This commentary is by Dr. John Raser of St. Johnsbury. He is a former member of the planning board and currently serves on the town bicycle and pedestrian committee. He is a clinical assistant professor of family medicine and community health at Dartmouth’s Geisel School of Medicine, and adjunct assistant professor at UVM Larner College of Medicine.
As a family doctor, a parent and just as a human, I sometimes feel overwhelmed by the crises of our time. We must stop climate change and cut waste. We suffer so much chronic disease, and healthcare is too expensive. We have epidemic loneliness, with the related crises in mental health and addiction. Our kids spend too much time inside and are too plugged in. On top of this, a decent life feels unaffordable for more and more people.
In the 20th century, we expected technology to save us. We now know technology cuts both ways. Drugs like Ozempic help chronic disease, but drive up costs. Electric cars decrease carbon emissions, but are expensive and require environmentally costly batteries. The internet connects us with the world, but can isolate and even alienate us from our neighbors.
We in Vermont are blessed with one technology, however, that might actually help save us — the town.
In an affordability crisis, towns are a key to living well while spending (and taxing) less. Here is a list of services that are cheaper to provide to denser settlements: roads, sidewalks, water, sewer, electricity, internet, police/fire, public and medical transportation, school busing, plowing, ambulance, mail, package services, home health, meals on wheels, etc. Among these you may recognize major expenditures in your town budget. This list doesn’t include the average cost to operate a vehicle in the U.S., which is over $1000/month (for a new car) and climbing fast.
Initial building costs are cheaper on undeveloped land, but “infill” development in towns is not just environmentally better — it is the fiscally conservative choice. Spreading out costs more, and we all shoulder that burden.
In the U.S. 53% of adults and 79% of children age 6-17 don’t get enough physical activity. This is a major contributor to diseases from heart disease and cancer to dementia and depression. Gyms are nice, but we know more powerful than a gym is a lifestyle based on walking. When exercise is your daily commute, you are much more likely to get enough to keep you healthy. We know after walking or biking to school, kids have fewer symptoms of ADHD and do better on tests.
For working adults, long driving commutes are associated with poor sleep and mental health. For older adults, living in town means remaining connected after losing the ability to drive safely. An intact town allows a healthier lifestyle at every age.
While you are walking to work or the grocery store in a Vermont town, you will inevitably run into someone you recognize. Science tells us that even a moment of recognition with your mail carrier or a neighbor walking a dog makes us happier. An impromptu chat with a friend or acquaintance has an even more positive mental health impact — triggering measurable increases in bonding hormones and decreasing stress hormones.
The surgeon general tells us that loneliness contributes to an early death as much as smoking, but suggestions like “make more time for friendships” feel like adding to our to-do list. The human-scaled life of a small town allows for many more social connections as part of daily life, something we all need to stay mentally healthy.
Of course a strong town center cannot be just a high-end shopping and restaurant zone. Towns at their best are places where we all belong. When we build car-centric development, we create places where you only belong if you are purchasing something or using a service. Public places like our libraries, parks, schools, and churches provide resources, refuge, and beauty without spending money. Even the humble sidewalk allows humans to belong in a way we are not allowed in an office park.
It is true that creating a truly welcoming place means we are more likely to come face-to-face with our neighbors who struggle with poverty and drug abuse, but we aren’t going to make progress on helping those neighbors by isolating them in the shadows. Intact towns create physical spaces that allow us all to be seen.
Here in my home of St. Johnsbury, I am grateful for the life made possible by this town, but my town could be better. Our government and institutions should invest in our towns as a matter of policy. When we build schools, clinics and public offices outside of town, we spend more resources long-term and miss opportunities to improve physical and mental health of employees, clients and non-clients alike.
On an individual level, those of us who live in town can lean into town life. We can let our kids walk to school and run errands on foot. If we are lucky enough to work remotely or in town, we can sell an extra vehicle or share it. In doing so, we will allow the town to make us healthier and wealthier.
Of course I’m not arguing that we should all live in town. I appreciate those who work the land and conserve open space. Many of the people who make my town’s institutions and business special don’t live here, but we all need a more clear recognition of the value that towns provide.
As someone who grew up in the Sun Belt sprawl, the Vermont town is a miracle to me. These places are not only beautiful, they may be the most powerful medicine we have to treat what is ailing our bodies, our environment and our culture.
Read the story on VTDigger here: Dr. John Raser: Town medicine.