditionalism as European” or from the antebellum South. Since early within the Twenty first century, Duany and Plater-Zyberk have targeted on post-Hurricane Katrina restoration initiatives in Biloxi, Mississippi, and New Orleans, stressing the healthful attributes of New Urbanist designs, positions that haven’t prevented controversy and fees that their nostalgic designs are accomplices to displacement of New Orleans’s Black inhabitants.
Well being as Privilege
Well being, Carr acknowledges, is a time period with “worth judgments, hierarchies, and blind assumptions that talk as a lot about energy and privilege as they do about well-being.” Writing within the context of the COVID-19 outbreak in spring 2020, Carr concludes that finally there may be “no inexperienced capsule” that solves every thing. However she notes that reality doesn’t preserve city critics comparable to Joel Kotkin from vindicating Southern California’s sprawling panorama of single-family houses as very important for minimizing virus exposures. Fairly often options are oriented towards bettering or justifying the lives of those that are already comfy fairly than towards extra equitable approaches.
Close to the guide’s conclusion, Carr features a rallying cry for panorama architects. She acknowledges that panorama structure “is commonly sufferer to worth engineering or dismissed as an ornamental artwork.” However it could actually additionally create a path to reconnect the design and planning of cities with public well being in thoughts. Panorama architects can reclaim their position by envisioning a extra expansive and politically engaged set of duties. Confronting intertwined problems with sprawling improvement, local weather change, spatial inequities, and continual illness transcends the standard boundaries of the occupation.
Nonetheless, embracing these challenges is a necessity. As an alternative of a solutions-minded focus, the important takeaway right here is the necessity to shift the attitude on well being and wellness and its relationship to landscapes if we’re to have a extra equitable society. Though panorama architects could discover the chapters within the second half most useful for his or her deal with modern actions, Carr additionally admonishes panorama architects to think about the chance that design practitioners have been “compliant in a system that exacerbates social inequity.” Panorama architects are political actors whether or not or not they wish to be. Recognizing that reality means inspecting the assumptions behind well being, cities, and design and understanding that the alternatives we make are something however impartial.
Pollyanna Rhee is an assistant professor of panorama structure on the College of Illinois Urbana–Champaign.
