ACTIVE TRANSPORTATION CREATES HEALTHY COMMUNITIES: How To Use Your Roads To Lower Your Doctor (and Insurance) Bills

The environmental movement has taught us that it’s a lot less harmful, difficult, and expensive to prevent toxins from entering the environment than to treat the problems poison creates once it is in our bodies and our world.    Even our medical system, which is essentially about treating sickness after it occurs, is beginning to put more emphasis on “preventive medicine” – the early detection and management of disease.

But the opposite of disease is not early detection, its wellness – staying healthy.   And one of the ways to do that, to be physically and emotionally well, is to be physically active.   According to the national Centers for Disease Control (CDC), “adults need at least 2 and 1/2 hours (150 minutes) a week of aerobic physical activity. This should be at a moderate level, such as a fast-paced walk for no less than 10 minutes at a time.”  The effort pays off in lower rates of obesity, high blood pressure, osteoarthritis, several kinds of cancer, diabetes, coronary heart disease and stroke.

You can be active by spending hours running in place or going to a gym, but it’s more likely that you’ll get in the needed exercise if it is part of your daily routine – as part of your commute, running errands and seeing friends, and socializing on the weekends. Facilitating daily routine exercise is one of the many jobs of our transportation system – making it easy, inviting, and even inevitable for people of all ages and abilities to safely walk and bicycle, while supported by a robust public transportation system.

• A study of over 3,200 overweight adults found that a good diet and walking 2.5 hours/week reduced their risk of developing diabetes by 58%. Participants aged 60 and older reduced their risk by 71%.

• Men who commute to work on public transportation are 44.6% less likely to be overweight or obese, probably due to the physical activity they get at the beginning and end of each trip, getting rid of the energy equivalent of a pound of body fat every six weeks.

• Of the women in the Harvard School of Public Health Nurses’ Health Study, those who walked 3 or more hours/week reduced their risk of a coronary event by 35% compared with women who did not walk.  The risk of death from breast and uterine cancer were reduced 19% in those who walked 1 to 3 hours per week, by 54% for walking 3 to 5 hours / week.

Any physical activity is better than none – even jiggling your body while sitting in front of the TV – but maximizing the benefits of walking requires a brisk pace that few people normally use.  However, slow, habitual cycling at an easy 10 mph, typical of many in-city commutes, has been shown to significantly increase fitness and longevity, even for people who are already active in intense recreational sports, giving regular cyclists an average level of fitness equivalent to people ten years younger than themselves.

Wouldn’t it be wonderful if we each truly had a choice about how we moved around – if enough was spent on transit, cycling, and walking facilities to make each of them safe and accessible for all? Unfortunately, our current transportation system falls unhealthily short: a CDC study found that almost 40 percent of Americans had not walked for 10 straight minutes in the previous seven days.    Whether or not Massachusetts diverts from that national reality and, instead,  creates a wellness-enhancing environment is significantly dependent on what happens with MassDOT’s proposed 10 year transportation plan, “The Way Forward”, along with an entourage of complimentary policies such as GreenDOT and Mode Shift – and all these are dependent on significant new revenue to meet our statewide transportation needs.

Of course, neither budgets nor plans and policies are enough to make things actually happen.  Advocacy is a critical part of the fuel that turns the engine of change.  And effective Advocacy requires us to both know what we’re talking about and then get involved.   In addition to what you can learn on the Transportation for Massachusettswebsite, visit our members’ websites to learn more. .  And when you’ve made up your mind, let your legislative representative know – the Metropolitan Area Planning Commission (MAPC) website lets you enter your zip code and the automatically provides a personalizable template addressed to the appropriate officials.  Use it – several times! – democracy only happens when we use it.

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GROWING SLOWLY

The Governor’s Transportation Plan, The Way Forward, is primarily intended to put our existing Transportation System on a sound fiscal and operational/maintenance footing.  It also includes a few of what it describes as “strategic investments” to expand transit (commuter rail, trolley and bus service) and bicycle/pedestrian infrastructure (mostly the statewide Bay State Bikeway).   All together, The Way Forward says this will cost a bit more than an additional $1 billion a year, $13 billion over 10 years, although the numbers in the current version of the Plan are difficult to accurately itemize and total.  However, the Governor’s proposed FY2014 budget only includes an additional $369 million for transportation:  $100m in relatively unrestricted Chap. 90 money to municipalities plus $269m for transit to cover this year’s MBTA budget gap, move operating salaries off debt money, provide one-year of forward funding for the RTAs, and restore some evening/weekend service on the T and commuter rail.  The rest of The Way Forward’s proposed Transportation spending seems to be contingent on passage of the budget’s proposed new revenue package.  And even in that case, it appears that the revenue increase will be gradual, not reaching the full $1b/annually until at least FY17.

Still, it is possible to begin examining the ways that the various components of the proposed Transportation reform will impact our public and personal health.

TRANSIT – RAIL, TROLLEY, AND BUS

A big part of the proposed “Strategic Investments” would be used to expand rail and trolley infrastructure: finishing the Green Line to Medford, upgrading/creating passenger service from Boston to Springfield, the South Coast, and Cape Cod as well as from the Berkshires to New York City, and remodeling South Station to accommodate more commuter rail service on existing lines.  These investments will help promote our economy while providing an alternative to car travel, thereby reducing pollution and congestion and contributing to the state’s Mode Shift/Green House Gas emission-reduction goals.   In addition, some $40 million will go for new vehicles for the Regional Transportation Authority’s regional transit services, restoring and increasing bus and shuttle services.

Nearly every trip begins and ends with walking and (potentially) cycling.  Urban transit and walking are particularly linked – a good walking city is impossible without a good transit system.  Transit is also related to bicycling: bicycle commuters need a way to get home when the weather changes too dangerously.  And, in some ways, the growing Hubway bike-share system is best understood as an extension of the MBTA for the “last mile.”

Because of the association of transit with walking and bicycling, it has a huge health impact: one study found that men who commute to work on public transportation are 44.6% less likely to be overweight or obese due to increased levels of daily activity.  Another study found that commuting by public transportation instead of by car increased energy expenditures equivalent to the loss of one pound of body fat per six weeks.   And transit is good for our lungs (and climate):  on average, public transportation produces 95% less carbon monoxide, 92% fewer volatile organic com­pounds, and 45% less carbon dioxide compared to private automobiles.

But in the suburbs, where much of the new rail road stations will be built, commuters tend to drive to the rail station – increasing physical activity will depend on zoning reform to encourage higher density in village centers and around stations as well as changes in local road layouts to make it easier to walk or bike to the station.

ROADS AND BRIDGE REPAIR

Much of the $13 billion will go towards fixing bridges and overpasses, upgrading the I-91 viaduct and the I-93-95 interchange, for the “multi-modal highway program” and “highway preservation.”   In recent years, MassDOT has tried, with some success, to incorporate pedestrian, bicycling, and bus-traffic concerns into its Accelerated Bridge Program (ABP) designs – the key was the state’s acceptance of Advocates’ demands that the ABP improve rather than simply repair the spans and their approaches, that the end result is to make them for functional for all users rather than simply recreating the inadequate current layouts.    Hopefully, the new bridge/overpass work will continue this pragmatic and cost-effective approach.

As for the rest of the state-run road system, MassDOT has officially adopted a “complete streets” policy, which it probably what the “multi-modal” phrase means.  But fitting bike lanes and sidewalks into the space left over after car needs are satisfied is very different than making up for past pro-car distortion by prioritizing bicycle and pedestrian needs.  The state’s Highway Design Guide’s granting of flexibility in road design to project engineers depending on local conditions and needs was boldly innovative when it was first adopted.  But that was nearly a decade ago.  Today, that flexibility is too often used to continue incorporating only minimal non-car accommodations.  MassDOT’s leadership needs to make it clear to its engineering staff (and to its construction contractors!) that traffic calming strategies, narrow traffic lanes (10” wide), protected bike lanes (cycle tracks or buffered lanes), wide sidewalks, and bus priority are the expected norm – and that all other approaches require exception requests.

Encouraging people to walk further than the bus stop (or their parked car) requires careful attention to sidewalks, intersections, and snow removal.  Similarly, encouraging people to use their bicycles, rather than their cars, for the ½-mile to 3-mile everyday trips to the store or to visit friends (which constitute a majority of American’s daily travel) requires creating more protected bike lanes (buffered or physically separated) and off-road paths tied together into seamless networks.  And most of this foot or bike travel will occur on local roads, which are designed and maintained by municipal Transportation, Public Works, or Facilities departments.

Local road work is largely paid for through “Chapter 90” money, a form of state-funded local aid. The political negotiations that allowed MassDOT to originally issue its Highway Design Guide prevented the state from requiring that local Transportation and Public Works departments follow its rules.  Some cities have been ahead of the state in making their roads safe and inviting for walking and bicycling.  But most haven’t, although including some amount of sidewalk and (less frequently) bicycling infrastructure is becoming common.  While doing a little is better than doing nothing, it’s not enough.  Unless local road projects are required to give equal – if not greater – weight to the needs of non-motorized travel, this money will contribute very little to public health.

BIKE AND PED FACILITIES

Increasing active transportation saves money.  According to the Massachusetts Department of Public Health, if only one-tenth of the state’s adults began regularly walking or bicycling, taxpayers would save nearly $121 million in annual heart disease costs.

The Way Forward includes nearly $430 million for expanding and upgrading the state’s bicycle and pedestrian facilities.  MassDOT is likely to prioritize spending on its state-wide Bay State Greenway system, a seven-corridor, 788-mile network of bicycle routes that comprise both off-road and on-road bicycle facilities.   Within this, the focus will be on the BSG-100, a subset of about 100 miles that will extend existing paths and add some connections to urban areas.  This is a lot more than has ever been previously promised, and the Rail-to-Trail advocates should be extremely pleased.

While some of the BSG routes are typically used for daily travel, most are primarily recreational.   But in terms of public health, the biggest need is for active transportation facilities for commuting and short-distance travel.   This requires both the city-wide networks (such as Boston is creating) and the regional corridors (such as the proposed Green Routes Network for the Metro area).

The creation of these seamless, family-friendly, every day-use networks will primary happen through changes to the normal road-design and repair/construction process – both those funded by the state (as described above) and those funded through the decreasing amounts of federal transportation money, currently coming through legislation called MAP-21.  Doing that, in turn, will require changes to the Metropolitan Planning Organization (MPO) decision-making process that shapes regional transportation spending.  But there will always be specific projects needed to complete walking and bicycling routes that fall outside the bureaucratic limits of those programs.  It would be extremely smart for MassDOT to set aside some amount of money – maybe $100 million – for a competitive program that funds these “missing links.”

THE BOTTOM LINE – DO NO (MORE) HARM

Critics have already begun complaining that the investments laid out in The Way Forward are too much for the state to handle right now, or that the amounts listed are larger than they should be.  It’s quite possible that the plan can be improved in many ways.  But in the real world, the alternative to this plan is not a “better plan” but nothing.  It’s taken several decades to build the public’s understanding of how dangerous our transportation system has become and how much it is going to cost to fix it.  It’s taken almost as long for people to come to understand that our prosperity depends on upgrading, modernizing, and expanding our transportation system even if that requires higher taxes.  And it’s been only in the past couple of years that the majority of people have learned the vital importance of active transportation on physical activity and the importance of that on their personal and family well being.  It took courage for the Governor and his Administration to make these proposals. If we miss this opportunity it will be a long time before anyone tries again.

It’s now up to us to tell the Legislature what we want them to do.

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Thanks to Kara Oberg (LivableStreets) and Lizzi Weyant (T4Mass) for feedback on earlier drafts.  Another version of the introductory section of this post previously appeared as part of the Transportation for Massachusetts blog.

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SOME REFERENCES:

Andersen LB, Schnohr P, Schroll M, Hein HO, 2000. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med 2000 Jun 12;160(11):1621-8.

Tuxworth W, Nevill AM, White C, Jenkins C, 1986. Health, fitness, physical activity and morbidity of middle aged male factory workers. British Journal of Industrial Medicine 1986 Nov;43(11):733-53.

US Department of Transportation; Federal Highway Administration; Office of Planning, Environment, and Reality; Health and Environmental Benefits of Walking and Bicycling.

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RELATED PREVIOUS POSTINGS:
> GOVERNOR PATRICK’S FY2014 BUDGET PROPOSAL: A Promising Start To Future Improvement
> GUNS, TAXES, TRANSPORTATION, AND THE MEANING OF LIFE: Why Government Is A Precondition for Livability
> HEALTHY PEOPLE, SAFE TRAVEL, GOOD BUSINESS, PERSONAL CHOICE: Framing Mode Shift
> WHEN BEING “COMPLETE” IS DANGEROUSLY UNFINISHED: From The Gutter To Victory on Causeway Street

And check out the great “infographic from NewPublicHealth.org, Better Transportation=Healtheir Lives

 

 

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