We Can't Rely on Doctors Alone to Make the U.S. Healthier

Healthy living means more than just diet and exercise. Where you live, work, and play makes a difference, too.

The US
spends more on health care than any other country, but we are far from the
healthiest. If we look to our health care system to correct this imbalance, we
may be looking in the wrong direction, because health starts where we live,
learn, work, and play–long before we step into the doctor’s office. Factors such
as neighborhood walkability, healthy eating habits, safe housing, and access to
good jobs all help to make the healthy choice the easier choice. Keeping people out of the doctor’s office in the first place is the best
prescription for better health.

Solving the nation’s most entrenched problems

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For example, let’s look at investments in low-income communities,
where families with lower incomes are most often the same families with high
rates of obesity and chronic disease. Investing in the health of these
communities involves much more than treating disease. Housing matters, as does
transportation. School quality is also important, because an individual’s level
of educational attainment is a good predictor of both health and future
earnings. But too often, when attempting to battle diseases like obesity, we
ignore the way people from the hardest-hit communities actually live. Are buildings
situated to promote eyes on the street to reduce crime? Is public
transportation designed to get parents to a good job? Are routes to school
walkable and bikeable? Do schools offer healthier food options? Have
playgrounds replaced vacant lots? This shift in thinking and action is the X
factor: converting personal motivation into community transformation.

Dotted across the country are places where health is up
front in community planning and policy. In Hernando,Mississippi,
a creative partnership between the city and a local bank has launched a plan to
turn foreclosed land into 37 acres of green space, with playgrounds and walking
and biking paths. The town has also made low-cost policy changes–joint-use
agreements that allow sharing of school gyms and playgrounds when schools are
not using them, establishing bike lanes, and enacting no-smoking laws. In Cincinnati, Ohio,
collaboration between the police department and
volunteer organizations to clean up high-crime neighborhoods by creating green spaces, enhancing lighting, and
adding benches and trash cans resulted in a 22 percent
reduction in crimes including murder, rape, and robbery. Drops in crime mean
increased opportunities for community residents to pursue healthier lifestyles.

Looking at communities through a health lens, there
are many affordable, cost-saving changes that can be made through tax
credits, loan incentives, small municipal investments, and policy changes
including in zoning and building codes.

States
can make a difference too: in North
Carolina, state law requires that any land purchased
or leased with state funds include public bike and pedestrian access.Washington State‘s Growth Management Act requires that comprehensive county and city plans address pedestrian and bike access and free or low-cost
recreational opportunities.

Access to high-quality health care is essential to improving
health in the U.S.
But equally essential is a change in the way we structure our communities. As Dr. Bill Paul, Director of Health for Nashville/Davidson
County, Tennessee puts it: “It’s about weaving opportunities for
healthy living into the fabric of the city. The vision is that a healthy city
is a more livable city where employers want to locate and where employees can
stay healthy.” 

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