Measuring the hidden costs of unhealthy infrastructure
Measuring the hidden costs of unhealthy infrastructure
Local land use regulations are levers that encourage or prohibit healthy living. 🚶♀️🚴🚶♀️🚴
Medical expenses increase with a person’s body weight
How much does unhealthy infrastructure cost? A ton.
It’s impossible to totally grasp the financial hit of modern infrastructure that keeps Americans trapped in cars. You could start by finding order-of-magnitude engineering, construction, and maintenance costs. Add all the stuff up, and you still don’t factor in the cost of displaced households, lack of access to jobs, increased household transportation costs, and all sorts of costs resulting from mental and physical decline.
Consider just one type of public health cost: obesity. According to the State of Obesity report, over 80 million Americans are inactive. And that’s no surprise considering most neighborhoods developed in the last 75 years were oriented around household automobiles. Thus, the jokes about driving a mile to a building where you walk up pretend stairs for 30 minutes and then drive back home. It takes a lot of effort to be physically active when the surroundings discourage it at every turn.
The sobering chart below was published by George Washington University.
Another George Washington University study summarized the rising financial costs of obesity.
In one of the earliest analyses, Colditz looked at the direct and indirect costs in the U.S. of six common obesity-related conditions-type 2 diabetes, high blood pressure, cardiovascular disease, gallbladder disease, colon cancer, and postmenopausal breast cancer-and determined what percentage of those costs were due to obesity.
He estimated that in 1986, obesity was responsible for 5.5 percent of the direct and indirect costs associated with these common medical conditions, or about $39 billion. (3) Subsequent reports on obesity-related medical spending (direct costs) have charted a steady rise in obesity’s cost over the years, as the epidemic has grown.
I write about urbanism and have no medical expertise. I’m sharing what I’m learning about the cost of obesity because there’s a direct connection to the built environment.
80-90% of a person’s health is dependent on that person's environment.
Obese adults have double the medical expenses relative to those of normal weight. That's not even including costs for inpatient care, outpatient care, and prescription drugs. Local land use regulations are policy levers that encourage or prohibit healthy living. 🚶♀️🚴🚶♀️🚴
Local rules force everything to be spread out: homes, grocery stores, dry cleaners, restaurants, and places of worship. Everything in its own zone, separated by a car trip. Land use reform won’t instantly eliminate body fat, but it’s a dramatic step in a healthy direction. It’s not just a step, it’s permission to lead a healthy lifestyle.
The CDC will remind you that:
People who are physically active live longer and have a lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers. Improving spaces and having safe places to walk can help more people become physically active.
Knowing the benefits of walking, it's disappointing that major coverage of a new childhood obesity study has so much emphasis on medication and surgery.
With articles like this, journalists are performing a type of book marketing, when they could be investigating claims or at least feigning skepticism. It wouldn’t take too hefty of a web search to find doctors and academics describing the role of environmental factors in public health.
People need safe, convenient places to walk. Not just sidewalks but destinations.
Why are walkable neighborhoods rare? What's blocking healthy infrastructure?
As weight goes up, so do the medical costs. The only thing going down is life expectancy.
Urbanists have ample reason to show a sense of urgency about walk-friendly environments.
I’ll leave you with an encouraging story I came across recently (thank you, Twitter!). Vanessa Garrison and T. Morgan Dixon formed the nonprofit GirlTrek to reclaim their health through walking.
"We believe walking 30 minutes a day is a radical act of self-love and the root of a cultural revolution."
Take some inspiration from them, along with some practical group walk logistics. The more you wander your community by foot, the better informed you’ll be about where the local public works department needs to improve walkability.
GirlTrek members are sharing stories and tracking personal milestones. Look at some of their results!
What came first, the walkable network or the walking habits? It doesn’t matter—plan, design, demand (!) healthy infrastructure.