When someone thinks about healthcare, they often think of hospitals, doctors, and clinics. But the design of a city, the way its streets are connected, where stores are placed, and how public transportation is run, has an equal, if not greater, effect on public health. Land use policy can shape how people eat, move, and access care, controlling where homes, shops, grocery stores, and clinics exist, determining large factors in a person’s health.

Zoning began in the early 20th century as a public health measure, with cities using it to keep factories away from humans, reducing pollution and controlling the spread of disease. However, over time, zoning has changed to serve economic and aesthetic purposes. Today, zoning laws dictate where businesses can open, where housing is built, and how far people must travel to reach their daily needs. With outdated policies isolating residential areas, they can unintentionally cause health issues, reducing access to healthy food, green space, and medical services. The American Journal of Preventive Medicine states that zoning reforms are one of the most powerful and underused tools for improving population health.

Modern research states that city planning, deciding where people live, strongly influences their health. A study analyzing more than 150,000 satellite images across U.S. census tracts found that features of environment, like road networks, density, and land cover, could explain up to 90 percent of the variation in obesity today.

Neighborhoods that are walkable, more compact, and connected consistently had lower rates of obesity and heart disease. According to the National Library of Medicine, communities designed for walking and biking that promote physical activity always had longer life expectancy.

Communities having more diverse land use, meaning that they have a variety of infastracture from homes to stores to clinics, and parks all coexisting, almost always tend to be healthier and more equitable. In contrast, areas limited to single-use zoning leaving residents lacking and isolated from many basic services like nearby healthcare or afforable close grocery stores. A 2021 study by West Chester University found that counties with high land use diversity had stronger health equity, particularly for low-income populations. Similarly, the Pew Charitable Trusts states that mixed-use planning improves access to fresh food, safe spaces, and reliable transportation, especially in historically underinvested neighborhoods.

While there are many benefits of health-centered zoning, many obstacles remain. Infrastructure upgrades are often expensive and unequally distributed. Political resistance is common, with residents opposing new zoning laws for fear of displacement. Department silos aswell from health, planning, and transportation departments very rarely being able to coordinate effectively. Uneven adoption with smaller or lower-income cities lacking the resources to make such changes.

Land use overall should be recognized as a form of preventive medicine. By embedding health goals into zoning and transportation decisions, cities can reduce chronic disease rates.

From integrating Health Impact Assessments (HIAs), a systematic proces that helps decision makers understand the postiive adn negaive health effects of a project, requiring Complete Streets and mixed-use zoning in new developments meaning transportation design approach where every street is safe and acessible, prioritizing investment in low-income and marginalized neighborhoods, and tracking metrics like walkability, food access, and chronic disease widespread alongside traditional planning goals.

When land use policy is written with public health at its core, every sidewalk, grocery store, and bus stop becomes an act of prevention towards future generations and the ones that currently roam its streets.