Walking Cities and Commons-Based Health Policies

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August 17, 2007
OnTheCommons.org

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When I lived in New York City I walked everywhere, and all the time.  It wasn’t just because driving there is insane and I didn’t have a car anyway. The city calls you forth.  In decent weather you can walk for miles and hardly be aware of it. As a walker I was not alone. New York is a city of them.  On visits upstate I’d see a great many hefty people. At malls I’d get stuck in aisles behind matching double-wides.  In the city there wasn’t much of that.

People often think of New York as a decadent and unhealthful place.  I began to wonder if in fact the opposite was true. I made some calls but couldn’t get anywhere.  This was about fifteen years ago.  Apparently, some researchers have been on the case in the years since.  The current (August 15th) issue of New York magazine has a feature story called “Why New Yorkers Last Longer.”  Residents there, it turns out, live on average nine months longer than Americans do generally. Their life expectancy is increasing at a faster rate. Walking is a major reason why.

Prevention Magazine  has named the city the nation’s best for walking, for two years.  This will come as no surprise to most who have spent time there.  But walking is not just a matter of evening excursions to the East Village for dinner, or to Central Park.  It is built into daily life.  Even if you take the subway you are rushing up and down the station stairs.  If you live in a walk-up apartment, you lug your groceries up several flights at the end of the day.  It can be a drag.  But it does keep the lard off.

New York compares the city to a “massive exercise machine.” “Every block doubles as a racewalking track, every subway station is a StairMaster.”  This is suggestive, moreso than the writer seemed to realize.  What New York City still provides today once was part of daily life generally.  People used to walk.  They used to climb stairs, cut wood, carry water, sweep floors.  In the U.S., this thing we call, with strange euphemism, “the economy”, has eliminated such physical exertions from daily life, and then sold us commoditized substitutes for them.

People drive to suburban “health” clubs and then walk on treadmills, using electricity  in the process instead of using productively the energy they already have consumed in the form of food.  Destroy what we have for free, then sell us a substitute for money.  Economists call this “growth.”  In reality it’s a treadmill that keeps us running faster – and spending more – just to stay in place.

The walking city has large implications for the nation’s debate over health care, which is not really about health at all.  It is about sickness treatment. Sickness is assumed.  The only question is how to pay for medical treatment and how it will be delivered.  Yet even if the nation embraces some kind of unified finance system, which I favor; and even if it goes to a socialized delivery system, which I think I don’t – we still will be on a collision course with reality.

Treatments are becoming ever more sophisticated and expensive.  Drug companies and their helpers in the psychiatry profession are redefining every state and stage of existence as a pathology in need of a pharmaceutical “intervention.” There isn’t enough money in existence to pay for all the treatment the drug companies et al want us to believe we need, under single payer or any other plan. (Don’t forget.  For the treatment industry to meet its own growth targets, it is necessary for us to believe that we need more and more.)

The alternative is prevention, and that means public health.  Public health has gotten short shrift since the Reagan years. Corporations cannot make much money from it, so the Reaganites, and the Bushites after them, turned instinctively to individual medicine and its high-tech wonders. Yet public health has been responsible for most increases in longevity.  It is not just a matter of vaccination and sanitation, a healthful environment, fewer toxics in our food, and the like, important as those are. Public health involves as well the design of the places we inhabit — for example, walking cities.

People of a Rightward bent harrumph about individual initiative and virtue.  If we have character and gumption we will get off our duffs and walk regardless where we are.  Actually, I’m pretty big on those myself.  But we individuals live in a world of others, and built by them. We walk where the sidewalks already are.  If housing is too far from work and shopping then we can’t walk at all.  I have tried using my gumption and initiative to go for walks from motels on neon nowhere fast food strips.  I didn’t get far.

Design has an affect on us.  The people who build supermarkets and malls have turned this into a science of consumer atmospheric.  We walk more in New York City than in suburbs where there is no place to walk to.  Destinations pull us on, as does the life we pass along the way.  Build it for walking and they will walk.  Enable kids to walk to school, and provide plenty of time and space for play afterwards, and they will be far more healthy as kids and as adults.

This is commons based health policy.  It starts with the places we inhabit together as opposed to the treatments – no matter how paid for – that we consume apart.  Let’s listen to the presidential candidates  expound on “health care” and see if they mention public health, prevention, and habitat design.  Let’s see if they talk about health at all.

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