X-POSTED REVIEW: Smith-Howard on Carr, 'The Topography of Wellness: How Health and Disease Shaped the American Landscape'

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Sara Jensen Carr
Kendra Smith-Howard

Smith-Howard on Carr, 'The Topography of Wellness: How Health and Disease Shaped the American Landscape'

Sara Jensen Carr. The Topography of Wellness: How Health and Disease Shaped the American Landscape. Charlottesville: University of Virginia Press, 2021. x + 276 pp. $34.50 (paper), ISBN 978-0-8139-4630-6.

Reviewed by Kendra Smith-Howard Published on H-Environment (April, 2022) Commissioned by Daniella McCahey (Texas Tech University)

Printable Version: https://www.h-net.org/reviews/showpdf.php?id=57216

Kendra Smith-Howard on Sara Jensen Carr, The Topography of Wellness: How Health and Disease Shaped the American Landscape

In Topography of Wellness, Sara Jensen Carr seeks to examine how Americans have built for health—that is, how ideas of health and wellness have influenced architecture, city planning, and urban design for the last two hundred years in the United States. The first half of the book, “Infectious Terrains,” examines efforts to contain the risks posed by infectious agents of disease. Here, the author both traces efforts to introduce infrastructure to contain urban wastes, as well as building that encouraged access to sunlight and fresh air, such as playgrounds. The second half of the book, “The Chorography of Chronic Disease,” explores how rising concerns about chronic diseases have shaped urban form. The author notes how frequently advocates of urban renewal, for instance, turned to metaphors for cancer to justify slum clearance. Within the past three decades, the author notes, public health experts have turned anew to the built environment to explain the rise of diseases like obesity and heart disease, and also have urged modifications to urban spaces to remediate those diseases.

Topography of Wellness reflects the author’s perspective as an architect positioned in a school of Architecture, Urbanism, and Landscape. One of the most effective chapters, for instance, analyzes the ways in which Le Corbusier’s 1923 Towards a New Architecture departed from the vision expressed in Ebenezer Howard’s 1898 Garden Cities of Tomorrow. Whereas Howard’s garden city plan reduced density and provided for greenways to create a smokeless city, Le Corbusier sought to maximize sunlight and access to open space on patios and balcony gardens, but expressed few reservations about dense housing. If Howard’s plans aimed to provide easy circulation to the city center and structured the garden city to build community amenities, Le Corbusier sought to make each building a self-sufficient dwelling, set apart from the city. In both cases, wellness and health shaped urban form, but the mechanisms for introducing air and light, and the landscapes the plans inspired, created fundamentally different urban forms. Attentive to architectural thinkers, the book focuses nearly entirely on urban spaces, with the exception of a brief discussion of health resorts and curative landscapes of the nineteenth century.

Topography of Wellness sets itself apart from many works in urban planning by disavowing a prescriptive planning vision. Rather, the book seeks to intervene in contemporary discussions of walk scores and WELL building standards by noting that designing with wellness in mind has not always achieved its aims. By narrating the ways that prior efforts to design for health have fallen short, or been provided exclusively to white or wealthy residents, the book offers caution. Housing covenants that restricted neighborhoods by race appealed to “sanitation and health.” Efforts to enhance walkability and green space have often cut former residents off from the wellness improvements touted by landscape designers. The book’s long-term perspective provokes self-reflection and analysis, tempering and contextualizing existing plans that appeal to health to justify urban design. Thus, the author offers a distinctive contribution to contemporary planners’ discussions of how to design for health and wellness.

One of the conceptual challenges the book poses is that it traces intellectual currents through two interdisciplinary fields: urban planning and public health. On one hand, the book focuses on urban planners and designers, looking for ways this group approached and understood concepts of health. On the other hand, the book traces the works of public health practitioners, seeking to uncover what they said about urban environments. Both of these groups considered the intersection of wellness and urban form, but they did so in largely separate rooms. Only in rare cases did the ideas and concepts about the intersection of health and environment reverberate beyond a single professional audience. Thus, Jensen Carr largely reconstructs parallel conversations, juxtaposing the insights of each field across time. The author proves largely successful, but struggles to integrate and toggle between the fields, making the discussion disjointed and hard to parse. For example, what ought readers make of the fact that modernist housing codes had “no overlap or references” shared with housing guidelines of the same period published by the American Public Health Association (p. 103)? The author states that the absence of a common conversation is “notable,” but it would have benefited the book and its readers had she reflected more fully on how and why these professional boundaries remained firm, even as groups considered ideas beyond the traditional scope of their fields.

In the introduction, Jensen Carr makes a case for the book’s significance based on its novelty, writing, “there have been many thorough accounts of both public health history and environmental/urban history, but they have yet to be combined in a narrative that shows their overlaps, divergences, and parallels” (p. 3). To the contrary, the past two decades have witnessed a surge in works in environmental history examining the rich interplay between health and the environment, like Linda Nash’s Inescapable Ecologies (2007), Melanie Kiechle’s Smell Detectives (2019), and Dawn Biehler’s Pests in the City (2013). Like Jensen Carr’s, these works examine shifting authority of knowledge and conceptions of health and how they shaped urban form. They share the book’s long-range perspective, considering how the rise of germ theory and then attention to chronic diseases transformed how experts thought of the healthfulness or hazards of the landscape. Unfortunately, like public health and planning experts of earlier generations, design historians and environmental historians seem to be engaged in parallel conversations in separate circles.

For environmental historians, Topography of Wellness’s contribution is less in its juxtaposition of public health and landscape histories, and more in the way it offers a bridge between historical understanding and contemporary planning practice. Many environmental historians find themselves making a case for how and why their historical insights can benefit students interested in addressing contemporary challenges in urban environments. Others find themselves working on grants alongside public health and planning colleagues. Books like Jensen Carr’s provide the language and concrete examples to foster more fruitful connections with colleagues in urban planning, public health, and public affairs. As I worked on the review for this book, I attended a meeting of my city’s own sustainability committee, and found my mind abuzz with the insights the book lent to my own understanding of the proceedings and assumptions of that meeting. By providing a public record and reflection, Sarah Jensen Carr clues readers in to the current and past contours of conversations in health and urban design. A conversation starter if not the last word, Topography of Wellness poses important questions for those who seek to collaborate to create more just and sustainable cities.

Citation: Kendra Smith-Howard. Review of Carr, Sara Jensen, The Topography of Wellness: How Health and Disease Shaped the American Landscape. H-Environment, H-Net Reviews. April, 2022. URL: https://www.h-net.org/reviews/showrev.php?id=57216

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