State of Place: An iPhone or Healthcare

Posted on April 10, 2017

Mariela Alfonzo has over 15 years of expertise in the field of urban design and behavior research. In 2014, Mariela was recognized as one of Urban Land Institute’s 40 under 40 best young land use professionals around the globe. In 2013, Dr. Alfonzo was awarded a Fulbright to examine walkability in China.

By Mariela Alfonzo (LinkedIn), State of Place

 “…Americans have choices. And they’ve got to make a choice. And so, maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest it in their own health care. They’ve got to make those decisions for themselves.” Congressman Jason Chaffetz.

I’ll leave that there for you for a minute, or two. To digest (or not) for a moment…

Obviously, there’s a LOT to unpack here. We (mostly) stay away from making overtly political statements. We’re going to confine our thoughts regarding this ill-conceived remark to how it pertains to placemaking and planning. Deep breath. Here goes.

Pitting an iPhone against health care as two options that consumers must “choose” between is a false dichotomy:

  • This isn’t an either – or – scenario. There are many other goods and services that must be considered in this equation – think groceries, mortgages, car payments, vacations, etc.
  • This assumes that the iPhone is a luxury item. There are less expensive smartphones on the market, but to suggest that at this point in time, a portable, internet-enabled, telecommunication device is a luxury is false. You need a cell phone, and it needs to be “smart”.
  • This assumes that health care is just going to be expensive, period. But this is a myopic supposition (more below).

So how does this all tie into “place?” Placemaking can be seen both as the iPhone and as health care in this scenario.


Often, city administrators and elected officials view placemaking as a nice-to-have and not as a need-to-have. Yes, it would be nice to create that new park. But we have to pay for policing services. Yes, it would be nice to widen that sidewalk. But we have to pay for fire safety. Yes, it would be nice to plant some trees. But we have to pay for road maintenance. These are false dichotomies. Governments make hard choices and establish priorities, but like the iPhone vs. health care “choice,” there are multiple line items that need to considered concurrently. Placemaking need not be “pitted” up against some other seemingly more basic “necessity.” Also, giving up the iPhone – or Placemaking – isn’t going to make much of a dent in the overall budget, given the high costs of the other “option” your weighing it against. And having access to better places – that isn’t a luxury…at least it shouldn’t be seen as one in 2017 (more on this below).

This is the textbook definition of a false choice.


As with healthcare, it is often assumed that making places better is expensive. I have two questions for you here. 1) Does it have to be? 2) How are you assessing the costs?

With regard to placemaking, last week we made the point that “many roads (sidewalks ;)) lead to Rome.” I’d add that those paths are not all paved with gold. Consider that the State of Place Index accounts for over 290 built environment features. There are near-infinite ways to make places better and they are not all expensive. In fact, every time I demo the State of Place Prioritization feature, I explain that some changes – like reconfiguring the street network – are harder and more expensive to make than others – like adding a coat of paint or repairing broken windows. So to simply eschew placemaking as an expensive, nicety compared to fixing potholes is not only a false dichotomy, it is a false generalization.

It is interesting that Chaffetz described health care as an “investment.” Health care, in the way that Chaffetz meant it, is an insurance. While you will “save” a lot of money if you get sick, you’re not going to get an ROI out of paying for your health care premium. However, there is a high potential ROI related to investing in your health – proactively – like eating well, exercising, etc.

As far as placemaking goes, I’d argue that it’s both – an insurance and an investment – and that’s why seeing it simply as a “cost” is myopic.

Placemaking – making places better – is increasingly a requirement to “ensuring” a city’s economic competitiveness. In an ever-globalizing world, more people choose where to live first and then find employment. Indeed, more firms are offering remote-working opportunities making personal location choices that much more important. And people are demanding more – walkability, livability – from places. So providing better places is in a sense like an insurance that you are offering the basic requirements needed to offer a thriving environment.

But placemaking is so much more than an “insurance” – it’s truly an investment that will pay off in spades.

The last several years of research show that more walkable, livable places aren’t just good for one’s health, happiness, and soul, but also in terms of hard dollars and cents. The ROI is significant – for example, we’re talking about differences of up to $1200 in residential rents and $324/sq.ft. in for-sale residental value between the lowest and highest walkable neighborhoods…that adds up when you think about how this impacts a community’s tax base. But these ROIs are not considered when choosing (falsely) between paying for every-day city services or repairing basic infrastructure and investing in better places. And of course, this almost goes without saying, better places actually can promote healthier behaviors and ultimately reduce healthcare costs…and now it comes full circle.

While I’m 100% certain than 100% of you cringed when you heard Chaffetz’s statement, many of us fail to realize that we make cringe-worthy assumptions daily in the planning and development world. We must stop seeing placemaking as a nice-to-have. We must stop thinking that we need to make “hard choices” between this “nice-to-have” and all the other city services that must be provided. We must transform our thinking and acknowledge that placemaking is one of the most lucrative, worthwhile, ethical investments we’ll ever make.

We’re making it possible – easier – for you all to consider the ROI of place in your budgeting and decision-making – not just to help you make better, more informed choices, but also to help you defend those choices by translating their benefits into hard numbers. We want to help you get that iPhone, Healthcare, and then some!

Supplemental Reading

Close window