How to Create Healthier Communities without Breaking a Sweat

healthy_placesby James A. Bacon

American society is buckling under the strain of health care costs. The debate, as I have often opined, is stuck on the question of who pays those costs rather than how we can bring costs down. Improving Americans’ health is not a job we can should relegate to Congress and the General Assembly. It is a job for all Virginians — including the real estate industry, as Maureen McAvey with the Urban Land Institute noted at a meeting of ULI’s Richmond branch Wednesday morning.

Chronic diseases such as obesity, heart disease and diabetes reflect 21st century lifestyles marked by too many calories and too little exercise. Exhorting the populace to work out more has not proven terribly successful. But there is a growing conviction that we can design our communities to make moderate activity a routine aspect of our lives. During her presentation, McAvey hit the highlights of a recent ULI publication, “Ten Principles for Building Health Places,” which outlined several approaches to making our communities more hospitable to healthy living.

The publication contains many ideas that should appeal to fiscal conservatives and free-marketeers allergic to the social engineering impulses of the do-gooders who normally champion such things. Designing communities to encourage people to get more exercise should not be an ideological issue. If anything, conservatives should applaud any approach that encourages individuals to assume more responsibility for their own health.

Here are some of the ideas I plucked from the publication and McAvey’s remarks that philosophical conservatives should embrace.

Build complete streets. Conceptually speaking, there is a critical difference between roads and streets. It is OK to design roads with the primacy of the automobile in mind; their function is to increase mobility between cities, towns and major activity centers, which is usually best accomplished with cars. Streets should be designed with the idea of accommodating pedestrians, bicycles and motor scooters in addition to cars for the purpose of providing local access. Reconfiguring the public right of way in accordance with “complete streets” principles makes it safer and more convenient for people to conduct more of their business and run more of their errands on foot. Not only does that take cars off the streets, it builds light exercise into peoples’ daily routine.

Mix it up. Mixed-use development combines the functions of daily life in a concentrated area rather than mandating the separation of housing, jobs and amenities in separate pods. As the report states, “ULI has concluded that mixed-use development makes people much more likely to walk or use transit to run errands, go shopping, or go to lunch than does spread-out, automobile-oriented, single-use development.” Combine mixed-use development with complete streets and mass transit, and you get a winning formula for getting people to walk more.

Conservatives, please note: No one is talking about shutting down the suburbs and herding people into buses and apartment complexes. All we need here is for local governments to meet the large unmet demand for walkable communities. The idea here is to allow more freedom, not less, by freeing builders and developers from restrictions imposed by local zoning codes in order to build the kinds of communities people want to live in.

Ensure equitable access. Cars are expensive. Not everyone can afford them, and not everyone can drive them. Children under 16 cannot drive. Many elderly and handicapped people cannot drive. Many poor people cannot afford to own a car. Conservatives should aspire to build communities that allow more people to be more self reliant and not to rely upon others for their transportation. People who use mass transit also walk. By necessity, if you ride the bus, you walk to the bus stop.

Another note to conservatives: Supporting mass transit through complete streets and mixed-use development need not entail writing a blank check to money-losing municipal transit authorities. Rather than abandoning the idea of mass transit, we should strip away the subsidies, regulations and politicized decision-making that makes mass transit a financial loser. Conservatives should champion profitable, self-supporting mass transit.

Energize shared spaces. Humans are social creatures and they like to socialize. Creating great public spaces encourages people to get outside, walk and mingle with others. As ULI explains, “the residential street should be regarded as a primary public space, not merely a conduit to meet travel needs. A living street is a street … where people can meet and children can play safely and legally.” Best practices include zero-grade separations between sidewalk and street to create a plaza-like feel, wide sidewalks, installation of trees, planters, public art and ground-level retail.

Local governments can create pocket parks out of existing rights of way and encourage restaurants and other retailers to put chairs and tables on the sidewalk. Authorities can encourage local groups to create “pop up parks” that temporarily use vacant or underutilized space, and they should not be afraid to experiment with inexpensive ideas that might end up as failures.

Make healthy choices easy. Traffic conditions and poor street design can discourage cycling. Dirty and dimly lit streets can feel unsafe and uninviting to pedestrians. Simple measures can encourage street use: design sidewalks with appropriate width, lighting, shade trees, street furniture and buffers from traffic; protect bikeways from traffic through striping plants, street parking and curbs; create refuges for pedestrians through raised and buffered islands at wide intersections; install planter boxes or bollards to separate bikes, pedestrians and cars.

None of these ideas require the expenditure of massive funds. Many streets can be re-worked as part of routine maintenance funded by the public works budget. All it takes is reallocating slivers of existing right-of-way from space devoted to traffic and parking to space for bikes and pedestrians. Indeed, attractive streetscapes can often pay for themselves by bolstering property values and stimulating retail sales. We can design healthier communities without social engineering and without busting the budget. Let’s go!

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10 responses to “How to Create Healthier Communities without Breaking a Sweat”

  1. Peter Galuszka Avatar
    Peter Galuszka

    Do conservatives sweat?

  2. do bears crap in the woods?

    call me a serious skeptic of the idea that the reason Americans are fat and unhealthy and die 10 years younger than many other OECD countries is because we don’t have more smart growth …

    If you take a guy that is 100 pounds heavier than he/she should be, has high blood pressure and diabetes .. and shows up at the ER because he has no insurance – and they tell him he needs to be seeing a doctor on a regular basis to manage his condition. – he’s going to die. He’s going to die young but slowly and he’s going to die expensively …. from ER and then MedicAid money spent in a heroic fashion to try to save his life – when it is basically too late because he never did see a doctor regularly and get his condition treated.

    This is how folks die in this country -who do not have insurance. They have the same unhealthy habits that those with insurance have – but their options for treatment, especially for chronic conditions are not the same and sidewalks and bikes won’t save them either.

    the biggest frustration is that people do not want to face the truth on this.

    and the truth is – we have a lot of folks in this country that are fat and sedentary and some of them have insurance and get treatment and some do not – and don’t get treatment until they are so sick they go to an ER.

    when will we face the truth on this?

  3. re: sidewalks in single family detached subdivisions.

    down (or up) our way -the developers argue vehemently that sidewalks add to costs and that people largely don’t won’t them.. they do not want people walking in their front yards…

    commercial developers argue just as vehemently that no one uses a sidewalk to get to a shopping center.. everyone drives.. and everyone parks and walks to the business.

    so here’s the “money” question. If you are a conservative do you think it is a proper role of government to require sidewalks because they will improve the health of people – or for that matter any other “good” reasons?

    eh… In today’s conservative political environment, I think Bacon is more like a liberal bug in a room full of elephants doing the Mexican Hat Dance that a beacon of light and hope.

  4. Breckinridge Avatar

    Yes, there is a utopian, nanny-state tone to much of what I read here. Jim’s not a liberal, but then liberals aren’t the only people trying to tell their neighbors how to live. Don’t confuse conservative with libertarian.

    America is seriously fat. Fat fat fat. Spend a couch potato afternoon and come back and tell me how many fast food adds you counted (Hardees is the worst) glorifying gluttony. I went into a Popeye’s the other day and you order something from their menu and they will give you the ultimate combo unless you tell them not to. (Given the neighborhood I was in, this practice helps explain poverty as well as obesity.) A cat could swim in the cup they handed me to go fill up with high fructose corn syrup.

    If government subsidizes something you get more of it. That has become my mantra. If Medicaid will keep you alive with the diabetes drugs and statins, pay for the cardiac tech who comes in the ambulance for your infarction, if your employer-provided Anthem plan (tax free to you and the employer) does the same, what incentive is there to change behavior? There is no more shame in being fat these days then there is in being pregnant and unmarried.

    I’m not offended by a building code that requires sidewalks. If you are going to have a building code at all — that is the conservative/liberal/libertarian test — do you have a building code at all? If the government could figure out a way to subsidize exercise and healthy eating instead of sloth and gluttony, that might be an abuse of power but it might work.

    1. Re: “building code as test for conservative/liberal/libertarian”

      Never heard an argument against building/fire codes from even the staunchest libertarian. It’s really akin to arguing for a total societal disregard for public safety, and by that logic we should do away with police and fire departments and maybe traffic lights while we’re at it. Perhaps you meant zoning codes?

      1. re: “building codes:

        might need to go back to these words:

        ” The lean urbanism concept, he says, is like a software patch, or a workaround – ultimately a guide or a tip sheet to navigate the complicated, and often very expensive, maze of working in the built environment in the U.S. “It’s about knowing that with certain building types, under a certain threshold, you don’t need an elevator. Or a sprinkler system. A lot of developers know that, and we want to daylight that. We want to present that thematically.”

        Roberts is a master of what is often referred to as Tactical Urbanism — grassroots, impromptu takeovers of public space — to drive change at the block level. In the Ted talk below, he describes how his “just do it” approach — civil disobedience against arbitrary zoning rules that, say, prohibit awnings or ban congregations of people on sidewalks.”

    2. well.. the problem is that “conservatives” have moved further right. They’ve dumped the RINOs (of which Bacon walks, talks, and quacks like one in my view).

      so you’ve got what I call “closet” conservatives these days that are fiscal conservatives but social moderates..that still self-identify with the GOP and unfortunately still vote with them – but they are ducks out of water with the rest of the GOP these days who are for the most part, virulently anti-govt, and would, if they could, get rid of SS, Medicare, MedicAid and EMTALA but they do not make that an explicit visible campaign plank to voters.

      they talk one way to their hard right base and another way to more moderate conservatives and independents because if they really made clear what they want – they’d lose and they know it so they fan dance.

      I think the “if you subsidize something” is simplistic – sound bite simplistic – and just plain not true across the board.

      we don’t even agree what a “subsidy” is.

      Are schools “subsidized”? Police? Roads? employer-provided health-care?

      when we use the word “subsidy” we use it arbitrarily and capriciously to apply to the things we disagree with being paid for by taxes while we ignore the other things provided by taxes – that we like and approve of.

      what would happen to people with employer-provided insurance if it was taxed as compensation AND the GOVT rules for pre-existing conditions went away and the insurance company could deny whoever they wanted ?

      the govt provision that requires insurance companies to cover everyone for employer-provided – is a de facto subsidy.

      roads and rail and pipeline/electric grid rights-of-ways are de facto government subsidies.

      schools are subsidized as well as fire and rescue and libraries… they tax everyone and I just don’t see MORE of these things because they are subsidized.

      so the whole conundrum is not bright line truth but rather shades of partisan thinking in my view.

      and that’s now because I favor or oppose my own set of things – it’s because I believe we cannot have an honest dialogue when we use inconsistent judgement of things.

      basically we subsidize the rich and the middle-class out the wazoo and then we talk about what a bad thing it is to do the same thing for the poor and uninsured.

      we live a lie.

      we provide guaranteed access to the ER for anyone and that’s the mother of all moral hazards. And yet that’s our excuse for how we deal with those who are uninsured. We agree to subsidize it with disproportionate share subsidies to hospitals and cost-shifting from the uninsured to the insured.

      and yet – not one GOP that I know of – not one – not even the whacko birds have advocated REPEAL of EMTALA along with their repeal of ObamaCare.

      why is that?

  5. DJRippert Avatar

    It is kind of funny to read BaconsRebellion sometimes. You read over and over about how Fairfax County is dysfunctional, un-walkable and sprawled. Then you read that functional, walkable and non-sprawled communities will increase health and prolong life. Then you read about how unfair it is that the 1.1M residents of Farifax county enjoy the longest life expectancy of any county in the United States.

    However, I have a better Virginia discontinuity. Where are taxes higher – Massachusetts (also known as Taxacheussetts) or Virginia?

    Would you believe Virginia – by quite a margin?

    Virginians pay $500 per year more in state and local taxes than our neighbors up north. We pay 5% over the national average.

    Meanwhile, in Massachusetts – they have:

    1. The best public schools in the United States, in the top 5 in the world.
    2. Universal health care.
    3. Expanded Medicaid.

    Maybe it’s time we asked the Imperial Clown Show in Richmond just what we are getting for all the money they (and the localities) are taking from us.

    1. geeze DJR , I don’t know what to say other than GOOD ON YOU!

      sometimes I think in our quest to make sure the poor and uninsured don’t get anything we think they don’t deserve, we end up shooting ourselves in our proverbial feet.

      compare Massachusetts not only to Virginia but every Red State in the union on health care and public schools.

    2. Interesting statistics. If I have time, I’ll post them on the blog. There is still a widespread belief that Virginia is a “low tax” state, that we don’t spend enough money and that our taxes ought to be higher.

      One theory worth pursuing why Massachusetts has all those goodies that Virginia does not: Massachusetts, though not without sprawl, is overall a more compactly developed state and, therefore, does not need to spend as much on transportation and infrastructure. Just a hypothesis.

      As for Fairfax residents having a longer life expectancy than other Virginians… that’s tied to two things: more education and higher incomes. Those two factors are prime drivers of health. But that’s not an argument against building healthier communities. Fairfax citizens could be even healthier.

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