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Posts from the "Public Health" Category

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Study: People Living Near Biking and Walking Paths Get More Exercise

Walking and biking activity increased for people living near new facilities, in three U.K. communities examined. Connect2 is the name of the nonprofit group that helped install the infrastructure. Image: American Journal of Public Health

New bike/ped infrastructure in three UK communities (labeled “Connect2″ — the name of the nonprofit group that helped install the infrastructure) led to more physical activity. Graph: American Journal of Public Health

People who live near safe, high-quality biking and walking infrastructure tend to get more exercise than people who don’t, according to a study published last week in the American Journal of Public Health.

Researchers surveyed randomly selected adults before and after new bike/ped infrastructure was built in three communities in the U.K. Two of the selected communities opened bike and pedestrian bridges with well-connected “feeder” infrastructure. The other community upgraded “an informal riverside footpath” into a boardwalk during the study period.

Over two years, about 1,500 people responded to annual surveys about their walking and biking habits as well as other exercise behavior. During the first year of the survey — before the bike/ped improvements had been completed — there was no difference in biking and walking levels between people living close to the project areas and people living farther away. But by the final survey year, after the new infrastructure had been built, a disparity began to emerge.

Researchers found that people living within 0.6 miles of a protected bikeway got about 45 minutes more exercise biking and walking per week than people living 2.5 miles away. For every kilometer (0.6 miles) closer respondents lived to the infrastructure improvement, they exercised roughly 15 minutes more per week. People without access to a car were most likely to exercise more in response to the infrastructure improvements.

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What Sets Apart the Places Where People Walk More?

A lot of research has shown a link between living in a walkable community, active transportation habits, and better health outcomes.

Image: PLOSE ONE

As residential density increases, so do walking and biking. Image: PLOS ONE

But what aspects of “walkability” are tied to better health? Is it the mix of uses, the connected street grid, the density of housing, or all of the above? It’s an important question to understand if we want to design places that encourage healthier habits.

Researchers at St. Michael’s Hospital in Toronto set out to determine what features of urban neighborhoods lead to more activity and thus better health outcomes. Their study of Toronto-area residents, published in the peer-reviewed science and medical journal PLOS-ONE, examined the link between four built environment factors and people’s health records and transportation habits.

Researchers started by looking at street connectivity, population density, residential density (which measures occupied housing units), and “availability of walkable destinations” (a measure of non-residential uses).

They found that street connectivity was not an especially strong predictor of active transportation habits, but the other three factors were. Basically, if you live in a dense area, you are more likely to walk and bike often, and you’re even more likely to get physical activity if there are a lot of destinations close to your house.

The team found that both residential density and the presence of walkable destinations were strongly predictive of residents’ transportation habits, and that walking and biking trips per person seem to be linked most strongly to residential density. Even in low-residential-density areas with a high number of destinations, people were unlikely to walk or bike.

More often than not, however, the places that were densely settled also had a high number of destinations. And while both factors make pretty good predictors of how much activity residents get, the combination of the two — places that are both dense with residences and full of other types of uses — is especially powerful. Street connectivity was found to be a weaker predictor of travel behavior than the other measures, but was also strongly correlated with density and number of attractions.

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What Should Doctors Do to Prevent Traffic Deaths?

When cars first became a common presence in American cities, doctors were shocked by the carnage. In 1925, editors of the New England Journal of Medicine called the bloodshed caused by motorists “appalling” and lamented children’s loss of life as “a massacre of the innocent.” The sense of urgency was still detectable a few decades later. In a 1957 report, Harvard researchers called the public health threat posed by automobiles a “mass disease of epidemic proportions.”

The medical profession was alarmed about the bloodshed that accompanied the introduction of cars into mainstream society in the early part of the last century. Since then, views have evolved considerably. Image: New England Journal of Medicine

The medical profession was alarmed about the bloodshed that accompanied the ascent of cars in the early part of the last century. Since then, views have changed considerably. Image: New England Journal of Medicine

But as time went on, the medical establishment became much more muted in its response. Public health research gravitated to relatively minor risks — like the connection between traffic collisions and diabetes or sleep apnea — instead of more significant dangers like drunk or distracted driving. In 1987, some doctors took to the pages of the Journal to criticize their colleagues for being “relatively silent about the relation between alcohol and motor vehicle accidents.”

These shifts are charted by David Jones, a doctor who studies the history of medicine at Harvard, in a recent review of how American physicians have addressed the public health threats posed by automobiles. Looking at the last century of articles about cars and public health published in the New England Journal of Medicine, Jones charted the fascinating historical trajectory of how physicians’ views on driving-related health risks have shifted, in an article that was itself published in the Journal earlier this month.

Despite an article in the most recent edition of the Journal finding that distracted driving is associated with significantly increased crash rates among both novice and experienced drivers, Jones says doctors still don’t seem to be comfortable taking decisive action to prevent these kinds of collisions.

I recently spoke to Jones about his research. Below is an edited transcript of our interview.

It sounds like doctors have been a little bit hesitant to intervene.

Because of their position on the front line of disease, doctors become aware very early on of what types of things in our society are causing threats to life and health. The question is: What’s the appropriate response?

When the first cars started showing up on the roads in the 1890s, within 10 years doctors at medical journals were astonished by the rising numbers of people who were killed in driving accidents.

Pretty early on, probably by the 1920s or 1930s, most doctors would say the biggest problem with driving is drunk driving. That’s totally clear now. If you look at the leading cause of car accidents, it’s alcohol. Society has responded by criminalizing drunk driving, which is probably appropriate — although there are a lot of people who would say that the sanctions aren’t nearly strong enough.

What’s the role of doctors in all of this? One question that came up in the 1920s: Should everyone who wants a driver’s license undergo a medical examination? And many states considered those laws but none of them were seriously enacted. The doctors who responded to the New England Journal didn’t want to do that. That would have been a huge burden on physicians.

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TED Talk: OKC Mayor Mick Cornett on Designing a City for Fitness

I got to know Oklahoma City Mayor Mick Cornett last year, when I interviewed him at the annual meeting of the United States Conference of Mayors. We talked about his realization that he and his constituents (generally speaking) were obese, and how he stood in front of the elephants at the zoo on New Year’s Eve six years ago and announced that the city was going on a diet. He set out to have the residents of Oklahoma City lose a million pounds — and the city achieved it.

In a TED talk taped in April and posted online last week, Cornett tells the story of how OKC went from being ranked by Men’s Fitness magazine among America’s fattest cities to being ranked as one of the fittest.

“I started examining my city — its culture, its infrastructure — trying to figure out why our city seemed to have a problem with obesity,” Cornett says. “And I came to the conclusion that we had built an incredible quality of life if you happened to be a car. But if you happened to be a person, you were combating the car seemingly at every turn.”

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Heart Disease, Traffic Jams and ADHD Share One Simple Solution: Drive Less

This is an excerpt from “Bikenomics: How Bicycling Can Save the Economy,” by Elly Blue (Microcosm Publishing, December 1, 2013, bikenomics.com). See our interview with Elly from spring 2013. 

Car exhaust is no laughing matter. Nearly half of residents in major urban areas in North America live close enough to highways and other large roads to experience serious problems as a result. Exposure to car emissions worsens and may cause asthma and other lung conditions, including lung cancer. There is evidence to suggest that it leads to hardening of the arteries and thence to heart disease. One study has found an increased risk of heart attacks while in traffic, either while driving or using public transportation. Breathing car exhaust may increase the risk of developing diabetes; it is certain, however, that people who have diabetes suffer disproportionately from the effects of air pollution.

Traffic flows and air quality improved with the odd-even license plate restriction in Beijing during the Olympics. Photo: Traffic Technology Today

The worst effects of breathing polluted air are experienced where it is densest: in traffic. Spending time on and near highways, freeways, and other busy roads is terrible for your health. How near is a question that is still being studied, but researchers believe that the effects are worst within either a fifth or a third of a mile. People in cars or buses are exposed to considerably more air pollution, perhaps because of, rather than despite, being in a closed space. People walking and bicycling on or next to roads breathe more air, but inhale somewhat less pollution; and cyclists have been found to have even less risk if they are on paths that are separated from the road.

The burdens that come with air pollution are, as with so much else, not evenly distributed. Poverty and ethnicity are both major factors that determine the amount of car exhaust we breathe. Housing near a source of pollution, such as a freeway, busy road, or industrial site is generally where people with low incomes are able to live.

Children are particularly at risk, beginning before birth. Air pollution affects prenatal development, and a recent study suggests that exposure to air pollution such as diesel particulates, mercury, and lead may put a child at risk for autism. A separate study found double the rate of autism among children who live within 1,000 feet of a freeway in several major cities. Air pollution has also been linked, tentatively, to hyperactivity in kids and childhood cancers. And kids who have high daily exposure to car exhaust score lower on intelligence tests and have more depression, anxiety, and attention problems. This isn’t just a matter of where children live – one in three public schools in the U.S. are within a quarter mile of a highway, well within the danger zone.

Traffic jams and air pollution are often talked about at once, as though one inevitably causes the other, and that by fixing one you can also solve the other.

It doesn’t quite work that way.

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The Defense Department’s Embrace of Livability Will Save Money — and Lives

On Tuesday, we wrote about the Defense Department’s new rules for the design of their bases and installations. These rules make smart growth the law of the land on hundreds of vast military installations in the U.S. and abroad. There’s more to the story: In this post we examine how a smart growth development model will bring wide-ranging benefits to the defense complex.

Pendleton Avenue at Joint Base Lewis-McChord is being transformed into a complete street, following strategies in the new Unified Facilities Criteria for Installation Master Planning that call for compact infill development, transit, and safe pedestrian access. Image courtesy of the Urban Collaborative, LLC

Many of the benefits of smart growth are clear enough. By mixing uses, clustering destinations together, and improving transit, sidewalks, and bike facilities, a city — or military base — makes driving less necessary and encourages other ways to get around, like walking. That, in turn, reduces congestion, improves health, and gives people back the time they might otherwise spend in their cars.

It can also save lives.

The epidemic of suicide in the military is growing much faster than in the general population. “DoD is suffering from some of the highest rates of suicide ever,” said University of Oregon professor Mark Gillem, the former Air Force architect and planner who helped rewrite the rules that govern master planning on military bases, which were published last year. “And I believe part of that is because our installations have become office parks and not communities.”

When families live scattered around, 30 minutes from base, Gillem said, they don’t have the “esprit de corps” that used to exist.

“And when families live off base, the on-base amenities that used to serve them — the theaters and chapels and community centers — no longer have the patronage, so they have to shut down,” Gillem said. “So there are very few places people can go to be amongst their friends and colleagues. And I think that hurts, especially with our high operations tempo and consistent deployments. When you have a spouse that’s hanging out in the middle of nowhere, alone, that’s very hard.”

Gillem’s work to bring walkable development patterns to military bases is partly based on his conviction that by designing better, more attractive and livable installations, the military can lure families back on base, bringing a return to the kind of community that not only builds friendships, but saves lives.

The military uses another rationale to explain its turn away from sprawl and toward smart planning: Walkable development saves a ton of money. The Unified Facilities Criteria [PDF] – the document that mandates the new rules — focuses almost exclusively on cost when listing the benefits of the new model. It starts with lower initial costs during planning and construction and moves on to lower life cycle costs (less energy consumption, less pavement), reduced maintenance costs, general efficiency, and, of course, safety – which has its own economic benefit.

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Celebrate Bike to Work Week, No Matter What You Weigh

Happy Bike to Work Week, everybody! It’s a great time to give a gentle nudge to someone who you think would benefit from biking. In that vein, personal trainer and fitness coach Stephanie Averkamp of San Diego posted this infographic to her personal health website. She says she especially hopes to convince overweight and obese people to bike more.

“Biking’s a great exercise because it supports 50 to 70 percent of their body weight,” Averkamp told me. “It’s not like running. It’s something they can do without the extra weight and impact on their joints.” She said biking is a great way to get exercise outside of a gym, which can be intimidating and unpleasant.

She encourages people to start by biking halfway to work. “That counts!” she says.

Infographic after the jump.
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What Should the Surgeon General Say to Get More People Walking?

What if cars came with a Surgeon General’s warning like the ones that come on cigarette packs: “Sitting in this seat could lead to obesity, diabetes, heart disease, depression, and divorce.”

The Surgeon General wants your help to get more people to walk for exercise and transportation. Photo: Digital Deconstruction

Surgeon General Regina Benjamin is getting ready to go halfway there. She announced in December that she’d be issuing a call to action on walking sometime in 2014. Yesterday, she and the Centers for Disease Control and Prevention asked for help crafting the call.

The CDC opened a docket yesterday to solicit information from the public “on walking as an effective way to be sufficiently active for health.” That information will be used as part of the call to action.

The wording is notable. The CDC is making the case that even if walking is the only exercise you do, it could be “sufficient” to stay healthy.  It echoes the recent findings of Australian researchers, who concluded that going to the gym isn’t as effective as active transportation at keeping weight off – largely because it’s easier to work exercise into your day when it accomplishes two goals at once.

What the CDC is trying to do is identify not only what government agencies can do, but what civic organizations, health care providers, educational institutions, worksites, industry, and others can do to provide access to “safe, attractive and convenient places to walk (and wheelchair roll).”

The CDC is off to a good start even before the public chimes in with its collective wisdom. The request for public comment laid out the scope of the problem:
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Designing Communities for Longevity: The Blue Zones Project

Is your neighborhood designed to make people healthy or sick? With the right characteristics, the place where you live could add years to your life.

Children in Redondo Beach, California -- a Blue Zone community -- take part in morning exercises. LA Times

In 2004, Dan Buettner, CEO of the Blue Zones Project, partnered with researchers from National Geographic to study the places around the world that enjoy the greatest longevity. They found that what distinguishes places like Ikaria, Greece, and Okinawa, Japan, are environments and cultural attributes that foster community, family life, connectedness, and physical activity.

The team boiled down their research to nine principles for longevity and health. The number one principle? “Move Naturally.”

“The world’s longest-lived people don’t pump iron, run marathons or join gyms,” the researchers wrote. “Instead, they live in environments that constantly nudge them into moving without thinking about it.”

Now the Blue Zones Project — run by Healthways, a company focused on improving health, in partnership with AARP, Wellmark Blue Cross Blue Shield, and the Walkable and Livable Communities Institute — is trying to create cities and towns that promote wellness across the U.S.

More than a dozen places, from the Los Angeles suburbs to small-town Iowa, have been designated as “Blue Zone” communities. The partnership is helping these places advance complete streets, walking school buses, and safe routes to school. The program also focuses on goals like gardening, volunteering, smoking cessation, and providing access to fresh food.

“Seventy percent of our health outcomes are predicted by our behaviors and our environment,” said Laura Jackson of Wellmark, which insures 2 million people in Iowa and South Dakota, during a seminar at the New Partners for Smart Growth Conference taking place this week in Kansas City. “We searched around the world to try to find the magic bullet.”

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Surgeon General Announces Call to Action on Walking

Walking can seem like a rather mundane thing to get organized about, until you realize that it’s a direct challenge to car-oriented transportation and it’s the best thing people can do for their health. Then walking is downright revolutionary.

U.S. Surgeon General Dr. Regina Benjamin exhorted advocates this morning to make walking "joyful." Photo by Tanya Snyder.

Not only that, but it can be joyful. That was the message that the U.S. Surgeon General, Dr. Regina Benjamin, brought to a gathering of walking advocates in Washington today. “We have to make being healthy joyful,” she said.

“One person’s joy might be to run a marathon,” she said. “Another person’s is just fit into an old pair of jeans. And another’s is just to sit up all day with their grandkids. We have to stop telling people what they can’t do or what they can’t eat. We have to tell them what they can do. They can go out for walks. They can go out with their friends.”

When Benjamin was nominated to her post, she was immediately barraged with questions about her own weight. Critics said it was inappropriate to have a full-figured person as the leading public health official in a country that struggles with a 36 percent obesity rate. But Dr. Benjamin’s message is, “If I can do it, anyone can do it.”

Benjamin recounted a tale of a friend of hers finding out she liked walking and inviting her to go on a walk – to the bottom of the Grand Canyon. She said she huffed and puffed her way back up the 4,000 feet of altitude change, but it was fun. “But you don’t have to have a national park,” she said. “You just have your street outside your house.”

The CDC is going to produce a Surgeon General’s report that is “a call to action on walking.” That’ll be accompanied by a national campaign for walking. “We want to lend the voice of the Office of the Surgeon General to this particular physical activity,” she said. “It’s easy to do, anyone can do it and it’s fun.”

She told Streetsblog after her remarks that it will, realistically, take 18 months to launch the call to action.

Benjamin’s commitment to walking as an inclusive form of physical exercise dovetails nicely with First Lady Michelle Obama’s “Let’s Move” campaign, which also embraces biking and walking as a good way for young people to work physical activity into their day. And not only that: Dr. Benjamin ended her speech by thanking the walking advocates in the room for “implementing the Affordable Care Act’s prevention strategy.”