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Posts from the "Public Health" Category

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India’s Health Minister Wants Protected Bike Lanes Nationwide

There’s encouraging news out of India, where cities expect to add hundreds of millions of residents in the next few decades but are already choking on traffic congestion and auto exhaust.

The Indian government appears to be embracing bicycling. Photo: Wikipedia

A senior Indian government official wants the nation to embrace bicycling. Photo: Wikipedia

Dr. Harsh Vardhan was appointed to lead India’s health ministry by newly elected prime minister Narendra Modi this May, and he wants to promote bicycling as a way to improve public health and air quality while adding more transportation options, especially for low-income people.

According to the Indian news outlet First Post, Vardhan would like to see a nationwide effort to install protected bike lanes:

Union Health Minister Dr Harsh Vardhan said that he will approach the Surface Transport and Urban Development Ministries for the development of cycle tracks alongside roads to make cycling a “huge movement” in the country.

“I will personally write to Surface Transport and Urban Development Ministries to do whatever they can in this initiative and also ask them to develop cycle tracks,” Vardhan said as he released a study report titled “Peddling towards a Greener India: A Report on Promoting Cycling in the Country”, prepared by the Energy and Resources Institute (TERI) in New Delhi on Wednesday.

The report also recommended that India offer residents micro-loans to purchase bikes, as well as tax incentives to promote bicycling.

The health problems that auto emissions cause are now grave enough to threaten India’s economy, as the number of private vehicles has tripled to 130 million since 2003.

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Memo From Massachusetts: 25 MPH Speed Limit Would Save Lives

If it dropped the speed limit on local roads from 30 to 25 mph, Massachusetts would save 18 lives per year, according to an analysis performed last year. Image: MAPC

If Massachusetts dropped the speed limit on local roads from 30 to 25 mph, it would save 18 lives and prevent 1,200 injuries per year, according to an analysis performed last year. Image: MAPC

Researchers in Massachusetts have concluded that lowering the default speed limit on local roads from 30 to 25 mph would save lives and yield big public health benefits. Even without additional traffic calming measures, a lower speed limit on its own would prevent 2,200 crashes, 1,200 injuries, and 18 fatalities in the state of 6.6 million, according to an analysis of a 25 mph bill considered by the Massachusetts legislature last year. These numbers should be on the minds of New York legislators, who have the potential to save lives with a 25 mph bill of their own.

By lowering speed limits on local roads to prevent deaths and injuries, Massachusetts workers and employers would save $210 million annually by avoiding the costs of medical payments and missed work, according to a first-of-its-kind health impact assessment from the Metropolitan Area Planning Council.

Traffic analysts found that lower speed limits would add $148 million in annual costs, based mainly on the assumption that drivers would seek out longer routes that may not be as direct but would yield higher speed limits. Even with the added driving, the extra pollution would not result in any deaths, and the reduction in injuries and fatalities outweighed the additional costs.

If anything, the study undercounted the potential benefits of lower speed limits. “The health cost savings are done very, very conservatively,” said MAPC public health manager Barry Keppard. For example, the study did not measure the impact of calmer streets on property values, or whether lower speeds would encourage more people to walk or bike.

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How Road Planners Fail Neighborhoods

Why do neighborhood groups — especially in low-income areas — have such a hard time influencing the design of major road projects? An interesting case study from the University of Colorado-Denver sheds some light.

In the planning of Verona Road in Madison, Wisconsin, neighborhood concerns took a back seat to moving traffic. Image: Google Maps

In the planning of Verona Road in Madison, Wisconsin, neighborhood concerns took a back seat to moving traffic. Photo: Google Maps

To examine the barriers to incorporating public health principles into transportation planning, researchers studied the Allied-Dunn’s Marsh neighborhood in Madison, Wisconsin, a disadvantaged but organized community.

Locals spent years preparing for the redesign of Verona Road, a wide street that carries 50,000 to 60,000 vehicles daily. Although Verona is a major, high-traffic road in the federal highway system, it functions not only as a thoroughfare for vehicles but also a community space, with residential development and neighborhood-serving businesses on both sides.

The study found that neighborhood residents had many concerns about the road, including difficulty and danger of crossing it, and that it was noisy and blighted. But they weren’t very successful at winning support for proposals that would address those concerns.

“Their main concerns were excluded,” authors Carolyn McAndrews and Justine Marcus wrote, “even if some of their ideas were adopted.”

The planning process itself — led by the state, which produced the official Environmental Impact Assessment — presented three major barriers for residents of the neighborhood:

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More Walking and Biking, Better Health: New Evidence From American Cities

States with higher rates of walking and biking to work tend to have lower rates of diabetes. Click to enlarge. All graphics: Alliance for Biking and Walking

New data from the Alliance for Biking and Walking’s 2014 Benchmarking report bears out the notion that people tend to be healthier in cities where walking and biking are more prevalent.

The Alliance compiled active commuting rates in the 50 largest American cities as measured by the U.S. Census. Then it compared that data with health information from the CDC. On health outcomes like diabetes, obesity, and high blood pressure, a pretty clear correlation emerges.

Not all of it can be explained by active commuting, of course. But notice how, in the top chart, as statewide active transportation rates increase, diabetes rates decline.

About 9 percent of Americans have diabetes, but the incidence varies greatly between different places. Diabetes tracks closely enough with walk and bike commute rates that the Alliance and other researchers have concluded there’s a strong correlation.

Rates of elevated blood pressure display a similar pattern:

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Boston Doctors Now Prescribing Bike-Share Memberships

The newest tool for doctors in the fight against obesity? That’s right: Bike-share.

Doctors in Boston are now prescribing Hubway memberships. Photo: Hubway

Doctors in Boston are now prescribing Hubway memberships. Photo: Hubway

This week in Boston, doctors introduced a program called Prescribe-a-Bike, offering low-income residents struggling with obesity an annual Hubway bike sharing membership for the low price of $5. The program is being administered by Boston Medical Center in partnership with the city of Boston. Qualifying patients will have access to Hubway’s 1,100 bikes at 130 locations. Participants will also receive a free helmet.

“There is no other program like this in the country,” Mayor Marty Walsh told Boston Magazine. “Prescribe-a-Bike makes the link between health and transportation, and ensures that more residents can access the Hubway bike-share system.”

Local officials hope the program will result in about 1,000 additional memberships, according to the Boston Globe.

In the medical community this type of recommendation is known as an exercise prescription, and it is a growing practice. More doctors are prescribing exercise, the CDC says, as “lifestyle diseases” like obesity, heart disease and diabetes have become some of the leading killers in the United States. In addition, police measures like the Affordable Care Act are providing incentives for the healthcare industry shift focus from treatment of disease to the promotion of wellness.

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Poor NYC Neighborhoods “Less Conducive to Walking” Than They Appear

A fact sheet [PDF] released by the city’s health department today makes the case that New York City’s walkability contributes to the health of residents — but a deeper look into the research shows that not all New Yorkers are benefitting equally from walkable neighborhoods.

The more walkable your NYC neighborhood, the more likely you are to engage in physical activity. Image: DOHMH

The more walkable your neighborhood, the more likely you are to engage in physical activity. Image: DOHMH

The brief draws on recent data from two sources: Research by Columbia University academics on the walkability of the city’s neighborhoods and the health department’s own survey of 3,800 New Yorkers about physical activity and transit.

The Columbia researchers measured walkability using five components: Residential density, density of street intersections and subway stops, land use mix, and an estimate of the prevalence of large retail parking lots. The health department tracked the health and transportation behaviors of New Yorkers through surveys, accelerometers, and GPS devices. By looking at the two datasets together, the bottom line became clear: ”Physical activity levels were substantially higher in people living in higher-walkability neighborhoods,” the report says.

People in the most walkable neighborhoods averaged 233 minutes of moderate physical activity per week, burning 1,200 calories, while people living in the least walkable areas averaged 134 minutes of activity per week, burning only 690 calories.

The Columbia academics, based in the university’s Built Environment and Health Research Group, dove deeper by adding income to the equation. Matching places with the same walkability scores, they compared neighborhoods where at least 20 percent of the residents live in poverty with neighborhoods where fewer than 20 percent of residents live in poverty.

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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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For One Reckless Driving Survivor, “Life Looks a Lot Different Than Before”

Traffic fatality numbers usually get the headlines, but as a measure of how safe or dangerous it is to walk and bike, injuries are the more stable metric. Since 2003, according to state DMV data, an average of just under 14,000 people were injured by motorists while walking and biking in the city each year.

Lalita Rao. Photo: Brad Aaron

Lalita Rao, left, with her daughter Amita. Photo: Brad Aaron

Of the 38 pedestrian and cyclist injury crashes in NYC on an average day, few are investigated by NYPD. Not all pedestrian and cyclist injuries are classified as “serious,” but traffic violence disrupts the lives of thousands of victims — and their loved ones — permanently. For every victim’s story the public sees or hears in the press, dozens go untold.

On May 28 of last year, Lalita Rao was walking home from Elmhurst Hospital, where she worked, when she was hit by a school bus driver making a turn. Lalita got up from the pavement and, believing she was not seriously hurt, was prepared to continue on her way. The bus driver, too, was about to leave the scene before a neighbor intervened. Responders arrived, and Lalita was taken back to Elmhurst, where she would undergo emergency brain surgery to save her life.

Lalita, who spoke at the Elmhurst pedestrian injury summit in December, suffered two brain hematomas. “The fact that I am alive is a miracle,” she said. “I never thought my life would change totally like this.”

Before the crash, Lalita ran every day — she’s run the New York marathon. She was a gardening enthusiast and loved to cook. She traveled a lot. After the crash, Lalita had to relearn how to walk, and how to use her arms and hands. She uses a walker now, and even so needs help keeping her balance. She suffered a seizure and may be on seizure medication the rest of her life.

Lalita can’t cook anymore because of her unstable balance. She can no longer tend to her garden. “Instead of going to work,” she said, “I go to rehab twice a day.”

According to Lalita, the driver who hit her was talking on a cell phone. Because of this, and since there were children on the bus at the time of the crash, she said the bus driver lost his job. But he was not arrested for hitting Lalita, and she does not know if he got a traffic ticket. Lalita and her family members said they didn’t hear much from NYPD after the crash.

“Because of a distracted driver,” said Lalita, “I need help for everything. I went from being independent to total dependency.”

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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.”