Your Health & Urban Mobility

by Allen Weiss, MD, MBA, FACP, FACR
President and CEO, NCH Healthcare System
Where you live matters. Your zip code is more important than your genetic code in predicting your health and life expectancy.

Your built environment has a tremendous influence on how well you live. A recent Bloomberg Businessweek article with the catchy title “This Bike Lane Can Save Your Life” states, “If you lay down enough bike lanes, something magical happens: Nonriders begin to benefit from cleaner air when the network of bike lanes get complete enough that people start riding bikes to work instead of driving.”

Bike lanes like those recently added to the beautiful, downtown Naples Central Avenue complete-street encourage both bike riders and walkers to get out of their cars and use their own mobility to enjoy a safe and vibrant community. An interesting cityscape stretching from the Gulf of Mexico to the Gordon River is another gem that enhances the walking paths from Third Street South to Fifth Avenue to the Gordon River Bridge to the Greenways Path and beyond.

Many larger cities are embracing biking lanes, including London which is building twelve “cycle superhighways” with extra-wide lanes dedicated to bicycles. New York, hilly San Francisco, Sao Paulo, Delhi and even Moscow are also expanding bike lanes.

Urban planners, health care economists, and others interested in assessing health benefits use a metric called a quality adjusted life year(QALY) which measures the cost benefit of adding one extra valuable year to a person’s life.

A medical example is kidney dialysis which costs about $100,000 per QALY. A recent environmental example can be found in New York City which spent about $8 million in 2015on bike lane expansion, equating to $1,800 per QALY according to a Columbia University Mailman School of Public Health paper entitled, “The Cost-Effectiveness of Bike Lanes in New York City.”

Urban Mobility is at a tipping point where many large, already congested cities are becoming even more uncomfortable and unhealthier. Less congested geographical regions are being built and older regions are being modified, both locales encourage natural movement by their citizens.

Quality of life matters to your physical and mental health while contributing to a longer life expectancy.

Although today’s prediction that the1.2 billion global car fleet could double by 2030, others believe that four major technology trends will change the way we transport ourselves:•

IN-VEHICLE CONNECTIVITY

Who likes being stuck in traffic when alternate, non-congested routes are available that will get you to your destination faster? A few “apps” including Waze (https://www.waze.com/) which share traffic conditions, accidents, and speed traps are fed by vehicles just like yours to provide up-to-the-minute intelligence about current road conditions. This sharing is a perfect example of crowd sourcing.

ELECTRIFICATION

Hybrids, a combination of battery and gas powered engines, and full electric vehicles are expected to increase from about 2.3 million vehicles in 2014 to 11.5 million in 2022, representing an 11 percent increase globally. Shorter driving distances in urban areas with battery recharging stations or battery exchange facilities will encourage the conversion to electric, which is more environmentally friendly and less expensive, reducing the global dependence on oil with all the attached geo-political implications.

CAR SHARING

Most cars sit idle 90 percent of the time. By sharing cars the average yearly miles traveled by each auto would increase from an estimated11,700 to 20,400. Car manufacturers whose success has been measured in the past by the number of units sold will be rewarded in the future for mileage travelled and years serviceable by their vehicles.

AUTONOMOUS DRIVING

“The future is now” is the classic General Electric slogan popularized in the World of Tomorrow at Disney World in Orlando when many of us were growing up. Imagine safely working on your email or text messaging while your car was driving on its own to your destination.

Obviously, texting while driving is not safe, because the accident rate currently is similar to driving drunk. Cars are dangerous but necessary. Consider the fact that driverless cars have about 10 percent of the accident rate of conventional drivers. Removing 90 percent of car accidents would be a tremendous avoidance of injury, death, and misery along with a huge cost savings in car insurance and collision repair.

More synergy will occur when the above four trends are combined with the largest taxi fleet in the world, namely Uber. Carnegie Mellon University is exploring with Uber’s Advanced Technologies Center the possibility of having an autonomous fleet of vehicles callable from your personal handheld device to subsequently deliver you to your destination.

Easier commuting to work, reduced parking garage capacities, less general-street parking, and so many other unforeseen good changes are coming which would be health advantageous. Think about linear parks and walking paths replacing street parking which would become obsolete. Also consider the societal savings on the cost of a parking space, estimated to be worth $10,000 to $20,000 per space.

Bike sharing has also become popular in many cities. For a modest fee one can pick up a bike and peddle to another location, leave the bike parked in a secure location, go about one’s business and then pickup another bike to return home. At a recent national meeting of the thirty Blue Zones Project cities in Fort Worth, Texas, Mayor Betsy Price traveled to and from a nearly evening event by rental bike. Cities which are bike and walking friendly are already seeing quality adjusted life years added with drops in health care insurance premiums—overall the making of happier and healthier citizens as measured by the Gallops-Healthways Well Being Index. (http://www.well-beingindex.com/)

Sixty percent of Americans desire to live in an environment where they can walk to amenities. Consider the number of gated communities in Southwest Florida where the residents generally avoid leaving their neighborhoods. Dining in the clubhouse, receiving groceries by delivery, partaking in recreation, and socializing with neighbors can all be enjoyed without leaving the confines of the gated community. Multi-unit condominiums as opposed to single family homes with large yards encourage walkability as density increases.

Antiquated regulatory challenges and the general resistance to change can slow progress, postponing the tipping point, which in the case of overcrowded cities is gridlock, excessive automobile dependence, and worsening health. Urban planning, solving some of the technical challenges, and a general desire to help everyone live a longer, happier, and healthier life will make a huge difference for the better as we all embrace moving naturally.