Monday, July 13, 2009

Public Health

We often think of the public health in mechanical terms. What is the average life span? Which diseases are most prevalent? How can money be made by selling health to people? How much does it cost to provide "health care"?

I suspect this train of thought is simplistic.

It is driven in part by big insurance and its dollars and cents approach to health (and life); driven also by the legal system, using the adversarial system as a means toward rewarding those made ill by other's negligence, but also succumbing to the ideal that money can heal and punish; driven by the business of medicine and the view that health may be bought and sold.

But of course it may, you might think. Those with money can afford to live in safe areas and purchase healthy food, live in well-built homes, buy the latest drugs and health-fads, and pay for insurance and hospital visits. This consumptive view of medicine and health, however, ultimately has a deleterious effect. It reduces public health to a budget line and obscures our understanding of what the public health is.

At its foundation, better public health is both easier and harder to achieve than universal health care and cheaper prescription drugs. It is easier in the sense that it may be reduced to simple concepts: we should create living environments that promote life and wellness, where ample shelter, fresh food, and clean water is available and people have the opportunity to engage in physical activity and nurture positive relationships. It is harder in that it requires a holistic and multi-modal understanding of health that reaches far beyond the hospital and the insurance companies' balance sheets.

Public health has as much to do with things like walkability, bike lanes, farmers markets, crime reduction and open spaces as it does with access to hospitals and advances in pharmaceutical technology or surgical procedures. We limit our understanding of public health if we conceive of it in purely medical terms. Instead, it will benefit urban areas to think about the public health impacts of every decision, particularly decisions regarding transportation and public space.

Several years ago, I spent a few months undertaking research for a paper on the importance of walkability towards creating and fostering urban relationships. My thesis was not revolutionary. I merely argued that walking brings people in closer contact with their cities, that it is more democratic than driving, and that a pedestrian friendly city will ultimately be a better place to live than an auto-centric city.

An idea that I tossed around in my head but never committed to paper was the life:death ratio. When making public decisions, I thought, we should think simply about whether our plans nurture life or risk harm, disease, and death. It seems obvious that walking environments promote life and don't increase death or disease, but that auto-centric environments lead to more carbon dioxide, more obesity, more unnecessary fatalities. Of course it is also true that automobile technology and open roads allow emergency personnel to react quickly to fires and heart attacks, but that is why we have the ratio. The ability to give and sustain life must be balanced with the susceptibility for disease and death.

Walking up Scott street the other day, from Lower Haight towards Alamo Square, I noticed a freshly planted tree and for a second envisioned the potential of the road before me and before us all. I saw trees in strange places, scattered down the middle of the road, and imagined the flow of bikers multiplying as the parked cars vanished to their place in history books. I saw a space that was public and open, one that promoted life and activity, a street where children could pick fruit from trees and people could walk to their neighbor's house without the threat of anything more imposing than a stream of bicycles and pedestrians.

1 comment:

  1. If only every gov't action would be thought of in terms of increasing life/death. I would love for somebody to write a NEPA-style policy act where everything would go through this analysis.

    Unfortunately, like NEPA, it would probably be toothless and easy to manipulate. Still how refreshing would it be to see everyone thinking in terms of quality of life rather than $$$.