LIVE RECORDING: How Do Urban Landscapes Shape Our Health?

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This is a special collaboration between the Brown School of Public Health and Brown's Urban Studies Department. Our topic today, the City Effect, how Urban Landscapes shape our Health. We're joined by Sandy Zipp, the director of Brown's Urban Studies Program. He's an urban and cultural historian who thinks about how ideas shape cities and how city life shapes ideas.

We also have Erica Walker, an assistant professor of epidemiology at the Brown University School of Public Health. She studies the environmental exposome. Air, noise, water and soil pollution, and their impacts on children in Mississippi and Rhode Island.

And Joe Braun, a professor in the Department of Epidemiology at the Brown University School of Public Health. He studies how chemical pollutants like PFAS, also known as the Forever Chemicals impact the health of infants, children and adults.

So I personally think about the connection between cities and public health all of the time. I was an urban studies concentrator at Brown, and that's probably because I was fascinated with the ways our cities could improve our lives or make them worse. So you could have a plaza that was very welcoming that brought together community members, or you could have another one that made people feel excluded. Curb cuts and sidewalks make the difference between people walking or driving to work. And zoning can make a place vibrant or feel like a dead zone. And what is public health, but the study and practice of improving people's lives. So to set the tone for this conversation, I'm going to read a quote from Jane Jacobs. She was a journalist and activist who loved cities. Here's what she said:

Far from denigrating cities because of the problems they create. We should recognize that these problems are opportunities, what we call faults of cities, are really bringing problems to a head where they can be solved. Life keeps casting up new problems, and the cities have been and certainly will continue to be the places where they can be solved.

So that's what we're going to talk about today, how cities collect public health problems and the ways they might help us address those very same issues. So to give us some context, let's start with Sandy Zipp. You are the urban historian and you're also an expert on Jane Jacobs.

So for people who don't know, will you briefly explain who she was and what she's talking about here in this quote?

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She's most well known for that book and the role it played in transforming the way people thought about cities in the middle of the 20th century. She's somebody who lived in New York City up until the late 1960s when she decamped for Toronto as a protest against the Vietnam War – uh Oh, interesting, resonances with today – interesting. So she lived in Greenwich Village in New York City. She's one of the people who contributes to the sort of romance that continues to hang around the neighborhood of Greenwich Village, living on Hudson Street there for 20 or 30 years from the 1940s up into the 1960s.

y city planning ideas. In the: 1950

And she set into motion, a set of ideas about how cities should be lived in, that have kind of resonated down to our own day. I personally, and the quote that you, that you read today, Megan comes not from Death and Life, but from one of her essays from later on, in her career. And one of the things that my colleague and I, Nate Storing, did was collect a series of her essays from across her whole career in a volume called Vital Little Plans.

That is an attempt to try to understand her work at a larger scale. And one of the things that I think is most important for us to think about when we think about someone like Jacobs, which he gives us resources to do, is to think about city life, at its most complex, in its most varied set of ways.

So I think she was most valuable for the ways that she saw cities as forms of social and economic organization, right? That she was not just an actor in time, but someone who gives us concepts and ideas to play with, to think through about cities. She encouraged all of us to understand the properties of healthy city life.

Cities she thought are about human density and intensification of interdependence, a density of people and ideas, and this is how cities thrive and what they bring to human life. So she sees them as dynamic organisms, self-organizing systems of interdependencies, seed beds for what she called organized complexity that are predisposed to create vibrant social worlds.

If the planners and bulldozers could only sort of be stopped from overwhelming them with their top down plans. So as places for freedom and creativity, she saw cities as places where problems gathered not to only fester and, and to kind of last, but to be solved, right, to be, to be addressed. because cities multiply experiences, viewpoints, perspectives and ways of doing things. She thought they throw all these human practices into a kind of fortuitous relationship with one another. A combination you might say. And so they produce new ideas and new practices to solve the problems that they also collect, and allow us to see quite powerfully.

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[00:07:08] Erica Walker: Yes. So I'm probably gonna be the cynic today.

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[00:07:011] Erica Walker: I grew up in a town called Jackson, Mississippi. I don't know if you guys have heard of Jackson, Mississippi, but recently it's been in the news for its water crisis. And so for me, I kind of wanted to believe in the beauty of Jane Jacobs’ quote, but I also know that cities are a place where problems fester and they remain.

, Mississippi, and as of like: 2019

I think that's a beautiful quote, but I always ask myself, well, why haven't these problems in Jackson, Mississippi been solved? Why have they been allowed to fester? and why have there been governments, there have been research grants, there have been all these kinds of things that have been poured in the cities, but the problems have not been solved . For me, I'm sort of bitter about that.

And I also have this weird sense of survivor's guilt, like why am I here? and I know lots of people when I go home to do research, you know, aren't in this position. So I wanna believe that cities are a place where problems are solved. I wanna believe that cities are vibrant. I wanna believe that cities are great places for people to live, but I just don't see that.

And I also see us being in Rhode Island and we are in a place where the public school system are failing in some locations. there, there, there's a need for data gathering and we haven't done that, so I don't agree with cities being a place where problems are solved. I also don't believe that we are solving the problems.

And for me as a public health, practitioner, a public servant, I think that that's unacceptable.

So a large part of my work is making sure that I'm there to collect data on things that people need, and to build the infrastructure needed to be able to start addressing these problems. For me, the question is why has it been, you know, why am I the first person to put up a statewide air and noise pollution monitor in the state of Mississippi that actually provides information and data to the communities?

hy did that have to happen in: 2025

[00:09:56] Megan Hall: Thank you. Joe Braun? You look at exposure to toxic chemicals, so how are you seeing those issues really fester in cities in particular?

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We know that lead is a neurotoxicant, even at very low levels, and cities are a place where lots of children live in these homes that have lead-based paint in them. And, the issue has been that this lead has remained there despite the fact that we know that low lead levels are associated with cognitive decrements in kids, as well as increased risk of behavioral disorders like ADHD or even things like violent behavior.

Some of the work that colleagues of mine have done have shown that children's lead exposure as early as five years of age is associated with criminal arrests later on in life in adulthood. So we know that these, Problems in the city, like lead exposure can have lifelong lasting impacts.

And you know, to Erica's point is that there's disparities in this. We know that, minoritized children, as well as people from lower incomes tend to live in poor housing that has more lead-based paint in it. So there is an increased risk of being poisoned.

We know that lead-based paint has been in houses. We know that children are exposed. and, for a long time there was no action. but now, we know what to do. We know that we need to get lead out of houses. We know that we need to screen kids for elevated blood levels and do something about that.

We've actually been doing work to, to say, well, let's take that a step further and say. Can we prevent lead poisoning? Right? Like, let's not wait for a kid to get poisoned and see like, oh, they're poisoned. What do we do now? Right? Yeah. Like they've just been done. Right? Right. You know, the damage is done.

id this in homes built before: 1978

Right. We don't need to wait for the kid to get poisoned. We can actually do something about it ahead of time. And I think there's a model for us in cities to actually put that into action. You know, a lot of the work that's been done here in Rhode Island and as well back in Milwaukee where I, where I did some work for the Milwaukee Health Department, the work around lead poisoning has been done, by parent advocacy groups.

You know, so parents whose kids have been affected by lead poisoning. They're the ones out there who are asking for tougher regulations. They're out there training painters and remodelers and contractors, how to do better lead abatement and do it safely and to make sure that their children, and then the children who are gonna live in the home afterwards are gonna be safe.

So there's a model for us to implement this. and I think there's a chance for us to be proactive with cities and not just reactive to our problems. And I think this speaks to what Erica is saying is that we shouldn't be reacting to problems always. We need to be proactive as well.

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[00:13:31] Joe Braun: Yeah. The presence of lead in a home predicts the next child who comes and lives in it is gonna get poisoned. Right? That increases their risk. We know that a home with lead is a hazard. So we have to act on the unit of housing in a city really, rather than thinking about acting on the unit of the person.

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[00:14:03] Sandy Zipp: Sure. I'm moved by what Erica said about the problems that cities have produced for us. And I think the idea that Jacobs wanted to get at, which I think is an imperfect idea, also, it's important to understand that it was an idea. That was said in the 1960s at the high point of a kind of idealism about the human capacity to solve problems.

We don't seem to be in that world anymore. We seem to be on the other side of that peak down the valley on the other side. But I do think that what we might be able to take from it is that. Cities are products of larger human systems, so they collect problems of inequality, divisions of race and class, because they are thrown up by complex forms of human organization.

But the thing that Jacobs asks us to think about is whether cities then give us some set of human interrelations that gives us ways to do something about that. If we figure out how to tap into what they let us do. And sometimes it seems to me like, what we have naturally or not, excuse me, not naturally, but unnaturally in many American cities is, hierarchies of power and hierarchies of resources, right? So a place like Jackson, Mississippi and a place like Providence, Rhode Island will have different kinds of hierarchies of ability to handle their problems due to longstanding kinds of separate histories of disinvestment and particularly racial segregation in various kinds of ways.

Northern and southern patterns of racial segregation, which are different, but in some ways quite similar. And those will be very different from a New York City or a Los Angeles or in Atlanta, big cities that gather a lot of capital around them, and have figured out ways to, to mobilize that capital, not to solve the problem sometimes to, to make it even worse, but, where that capital can gather.

I mean, I think the problem that maybe we have, one of the big problems we have in big cities today, and this will look different from a Jackson, Mississippi, but it might be important to think about it in in other places, is that we've, we've reached a strange kind of impasse that I don't know, we know how to quite get out of these days.

For many years we tend to think somewhat naively that just basic economic growth on a sort of national scale would tend to solve the kinds of problems that I'm talking about, or even the kinds of problems that Joe and Eric are trying, I'm trying to mention. We ignored, of course, in saying that, the forms of a historically created racial and class division that create the problems in a place like Jackson.

Now, today, we ignored those for a long time and now we're in a sort of different problem where lots and lots of money for the last 20 to 30 years have been 30, 40 years, have been flowing back into many cities, across the country. we had this idea that that would be a rising tide. That lift would lift all boats, but now we have come to some kind of new sort of kind of a more contemporary impasse, which is that generating economic activity in cities today often appears as necessarily a kind of process of what we've tended to call gentrification. In our system, cities as any municipal official will tell you, and we know all too well, right? Is that cities can only work if they generate private economic activity, if they deliver profit to the private sector, which means tax dollars for public efforts. This is their very function. This is what they have to do when they're working well, is to continue to generate all that kind of economic activity.

But in some senses these days, that's become something of a box for us. Today we're right to be suspicious of the way that economic activity tends to be generated in kind of, loops in cities that kind of collects at the top levels of city life. It sort of is corralled at the top of our already unequal society, so we have to find a way to re-energize cities as engines of driving that economic activity down the social scale and distributing it more equitably so that it can come, and get rooted in the places where city and local economic and social activity could be put to work to solve the problems that people in communities know their dealing with whether it's led in their, their houses or other forms of essentially socioeconomic inequality and racial distinction that create the problems of a place like Jackson.

So I think that if we're going to, take Jacobs forward today, it requires that kind of thinking of thinking about the, the power and inequality that she sometimes, in her, sort of more flights of fancy, she sometimes left out a little bit.

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[00:19:21] Erica Walker: No. I'm just kidding

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[00:19:30] Erica Walker: Yes. I'm gonna say two things though. I'm gonna say three things. So the first one is that yes, absolutely. I feel like, you know, I work in communities every day that are organizing, that are trying to solve problems that may seem small to us, but are very important to them. For them it may mean life and death, and I work with wonderful faculty that are helping to find solutions for this problem. Yes, that's the first thing. So, yes, absolutely. And I think many of us at Brown are also working on, on those problems. And I'm very thankful to be in a department where I, where I feel like there are like-minded people who can help me to direct my bitterness towards action.

But second, I wanna say that one thing that I am concerned about are that cities’ dysfunction is now bleeding into rural communities. So we're sort of now spreading. And so for me, I feel like in a lot of my work, the city's dysfunction is not being contained and it's now spilling out into small rural communities across the United States.

And I think that that's something that we need to be on the lookout for because we're gonna see these city problems seep into rural life. And I grew up in the capital city, but there were also rural elements to that, so I'm very concerned about that.

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[00:20:44] Erica Walker: Absolutely. So, you know – like a wood pellet plant, something that I'm very passionate about. You know, it's not gonna set up shop on the east side of Providence because there's gonna be an active and strong voice against that. So where are they gonna go?

They're gonna go to communities where there are very few people that are gonna say anything, and they're gonna be blinded by the economic activity, and they're gonna say yes without carefully weighing out the environmental health harms that could come as a result of that. So I think that we have let the horse out the barn and now it's infecting and infiltrating rural communities.

So not only have we not solved problems in cities, we are outsourcing our dysfunction to communities that didn't ask for that. That value, that quiet, calm way of life, we are disrupting their lives as well. And the third thing I wanna say, especially to the people that are graduating today, I see some, some people that I've worked with personally, don't be like us.

Don't just sit up here and talk about the problems and talk about and intellectualize the problems, actually use their degree. You've been well trained, to go, actually go out, identify problems and work on them and solve them. Please don't be like us. Please don't be sitting up here on a panel talking about them. Get out in the communities and solve them. That would be my response.

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[00:22:15] Erica Walker: I'm bitter. Nobody wants to be around bitter people.

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[00:22:48] Joe Braun: Yeah, I think there are examples when we can really leverage the partnerships between universities, like here at Brown and then turning that into action.

And so, you know, we've done work, a lot around air filtration and using, sort of do it yourself air filters to try to improve air quality and reduce people's exposure to,pollutants as well as, you know, respiratory viruses. And I think one of the ways that we can translate that work is, you know, in our research center.

We're trying to translate that into action at the state level with policy. And so, we've been trying to advocate for the state to adopt better indoor air quality standards for kids in schools. And this seems like something where, you know, there's a natural partnership between someone like Brown University and then someone like the cities and the school districts that are served by the state and the cities, where we can do that. And there can be successes and actually, you know, there have been several hearings now, in the Capitol to advocate for those bills.

If they move forward, there could be better air quality standards for children in schools. And so I think, this is another example of something like indoor air quality, which was really brought to light during the pandemic when, you know, we were worried about masking and the number of air changes per hour and respiratory viruses and, I think there's a real opportunity to use that, and act on that momentum that came from that to improve air quality. And a lot of the major societies that, like ASHRAE and others who, are involved in setting air quality standards, have jumped on that.

And the opportunity to have better air quality standards for buildings and everyone benefits from that. And it's not necessarily respiratory viruses, but now that we're dealing with things like climate change, where we're gonna have more frequent wildfires or more intense wildfires. You know, if some of you remember in Providence two summers ago, we had, you know, orange skies, right?

Because there was the haze from the fires up in Canada blowing down to here, and we had poor outdoor and indoor air quality as a result of that. And so if we have proper air filtration, not just to mitigate against air respiratory viruses, we can also mitigate against these things like air pollution that's gonna be coming from wildfires.

And that's gonna be something that we're gonna have more examples of that that are gonna come up with climate change coming around, whether it's more intense rainfall events, you know, which could lead to, you know more increases in GI illnesses because sewage is overflowing in the wastewater treatment plants, and we're gonna need solutions to that because, in the absence of doing something about rising temperatures, we need to have ways to mitigate against those damages, that are gonna come from, from climate change.

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[00:25:33] Sandy Zipp: sure. Quickly, thinking about what Erica said about how we think about these problems and how we do something about them. I do want to insist that these things are linked to each other, right? We have to try to figure out how we've done things poorly in the past because we've thought about them wrong, and how we might go forward in new ways, in new contexts.

As a, as a historian, I think about the stories of how people in cities have solved problems. And one of the most famous stories that many of you may know, and that I'm sure Erica and Joe know better than I, one of the most famous stories, from the history of public health is a sort of famous urban story too, where these two things coincide. It's the story of the way that cholera was understood in the 19th century. In London. Right. This is a sort of famous story. You guys will probably know all the ins and outs and, and the ways that it's actually kind of a myth or it's not quite right.

ight. Is that, is that in the: 1850

He collaborated with a young doctor named John Snow, who's usually I think, the hero of this story. A doctor who believed – you guys will correct me when I get all this wrong – but the diseases like Cholera traveled not by bad smells or unclean air, so-called miasmas. It's one of our favorite urban history words, but by material contagion, right by substances that traveled, as we know they do, right?

Passing from one human to another. So working together, they talked to lots of people in that neighborhood, worked their way through the working class districts, in and out of people's houses and in the tenements of that area. and tried to figure out how the patterns of these people's lives may have created this outbreak. and they found out that, it all came from the infamous Broad Street pump, right? This place where everyone or most people, many people in the neighborhood got their water. And so they took the handle off the pump to see what would happen. Let's hope they figured out another way to make water available to people so they could go on with the patterns of their lives, their bottom up patterns of their lives.

I can't remember the details of that part of the story. But anyway, that started to stop or slow the contagion. And from that right, this knowledge gathered in cities from urban life, from the very bottom up processes of urban life helped lead to the great revolution in science called germ theory and a great revolution in urban life called the sewer.

That's you know, so there's one story about how we think about the relationship between urban ideas, urban ideas about talking to people from the bottom up, which few experts in those years and for many years after, we're willing to do right? As you all know, in your field as well, right? This is something we still wrestle with today.

I don't need to tell anyone in the field of public health about its reception and the trouble in communicating with the public around questions of public health. But this is still something we wrestle with, but which we can take from these stories, ideas about how to go forward, from, from the, the sort of interlacing of urban and health.

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Who wants to start?

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RIPTA is now slowly rolling out electric buses, but of course they're gonna put 'em in this part of town and not where I live. I live right on a highway. And so we've tried, we've helped guide questions around where they should put these electric buses and this fall – and this is a pitch for you guys to enroll in my class if anybody's still an undergraduate – we're gonna look at, comfort. Comfort in the city of Providence. People have reached out wanting to know about noise at night. They wanna know about air quality at night, and they wanna know about heat and temperature at night. So this is one of the things that we're gonna address. So I think I like to do that directly in my classes because I wanna train the next generation of students to not just sit idly by while the world burns, but actually get out there, roll up your sleeves, and get to work.

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[00:31:45] Erica Walker: But I'm still bitter.

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[00:32:57] Joe Braun: Yeah, so I think Erica's work really exemplifies what, you know this community engaged research and this approach to you know, to what Sandy was talking about with like really engaging with the people at the local level who are affected by the problems and then working from a bottom up approach rather than a top down approach, which I think goes in with the quote we started with, right?

We sort of speak to that you know, the cities are at the stoop level, right? And, you know, we should address public health problems from that stoop level up. Rather than from what we think from academics is important, which is a top down approach. Just to highlight some other work of people in our center, you know, another associate professor in our center, Alan Just has been doing some great work around climate change and thinking again about mitigation and dealing with climate change. They have a recent grant now where they're looking at the impacts of heat on nursing home residents and health outcomes in Medicare recipients. And one of the real issues with nursing homes is that not all nursing homes are created equal with regard to their ability to withstand heat as it gets warm in the summer. So some nursing homes are better insulated or have better air conditioning than others.

And so residents that might reside in nursing homes that are not as well insulated or have more sunlight, might have residents that are more at risk to these, to the health problems associated with heat, which includes cardiovascular disease and premature death. So Alan is doing work around this to identify where are these nursing homes? And what would be the impact of actually improving those nursing homes in terms of better insulation or installing better air conditioning systems? Again, being proactive and trying to do something about the problem before it starts.

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[00:33:39] Sandy Zipp: Lots of things, yeah. I mean, one of the big things about our program and for many, many years, we've encouraged students to get out into Providence and into other communities, the communities where they come from and to do work. And that's, in many ways, the origins of our program is students working here in Providence, to work with people in their communities to make this a better city. And so I'll just, think quickly about something that's just very proximate to me today, which is one of my own students this year, a senior independent concentrator and urban studies concentrator, Gabe Sender, whose senior thesis was in what he calls urban environmentality. And he went out into Providence and interviewed people working on climate issues all around the city and in neighborhoods across the city and asked them to think about and talk to him about what it was that motivated their sense of who they were in their relationship to the problem of climate change and how cities helped them, or hindered their abilities, their ability to think about and do something about climate change. And the kinds of things that he found were really profound because they asked us to think at this intersection of action and thinking, right? Thinking about who you were and how you imagined, the capacity that you had to act. And he found something really kind of interesting, which was that. This is sort of contra-Jane Jacobs, I think in some ways is that they, that many people didn't feel that there was anything necessarily profound about city life or about particularly Providence's life that helped them to, to do something about climate change.

In part because they found that providence tends to be a somewhat disparate and some times kind of isolating city. A place where people imagine they're close together because it's a small city, but actually are in their little bubbles and, and little groups, in a somewhat divided city. He did find that when they talked about the ways that small organizations are able to pop up in Providence life and address individual problems, those small organizations become the seedbeds for all kinds of conversations about the character of, of life in our time and in our moment and they are becoming, for many of these people, the, the actual, working on individual problems, sometimes not even having to do with climate that are building. The beginnings of connections that might work their way back towards solutions to climate in the end. And so in some sense, yeah, it comes back around, to the principles that Jacob started us with today. That cities are in some sense, an accelerator of, of problem solving, or could be, should they, continue to provide their activity, that we hope they would.

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Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded in front of a live audience during Brown's commencement weekend. Thank you all for being here. I'm Megan Hall. Talk to you next month.