Reforming Health Care Reform – The Transportation Connection

The original health care proposals put forth by the Obama Administration mainly focused on insurance and coverage issues, but also addressed prevention.  Encouragingly, these proposals went beyond preventive medicine (the early detection and therefore less-intense treatment of disease) to also include health protection – shaping the environment to encourage behaviors that reduce the risk of getting sick in the first place.

The Obama proposal recognized that long-lasting chronic diseases – cancer, diabetes, hypertension, asthma – now cause 7 out of 10 deaths and are overtaking acute diseases like heart attacks and injuries as the long-term drivers of rising health costs.  And researchers estimate that between 50 and 75% of chronic diseases are preventable through environmental and lifestyle changes.

Unlike preventive medicine, which significantly improves people’s lives but doesn’t necessary save money over the long term, making our surroundings more health-promoting (more livable!) is likely to both improve lives and save money.  Why?  Because projects that facilitate wellness are often required anyway, and making them public health projects only requires minor changes in design or implementation.

Transportation is a perfect example of this “twofer” advantage.  It takes very little additional work or money to build “complete streets” rather than car-centric speedways, or to include fully developed accommodations for pedestrians and bicyclists in road projects, or even to create transportation systems that prioritize the needs of walkers and cyclists (including their need for public transit backup) rather than cars.

And “active transportation” systems have enormous payoff in public health (as well as in the safety, economic development, and overall “friendliness” of our communities).  The list of diseases associated with a lack of physical activity is terrifying: 30-50% increased risk of coronary heart disease, 30% increase of risk of hypertension, 20-50% increase in strokes, 30-40% increase in colon cancer, 20-30% increase in breast cancer, significantly higher risk of type 2 diabetes, possible increased risk of onset of Alzheimers and symptoms of Parkinsons, probably risk in men of erectile dysfunction.

Our car-dominated landscape is part of the problem.  Not only do these vehicles spew pollutants – between half and two-thirds of US children live in areas that exceed EPA standards for car-created ozone and other toxins, which are often sucked into the lungs of the car drivers as much as those they pass – the addictive ease of using gasoline instead of muscle power keeps us pulling us into these death traps despite the fact that the risk of heart attack triples for people who’ve spent the past hour in their car and every hour spent daily in a car correlates with a 6% increase in body fat.

But how many working parents, especially those who are single mothers or holding down multiple jobs, have spare time (or money) to go to the gym?  Our lives are already so stressful that half of the leisure hours of the average American is spent watching TV.  As a result, only about 46% of U.S. adults engage in recommended levels of physical activity associated with health benefits – 30 minutes of “moderate intensity” activity 5 times a week or 20 minutes of vigorous effort 3 times a week.  Since changing diets without increasing physical activity seldom results in permanent weight loss, is it any surprise that more than 2/3rds of adults are overweight or obese?

The solution – create a built environment that integrates physical activity into the ordinary tasks of everyday life.  Make it as easy to use the stairs as the elevator to go up one or two flights.  Or, more to the point of this blog — make it easier (and safer!) to walk or ride a bike over to a friend’s house, or to the local store, or to school or work, than to drive your own car.

It is these non-car aspects of the upcoming five-year federal transportation funding bill, as proposed by Representative Jim Oberstar, Chair of the House Transportation Committee, that are most important from a public health – and livable communities – perspective.  Unfortunately, they are – like the health promotion aspects of the Health Care Reform bill – exactly the ones that are most under attack by conservatives who think they represent governmental intrusion into people’s lives.

If this is social engineering by Big Brother, then bring it on.  We will all benefit.  In any case, I think that the people who supported warrantless wiretaps and the torturing of civilians have little standing to preach about government abuses.

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