Over the past 50 years, the size of virtually every major metropolitan area in the United States has expanded dramatically, and the rate of land development has outpaced the rate of population growth. Much of this growth has occurred in suburban and rural areas, with much less growth occurring within the urban centers. Dispersed growth patterns and other local land-use practices have had a significant effect on the environment and human health.

Correspondence: Please direct correspondence regarding this Health Impact Assessment to Janine Sinno Janoudi at jsinno@ingham.org.