Deadly Design: Suburbia and the Social Determinants of Health

Imagine being told that your zip code is a large predictor in how well you live or how quickly you die. While that is a bit dramatic, it is indicative of how health outcomes are so closely tied to where we live, play, work, and occupy most of our time.

Now imagine that one man decided what your community would look like…what your house would look like, your neighbor’s houses, your yard…what would you want to know about this person? Perhaps his motivations? His preferences? Prejudices?

What if you learned that the very suburb that you grew up in was largely because of a racist developer who wanted to separate the working poor and minority population from the white middle-class, wealth-building machine? How might that make you feel?

Our perspectives about the suburbs may vary depending on what side of the fence we grew up on: those who grew up out of the city center are either familiar with the quaint cul-de-sacs and tree-lined dividers. Riding bicycles in The Loop and attending HOA meetings with our parents. On the other hand, those who grew up in the middle of the city may recall having school numbers instead of names, socializing with friends on stoops, and walking to corner stores for life’s daily essentials.

Now imagine how one man’s plan shaped these memories…and determined health outcomes in the process.

The Birth of the Cookie Cutter Community

After a stint in college and multiple failed marriages, William Levitt tucked his tail between his legs and joined his dad’s development company. It was only after his Naval service during the second World War, though, that his vision began to materialize. What Levitt saw, was a desperate thirst for veteran housing…and an opportunity to quench it. Levitt didn’t just build houses, he manufactured the “American dream”. Using Henry Ford-esque assembly-line logic, Levitt designed thousands of mass-produced, Cape Cod-style homes and promised them to be the white middle class exodus from the congestion and chaos of the center city. They touted modern kitchens, manufactured yards, and a utopian escape from city life. These were more than houses: they were a symbol of status. Levitt houses formed “Levittowns”, as they became colloquially known as, and these communities became the precursor to what is known today as the suburb.

Planned Morbidity: Engineering the Social Determinants of Health

The three things most systems have, as any systems theorist will tell you, are boundaries, interrelationships, and perspectives, and for Levitt, each element held a special place in Levittown. For clarity, when thinking in terms of boundaries, think about marginalization. When thinking about interrelationships, think community. When thinking about perspectives, think in terms of bias. Levitt was a staunch supporter of segregation and fought tooth and nail to keep Levittowns white. He promoted his communities as a pleasant escape from the urban unpleasantess his bias connected with black and brown neighborhoods. They were designed to be tools for wealth-building, accessible by only those privileged enough to afford individualized automobile transportation. While he was building his houses, Levitt was also engineering housing disparity. For Levitt, it was more than aesthetics, it was planned morbidity. Why? Because those inside the borders of his communities gained proximity to health by maintaining distance from the crowded and polluted urban center. It also awarded residents the freedom of choice: about what doctors to see, what schools to attend, and what stores to buy groceries from. Those left to dwell in the urban centers became victims of marginalization, facing increased exposure to manufacturing chemicals, communicable disease transmission, and the psychological burden of finite resource competition.

A Full Circle Moment

However, today, we see the full circle of this design: zip code has become the largest predictor of health outcomes, and the architecture of suburbia became the blueprint of the health disparities experienced today. So then…what happened to Levitt? The man who developed the road map for the “American Dream” died a wretched nightmare…never even getting to enjoy his own idyllic ending. He died desittute and in poor health at the age of 86. Without waxing poetic about his legacy, the story of William Levitt and suburbia is proof positive that systems are constructs…and so are health outcomes.