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Surgeon General’s Warning: Unwalkable Places Are Hazardous to Your Health

Physical activity is essential to people’s health, but dangerous streets and spread-out, sprawling communities prevent Americans from getting enough of it, says the U.S. Surgeon General, Dr. Vivek Murthy.

Murthy issued a call to action this morning to highlight how walking — and building walkable places — can benefit a nation where chronic diseases like heart disease, diabetes, and arthritis afflict one in two people. Walking (or wheelchair rolling) is a simple and free way for people to get exercise, said Murthy, and even busy people can work it into their lives by making utilitarian trips on foot.

This isn’t the first time a surgeon general has highlighted the health benefits of walking, but it might be the strongest and clearest call to action of its kind so far.

Surgeon General Dr. Vivek Murthy issued his Call to Action to Promote Walking and Walkable Communities this morning. Screenshot from event.

Surgeon General Dr. Vivek Murthy issued his Call to Action to Promote Walking and Walkable Communities this morning.

The surgeon general’s campaign — #StepItUp — says explicitly that the transportation and planning professions should strive to improve public health through design that fosters walking. The first two goals of the call to action are to “make walking a national priority” and to “design communities that make it safe and easy to walk for people of all ages and abilities.”

“Thirty percent of Americans report they do not have sidewalks in neighborhoods,” Murthy said. “We can change that. We can change it by city planners, transportation professionals and local government leaders working together to improve the safety and walkability of neighborhoods for people with all abilities. Community leaders and the law enforcement can work together to make sure that no American is ever unsafe walking out the door.”

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How Seattle Children’s Hospital Took the Lead on Healthy Transportation

Seattle Children's Hospital demonstrating how healthcare providers can be leaders in healthy transportation. Image: Seattle Children's Hospital

Seattle Children’s Hospital’s sustainable transportation goals for 2028. Image: Seattle Children’s Hospital [PDF]

It’s more than a little ironic that in many places, hospitals are some of the worst offenders when it comes to perpetrating unhealthy transportation patterns. Often surrounded by enormous parking decks, hospitals have earned a reputation as isolated institutions hermetically sealed off from surrounding neighborhoods.

But that’s beginning to change. Healthcare providers are undergoing a fundamental shift from focusing on contagious diseases to treating chronic conditions that are often related to unhealthy lifestyles, like diabetes and heart disease. Industry leaders like Kaiser Permanente are pushing reforms not only in healthcare policies and procedures, but in the physical form of hospitals and the role they plan in their communities, write Robin Guenther and Gail Vittori in their book, Sustainable Healthcare Architecture

I asked Guenther which hospitals are leading the shift to healthier transportation practices, and she singled out Seattle Children’s Hospital as the best model by a wide margin. It is indeed impressive.

In 2008, under pressure from the city of Seattle, the hospital mapped out a comprehensive transportation plan [PDF] calling for major reductions in solo car commuting. Even before that, the hospital had demonstrated leadership. Beginning in 2004, it used a combination of strategies to reduce the share of daytime commuters who drive alone to work from 50 percent to 38.5 percent.

The 2008 plan laid out a new target: to reduce the share of commuters who arrive alone by private car to 30 percent by 2028. As part of an agreement with Seattle City Hall, the hospital’s permitting to build new clinical space is tied to reductions in solo car commuting.

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DOH: Motorist Crashes, Again the Top Killer of NYC Kids, Are Preventable

Image: DOH

Image: DOH

Each year the Department of Health and Mental Hygiene reports on the top causes of injury-related death for children in New York City, and traffic crashes consistently top the list. That remains true in the newest report [PDF].

The DOH report draws on crash data from the medical examiner’s office and DOT. From 2003 to 2012, an average of 44 kids aged 1 to 12 died annually from injury-related causes, including fires, suffocation, and falls, the report says. The largest share — 40 percent — were killed in traffic crashes. Of the 110 children aged 1 to 12 killed by motorists during that period, 78 were struck while walking.

Between 2009 and 2011, 23 kids aged 1 to 12 and 25 children aged 13 to 17 died in traffic crashes. Of those, 65 percent were struck by drivers while walking, 6 percent were hit while riding bikes, and 29 percent were riding in or driving a car.

Though boys, black children, and children from the poorest neighborhoods are a disproportionate share of the victims, traffic crashes were the top cause of such deaths for boys and girls across all races and ethnicities and all levels of neighborhood poverty.

The report says 19 of 31 kids aged 1 to 17 killed while walking between 2009 and 2011 were crossing against the traffic signal or crossing mid-block. But it does not specify how driver behavior or street design factored into those crashes. Instead, the report makes a general statement that driver behaviors “such as” inattention and failure to yield contributed to child pedestrian deaths. The report does not say what role driver speed, the leading cause of NYC traffic fatalities, played in crashes that killed children who were walking and biking.

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NHTSA Touts Decrease in Traffic Deaths, But 32,719 Ain’t No Vision Zero

Twenty-four-year-old Taja Wilson was killed near the Louisiana bayou in August when a driver swerved on the shoulder where she was walking. Noshat Nahian, age 8, was killed in a Queens crosswalk on his way to school in December by a tractor-trailer driver with a suspended license. Manuel Steeber, 37, was in a wheelchair when he was killed in Minneapolis while trying to cross an intersection with no crosswalk or traffic signal on a 40-mph road. One witness speculated that Steeber must have had a “death wish.”

Noshat Nahian, 8, was hit and killed by a motorist on his way to school in Queens with his sister, Nousin Jahan Nishat, 11. Photo: ## in US##

Noshat Nahian, 8, was hit and killed by a truck driver on his way to school in Queens with his sister.
Photo: Accidents in US

These are just three of the 4,735 pedestrians killed in 2013. Believe it or not, that was an improvement, down 1.7 percent from the year before. New data [PDF] from the National Highway Traffic Safety Administration (NHTSA) shows that overall, traffic fatalities went down in 2013 — reassuring news after a disturbing uptick in 2012. But 32,719 preventable deaths on the country’s streets is still an alarming death toll. Tens of thousands of lives would be saved if the United States achieved a traffic fatality rate comparable to the United Kingdom, Germany, or Japan. The Vision Zero movement is growing around the country, but advocates are still trying to come up with a way to bring the movement for zero deaths to the national level, instead of just city by city. Moreover, though the overall situation improved in 2013, beneath the surface there were some disconcerting trends and facts:

  • Bicyclists (categorized as “pedalcyclists” in NHTSA reporting language) were the only group to experience more deaths in 2013 than 2012. With more and more people riding bicycles, the 743 cyclists killed in 2013 probably still represents fewer deaths per miles ridden, but it also reveals a blind spot in many places in the country that have yet to adapt their roads to the reality of more people biking.

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Traffic Remains the Top Injury-Related Killer of NYC Kids Under 15

Last week, the city announced that it is kicking off the school year with the gradual roll-out of all 140 school zone speed cameras allowed under state law. There’s good reason for the expansion: Despite drops in fatality rates over the past decade, a report from the Department of Health and Mental Hygiene shows that traffic remains the leading injury-related killer of New York City children.

NYC's streets remain the top cause of injury-related death for children. Photo: Susan Sermoneta/Flickr

Car crashes remain the top cause of injury-related death for children under 15 in NYC. Photo: Susan Sermoneta/Flickr

Each year, the health department releases a report on injury-related causes of death for New Yorkers under the age of 18, using data from death certificates and the medical examiner’s office [PDF]. This includes fatalities from fire, drowning, suffocation, firearms, and falls.

As in previous reports, motor vehicle-related deaths are the top injury-related cause of death for New Yorkers ages 1 to 14, accounting for nearly 25 percent of all injury-related deaths in that age group from 2002 to 2011. Firearms account for a greater share of fatalities among 15- to 17-year-olds. In the 10-year study period, 216 New York City children age 1 to 17 died in motor vehicle crashes.

Things are worse in the rest of the country, where a higher mortality rate for people under 18 is driven in large part by a much higher death rate from car crashes. The motor vehicle fatality rate for children in the U.S. is more than four times higher than for children in New York City. This difference is most pronounced among children age 15 to 17. In New York, this age group is six times less likely to die in a motor vehicle crash than their peers in the rest of the nation.

Kids are more likely to be killed in NYC car crashes as pedestrians rather than as motor vehicle occupants, with children on foot accounting for 73 percent of traffic deaths among 5- to 14-year-olds. By examining NYC DOT’s traffic fatality database, the authors determined many of these victims were children emerging from between parked cars or crossing against the light. Separately, DOT has identified driver speed as the top factor in fatal crashes overall, most recently using data from 2012.

“Injuries are often inaccurately seen as a result of incidents that cannot be anticipated or avoided,” the report says. “However, most injuries follow patterns… that can be predicted and prevented.” The report recommends educating children about street safety, encouraging adults to drive carefully, implementing safer street designs, and expanding the use of automated enforcement.

The report does not mention Vision Zero, but a guiding principle of that program seems appropriate to mention here: Streets should be places where people, especially very young people, can make mistakes without losing their lives.

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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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