On a personal basis I am writing to state my decision to join the Coalition for Sustainable Jerusalem's demand for a formal Health Impact Assessment of the Safdie Plan. I was very proud that we, as a school, were able to lodge an official objection and give evidence. I believe there is already enough evidence to oppose the Safdie Plan, based on the weight of the evidence, on the adverse effects, both direct and indirect, of urban sprawl on public health. My decision to take a stand is based on the premises that we in public health have to use our tools not only to assess the effects of what has happened in the past, but to use our knowledge on such effects elsewhere to predict and prevent here, today. Our position is based, in part, on the material presented at the workshop on Health Impact Assessment last year, at which the Braun School of Public Health hosted Dr. Marco Martucci of World Health Organization-Europe. My colleague, Prof. Elihu Richter, has constantly called attention to the substantial peer-reviewed literature on the adverse direct effects of urban sprawl and the circular predict-and-provide scenarios it will induce. These direct effects include more road injury, sedentary travel time, air pollution, water pollution, and loss of green space. There also is a literature on the indirect effects of urban sprawl in promoting adverse socioeconomic trends, including increasing rich-poor gaps in access to mobility, breakdown of community, adverse effects on community mental health, and diversion of resources away from strengthening the central city's infrastructure in education, health and social services. Finally, we call attention to the need to address indirect macro geo-strategic effects resulting from ever greater dependence on motor vehicle transport and fossil fuels. This latter set of macro effects becomes even more critical in what we can expect to be an era of rising energy costs in countries whose policies increase energy demand and reduce energy conservation. The Safdie Plan explicitly means much more road building and traffic around and going into the city of Jerusalem. It explicitly means more urban sprawl, air pollution, road injury and destruction of what is left of its green lungs. It explicitly means the flight of middle and upper classes from the heart of Jerusalem and a decision to abandon the poor. If implemented, it will accelerate a process in which Jerusalem will move more rapidly towards becoming a barren asphalt jungle and its surrounding hills an asphalt moonscape. In many previous statements, the unit has listed these effects as its reasons for opposing the plan. The available data strongly state the case for choosing alternative plans for arresting the decline in Jerusalem and promoting a policy for self-sustainable healthy growth and development. We note that there already are in Jerusalem the lands and dwellings which enable population expansion in the heart of the city - and the holding of its middle class and their support of the city's tax base to promote such growth and development - even in times as troublesome as ours. The billions which will go into the contractors and road builders to implement the Safdie Plan should go into strengthening education and other essential city services and drawing the middle class and younger couples back into the heart of the city. One cannot also be indifferent to the massive cost overruns of massive public works projects and their role in diverting funds from such urgent priority needs. In summary, I believe that every new development plan should undergo both an Environmental and a Health Impact Assessment - EIA and HIA. I wish the coalition every success and look forward to helping in any way I can in the future. This letter was originally addressed to the Society for Protection of Nature in Israel. Prof. Elliot M. Berry, MD, FRCP, is director of the Joseph and Belle R. Braun Hebrew University-Hadassah School of Public Health and Community Medicine.

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