To appreciate the classic American town, go to Europe. The narrow streets of most European cities and towns meander past a parade of tightly packed homes, cafes, shops, markets and parks, all teeming with people on foot. Today, we think of this buzzing pedestrian existence as the kind of quaint thing you plan a vacation to experience. It used to be daily life for Americans too, says James Sallis, a public-health and behavioral medicine researcher at the University of California, San Diego—right up until the early middle of the 20th century, when we started rebuilding the American community around the automobile. "People liked riding in cars, and so we got the suburbs," he says. "Now everybody has privacy, quiet and space."

What they also got, Sallis adds, was fat and unhealthy. Suburban Americans came to build their lives around sitting—sitting on the sofa, sitting at an office desk and, most of all, sitting in the car. The car became essential, increasingly so as work shifted from the local factory to offices in the city; as the local butcher, baker and grocer were replaced by more distant supermarkets; as malls three towns over pulled business from local shops. Kids went from meeting up with friends at nearby playgrounds or soda shops to being shepherded in a car from school to math tutoring to tae kwon do to soccer practice. Lost along the way were the daily walking and biking that used to get people from place to place in their self-contained communities.

This loss might not be worth mourning as more than the march of progress, if it weren't for the bonus it had quietly been delivering. We now have decades of ever-growing, nearly incontrovertible evidence that moving our bodies on a regular basis is a very healthy thing to do, and the loss of this habit in America has taken a horrific toll. Eight hours or more a day of sitting nearly doubles the risk of Type 2 diabetes and sharply increases risks for heart disease, cancer and earlier death, according to research from the University of Utah and the University of Colorado. The average American sits more than nine hours a day.

Simply walking, on the other hand, is, as one former head of the Centers for Disease Control and Prevention put it, "the closest thing we have to a wonder drug.” That's not hyperbole: The European Society of Cardiology found a 20-or-so-minute-per-day walk added an average of seven years of life. According to the CDC, more than one out of 10 premature deaths in the U.S. can be pinned squarely on a lack of physical activity, along with more than one-tenth of health care spending. Walking leads to a 14 percent lower risk of breast cancer for women, an American Cancer Society study reported. A Harvard study found that brisk walking or equivalent exercise cut stroke risk in half. Adding in walking three days a week sharply boosted cognitive performance in older adults, a study in the journal Nature reported.

In a nation whose leaders are preoccupied with the dauntingly steep rise of health care costs, walking would seem like an easy, free way to flatten that expensive curve over the long term. Yet we don’t do it: Only half of adults meet the minimum levels of activity called for by the surgeon general in 2013. Estimates from those who have studied the decline of walking suggest we walk on average about half as much or less as we did in the early 20th century, and the rate seems to keep dropping—an average decline of about 1 percent a year for the past 25 years. And this in spite of an array of experts sounding an unending drumbeat of warning about the need to walk more. The CDC openly admits all efforts on the parts of medicine and public health to cajole the public to get moving have failed.

If people can’t be cajoled to walk for its own sake, is there another way to get them moving? In recent years, planners and policymakers have begun to pull back and consider another solution: If suburbs are the problem, maybe suburbs can be re-imagined as the solution. People drive because their neighborhoods encourage it—and sometimes even leave them with no choice. What, then, if their neighborhoods were built to foster walking? With the right layout and development, the notion goes, our suburban towns and sprawling new cities might become havens of human-powered rather than petroleum-fired motion. Along the way, health should soar.

Brian Saelens, a behavioral sciences researcher at the University of Washington's School of Public Health, has for years been studying how people's activity levels are influenced by the "built environment"—that is, all the structures and surfaces of the communities around them. What he’s found is that about 25 to 30 percent of people walk because they like it. "The rest of the population needs help if they're going to get walking and be healthier,” he says. “If you can make walking easier than other forms of transportation, that's where you hit pay dirt." A study he ran on public-transit users confirmed this: Even people who aren’t recreational walkers will travel more on foot if the logistics of their lives encourage it.

Suburbs and spread-out cities around the United States are trying to rebuild their roads and other infrastructure to get residents walking instead of driving, as a long-term strategy to improve their health. Four towns on the forefront of that effort, clockwise from top left: Zebulon, N.C.; Fitchburg, Mass.; Baton Rouge, La.; and Cuba, N.M. | Erich M. Fabricius; Diderot; Alamy Stock Photo

Across the country, this idea has started to make the leap from universities and public-health panels to real town planning—as well as resolutions on the ballots of local elections, and in hundreds of cases, actual construction projects in communities all across America. These projects range from schemes to create appealing and safe paths for walking and biking, to rezoning that brings houses and businesses closer together, to the reconfiguring of old suburban street plans. And while, predictably, metropolises like Seattle, San Francisco and New York have jumped on board the walkability movement, it’s also being tried in a number of the towns and sprawling cities in red-state America that face the biggest long-term obesity crisis.

The challenge underlying all these changes is a very human one: In America, most people simply don't want to walk or bike. That means the redesigned built environments have to change people's minds, not just removing the excuses they have to drive, but encouraging them to think differently about how they get around in the long term. The goal is that they'll walk or bike as a matter of choice, not because a doctor or journalist tells them to. America is nearly a century into an environmental reengineering of the population's behavior away from walking and biking. Now it's setting itself to re-reengineer their behavior back.

WHAT IS IT in the landscape of a community that makes people choose to walk? That's a critical question for those who hope to redesign healthier towns. To get some answers, Saelens and colleagues wired up 700 people in the Seattle area with GPS trackers and mapped their routes when they walked. Then they analyzed what sorts of built environments were along those routes. They found that, roughly speaking, there are two types of walkers: Those who walk because it's an easy, fast way to get where they're going, whether it's work, a store or a cafe; and those who walk because they're interested in the natural scenery along their paths, such as parks, rivers and woods. In other words, walkers tend to be in it either for the journey or for the destination, but generally not both. "It's the difference between enjoying what you're seeing along the way, compared to just wanting the shortest route to the bus stop," says Saelens.

That's a critical insight, because it suggests that communities that want to make big strides in boosting walking and biking need to cater both to the destination-focused "utilitarian" walkers, as Saelens calls them, and the scenery-focused "recreational" walkers. The former calls for direct, safe routes; the latter for lovely, meandering trails and paths. Increasing the ranks of the "recreationals" isn't rocket science; it just takes the community will and resources to improve parks and add in networks of walking and bike trails. If a river, pond or other body of water can be worked into the trail network, so much the better.

The "utilitarians," on the other hand, are a tougher crowd. To be motivated to walk, they need to have places to get to that are within walking or biking distance, and with efficient and safe routes to connect them. The challenge of providing destinations close enough to make driving unnecessary is a big one for many communities, thanks to a century of development that prioritizes space over density—and often zones neighborhoods so that shops, restaurants and offices can’t be built there at all. Given typical suburban zoning, even the most delightful walking path won’t attract a big chunk of the population. "A sidewalk that doesn't go anywhere interesting isn't likely to be much of a resource for people," says Heather Wooten, a vice president at ChangeLab Solutions, a healthy-community advocacy group in Oakland, California. "When they lead to downtown areas within walking distance, then people will gravitate toward them."

Public transit, too, tends to encourage utilitarian walking—often without people realizing they’re getting exercise at all. "The walking that transit adds is important, because it's not associated with people wanting to be more active," says Saelens. "It's walking that's automatically engineered into their lives. They don't think of the walking as a special activity." But bus and train stops are uncommon in the kinds of spacious, all-residential communities where people drive to everything.

Bringing walkable and bikeable destinations throughout the suburbs requires two big shifts in zoning. First, zoning has to be relaxed to allow downtowns to blur into residential areas, and smaller pockets of shops and offices to spring up throughout the community. Secondly, overall residential density has to increase. A community with acre after acre of single-family homes plunked down on large lots typically can't provide enough walking traffic to support nearby businesses or public-transit stops because there simply won't be enough people in the area. What's more, sparsely populated communities tend to be less interesting and accommodating to walkers, often lacking long, straight streets with good sidewalks; they have no attractions to offer but monotonous views of lawns. The fix for these is allowing smaller lots for single-family homes and more multifamily homes and apartment and condo buildings.

Another key element of community redesign, says Wooten, is reconfiguring the streets to change the way people think about them. "The goal is to create the perception that a street is a place designed for people to walk and bike, instead of just as a place to accommodate cars and trucks," she explains. That means, for one thing, creating more and bigger sidewalks, and bike lanes—but without removing parking spaces, because communities tend to regard those as precious assets. The answer, in many cases, is what's called a "road diet": A road with two lanes in each direction is repainted to be a three-lane road with the center lane serving as a left-turn lane for both directions. That leaves more room for sidewalks, if needed, and especially for bike lanes. "It's a way of reprogramming streets to get space for biking and at the same time to get better traffic flow for cars," says Wooten. The street tends to feel more walkable as well, she adds, since bike traffic feels friendlier to pedestrians than four lanes of car traffic.

Safety is another requirement. Pedestrians are far more vulnerable to crime than drivers. Bikers perhaps less so, at least while they're pedaling—but when they park their bikes to shop, work or take public transportation, they risk losing them to thieves. "In the Bay Area, bikes left near public transportation stops for the day will have them stolen reliably," says Matt Normand, a behavioral scientist at the University of the Pacific in Stockton, California, who studies behavior change related to physical activity. As a result, says Normand, many would-be bikers simply give up on biking to the train station. That's why lighting, surveillance and policing can be important components of a walking- and bike-oriented community makeover.

Utilitarian walkers want to get to where they're going, which means they don't like standing around for long periods waiting to cross busy intersections. But Normand notes that pedestrian walk lights are usually timed to come on only after long traffic-light cycles, and in some cases only come on every two traffic cycles. For a pedestrian, hitting a few of those lights at the wrong time can mean doubling what would have been a fast walking trip. "There's a bias to keeping car traffic moving," Normand says. Speeding things along for walkers means changing the traffic-light cycles to shorten pedestrian waits, even at the cost of slowing traffic flow.

Communities eager to boost health through environmentally nudged activity, says Normand, have one other often-overlooked factor with which to play: embracing the vertical. Stair-climbing is terrific exercise, even in small doses, and Normand argues that U.S. communities and the businesses and institutions in them seem to go through a lot of trouble to protect residents and visitors from ever having to climb a flight of stairs. To be sure, he notes, elevators should always be an option to ensure access for people with disabilities. But there are plenty of established strategies for encouraging those people capable of climbing stairs to choose to do so, and a lot of them could be enacted with zoning and other regulations. Losing escalators in low suburban buildings would be one good step. Another is taking the conventional relative status of stairs and elevators—with elevators being bright, shiny, inviting and centrally located, and stairs darker, dingy spaces in the corners of the building—and flip them around. "Studies show that nice, bright staircases placed front and center greatly increase use," says Normand. (He himself focuses on plain old walking, averaging about 17,000 steps a day, according to his Apple watch.)

With roads designed strictly for cars, and neighborhoods designed for privacy over street life, American suburbs give their residents nowhere to walk—even if they wanted to. | Alamy Stock Photo

TAKEN TOGETHER, the elements of a walking- and biking-friendly community makeover aren't just challenges to town planners and zoning boards. They are an upending of how Americans have chosen to live. If, 30 years ago, a town announced plans to pack homes closer together, mix businesses in with them, give cars fewer lanes and more red lights, and appropriate land and funding³ for bike and walking paths, prospective residents would have jumped in their cars and raced in the opposite direction. Now, in more and more communities, these sorts of initiatives are becoming a point of pride.

Tailoring a community to spur walking and biking is easiest when the community is being built from scratch. Saelens says the best opportunity is around fast-growing midsize cities abutted by still-undeveloped surrounding land. He notes that springing up around Baton Rouge, Louisiana, and Gaithersburg, Maryland, are clusters of new, high-density communities laced with cafes, train and bus stops, good sidewalks, bike lanes on all the major roads, and parks and recreational spaces webbed with walking and biking paths. "There's almost a utopian quality to these carefully designed communities," says Saelens.

But most of America isn't going to be moving into brand-new towns and developments. For the vast majority of communities, what's needed are ways to retrofit walkability and bikeability into places built for cars. All the other elements of a walking-promoting makeover would be logistically and economically challenging even if everyone in the communities agreed on the needed changes—and, of course, they don't. "The biggest question is how much of this transformation are decision-makers going to allow to happen," says Saelens.

In spite of the daunting challenges, hundreds of cities and towns of all sizes throughout the U.S. have embarked on initiatives to pump up human-powered transportation and its associated health benefits. Most important, many of them are significant efforts taking place in communities whose residents have long resisted healthier lifestyles, and tend to not have resources to spare on other than essential projects, nor the inclination to invest in public health. "It's great when major cities do these things," notes Rich Bell, senior project officer with the advocacy group Active Living By Design in Chapel Hill, North Carolina. "But when you see it in other types of communities, it's especially encouraging."

For example, it's not often that public-health advocates look to Mississippi to point out shining beacons of leading-edge, grand initiatives. But the small town of Hernando has, since 2001, been advancing one of the most comprehensive plans in the country for remaking community design around health-boosting transportation. Former Mayor Chip Johnson, a Republican, declared several years ago he was going to make Hernando the "healthiest home town" in the state, which has the highest obesity rate in the country. Johnson spent the past 15 years cheerleading and cajoling the community into bowling through a wide range of objections, getting the town to force developers to add sidewalks, set aside 10 percent of their land for open spaces and parks, and slice big residential lots in thirds to increase density; subject major roads to diets that made room for bike lanes; set up oases of green throughout routes popular with walkers and bikers; and set aside 70 acres of prime land for mixed use development. The biggest triumph was getting the town to agree to pay for it all. "Mississippi isn't a state where people tend to be real generous with taxes," notes Sallis.

While most towns aren't ready to jump into major rezoning and redevelopment plans, many are determined to make progress by attacking walking- and biking-related transportation issues on all fronts, including public transportation, traffic control, and routes, paths and trails. Hidalgo, a tiny town in the southernmost tip of Texas, has begun efforts to bring in new public bus lines with stops, complete with bike-parking stations, every one-third mile along major routes. These routes will connect to a network of walking trails and bikeways, many of them along a canal that runs through the town, and some of them connecting to trails in neighboring town. A new bridge dedicated to pedestrians and bikes will help move people across the canal and thus more easily through the entire town. More stop signs and pedestrian walk signals, along with bike lanes, will make the existing road system friendlier.

Other towns are picking off the problems one at a time with focused projects intended to catalyze further change. A popular approach is the one taken by Zebulon, North Carolina, which has set up "greenway corridors" laced with walking and biking paths, strategically placed to connect to walking- and biking-friendly roads, schools, ponds, the downtown area and a boys and girls club. Cuba, New Mexico, has been building enthusiasm for rebuilding its sidewalks and adding paths and trails by developing an app aimed at walkers and bikers, as well as encouraging volunteer trail-maintenance groups and walking groups.

For some of the economically harder-hit and more diverse communities hoping to lift health with walking and biking, the bigger initiatives center around ensuring the safety of those who want to participate. Fitchburg, Massachusetts, enlisted businesses and community groups to "adopt" the town's 16 parks, freshening them up, adding 40 community gardens throughout the parks, and keeping them busier and thus safer. The efforts were supported by the police department, which made having a strong presence in the parks a top priority, declaring the parks to be "safe zones." The town also built a new major park and embarked on an effort to connect its streets to provide more efficient routes for walkers and bikers to the parks. Fitchburg registered the second-worst body mass index in the state when it began its initiatives in 2009; since then it has dropped its BMI 10 percent, falling well down the list. Similarly, Richmond, California, a diverse, midsize city outside Oakland that has struggled with a loss in manufacturing jobs central to its economy over past decades, has invested not only in better lighting, more police patrols and more appealing park spaces with walking paths, but also tighter air-quality standards, in order to get its residents walking and to bring in visitors and business investment.

To get people walking and biking, it's key for towns give them somewhere interesting to go. At left, San Antonio's Riverwalk; at right, bicycle tourists in Savannah, Ga. | Alamy Stock Photo

When you think of populations that just aren't getting any exercise and suffering for it healthwise, you probably don't think of college campuses—but you'd be wrong. "When I look out across our campus, I'm horrified by the physical condition of many of our undergraduates," says University of the Pacific's Normand. "We have a lot of Latino students from families with long histories of obesity and diabetes, and that's just part of the problem." To do something about it, the university embarked on its own walkability makeover, essentially banning all car traffic to an outer ring and turning all the on-campus roadways into pedestrian-only routes. Students who drove themselves around campus now have no choice but to walk.

ONE BIG CONCERN hovers over the field: When a community becomes bike- and pedestrian-friendly, home prices and business investment tend to shoot up. That's rightly seen by many as a big benefit, of course, and it's often touted by town leaders as an incentive for undertaking these transformations. But for others, rising home prices mean driving out longtime residents who are less affluent and can't keep up with escalating rents and rising local prices for food and other goods—so they end up moving to cheaper, less healthy towns. That wouldn't happen if all communities became more walkable, notes Sallis. But because many communities are, for any number of reasons, unwilling or unable to make the improvements, there's a pent-up demand among consumers and businesses for the places that do.

One reason more communities don't make the jump is that these changes are literally illegal in many suburbs—tight zoning restrictions on everything from mixing business with residences, to adjusting street size, to building height, to minimum home-lot size, can all conspire to derail pro-walking initiatives before they get off the ground. "The market wants walkable neighborhoods, but the law won't allow building them," says Sallis.

These restrictions can be overcome, to be sure, as they were in Hernando and Hidalgo, through committed leadership and coalition-forging—critical factors, according to ChangeLab's Wooten, who adds that a variety of local and even state agencies have to jump on board, along with business leaders and key influencers throughout the population. "You need to get the people running transportation, schools, housing, parks, environment and more all on board," she says. "It's not just the public health people. You have to get everyone thinking about all these resources as health-related resources. And they have to create durable policy collaborations that will last for the 25 years or more it can take to fully transform a community."

That sort of time frame may sound daunting. But it's merely a quarter of the full lifespan that a human being with good lifestyle habits and moderately good luck with genes might expect to achieve going forward. The long arc of population health improvement demands that we think in decades rather than months. There's little question that these investments are essential, and that they'll pay off; the only question is when we'll undertake them in our own communities.

Besides, although these plans may take a few decades to come to fruition and catch on, once they do, the improvements are likely to accelerate. That's because the ultimate investment is not in changing streets and parks—it's in changing the way we think and behave, which tends to be powerfully influenced by the thinking and behavior of those around us. We can make that big cultural shift of moving from cars to walking and biking, notes Normand—but risk seeing the shift peter out if we don't rebuild our communities in anticipation of that growing behavior change. "When you do get people willing to walk," he says, "you want to make sure the environment is in place to support them."

David H. Freedman is co-founder and Executive Editor of Global HealthCare Insights Magazine, and a contributing editor at The Atlantic. His most recent book is "Wrong: Why Experts Keep Failing Us."

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