Obesity, Land Use, Transportation and Healthcare Reform
A few weeks ago on a family vacation I made a pit stop along one of I-95’s fast-food dominated rest areas. I stood in horror at the sheer size of the people ambling out of their SUVs to load up on burgers, soda and fries. They were beyond just overweight or “fat”. I would say about half were morbidly obese. It was the intersection of our nation’s problems with automobiles, industrial food system and poor land use policies, all of which produced people that could barely manage to walk across the parking lot to load up on more empty calories.
As America suburbanized and sprawled in areas that were more dependent on automobiles, it became fatter along the way. Take a look at this CDC animated Obesity map to see how our obesity rates have evolved over time in the US.
Over the last few months there has been a concerted effort at reforming the healthcare sector to be more equitable and efficient. There is bi-partisan (if not universal) agreement that over the long haul, the most important issue is tackling the rate of inflation in healthcare costs. It is also nearly universally accepted that prevention is the best way to avoid future medical expenses. And one of the largest medical cost drivers is the rampant increase in obesity.
A recent Streetsblog DC post made the bold statement that “Transportation Reform is Healthcare Reform”. It cited a Forbes.com article about one of the many links between obesity, land use policies and transportation policy in this country
The link between walkable, bikeable, denser communities and public health is explored in depth by reporter Christopher Steiner, whose new book cites research by University of North Carolina economist Charles Courtemanche that found a causal relationship between the price of gas and U.S. obesity.
For every long-term $1 increase in gas prices, the national obesity rate drops by 10 percent, according to Courtemanche. That relationship goes a long way towards explaining why the House and Senate health care bills include "community transformation" grants to entice cities and towns into building bike paths, playgrounds, and other pedestrian-friendly improvements.
As a result many Americans are just not getting daily exercise. Only 26 percent of U.S. adults engage in vigorous leisure-time physical activity three or more times per week (defined as periods of vigorous physical activity lasting 10 minutes or more). About 59 percent of adults do no vigorous physical activity at all in their leisure time. About 25 percent of young people (age 12 to 21) participate in light-to-moderate activity (e.g., walking, bicycling) nearly every day. About 50 percent regularly engage in vigorous physical activity. Approximately 25 percent report no vigorous physical activity, and 14 percent report no recent vigorous or light-to-moderate physical activity. It seems the most exercise some people get is the short steps to and from their cars in parking areas.
A recent study reported on by the Washington Post concluded that automobile dependent Sprawl induces this lack of physical activity that causes obesity.
People who live in neighborhoods where they must drive to get anywhere are significantly more likely to be obese than those who can easily walk to their destinations, according to the first study to directly demonstrate that long-suspected link.
The study of nearly 11,000 people in the Atlanta area found that people living in highly residential areas tend to weigh significantly more than those in places where homes and businesses are close together.
The effect appeared to be largely the result of the amount of time people spend driving or walking. Each hour spent in a car was associated with a 6 percent increase in the likelihood of obesity and each half-mile walked per day reduced those odds by nearly 5 percent, the researchers found.
"The kind of neighborhood where a person lives clearly has an effect on their health," said Lawrence D. Frank, an associate professor of community and regional planning at the University of British Columbia, who led the study.
And while this is not necessarily a surprising finding, it does show the cognitive dissonance when it comes to the intersection of health policy and transportation / land use policy. Right now while the US Highway fund needs a $7 Billion cash injection because gas taxes revenue has not kept pace with inflation and the nation's obesity rate remains very high, the mere idea of raising the gas tax as a solution is considered a non-starter politically.
But this doesn't need to wait for a heavy political lift at the national level. Each locality can do its part to make its population healthier and more active by encouraging walking, biking and other regular physical activities and discouraging automobile dependent growth & development.
As a contrast to my I-95 pit stop, I recently took the Amtrak from Baltimore to NY Penn Station and found there to be a few older slightly overweight folks, but most folks were not only somewhat fit, they sprinted down the platform upon exiting carrying 20-30 lbs of luggage with them with little effort.