The Next West
Health and equity for all Coloradans
By Jessica Cox and Sarah Ryan
Illustration by Studio Muti
Colorado is one of the fastest-growing states in the nation. Population projections estimate everything from moderate growth to nearly 15 million residents in 2100. At the same time, the U.S. population is aging and increasingly urban. More than two-thirds of Americans will live in cities by 2050, and their health outcomes will be impacted by their built environment.
Larimer County Public Health Director Tom Gonzales (B.S., ’96) thinks about health and equity every day. “We have ZIP codes in Larimer County where the life expectancy is very different, up to 10 years less,” Gonzales says. “What causes that? It could be access to parks, access to healthy foods, air quality issues due to transportation.”
Kayla Lesperance, a public health officer and industrial hygienist in Denver, is also concerned about the intersection of race, place, economics, and health. “I think everybody should know about the disparities in health due to racial inequities,” says Lesperance (B.S., ’17). “Populations who live close to major highways and farther away from grocery stores and parks have a shortened lifespan. In Denver, their life expectancy is 75 years compared to 85 years for people in higher income areas.”
Dr. David Rojas-Rueda is a former surgeon who now teaches environmental health at Colorado State University. He studies how our options determine our behaviors – from how we move around our neighborhood to how much time we spend inside or outside – and impact our health.
“The amount of physical activity you’re doing daily, the amount of nature you’re in proximity to, the risk of traffic accidents – these are determinants of health. They translate into cardiac health, life expectancy, quality of life, and diabetes. They’re all connected,” Rojas-Rueda says.
Climate change is already exacerbating health inequities. Lesperance points out that climate change will affect everybody, but it will put more of a strain on the health of individuals who work outside or in manual labor. In Larimer County, hospitalizations increase during wildfire season and when ozone is high.
“What are the biggest contributors to ozone in Colorado? Transportation, oil, and gas. We have to keep addressing that as a region,” Gonzales says.
Public Health 3.0
How do we plan for growth AND reduce greenhouse gas emissions AND design urban areas that are healthy, resilient, and sustainable for all Coloradans during an era of climate change?
This is a wicked problem with many stakeholders and no “right” perspective or solution. Wicked problems require creative, collaborative, and flexible problem-solving, which has led to a sea change in environmental public health and urban planning.
“We’re moving into public health 3.0,” Gonzales says. “We’re becoming community health strategists working on the built environment and looking at inequities within our communities. We’re conveners. We bring experts together when we’re building communities.”
Rojas-Rueda agrees that perspectives have to change to improve health for all populations.
“We need to redesign cities because young, healthy, male practitioners were designing our cities based on their experiences and not thinking about other residents,” Rojas-Rueda says. “These biases need to change. We need to think about different and future perspectives. The built environment provides us a great opportunity to change public health.”
Health and equity can be integrated into all policies, from transportation and zoning to energy and sustainability. But the best solutions will be driven and owned by the communities they impact, which requires honest conversations about social justice.
“We’re going to our marginalized communities or people of color or communities with poor health outcomes and asking, ‘What do you need? What’s your agenda?’ Those conversations are happening. We’re building relationships we didn’t have before,” Gonzales says.
People, Profit, and the Planet
Environmental health specialist Shannon Oliver (B.S., ’06) argues that sustainability is also an essential lens. “True sustainability considers the triple bottom line – people, profit, planet. We can conserve energy, help the environment, reduce waste, and save tax dollars,” Oliver says.
Oliver is especially excited about transforming how we produce and use energy. “We are moving toward large-scale electrification and away from fossil fuels on all fronts – transportation, aviation, how we get energy, how we consume it,” Oliver says.
Oliver argues that in the future there won’t be large power plants scattered across the Front Range, but a distributed network of energy production. “We’ll make our buildings super energy-efficient and use a combination of renewables and small power plants. This is called ‘islanding.’ It’s starting to happen, and we need to do it,” Oliver says.
Sustainability expert Amanda Sutton (B.S., ’07) is cautiously hopeful about the future. She sees data and digital solutions as essential to creative problem-solving – with some reservations.
“We’re already seeing an exponential increase in the collection and availability of data that can be used to inform a more holistic design of our cities and buildings to create healthy and thriving communities,” Sutton says.
Data makes it possible to play with the digital environment, to test theories and understand the implications of decisions as we design our homes, office buildings, and communities. But technology can also lead to isolation and disconnection, which have their own health impacts.
“We should focus our attention on building communities that create opportunities for human connection,” Sutton says. “We have to be intentional about valuing connections with each other and our natural world.”
We asked community members who work in environmental public health to predict the future. How can we build communities that are healthy, sustainable, and resilient for all Coloradans? We asked our experts to dream big, and then we gathered their ideas into a bold vision of Colorado in 2100. Welcome to the Next West!
How We Move
In the 15-minute city, where you can walk to everything you need – school, work, food, health care, and leisure – in 15 minutes or less.
Biking, walking, public transportation, and autonomous electric vehicles have made individually owned, gasoline-burning vehicles obsolete. Residents can rent scooters, bikes, and electric vehicles from the city’s transportation program. Light rail and tube transport have replaced buses, trains, and airplanes for regional and international travel.
There’s a lot more space for people. The city’s main streets are closed to vehicles during the day to create open spaces for walking, cycling, classes, and events. Sidewalks and bike lanes are expanded, and terraces in front of restaurants and commercial spaces invite socializing.
How We Build
The built environment produces zero emissions. Waste, water, and energy have been decentralized. Individual buildings capture, clean, and recycle water and waste. They produce and store green energy, while passive heating and cooling systems reduce energy needs.
New buildings are designed for flexibility and longevity. Commercial and residential spaces co-exist. Buildings are retrofitted for new uses rather than demolished. City footprints have shrunk even though urban areas are denser.
Emissions-heavy materials such as asphalt and concrete have been replaced by renewable building materials that remove carbon from the atmosphere. These new materials use local resources and bacteria to capture carbon and can be recycled into permeable surfaces. They also change color with the season and the weather, so they can reflect heat when temperatures soar and absorb it when they drop. Outdoor lighting automatically dims at night.
Where We Live
We live in multiuse neighborhoods where work, school, and play are all within reach. The air is clean and there’s very little noise and light pollution. It’s easy for everyone to get outside, to exercise, and to socialize. The neighborhood is diverse and vibrant.
Microschools have replaced large brick-and-mortar schools with aging infrastructure and high utility costs. Small, agile learning centers offer year-round schooling for children and lifelong learning for all ages. Graduation and employment rates have increased for all populations.
Pocket parks, green spaces, and rooftop gardens invite healthy recreation, reduce disease, lower urban temperatures, and contribute to local food production.
How We Care
Health care is less expensive and more equitable. Public health spending is focused on primary care and prevention. Neighborhood clinics offer affordable, universal primary care.
Cardiovascular disease and cancer are no longer common causes of death for Coloradans. Obesity, diabetes, substance abuse, lower back pain, traffic accidents, and emergency room visits are all rare.
Rates of premature death have dropped dramatically, and life expectancy no longer depends on your race or ethnicity or where you live.
How We Grow
Agriculture is increasingly local and focused on products that are sustainable for the environment and human health. Community-supported agriculture subscriptions are available for everyone.
Data centers are co-located with farms. Their waste heat warms greenhouses and powers compost centers. The energy grid is electric, powered by a combination of geothermal, wind, and solar, and maintained by a highly educated workforce.
As greenhouse gas emissions decline, air quality improves. Air quality monitors track emissions across the state and power automatic warning systems that alert residents to wildfires and other sources of air pollution.