"The shape we give our city in turn shapes us." This is the ethos behind the Nashville Civic Design Center's Shaping Healthy Communities project, created in 2011 through a partnership with the Metro Public Health Department to address the impact of development and urban planning on health. Through research and education, the Civic Design Center seeks to improve Nashville's health by improving its design.

"The things that are really driving mortality and medical costs today are chronic diseases driven by choice," says Dr. William Paul, director of the Metro Department of Health. "So often, the healthy choices seem to be the harder ones. So how do we build opportunities to be healthy into our environment so it's a more natural, everyday occurrence?"

The relationship between infrastructure and health is not a newly discovered concept. In the 19th and 20th centuries, the redesigning of cities helped eradicate many infectious diseases and toxins. But today's design challenge is no longer about keeping cities clean. It's about making them more active and accessible.

Suburban post-World War II design created cities, like Nashville, in which transportation design was entirely car-centric. Prioritizing vehicles affected how cities allocated resources, sited schools and managed their green spaces. When those features could not be accessed without a car, the population became increasingly sedentary.

Now, contemporary cityscapes are being designed to better serve pedestrians, bikers and public transportation. Doing that helps grow the number of people using those modes of transit and improves access to a city's resources. In early 2015, the Civic Design Center will publish a major research project called Shaping the Healthy Community: The Nashville Plan, an in-depth look at the factors that impact health -- transportation, housing, neighborhood design and access to open space and food resources -- as well as how to improve them. The challenge for Nashville and its peer cities is getting those healthy design elements from theoretical renderings to groundbreakings.

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For older roads, however, simpler solutions are necessary. A cheaper option for improving access is a "road diet," says Ron Yearwood, urban designer for the Civic Design Center. Simply adjusting paint stripes can reconfigure streets, and one such example is the improved bike lane added to Korean Veterans Boulevard between Hermitage Avenue and Fourth Avenue South.

"Most of our streets are overbuilt," Yearwood says. "Road diets are an easy and cheaper way to capture a new set of spaces by reallocating them to multiple user types."

Enough buffer space is crucial for bicyclists and pedestrians to feel safe enough to increase their usage, Yearwood says. A number of low-cost solutions, such as repainting bike lanes in a bright color or adding rubber bollards, will not damage cars but reinforce the separation of the lanes.

Creating connections

As Nashville's population continues to grow, so will the number of cars on the roadways and the challenge of maintaining effective traffic flows. Effective urban planning, then, must emphasize transit as an integral component of commercial and residential development.

"You can't isolate," says Gary Gaston, design director at the Civic Design Center. "Development has to accompany transportation, and vice versa."

Currently, Nashvillians lack easy connections between many of the city's commercial hubs. Developing and connecting those centers and burgeoning areas along underdeveloped pikes is another priority for the Civic Design Center and the city's future planning efforts. As the city grows, finding new spaces for healthier, more walkable mixed-use districts adjacent to residential areas -- think 12South, Germantown and Five Points -- is a growing challenge, particularly as development impacts historic and lower-income areas. But Yearwood says planners are looking to the city's pikes and major corridors as commercial spaces that haven't quite hit the "center" status.

"Nolensville Pike, Gallatin Pike, Dickerson, Charlotte -- all the pikes and other major corridors. It's a matter of time before those areas become even more connected," he says. "So the goal is investing in those spaces where you can have that redevelopment, those connected communities, without the teardown of existing neighborhoods."

For the Civic Design Center, shaping healthy communities is all about seeing disconnected spaces in a different way. A street-level row of perpetually empty parking becomes a sidewalk to the bus stop. A turning lane with minimal usage gives way to bike lanes on roads that don't have them. Deteriorating fences behind retail spaces become pedestrian corridors between shopping centers.

"For example, Nolensville has so much activity and is such a diverse community. People who live there walk a lot already, but we're just starting to put our emphasis on development and density along those pikes," Yearwood says. "You can create those village centers more carefully along those corridors, enhancing existing neighborhoods without losing the affordability and characteristics that make it so great."

In the short term, people living in successful communities walk more, use more public transit and are better connected physically to their community spaces. In the long term, their overall health improves, particularly those who are now isolated in neighborhoods with inadequate accessible food and transportation resources.

"You just have to see the potential for these residential spaces and urban centers that don't quite exist yet," Yearwood says. "You want to see change and progress and accessibility, and it's about finding the incentive and potential for livable, walkable communities."