The former director of the Center for Disease Control’s Environment Health Department will take to the airwaves Tuesday in an interview with PBS’s Tavis Smiley. The interview will run in coordination with Dr. Jackson’s four-hour documentary series, Designing Healthy Communities (check local listings).

Dr. Jackson spent years researching public health epidemics and zeroed in on car dependence and sprawl as leading factors in America’s diabetes and obesity epidemics.

“We have built America in a way that is, I believe, is fundamentally unhealthy,” Dr. Jackson says. “It prevents us from walking. It inhibits us from socializing. It removes trees and the things that make our air quality better. We could not have designed an environment that is more difficult for people’s well being at this point.”

He adds: “Two percent of the United States’ gross domestic product goes to the treatment of diabetes. This is a crushing economic impact.”

The series looks at communities across the country, highlighting best practices while attempting to reveal the human suffering that results from poorly planned communities.

The full interview will be available 24 hours before screening at PBS.org.

Obesity rates are highest in Appalachia and the Southeast United States. Image: Planetizen

A map showing the percentage of car commuters shows a strikingly similar pattern.

Researchers Anne Price and Ariel Godwin at Planetizen caution readers not to conflate correlation and causation. However, when comparing other economic and demographic characteristics (unemployment, educational attainment, income), no other maps displayed such striking similarities.

Furthermore, when the research team created a scatterplot comparing obesity rates in U.S. counties with commuting habits, a “strong relationship” emerged.

This scatterplot shows the link between obesity rates in U.S. counties and rates of commuting by car. Researchers found the correlation to be "strong."

Again, Price and Godwin were cautious about drawing a direct causal relationship:

Considering that the percentage of active commuters in the U.S. is quite small, it is unlikely that walking and biking make any significant contribution to reducing the obesity rate in particular counties. More likely, counties with the highest percentage of walkers and cyclists also share other common characteristics that are driving this trend. Perhaps lower rates are driven by a cumulative effect of a more affluent and educated population. It may also be that counties with higher rates of active commuting have policies and cultures that have led to higher rates of physical activity overall.

Sounds like more research is needed — in addition to more transportation choices in the southeast and Appalachia.

It would also be interesting to examine whether the availability of alternatives to single occupancy vehicle travel contributes to some of the better economic indicators in some of the nation’s less obese, wealthier areas.

Dwayne Marshall, an East Harlem elementary school student, was one of many neighborhood residents who stood up in support of protected bike lanes last night. Photo: Concrete Safaris

At a long and at points contentious public hearing last night, a clear majority of speakers came out in support of protected bike lanes on First and Second Avenues in East Harlem. In addition to local residents, the public health community came out in force to demolish the opposition’s claim that installing bike lanes could worsen the neighborhood’s asthma rates.

Community Board 11 had previously voted overwhelmingly in favor of the lanes, then rescinded its vote in the face of business opposition. Last night’s testimony sets the stage for another vote on the project, perhaps in January.

More than 30 people spoke in support of the bike lanes, while only seven spoke against. The larger audience, a packed room of over one hundred, seemed to have a similar proportion of supporters to opponents. Local activist James Garcia also brought a petition with 850 signatures in support of the bike lanes, an amount he said only took seven hours to gather.

The community’s elected leadership continued their sustained fight to bring safer streets to East Harlem.

“Our public roadways are a public amenity that belong to every single individual who lives in our community,” said Council Member Melissa Mark-Viverito, who stayed for the full three-hour hearing. She argued that building complete streets not only protects people who already bike but also helps seniors cross the street and lets parents feel comfortable having their kids get on bikes. “I believe very strongly that this is a social justice issue. Our community doesn’t deserve any less than any other community, and our children don’t deserve any less.”

“As cycling becomes more popular among city dwellers,” State Senator José Serrano said in a prepared statement read by an aide, bike riders “deserve to have safe travel like pedestrians or drivers.”

The bike lanes had two strong bases of support in the neighborhood’s student population and in the public health community. Speaking first last night in order to be able to make it home for bedtime were seven elementary school students from the Concrete Safaris afterschool program. “Biking is good because you don’t get diabetes and pollute the air,” said a girl named Abigail. “I think East Harlem should have bike lanes. You get a ticket if you ride on the sidewalk and it’s extra-scary when you have to ride in a car lane,” argued Dwayne Marshall.

Three students from the Coalition School for Social Change, a high school located on First Avenue, also spoke in favor of the lane. They had participated in a DOT-led visioning process for the street and saw the bike lanes as part of a larger project to enliven the street and improve safety. “We would love them,” said one student. “Please approve them so that we can ride our green wheels safely to schools.”

Last night’s speakers also debated the public health implications of installing protected bike lanes. East Harlem suffers from elevated rates of asthma, diabetes and obesity, so health is a top concern for most families there. Erik Mayor, the owner of local business Milk Burger, again appealed to those concerns in arguing against the bike lanes. “The traffic conditions will get worse. It’s common sense,” he claimed. “Greater congestion creates greater emissions from vehicles.”

However, a parade of experts each testified that the lanes would, in fact, improve public health. “There is no evidence to suggest that bike lanes increase asthma rates,” said Joanne Eichel of the New York Academy of Medicine. “On the contrary, we know that riding a bike has extraordinary health benefits.”

Discussing both the expected safety improvements from the protected lanes and pedestrian refuge islands and the increased physical activity that comes from more walking and cycling, Eichel said the installation of the bike lanes would be “a major step toward improving the health of people of all ages in the community.”

La’Shawn Brown-Dudley, the deputy director of the Department of Health’s local district public health office, said her office hadn’t seen bike lanes worsen asthma anywhere in the city, but did see them as a way of encouraging healthy lifestyles. “We at the Health Department support the inclusion of these bike lanes,” she said. The bike lanes also won endorsements from Javier Lopez, the director of the New York City Strategic Alliance for Health, and two Mt. Sinai pediatricians, Kevin Chatham Stevens and Cappy Collins.

The opposition to the bike lane was fierce, if not widespread, and included every anti-bike lane trope in the book. “I love bicycles, it’s just not for First Avenue,” argued Frank Brija, the owner of Patsy’s Pizzeria who wanted to move the lanes to Pleasant and Paladino Avenues, which run for ten non-contiguous blocks east of First.

Mayor not only argued that the bike lanes would worsen traffic, but that they would block ambulances, prevent plowing, endanger senior citizens and sit unused. Rejecting evidence that the lanes work well in other countries and other New York neighborhoods, Mayor responded, “That’s not El Barrio, that’s not East Harlem, that’s not Spanish Harlem.” Mayor even cited the opposition of former transportation commissioner Iris Weinshall to the Prospect Park West bike lane to claim that DOT’s data couldn’t be trusted.

When bike lane opponent Pablo Guzman started to complain that bike lane supporters — the elected officials, DOT representatives, and students — were allowed to speak ahead of the regular order of speakers, the event briefly broke out into chaos. Charges of slander flew and the core of bike lane opposition led by Brija and Mayor stormed out of the room.

Mostly, though, the environment was one of thoughtful speeches and good nature. Harry Bobbins, a cyclist and bike lane supporter, even brought two Patsy’s pizzas in to show the bike community’s support for local businesses.

One issue raised that clearly needs more work, for example, is the parking regulation along First and Second Avenue. Though the installation of the bike lanes will include some new loading zones, the majority of the parking along the two avenues will remain unmetered alternate side parking, which DOT Borough Commissioner Margaret Forgione called “very unusual for a commercial corridor.” The lack of meters means double-parking is worse than it needs to be and finding a short-term parking space much harder. Metering the spaces “would be a tremendous benefit,” said Forgione, but not an action DOT will undertake without community support.

Altering the parking regulations was also a key post-implementation adjustment put into place along Columbus Avenue, one which helped calm an angry business community and create a popular new piece of infrastructure. “We had a learning curve,” said Mel Wymore, the former chair of Community Board 7, who spoke in favor of the bike lanes based on his experience on the Upper West Side. “I think you’ll see more and more, as bike lanes become the norm in New York City, just like in Times Square, all the businesses say business actually improves because of the life on the street.”

With a strong majority in support of the bike lanes, last night’s public hearing probably helped build some momentum for the community board to return to its previous stance of support for the project and for DOT to eventually move forward on installation. “The vast majority of the people in this room are very supportive of the lanes,” noted Forgione at the end of the hearing.

The hearing also provided a lesson for Diego Quiñones, a resident who was hit by a car while cycling on First Avenue in July. “Wow,” he said. “Change is scary, huh?”

Considering that streets and sidewalks make up 80 percent of New York City’s public space, the pedestrian plazas, car-free spaces, neighborhood bike networks and world-class bicycle lanes you have created are vital to the public health of our city. In piloting Safe Routes to School and Safe Streets for Seniors programs, reducing car hours in our largest parks and producing events like neighborhood play streets and Summer Streets, you are pioneering the redistribution of our public space for health’s sake.

While one can imagine a tsunami of ink engulfing the city if over a hundred doctors and other providers had joined up to condemn bike lanes and public plazas, with media types refusing to print a positive word about measures that are making streets safer, it will be quite a feat if this ringing endorsement pierces the news cycle.

Read the text of the letter after the jump; see the original with signatures here.

Dear Mayor Bloomberg,

We, the undersigned medical professionals, write to acknowledge and encourage your efforts to calm traffic and make New York City streets safer for bicyclists and pedestrians. As a result of your efforts, from re-envisioning Times Square to building the first protected bicycle lanes in the U.S., more New Yorkers are biking and walking than ever before. Mayor Bloomberg, we urge you to continue to set ambitious goals for how our streets and public spaces can help make all of New York City more healthy and safe.

Considering that streets and sidewalks make up 80 percent of New York City’s public space, the pedestrian plazas, car-free spaces, neighborhood bike networks and world-class bicycle lanes you have created are vital to the public health of our city. In piloting Safe Routes to School and Safe Streets for Seniors programs, reducing car hours in our largest parks and producing events like neighborhood play streets and Summer Streets, you are pioneering the redistribution of our public space for health’s sake.

These changes help pave the way for a city that breathes cleaner air and is in better physical condition. Commuting to work by bicycle or increasing the distance of daily walks has been shown to promote weight loss better than any exercise program or medication we could prescribe. Vital to fighting the epidemics of asthma and obesity is the opportunity for children to have safe places to play and clean air to breathe. The traffic calming infrastructure you have built is as valuable as a playground toward encouraging active youth and instilling healthy habits that will last a lifetime.

Thanks to your leadership, bicycling is the fastest growing mode of transportation in New York City and pedestrian safety is at an all-time high. Mayor Bloomberg, we enthusiastically support your efforts to improve bicycling and walking in New York City. As you shape your legacy, please continue to make safe, complete streets part of the prescription for a healthy New York City.

The United States has fallen far behind countries with high cycling rates, like the Netherlands, when it comes to overall street safety and preventing pedestrian deaths. Graphic: Streetsblog; Data: PPS

I’ve got a question for the purported defenders of pedestrian safety who sit on the editorial boards at the Daily News and the Post. I know they haven’t shown much interest in preventing the 10,000+ injuries and 150+ fatalities that motorists inflict on pedestrians in New York City each year, but the new Hunter College study on pedestrian injuries caused by cyclists has apparently piqued their interest in street safety. It seems we can all agree that the streets should be safer for walking.

So, here’s my question: Aren’t they at all curious why, statewide, the number of pedestrian injuries involving cyclists went from 1,097 in 2007 to 927 in 2010?

That’s a 15 percent drop in three years! Shouldn’t we try to find out why this is happening and apply those lessons to keep driving this number down?

The Post and the Daily News seem to think they already have the answers. Both editorialized that the introduction of a public bike system next year and the accompanying rise in cyclists is going to increase the risk of injury to pedestrians. This is bizarre, because the data in the Hunter College report suggest that as more New Yorkers ride bikes, the number of pedestrian injuries caused by cyclists has declined. And, more broadly speaking, evidence from all over the world has consistently shown that places with high rates of cycling are also the safest for pedestrians.

As Noah wrote on Monday, a recent analysis of 24 California cities and towns by civil engineering professors Norman Garrick and Wesley Marshall found that places with higher cycling rates tend to have lower rates of fatal and severe traffic injuries.

I can already hear the NYC chauvinists: “You can’t compare these laid-back West Coast towns to a world capital like New York.”

Well, how about Tokyo? A frenetic global metropolis with more than 13 million residents. With all those people rushing to get where they need to go, Tokyo still boasts a pedestrian fatality rate nearly half that of New York. And check this out: In Tokyo, 16 percent of all trips include cycling. That’s an order of magnitude higher than the current cycling rate in NYC.

Okay, so that’s just one city. The skeptical truth-seekers who write opinions for our tabloid press demand more data. Here it is…

The developed countries at the top of the list for bicycle mode share are the Netherlands (27 percent of trips), Denmark (17 percent), Japan (14 percent), Sweden (12.6 percent), and Germany (10 percent). The annual traffic fatality rate in these countries ranges from less than three per 100,000 people in Sweden, to 7.4 per 100,000 people in Denmark. In the U.S., with our approximate 1 percent bicycle mode-share, the carnage on the roads is much greater: 12.3 traffic deaths per 100,000 people, which works out to between 35,000 and 40,000 lives lost annually. Tens of thousands of lives would be saved each year if we could catch up to the world leaders in street safety.

The top cycling countries have also attracted international attention for achieving dramatic reductions in pedestrian fatalities. Sweden, with its Vision Zero initiative, cut pedestrian deaths in half in five years. Germany and the Netherlands are also leaving the United States behind when it comes to street safety. Between 1975 and 2001, American pedestrian deaths declined 27 percent while Dutch pedestrian deaths fell 73 percent and German pedestrian deaths fell 82 percent, according to a 2003 paper in the American Journal of Public Health by Rutgers professor John Pucher [PDF].

How did Germany and the Netherlands save so many lives? Pucher and co-author Lewis Dijkstra attribute much of the success to street design:

One emphasis of Dutch and German policy has been to improve the transportation infrastructure used by pedestrians and bicyclists.  For pedestrians, that has included extensive auto-free zones that cover much of the city center; wide, well-lit sidewalks on both sides of every street; pedestrian refuge islands for crossing wide streets; clearly-marked zebra crosswalks, often raised and with special lighting for visibility; and pedestrian-activated crossing signals, both at intersections and mid-block crosswalks.

Dutch and German cities have also invested heavily to expand and improve bicycling facilities.  From 1978 to 1996, the Dutch more than doubled the extent of their already massive network of bike paths and lanes (from 9,282 km to 18,948 km).  From 1976 to 1995, the Germans almost tripled the extent of their bikeway network (from 12,911 km to 31,236 km).

More car-free zones, pedestrian refuges, clearly marked crosswalks, and extensive, high-quality bike networks. Hmmm… Seen any changes like that around NYC recently? Imagine how much more progress we could make if our daily papers actually cared about street safety.

Transportation-related deaths, represented on their own as the thick green line in this chart, remain the single largest killer of New York City children. Image: NYC Department of Health

Every year, the Department of Health releases a report on the injuries that kill NYC children [PDF]. And every year, the grim statistics show traffic to be the single largest cause of injury-related death among kids.

Between 2001 and 2009, 1,681 children under 13 years old died in New York City, 324 of them from unintentional injuries. Of those, 41 percent — 134 children — were killed in traffic crashes. Most of them were on foot when they were hit by a car or truck driver.

“Unintentional motor vehicle traffic accidents contributed the most to child injury deaths in NYC overall, with more than three quarters of deaths occurring among pedestrians,” the authors write.

The first report in this series focused specifically on traffic crashes, detailing specifically how motor vehicles kill New York City children. Last year’s report examined the massive racial inequalities in traffic fatalities; though 26.6 percent of New York City residents are black, black children make up 46 percent of all kids killed by cars.

This year, the Department of Health expanded the scope of its research to include serious injuries as well as fatalities. Between 2001 and 2008, 4,944 children were hospitalized with injuries from traffic crashes. Again, most were walking when hit. Traffic crashes are not the leading cause of hospitalizations among kids — about twice as many are caused by falls.

As preventable as these injuries are, and as much as these numbers need to come down, the rate of traffic injuries and fatalities suffered by NYC kids is lower than other American cities. Because New Yorkers extensively ride transit and walk rather than drive, child traffic deaths are three times lower per capita than the national average. New York’s far safer transportation system saves enough lives that it is the primary reason why the overall mortality rate for local kids is 30 percent below the national average.

In addition to urging parents to buckle in their children properly and teach them to cross the street safely, the Department of Health repeated its call for Albany to authorize camera enforcement of the speed limit on dangerous streets. Legislation to that effect went nowhere in the state legislature this spring.

New Yorkers get most of their physical activity simply from getting around, not from working out. Image: NYC DOH

The New York City Department of Health is out with a new bulletin [PDF] articulating the public health benefits of walking, biking, and taking transit. Encouraging those modes — and curbing the amount we drive — will reduce deaths and injuries from traffic crashes, prevent lung disease by lowering exposure to air pollution, and improve cardiovascular health by increasing exercise.

The evidence is pretty overwhelming — just 30 minutes of walking or biking each weekday reduces your risk of premature death by 20 percent — and the department’s recommendations are clear: New Yorkers should drive less, and the city should build the infrastructure to make walking, biking, and riding transit as safe and convenient as possible.

Most of the Health Department’s factoids have already been reported, like the life-saving improvements in air quality as a result of closing parts of Broadway to traffic. But one caught our eye as a new reminder of the importance of daily commute habits for your health.

While many think of going to the gym or for a jog as the key to staying in shape, a DOH survey found that New Yorkers get most of their physical activity as they go about their daily routine. The majority of New Yorkers who take transit to work, for example, get eleven minutes of physical activity each day from recreation. But they move for 57 minutes a day just to get around, whether it’s to walk to the bus or run some errands during lunch. New Yorkers who walk or bike to work get slightly more exercise than transit riders as part of their daily routine, while drivers get less than half as much. The city’s compact development and strong transit system are the key to incorporating activities that lower New Yorkers’ risk of diabetes, cancer, and cardiovascular disease.

The Health Department report should also underscore how misguided it is to argue, as Assembly Member Dov Hikind has, against traffic calming on the grounds that it might some day slow speeding ambulances by a few seconds. The city’s top doctors are making the case for more traffic calming on city streets, not for the primacy of free-flowing traffic. This bulletin even singles out pedestrian refuge islands, the very safety feature that Hikind is suing to eliminate, for an endorsement.

Let’s make not strapping a child into a car seat a symbolic act of love. Photo: Lafayette County Health

For decades, Americans have been hearing about the dangers of air pollution, much of which derives from our fleet of vehicles. Yet as the body of research has grown, clarifying just how damaging automobiles are to human health and the environment, we’ve persisted in spending an astounding amount of time in cars. As a nation, we drove three trillion miles last year. We have developed responses designed to treat symptoms of the underlying ailment, like keeping children indoors when the local ozone level triggers “code red” or “code purple” alerts. But as a whole, we have not responded to the everyday contamination of our bodies by driving less.

Most of us feel powerless to affect air quality. Many feel trapped by the built environment and unable to cut down on driving. Plenty also see no point in changing their behavior when “everyone else” is going to drive as much as they wish to. It’s unsurprising then that news about pollution is brushed aside—as is news about other ills caused by driving, including crash fatalities and injuries, stress, and obesity.

The UCLA mouse study joined other recent reports that highlight the variety of ways in which remaining overly reliant on the private automobile is self-destructive. But these reports should also make clear that changes in individual behavior can alleviate some of the problems. Here’s just a sampling:

• Sitting for long stretches greatly increases the risk of heart disease – even if you exercise afterwards – according to a study in the Journal of the American College of Cardiology. It may come as no surprise that sitting isn’t good for your health, but what’s shocking is that the raft of articles following the study tended to ignore active transportation while advocating improbable solutions such as standing treadmill desks. What’s more practical than replacing some of our long hours planted in the driver’s seat with walking, biking, or getting by foot to public transit stops?
• While there was some good news in the American Lung Association’s 2011 State of the Air Report, as one commentator put it, it was “like getting a 53 on your math test after you got a 49 on your last one.” Half of Americans live in areas in which air quality is unhealthy. The ALA points out that the elderly, the young, and the sick are most vulnerable to the effects of pollution. And of course some of the sick—such as those suffering from asthma and heart disease—can trace the very causes of their conditions to air pollution.
• The obese are at increased risk of injury in a car crash, according to University of Michigan researcher Jonathan Rupp, and the percentage of the population that is obese is rising. The automotive press presented this as a problem faced by the industry, rather than exacerbated by it. Their answer, of course, is not to encourage more walking and biking but to push for improved safety equipment so that drivers can stay obese and stay on the road.

Meanwhile, auto industry commercials increasingly feature children, suggesting we best show our love for them when we put them into those manufacturers’ cars. But we should reject the self-serving advertising message that time spent with our families in a vehicle is quality time. In fact, the more we drive, the more our own family suffers physically and mentally.

Given that the 40 percent of all trips in urban areas are within two miles of the home and that a good number of us can choose to live closer to work, we do have the power to make our families’ lungs, hearts, brains, and waists healthier, starting today. Let’s make not strapping a child into a car seat a symbolic act of love.

Anne Lutz Fernandez, a former marketer and banker, and Catherine Lutz, an anthropologist at the Watson Institute at Brown University, are the authors of Carjacked: The Culture of the Automobile and its Effect on our Lives (Palgrave Macmillan).

On February 23, Senator Barbara Boxer and Representative John Mica held a congressional hearing here in Los Angeles to discuss the federal transportation bill. The dominant theme of the hearing was expanding and establishing federal financing programs to provide capital for major infrastructure projects such as Los Angeles’s 30/10 plan, an initiative to build 12 major transit projects in 10 years. The elected leaders and assembled experts lauded the proposed programs for their potential to rapidly stimulate job creation and economic growth. Very little was mentioned, however, about the need for transportation investments to also be guided by other objectives, such as reducing air pollution, investing in biking and walking networks, and improving safety – all critical elements for improving the economy and public health. Transportation has immense impacts on human health, both positive and negative. Current policies fail to consider and value these impacts, but they must.

Dr. Richard J. Jackson

Traditionally, federal transportation funds have been given to states according to formula and with little accountability for how they are used. In Los Angeles the results are staggering. The annual health impacts from air pollution in our region alone are conservatively estimated at $22 billion, or $1,250 per person per year. Also, while pedestrians or cyclists account for 12 percent of all trips, they suffer 25 percent of all traffic fatalities. And as we have become more dependent on cars as a way to get to our jobs, to the store, to our doctors’ offices, and to every place else, our physical activity has declined, and coronary heart disease has become the number one killer of LA County residents.

To the credit of many public health leaders, elected officials, local policymakers, and engaged citizens, cities throughout the region are investing in biking and walking infrastructure to address these issues, revitalize local economies, and increase the effectiveness of transit systems. Planners in numerous cities — including Pasadena, Long Beach, Culver City, Glendale, Santa Monica, and Los Angeles — are setting strategic long-term goals and formulating plans to expand biking and walking networks, make them safer, and integrate them into existing and future public transit networks.

California is moving forward with its SB 375 law to reduce emissions by focusing on the communities we build and the types of transportation we use. This landmark law has initiated a process where planners, regulators, and the public have come together to set long-term goals and plan to achieve them. One purpose of this law is to comprehensively evaluate how different projects — including public transit, bicycle and pedestrian infrastructure, car-pool lanes, and roads — contribute collectively to achieving these goals.

But federal transportation bills have not set these strategic goals. As a result, despite continuous increases in federal funding, public health has not been a major factor as transportation projects are selected. Los Angeles, for example, has seen its air quality improve significantly but not as a result of more public transportation or communities where people can bike and walk safely and efficiently, but rather because cars are cleaner. At the same time, sprawl has continued to increase to a point where, in Los Angeles alone, we spend 490 million hours annually stuck in traffic. The combined weight of the health impacts from air pollution, traffic accidents, and lack of physical activity along with the costs of wasted fuel and time is a collective drag on our health and economy.

To address these issues, our next federal transportation bill should contain long-term goals, measure progress toward achieving them, and provide the funding needed to do so. Such goals should include measuring whether infrastructure investments contribute towards achieving needed public health improvements, such as: improving air quality to healthy levels; improving traffic safety for all users regardless of whether they walk, ride, or bike; increasing biking and walking trips; and improving and expanding public transit, as well as fixing the infrastructure we have.

During the worst and most prolonged economic downturn in many decades, it is critical for the health of our economy and our public health that we get the most bang for every transportation dollar we have available. As Senator Boxer and Representative Mica return to Washington to write the next federal transportation bill, we ask them to focus on a bill that will set these goals and provide funding to build the projects needed to achieve them.

Dr. Richard J. Jackson is Professor and Chair of Environmental Health Science in the UCLA School of Public Health. He has done extensive work on the impact of the environment on health, particularly relating to children.

Jackson chaired the American Academy of Pediatrics Committee on Environmental Health. He has served many leadership positions in both environmental health and infectious diseases with the California Health Department, including the highest State Health Officer. For nine years, he was director of the CDC’s National Center for Environmental Health in Atlanta, and received the Presidential Distinguished Service ward. He co-authored Urban Sprawl and Public Health, published in 2004. Over the past decade much of his work has focused on how the built environment affects health. He recently served on the Board of Directors of the American Institute of Architects and has written and spoken extensively on the above areas.

Jackson holds an MD from the University of California, San Francisco and an MPH from the University of California, Berkeley.

Access to healthy food is just one reason to build walkable places with a mix of uses and diverse transportation options. The places on this map are where people have been stranded — how walkable can your neighborhood be if you can’t walk to buy fresh produce? Many of the people identified here are poor and can’t afford cars. Some are elderly or disabled and can’t drive.

The most vulnerable members of our communities are the ones most hurt by transportation policies that keep a singular focus on automobile transportation and ignore those who need other ways to get around. What Slate is calling a food desert, you could also call an unlivable neighborhood, where even residents’ most basic needs — like access to healthy food — are denied.

Linda Prine

After Markowitz had his moment, dozens of other people came to testify with less camera-ready but more substantive comments. One of them was Linda Prine, a primary care physician who works for a network of New York City-based health centers called the Institute for Family Health. She also heads up the Manhattan chapter of the New York State Academy of Family Physicians. Streetsblog had a short chat with Prine this week about what led her to testify.

Prine and a group of colleagues who cycle regularly (they call themselves “biker docs”) began meeting and strategizing early this fall about how to promote active transportation. “Those of us who are in primary care are struggling with what to do with obesity and the health problems that come with it,” she said. “One of the good pieces of data about exercise, is that people who incorporate exercise into their commute have a better likelihood of actually exercising regularly.”

The biker docs came to the conclusion that promoting physical activity was “a systems problem,” Prine said. One doctor at a time telling patients to exercise won’t change habits on a large scale, but “making systemic changes like putting in bike lanes gets more people to bike.”

The day of the City Council hearing, Prine presented a letter from her and more than 150 medical professionals to Mayor Bloomberg supporting the continued expansion of the city’s bike network.

The biker docs are also taking their message out to peers in the medical community. Prine will be giving a presentation this Friday to the Beth Israel family medicine department, making the case for policies that promote biking and walking. Other biker docs will make similar presentations at Mount Sinai, Bellevue, and Montefiore medical centers.

You can read the letter to Bloomberg as a PDF and follow the jump for Prine’s testimony to the Council.

Testimony Dec 9th Linda Prine MD

I am a family physician practicing in lower Manhattan in a Federally Qualified Health Center, one of the types of practices that are expected to double in capacity under health care reform.  In health care, we are dealing with an obesity epidemic. Obesity contributes to diabetes, heart disease, high blood pressure, joint problems and depression.

The medical community has seen the amazing public health benefits that the stop smoking initiatives of the Mayor and City Council have had on the smoking rates in NYC.  We have learned from this that systemic change does much more than one doctor at a time telling one patient at a time to stop smoking.

Studies show that commuting to work by walking or biking is one of the most effective ways to lose weight and stay fit.  Exercise is good for joints, hearts, muscles, memory, and even effective against depression.  But most people can’t find time to exercise, and don’t manage to do it just because doctors tell them to.  Exercise by commuting, however, is much more plausible for most busy New Yorkers.  Cities with a high percentage of the population getting to work by bike correlate with cities with a low rate of obesity.

Biking to work is a good thing in so many ways:  less dependence on oil, cleaner air, more exercise for the individual, less need for parking spaces, less crowding on subways…  It is really hard for me to conceive of how there could be opposition to making this a priority for New York City.  Our gridlock of cars and trucks is unhealthy.  It clogs up our air, it causes many of the 250 plus traffic deaths every year, it promotes a sedentary lifestyle, and it uses up our public space with heavily trafficked streets and parking spaces.  This public space could be put to much better use, the way the Broadway mall has beautified the Times Square area.

Biking lanes provide a safe passage for those of us who bike to work.  I bike to work every day and now get to happily use the new Columbus Avenue bike lane.  I take it from 93^rd street to 77^th street.  Then, I take my life in my hands from 77^th street to 33^rd street until the 9^th Avenue bike lane begins.  At that point, I feel safe again and can travel the rest of the way to East 16^th street on bike lanes.  On the way home, I take Sixth Avenue in a skinny and unprotected bike lane until it disappears north of 44^th street.  That upper section of Sixth Avenue is really scary, with cars easily going 50 miles an hour. I breathe a big sigh of relief when I hit Central Park and the rest of my commute home is lovely.

Biking to work for me is essential to my health.  I have two sisters who are several years younger than I am, and they both need medication for high blood pressure and high cholesterol and they both weigh about 100 pounds more than I do.  These are the genes that I have, too, but I don’t have the same medical consequences because I bike 5 miles or 40 minutes twice a day, every day, to and from work.  It would take me 40 minutes to get to work anyway, and this way I get my exercise done for the day.

Over half of New Yorkers who drive cars to work are going 5 miles or less!  Most of these are going 3 miles or less.  These people could be walking or biking to work.  Imagine how much that would cut down on traffic, add to the health of these individuals, and make our air cleaner.  But when I ask my patients why they don’t bike or walk to work, they answer that the streets in their neighborhood are not safe for biking and sometimes not even for walking.

Anyone who cares about the health of New Yorkers must understand the importance of promoting bike travel.  European cities have made it happen and collected the data on health benefits.  New York should lead the rest of the US, as they have in providing mass transit and as they have in stopping smoking, by making biking a safe commuting option for our residents.  And, as we know from the stop smoking campaign, this requires systems changes like congestion pricing, more bike lanes, lower speed limits, increased parking fees, speed cams, bike parking lots, bike racks on busses, car-free parks and so on.

I hope to see some brave leadership from the City Council’s committee on Transportation in order to make New York a safer and healthier city.  More and better bike lanes is a good way to start.

In talking to you today, I want you to know that I represent the New York County Chapter of the NY State Academy of Family Physicians.  We have more than 100 family physician, resident, and medical student members in Manhattan.  We hope that you will help us make New Yorkers healthier; physicians can’t really do it alone.

Linda Prine MD
President, NY County Chapter of the NY State Academy of Family Physicians
Institute for Family Health
16 E. 16th Street NY, NY 10003

For New Yorkers concerned about making our streets safer, Transportation Alternatives’ Stop Speeding Summit was the place to be on November 19. If you couldn’t make it to the all-day event, now there are some highlights available which you can browse on your own laptop. You can download every PowerPoint from summit at T.A.’s website (click on the presenters’ names to download). And Health Commissioner Thomas Farley’s keynote address is online, thanks to NYU’s Rudin Center.

As we reported at the time, Dr. Farley gave a concise, 20-minute explanation for why traffic calming is essential for the city’s health. If you want the highlight reel, here’s our cheat sheet:

• Check in at the 3:29 mark to hear Farley say that after quitting smoking, physical activity is the best thing you can do for your health.
• At 9:38, he explains why health professionals are looking to the built environment to promote activity, and at 12:25 he lays down some evidence for the impressive health benefits of infrastructure like sidewalks or a transit system.
• And at 14:35, Farley make the argument for re-engineering streets, recommending traffic calming treatments, including bike lanes.
• Farley also makes the case that reducing the number of traffic crashes is a key public health issue. “Pretty much the entire reduction in child mortality in New York City is due to better transportation infrastructure,” he says at the 16:33 mark.
• Finally, Farley explains why slowing down traffic will save lives. Check out minute 19:00.

Health Commissioner Tom Farley, a sometimes-bike commuter, offered strong support for slower traffic speeds last Friday. Photo: Daily News

Last Friday, Transportation Alternatives kicked off a new phase of its campaign for safer streets with the Stop Speeding Summit, bringing together doctors, elected officials, transportation advocates and engineers to outline the high costs of high vehicle speeds and plot a course toward slower traffic.

We’ll be bringing you a series of posts from Friday’s event and wanted to let Thomas Farley, the city’s health commissioner, start things off. Farley laid out the public health argument for 20 mph traffic at the summit and offered to send Health Department staff to community boards and other public meetings to lend some lab coat gravitas to livable streets arguments.

Farley made clear that building safer streets is a top priority for him as a health professional. “We are living in the era of chronic diseases and injuries as the top killers,” he explained. Nearly all the top killers in New York are chronic diseases, with heart disease topping the list. “Accidents,” a category which includes traffic crashes, come in at number four.

That means promoting physical activity is a public health necessity. “Even just taking transit as opposed to driving could make a substantial reduction in heart disease deaths,” Farley said, adding that walking or biking for longer distances would improve health even more.

Because obesity, diabetes, high blood pressure, and other conditions correlated to the lack of physical activity are so widespread, Farley said that New York needs to address them by redesigning the city, not through individual conversations with doctors. “The way that we have an impact on the entire population is change the environment in which they live,” he said.

To that end, Farley endorsed both traffic calming and bike lanes as changes that make it safer, easier and more pleasant to get physical activity. Street redesigns also help reduce injuries and deaths sustained in traffic crashes. While New York’s streets are extremely safe by national standards, said Farley, the number of traffic fatalities and injuries remains indefensibly high. The Department of Health released a short report on traffic safety this morning [PDF].

Farley also endorsed taking steps to reduce traffic speeds. “We definitely are in favor of having lower speeds to reduce injuries,” he said, though he couldn’t say what approach might be the most effective. He did imply that addressing the problem would entail more than cracking down on those driving above the city’s 30 mph speed limits. “There’s a huge difference between being struck at 30 mph and 20 mph,” said Farley.

And for the hard-working activists in the trenches, working to convince New York’s community boards to get behind street safety, Farley made a promise they’ll be sure to appreciate. He said he’d be happy to send Department of Health staff to community board meetings whenever it would help bolster the argument for safety.

A new report written by the Victoria Transport Policy Institute's Todd Litman for the American Public Transit Association [PDF], the trade organization for the nation's transit agencies, reminds us that one of the most valuable benefits of transit is to our health. Summarizing the state of research in the field, "Evaluating Public Transportation Health Benefits" lays out the basic fact that increasing transit use is an easy way of preventing thousands of unnecessary deaths each year. 

The damage that our current transportation system does to our health is staggering. Each year, 40,000 Americans die in traffic crashes, according to the report, the equivalent of 1,186,070 years of life lost. Estimates attribute an equal number of deaths to motor vehicle air pollution, which tends to affect an older population. The number of deaths attributable to a third category of health impact, the sedentary lifestyle driving promotes, wasn't estimated.

Importantly, the report points out that these tens of thousands of deaths, along with a number of injuries and illnesses an order of magnitude larger, aren't the result of how we drive but of how much we drive. For example, the United States has by far the highest traffic fatality rate among its peer countries per capita, but not per mile driven (that title goes to Ireland). Americans die more because we drive more, not because we drive worse.

Transit riders of all income groups walk significantly more than non-transit users. Image: "Evaluating Public Transportation Health Benefits"

The good news is that transit provides proven health benefits. Public transit and transit-oriented development both reduce air pollution, research shows. Transit also increases physical activity. One of the studies detailed in Litman's report found that Americans walk an average of six minutes per day overall but that transit riders walked an average of 19 minutes per day, pretty close to the medically recommended 22 minutes.

Put those together, and it's no surprise that locations ranked higher on a "sprawl index" have higher rates of asthma, diabetes, hypertension, and cancer after controlling for a slew of demographic factors. 

And of course, transit is very unlikely to crash; overall, it has only one-twentieth the passenger fatality rate of automobile travel. 

Finally, Litman offers some guidance for those looking to turn these health benefits into a monetary number, often a cold necessity for decision-makers constantly asked to justify the large price tag of a transit project. A variety of tools, like ICLEI's Active Transport Quantification Tool or Litman's own Transit Health Benefits Calculator [.xls] can help turn important health benefits into easy-to-compare numbers. 

One caveat: This report is an APTA project and the goal is to lay out the benefits of using transit, not necessarily to paint the fullest picture. The report's argument that four percent of American children were unable to get important medical care because of inadequate treatment, for example, skips over the fact, found in the cited study, that those children primarily lived in rural areas that are often poor targets for transit. The health benefits of transit, as catalogued here, are completely real, but as you read the report, take it with a grain of salt.

States with the highest obesity rates also tend to be where the fewest people bike or walk to work. Image: CDC

A report from the Centers for Disease Control and Prevention released Tuesday showed the number of obese Americans has increased by 2.4 million since 2007. There are now nine states where more than 30 percent of the population qualifies as obese -- up from three states in 2007. (Just ten years ago, no state had obesity levels above 30 percent). 

The following day, Gallup released a ranking of the nation’s most and least obese states as part of a broader index of well-being. By its accounting, a cluster of states in the southeast -- West Virginia, Kentucky, Mississippi, Arkansas, and South Carolina -- have the highest rates of obesity, while the thinnest states, mainly in the west and New England, tend to have obesity rates about ten percentage points lower.

In the CDC ranking of states (which varies slightly from the Gallup ranking), Colorado and the District of Columbia are the only states with obesity rates under 20 percent, making their rate nearly 15 points lower than the most obese states. Their secret? During a press briefing, the CDC's Bill Dietz speculated that Colorado’s investment in biking and walking trails, as well as District residents' frequent use of public transportation, which goes hand in hand with walking and thus burns more calories than driving, are possible factors.

Indeed, if you look at rates of active commuting (walking and biking) in the most and least obese states, a revealing correlation emerges. Three of the five most obese states in the Gallup ranking are also among the five states with the smallest percentage of people who bike to work. At the other end of the spectrum, four of the ten thinnest states are among those where people bike to work most frequently. (The commuting rates come from Census data detailed in this League of American Bicyclists report.)

The relationship seems to hold up when you include walking. People in the five most obese states make about 5.2 percent of all trips by bike or on foot, according to data published recently in a 2010 benchmarking report from the Alliance for Biking and Walking. In contrast, people in the five least obese states made twice as many trips -- 10.2 percent of them -- by bike or on foot. 

It seems unlikely that you can chalk this all up to coincidence, but it's worth noting that these are back-of-the-envelope comparisons made without the eye of a trained statistician. And, as Dietz noted in the press briefing, other factors (such as demographic differences) surely play an important role.

For a second opinion, I checked with John Pucher, a Rutgers University planning professor with ample experience crunching these sorts of numbers. The relationship between a lack of active commuting and obesity is absolutely real, Pucher said via email. In fact, Pucher and colleagues have just completed a rigorous study of the relationship in which they examined health and travel data for 14 countries, all 50 U.S. states, and 47 of the 50 largest American cities.

At all three levels, the researchers found a clear negative relationship between active travel and obesity. Differences in transportation choices account for nearly a third of the variation in obesity rate among states, their analysis shows. Since the study hasn't been published officially, Pucher couldn't reveal any more specifics at this time. But stay tuned: The full study will come out in the American Journal of Public Health on August 20, and we'll have more details then.

Containers at the Port of Oakland. Photo: NOAA

Nearly a quarter of transportation-related greenhouse gas emissions come from freight. The movement of goods from port of entry to a store near you throws enough particulate pollution into the air to shorten the lives of 21,000 people each year, according to the Clean Air Task Force.

The freight sector is lumbering under inefficient and outdated systems that cause pollution, public health problems, safety hazards, and delivery delays. There’s never been a coordinated national approach to solving these problems. And with no deliberate strategy, the default approach is often to build more highways.

As Stephen Davis of Transportation for America writes:

If a port is congested or wants to expand, there’s little available
federal money to spend directly on rail or any other mode. Your choices
are highways or highways. When a state or port does spend to improve
operations, there is no accountability to make sure they’re actually
reducing port/freight congestion, moving freight faster, or reducing
air pollution in surrounding communities.

Enter the FREIGHT Act. (That’s the Focusing Resources, Economic Investment and Guidance to Help Transportation Act of 2010, with true Capitol Hill acronym panache.) The FREIGHT Act was introduced in the Senate toward the end of July and in the House a week later.

The bill focuses on areas known as "connectors," said Kathryn Phillips of the Environmental Defense Fund. “All the literature and studies say it’s the connector areas, the hubs, where you have the most congestion and environmental impacts.” The bill calls for troubleshooting at these bottlenecks, where products are transferred “from boat to truck to another truck to rail” and everything gets bogged down. Trucks get stuck in traffic; trains sit on the tracks; ships idle at port.

Communities near international ports pay the price. In Riverside, California, traffic gets tied up at 26 at-grade rail crossings 128 times a day when trains pass. Add to that the noise and pollution nearby neighborhoods must contend with.

“We don’t just want to pay for asthma filters for schools,” said Isaac Kos-Read of the Port of Los Angeles. “We want to fix the emissions problem from the ground up.”

Meanwhile, the bridges near the Port of LA are in alarming condition. The Schuyler Heim Bridge is expected to fail in the next major earthquake. The Gerald Desmond Bridge — which carries 15-25 percent of all cargo containers coming into country, according to Kos-Read — wears a “diaper” to catch chunks of falling concrete.

The Port of Oakland is struggling with antiquated rail lines over the Sierra Nevada Mountains, said port spokesperson Matt Davis. “Some of the tunnel clearances are not high enough to accept double-stacked containers,” he said. State assistance to fix the problem didn’t come through. Davis is convinced a national approach is needed to address problems like these.

“We’ve seen previous projects of national and regional significance end up in the earmark process, and what you get is some random highway in Ohio,” said Davis. “It’s a hopscotch approach, not looking at it as one coordinated freight corridor.”

Kos-Read agrees. He added that Canada is giving the U.S. an added incentive to pull together to improve the freight sector — or else “Canada is going to eat our lunch.” Canada has articulated a national freight plan — and it’s marketing itself to Asia as the gateway to “North America’s economic heartland.”

The FREIGHT Act would mandate the creation of a National Freight Transportation Strategic Plan, as well as a permanent Office of Freight Planning and Development within the U.S. Department of Transportation. It would also start a grant program to focus funds where they’re most needed.

The legislation seeks not just to improve efficiency, but also to reduce “air, water, and noise pollution and impacts on ecosystems and communities.” It sets goals for improved outcomes, like improving travel time reliability, cutting 40 percent of carbon emissions, and reducing freight transportation-related fatalities by 10 percent.

How those outcomes are achieved will be up to the new office and the strategic planners to figure out. It stands to reason that some trucking will be replaced with rail, or short-sea shipping, but none of that is prescribed in the bill.

Don’t expect this legislation to follow the normal process of How-a-Bill-Becomes-a-Law. Its introduction in the House is, in part, a product of the slow pace of the massive transportation re-authorization bill, which seems to be proceeding on a glacial time scale. While it stalls, lawmakers are picking off pieces of it to work on.

But Transportation Committee Chair Jim Oberstar (D-MN) is “not fond of doing things piecemeal,” according to committee staffer Jim Berard. “He feels the authorization bill should be a comprehensive approach to surface transportation issues.” So the FREIGHT Act, in the House, is likely to be folded into the larger transportation legislation, and not passed as a stand-alone bill.

It works a little differently in the Senate. The Commerce Committee will take up the FREIGHT Act, while the Environment and Public Works Committee takes up the highways portion of the re-authorization, and other committees bite off their pieces of the transportation pie. Those various committee measures will then form the Senate’s transportation proposal.

However it gets done, port operators, environmental justice advocates, and supporters of transportation reform agree that it needs to get done.

States where more people drive to work face an even worse obesity crisis. Graphic: Noah Kazis and Carly Clark

Transportation is a public health issue. As profiled in the recently released report from the Trust for America’s Health, "F as in Fat," obesity rates continue to rise across the nation, increasing the risk of serious health problems like diabetes and hypertension. To solve the obesity epidemic, the data suggest, we need to rethink our dependence on the automobile. 

"F as in Fat" breaks out obesity numbers state by state. After glancing at their map, it seemed like transit and pedestrian-friendly states were doing better than the national average. To get more precise, we decided to compare adult obesity rates, as gathered in the report, to commuting statistics in the U.S. Census. You can download our spreadsheet here. 

The result is the scatterplot shown above, which clearly shows that states where more people drive to work have higher obesity rates. Caveats abound — correlation isn’t causation and state-level data can obscure important patterns visible only through a closer microscope — but the result is provocative. The two outliers are D.C. and New York State; they imply that while a large shift away from driving can make a big difference, it can’t solve the obesity crisis on its own.

Although "F as in Fat" doesn’t analyze transportation behavior itself, the authors agree that moving away from a reliance on the automobile is a critical component in curbing obesity. Their recommendations include: passing legislation supporting non-motorized transportation, such as an expansion of the Safe Routes to School program or a national complete streets bill; building more safe pedestrian space and bike paths to encourage active transport; and supporting mixed-use, walkable, and transit-oriented development.

Transportation-related injuries, overwhelmingly caused by motorists hitting pedestrians, remain a top killer of New York City children. Graphic: NYC Department of Health

Last week the health department released their fourth yearly report on children's injury deaths [PDF]. As in past years, motor vehicles are the leading cause of death due to injury among children. Between 2001 and 2008, 1,535 children died in New York City, 445 from injuries. Of those, 106 were killed by motor vehicles. The overwhelming majority of these victims were walking at the time they were fatally struck, while a few were in cars themselves or on bikes or scooters. The first report in this series focused more closely on traffic crashes and offered a more detailed look at how cars kill children.

In this year's report, the Department of Health focused on disparities in fatalities, and the unequal burden of traffic couldn't be clearer. For instance, 26.6 percent of city residents are black, but black children account for 46 percent of the transportation injuries that claim the lives of New Yorkers age 12 and under.

"The public health imperative for safer streets has never been clearer," responded Transportation Alternatives' Wiley Norvell. "Our city's children are falling victim to dangerous roadways and reckless driving."

The ray of light that emerges from the grim statistics is that because so many New Yorkers rely on public transportation to get around, children are much safer than they would otherwise be. New York City has only a third as many transportation-related child fatalities as the national average. Our safer transportation system is the prime reason that overall, New York City kids die from injuries at half the national rate. 

The report also offers a few recommendations for how to keep New York's children safe. With regards to transportation, they recommend stronger enforcement of traffic violations and allowing cameras to enforce speeding laws on dangerous speeds (a measure that has seemingly stalled in Albany this session), as well as installing convex mirrors on trucks and better installation of child car seats. Said Norvell, "It's time to marshal every lever in government to bring these numbers down."

Traffic brings with it billions of dollars in "hidden health costs," according to the APTA. (Photo: NYT)

But APHA, a trade association representing public health workers, went further than the government by adding up the estimated costs imposed by the absence of any mandatory evaluation of the health consequences of transportation decisions.

Citing U.S. DOT and American Automobile Association studies, respectively, the APHA pegged the annual price of congested roads at between $50 billion and $80 billion, with the health toll of traffic crashes -- including the treatment of fatalities, the resulting court costs, and lost wages -- reaching $180 billion per year.

The majority of those bills are paid indirectly by the transportation system users they affect, not factored in advance into local planning, as the APHA writes:

The federal government does not require a consistent methodology for environmental impact analysis, transportation modeling, or cost-benefit analysis for agencies seeking federal highway funding -- and while this approach allows agencies to tailor analyses to fit their needs, it makes it impossible to compare potential project effectiveness at a national level. It also means that health impacts, costs and benefits are often left off the table when projects are being considered.

What can be done to build those health risks into the calculus that determines where roads get built, bridges fixed, and crosswalks painted? The APHA offers San Francisco, where health officials used economic modeling to weigh the likely pedestrian injury rates caused by five alternative development plans, as an example of effective local analysis of transportation's effect on public health.

But the APHA report underscores the difficulty of achieving a broader shift without Congress requiring a stronger emphasis on transport policies that tangibly improve Americans' health. In addition to endorsing the concept of national transportation objectives -- which has won some Democratic support but sparked resistance from state DOTs -- the group's new report urges that those new federal standards "allocate more funds to projects and efforts that support healthy communities and active transportation."

(Chart: LetsMove.gov)

During the February launch of the task force, Mrs. Obama noted the public health benefits of promoting biking and walking among U.S. kids, but today's report goes into far more detail about the link between non-motorized transportation, local land use, and children's rate of physical exercise. Among the task force's recommendations are an addition of "complete streets" design rules to the next long-term federal transportation bill and expanding the Safe Routes to School (SRtS) program to include high schools.

"Children’s ability to be physically active in their community depends on whether the community is safe and walkable, with good sidewalks and reasonable distances between destinations," the report states in a section entitled 'The Built Environment' that got an early plug from Transportation Secretary Ray LaHood.

A chart featured in the White House report, viewable above, mirrors the assessment of a recent SRtS release that found ample opportunities for families to transition their children from school commutes via auto to trips by foot or bicycle.

The task force also encourages local governments to conduct "Health Impact Assessments," or HIAs, before building new developments. The HIA concept, similar to environmental reviews of federally funded transport projects that are currently mandated by law, would evaluate the effect of construction and land-use decisions on the physical activity of community residents.

The first lady's group also took a notably holistic approach to the effect of neighborhood quality on children's health. In a lengthy section on the findings of a recent socioeconomic study published in the journal Health Affairs, today's report states:

• Children living in unsafe neighborhoods or those characterized by poor housing and the presence of garbage and litter on streets had an approximately 30-60% higher chance of being obese or overweight than children living in better conditions;
• Children with low neighborhood amenities or those lacking neighborhood access to sidewalks or walking paths, parks or playgrounds, or recreation or community centers had 20-45% higher odds of becoming obese or overweight compared to children who had access to these amenities;
• The impact of the built environment was particularly strong for younger children (ages 10-11) and for girls. Girls ages 10-11 living in neighborhoods with the fewest amenities had 121-276% higher adjusted odds of being obese or overweight than those living in neighborhoods with the most amenities
  

As a standard to measure the success of its proposed policy shifts, the task force suggested aiming for a 50 percent increase in the share of children walking or biking to school over the next five years.

"We don't need new discoveries or new inventions to reverse this trend" of obesity that has manifested in an estimated one out of every three American children, Mrs. Obama told reporters today. "Again, we have the tools at our disposal to reverse it. All we need is the motivation, the opportunity and the willpower to do what needs to be done."