The article discusses elements of the Portland Plan focused on specific areas of the city where dysfunctional infrastructure tends to contribute to public health problems:
By redesigning the area where people live, they hope to change how they live, making it so simple to move and eat good foods that people start leading a healthier life. Advocates call the concept "working upstream," tackling diseases on a social level instead of an individual one.
As Dworkin outlines, urban plans and infrastructure development projects from the late nineteenth through the 1970s or so often centered on separating areas zoned for industry, commerce, and residences. This separation of land uses came about for very real public health reasons and, later, because of the mobility offered by widespread use of the automobile. However,
the separation of homes and business also wound up fueling some of today's biggest health problems. Sprawling cities that force people to drive long distances to work, school or shopping reduced the amount of exercise people got by replacing walking with increased driving. Diseases linked to sprawl include heat stroke, road rage, obesity, asthma and diabetes.
Whereas the kind of urban changes represented by the "20-minute neighborhood" may have a range of beneficial results, one thing to be mindful of is the impact that this development will likely have on real estate prices in a given neighborhood. That is, creating walkable neighborhoods often raises real estate prices in the area, which, in turn, often leads to gentrification, and gentrification often pushes long-time residents out of a given neighborhood because these residents can't afford to rent or own their homes anymore, and/or these residents lose their connection to the community as their neighbors and community institutions change.
Public health of a privileged class at the cost of diversity, equity, and community cohesion is likely not a productive long-term outcome.