Public Health has its origins in catastrophe, the realization that if an out-of-the-ordinary pestilence is suddenly sickening large numbers of people there must be a general cause rather than individual failures.  In contrast to Medicine, which traditionally is about treating an individual’s existing disease, Public Health seeks to keep large groups from getting sick.  In contrast even to Preventive Medicine, which tends to focus on increasing compliance with medical prescriptions, Public Health is about wellness and well-being – a holistic concern with an entire population’s overall quality of life.  And in Massachusetts, a national leader across a wide range of Public Health issues, one of the most innovative and powerful strategies to improve population health has been the Mass In Motion program.

Everyone officially puts “safety first.” Everyone wants to prevent accidents. Car crashes are treated as lead stories on TV news – the images are horrific and we all fear our vulnerability. But, in fact, our roads are safer than ever. In 1956, when Interstate construction began, the national fatality rate was 6.05 per 100 million Vehicle Miles Traveled (VMT). By 2011, the fatality rate had dropped to 0.8 per 100 million VMT on the Interstate and 1.1 (the lowest ever recorded) nationwide, even though about 85% of people including those in metro areas, still get to work by car. (Massachusetts has the nation’s lowest fatality rate, 0.62!)

Studies have shown, and the Traffic Engineering Profession has internalized, that highway accidents go down when there are wide lanes, gentle curves, no sight-line obstructing hills, limited entering/exiting locations with long ramps, no visual distractions other than large and uniform directional signage, and the absence of slower or more vulnerable traffic.   The Interstate is safest when it is “error tolerant” and forgiving of driver distraction. (Other contributors along the same lines: slide-resistant pavement, break-away sign and light poles, and better guardrails.

But the reality is that safety lapses aren’t the biggest transportation-related source of injury. In fact, putting too much emphasis on preventing car crashes can make non-highway streets more dangerous – not only for pedestrians and cyclists but also for car occupants! Car accidents cause half as many deaths and several multiples fewer health problems than transportation-caused air, water, and noise pollution.   The amount of paved land in our cities makes us more vulnerable to climate change, rising temperatures, and floods while housing sprawl makes us less resilient in terms of agriculture and disaster-recovery.   Most subtly, life in and around automobiles changes the way we relate to our neighbors and friends, reducing our collective social capital and our individual life style satisfaction.

Bills submitted by the Governor, by Legislative Leadership, or in response to a media-enflamed crises can go from idea to law very quickly.  The many thousands of other proposals have to wind their way through a very complicated and multi-stage process.  Almost every proposal has to go through several different committees and at least one public hearing.  Committee chairs have to decide which of the submissions to prioritize, balancing demands from leadership, other committee members, and their own constituency.  Opponents have to be negotiated with and compromises reached.  The vast majority of bills are either “sent to study” or simply never reported out of Committee and therefore never receive an up/down vote by the full House or Senate membership.   Even for those bills that pass the crucial “get out of committee with a positive recommendation” milestone, very little gets settled until a deadline hits or until the two-year session comes to an end, at which point a proposal either is voted up or down or has to start all over again from the very beginning in the next two-year Legislative session. It’s slow, seldom fully transparent, and often quixotic.

“Health In Everything” is an important slogan, pointing out that personal and social well-being is impacted by every public policy and every aspect of our built and cultural environments.  Partly based on this insight, there is increasing interest in creating Health Impact Assessments (HIA) as part of the preparation for all kinds of policies and projects that don’t traditionally fall within the purview of public health – from transportation to commercial development, from agriculture to public safety.

For example, the 2009 enabling law creating the new Massachusetts Department of Transportation states that MassDOT “shall…institute and establish methods to implement the use of health impact assessments to determine the effect of transportation projects on public health and vulnerable populations for use by planners, transportation administrators, public health administrators and developers…”

It’s been fascinating and infuriating watching the Boston Herald try to conjure up anti-bicyclist hysteria.   Day after day, they throw out feelers, venomous outbursts testing the appeal of one angle after another: government waste, arrogant elites riding roughshod over ordinary people, preferential treatment of a minority group, discriminatory ticketing of car drivers while letting law-breaking cyclists get away with warnings, out-of-control youth treating the elderly with contempt….I’m sure that there is more to come.

Pandering to resentment is the Herald’s stock in trade.  Of course, it’s not them alone.  The modern model of nastiness was created by AM radio’s talk hate shows and spread to other media (and other countries) by Rupert’s Fox-media conglomerates.  They’re all anti-government, and jumping on the anti-immigrant bandwagon.  If this was any place beside Massachusetts we’d also be getting heavy doses of gay-bashing – but here the legalization of same-sex marriage has made it a non-issue.  (Has your marriage been having any extra trouble lately?  Has anyone you know suddenly woken up attracted to a different gender?)

We all know that being physically activity is good for you — good for your weight, good for your overall health, good for your mood, and good as a way to get around.  But recent research suggests that bicycling is particularly good — even better than other forms of physical activity.  This is important because, other than public transportation — whose routes are limited and expansion is very expensive — cycling is the only real large-scale alternative to cars for short, every-day trips and commutes. It is also important because it means that we need to be prioritizing bike facilities in every transportation plan and road design.

American medicine is only peripherally about health; it is primarily about treating disease.   It is a sickness treatment system.  Even so-called preventive medicine is really about screening and early treatment.  What we need is pre-disease prevention:  ways to create a lived environment that directly and through its impact on behavior significantly increases wellbeing and reduces the risk of getting sick in the first place.  This is where Transportation comes in. 

Public Health has traditionally focused on wellness, championing societal measures that that improve living conditions for large populations, or make it easier for individuals to make healthy choices within their everyday life.  Clean water, effective sewerage, tobacco taxes and anti-smoking campaigns, eliminating trans fats and other food toxins, requiring seat belts, reducing neighborhood and domestic violence, gun control, vaccination campaigns – these can all be considered public health measures that work by improving the environment, providing services, or shaping the market.

Transportation  & Health

• Only 46% of U.S. adults engage in recommended levels of physical activity associated with health benefits — 30 minutes of “moderate intensity” 5 times a week or 20 minutes of vigorous effort 3 times a week[1]; over 1/2 of the leisure time of the avg. American is spent watching TV; every hour spent daily in a car increases body fat 6%; heart attack risk triples for people who’ve spent the past hour in their car.    66% of adults are overweight or obese[3].

• Almost 33% of high-school-age teenagers do not meet recommended levels of physical activity[2].   16% of children and adolescents are overweight and 34% are at risk of overweight[4].

• Change in diet without increased physical activity is unlikely to result in lasting weight loss.

• Diseases Linked to Lack of Physical Activity or Overweight:  30-50% increase in coronary heart disease, 30% increase in 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 Alzheimer’s and symptoms of Parkinson’s, probably risk in men of erectile dysfunction.

• Half to 2/3rds of US children live in areas that violate EPA air quality standards for car-pollution-caused ozone

“The health experts are just recognizing what devoted transportation cyclists have always known, which is if you’re on a quick ride to the store to pick up a carton of milk, you’re not really paying attention to the exercise part.  You’re focused on the traffic, the sights, the (hopefully) fresh air, and the sheet job of movement.  It’s kind of like the same trick your mind plays when you hike to the far end of the shopping mall and back in pursuit of the perfect gift for mom.  You are thinking of the hunting and gathering, not the half-mile or so you’ve walked.

Pedaling Revolution, by Jeff Mapes