Cascadia Scorecard Weblog

Dead Man Walking

(Editor's note: See two other posts in series, "Carless in Seattle," and "A Mile From Home.")

Transit and walking are time consuming. Most people are just too busy. That’s obvious, right?

Well, as my family begins the ninth week of its experiment in car-less living, I’m finding a few flaws in that logic. Here are two.

1. Time spent on transit is different from time spent driving. People vary, of course, but for me, transit time is a pure gain over driving. I don’t enjoy driving. I’d rather read than listen to music or talk radio. And I can read without queasiness on all forms of transit. For me, then, car time is a waste of life, but transit time is living, and I’ll happily choose a 30 minute transit trip over a 15 minute car trip. For me, driving is time consuming.

2. Just so, walking doesn’t consume time, for different reasons. In fact, walking creates time. For one thing, if you walk for transportation, you don’t have to go to the gym as often.

More profoundly, walking gives you time you wouldn’t otherwise have at all. Walking makes you live longer, as Clark posted here. The largest ever study of the subject found that walking 30 minutes a day, five days a week, adds 1.3-1.5 years to your life, on average. (More vigorous exercise adds even more.) On reasonable assumptions (detailed below the fold), this relationship means that for every minute you spend walking, you get three back.

Time spent walking, then, is utterly free. It’s time you would have spent dead.

Nowadays, when I’m walking, I get a little pleasure in the thought that I’m cheating death, that every minute I spend afoot is an extra moment of life.

Boring, wonky, calculation notes:

My assumptions—which I’d appreciate some astute blog reader checking against the original journal article that reports the study on which Clark posted—are that you have to walk 30 minutes a day, five days a week, for thirty years to get the 1.3-1.5 year lifespan bonus. I made up the 30 year figure (too busy to read the journal (wink)).

Then I calculate 30 minutes x 5 (days) x 52 (weeks) = 7,800 minutes of exercise per year x (guess of) 30 years = 234,000 minutes of walking, repaid with 1.4 years or 736,000 minutes of added life. That’s about three minutes extra for every minute you walk.

Note that even if have to walk five days a week from birth to age 90, you’re still getting every single walking minute back, though you wouldn't get three.

Oh, Migratious!

Interesting:  a new study from the US Centers for Disease Control has determined that recent US immigrants are healthier than native-born US citizens:

Overwhelmingly, the study found, ... immigrants have lower rates of obesity, diabetes and high blood pressure; have less disability; and are less likely to acknowledge having mental health problems.

I've often heard it claimed that British Columbia's good health, relative to the Northwest US (longer life spans, lower rates of chronic illness, etc.) can be attributed in part to immigration patterns, rather than healthier lifestyles or better health care in the province.  The claim seems somewhat plausible:  BC has large numbers of well-off and healthy Asian immigrants, who likely buoy health statistics in the province; whereas international immigration in the Northwest US is usually from poorer parts of the globe, such as Central and South America. 

So it comes as a bit of a surprise to find that international migration may not be a drag on health stats in the Northwest US after all -- just as in BC, in-migration may give health figures a boost.   

Then again, perhaps it shouldn't be a surprise.  The Northwest states are healthier than the US average, but that's not saying much any more.  Life expectancy in the US ranks 29th in the world, behind nearly every other major industrial democracy.  It's now nearly a year shorter than in Costa Rica, and just behind such places as Cyprus and the United Arab Emirates.  Given that emigrants tend to be healthier than average for their home countries, and that the US's life expectancy lead has been slipping for decades, it probably shouldn't be at all shocking that in-migrants are now healthier on average than US natives.

Eat More Veggies

Lots more. According to a new biochemical analysis, the nutritional value of US vegetables has declined over the last 50 years. That's because new varieties of fast-growing crops designed to maximize output cannot take up or synthesize nutrients as quickly as more slow-growing plants. The result:

...of 13 major nutrients in fruits and vegetables tracked by the Agriculture Department from 1950 to 1999, six showed noticeable declines -- protein, calcium, phosphorus, iron, riboflavin and vitamin C. The declines ranged from 6 percent for protein, 15 percent for iron, 20 percent for vitamin C, and 38 percent for riboflavin.

Yikes. Just when the slow food movement is taking off, it turns out we need a slow-growing food movement too.

The Time of Their Life

According to the latest figures, life spans in the British Columbia are still on the rise.  In 2005, life expectancy for newborns topped 81 years for the first time ever, up a little over two months from 2004:

To me, the most remarkable thing about this chart is that life expectancy growth has been so steady -- the increases have been almost linear -- and is showing no signs of slowing down. Which suggests that we're nowhere near the end of life span increases.  Indeed, as this article points out (abstract only, unless you're willing to pay), lifespans around the world have grown fairly consistently for about 160 years.  Moreover, mortality experts who have predicted over the years that we're approaching an 'ultimate ceiling' for life expectancy have repeatedly been proven wrong.  Which might suggest that lifespans will continue to rise for quite some time.

Of course, if current trends continue life expectancy in the province will approach 100 years by the time that this year's newborns reach 81--as unthinkable now, perhaps, as a lifespan of 81 years might have been at the dawn of the 20th century.  But even if the growth in life expectancy does slow down some, we're still going to see major increases in the number of elderly people over the next few decades, as the baby boomers hit retirement age.  Those demographic shifts are going to force some major rethinking about how we as a society deal with seniors -- to make sure that their lives aren't just long, but also pleasant and affordable.

Toxic Cocktails

Two interesting -- and a bit disturbing -- pieces of toxics news today.

First, several news outlets are reporting on a new study, coming out of UC Berkeley, showing that mixtures of several environmental contaminants (in this case, pesticides) can be far more potent than higher concentrations of a single compound.  The problem is especially bad for frog populations -- which, as frog-watchers everywhere will tell you, are in particularly bad shape.

Second, there's this new report, put together by two breast cancer groups:

As many as half of all new breast cancers may be foisted upon woman by pollutants in the environment, triggered by such items as bisphenol-A lining tin cans or radiation from early mammograms, according to a review of recent science by two breast cancer groups.

No comments here, except that, perhaps--just perhaps--the former study might help explain the latter.

Slim City

New studies of King County, Washington find that sprawl is linked to dirtier air and bigger bellies. Walkable neighborhoods (those places with higher residential density, more street connections, and nearby to shops, schools, and parks) appear to be healthier for residents and less damaging to air quality--even when taking into account age, income, education and ethnicity.

A few key findings (liberally excerpted from the full coverage in the Seattle Times):

• On average the Body Mass Index — a measure of height and weight — of residents of the more walkable neighborhoods was lower, and they were more likely to get 30 minutes of daily exercise.
• People who lived and worked in more walkable neighborhoods produced fewer pollutants associated with smog.
• A 5 percent increase in a neighborhood's walkability index was associated with a 0.23-point drop in Body Mass Index. Bigger changes in a neighborhood's walkability would be expected to produce greater differences in weight.

Just My Opinion

Two op-eds in today's Seattle Times worth taking a look at...

• Biodiesel: short-term crush or long-term relationship?  Bruce Ramsey takes a balanced, but ultimately favorable, view of government programs to encourage home-grown fuels.


• The rapid disappearance of America's middle class.  We posted on a similar subject a few days ago, but it's worth repeating -- rising family incomes don't necessarily mean that we're better off.  In fact, after adjusting for inflation, male full-time workers earn $800 less today than in 1973, which means that the rise in median family income is entirely due to increases in two-earner households.  Of course, these sorts of trends are hard to make sense of across decades, since so many things change -- people's expectations, the quality of consumer goods and public services, enjoyment of time at work vs. time at home, etc.  Still, there's ample reason to believe that the well-being of the middle class has become uncoupled from steady increases in per-capita GDP. The money quote of the article. "All the talk about family values is just that — talk — when our financial policies are driving middle-class families to the wall."

I'm not sure I share all the opinions expressed in the op-eds -- but don't really have anything to add to either piece, either.

That's Just Not Healthy

Yoiks.  Total spending on health care in the US reached nearly $2 trillion in 2004 -- meaning that roughly one out of every six dollars the nation earns is now siphoned off to pay for medical care.  The growth in health care spending slowed a bit from 2003 to 2004, but medical expenses still grew much faster than the economy overall.  Spending per person across the country averaged $6,280. 

From what I can tell, spending in the Pacific Northwest states is a bit lower than the US average.  In 2000, the most recent year for which state-level data are available, Oregon, Washington, and Idaho's health care expenditures, measured as a share of the states' economic output, were about 10 percent below the national average.  Still, medical care is a huge expense; about $38 billion was spent on medical care in Washington, Oregon and Idaho in 2000 alone.  Given the pace of medical inflation over the last 5 years, that figure has probably topped $50 billion, combined, in the three states.

What all this means is that steps that could shave health care costs, even by just a few fractions of a percent, can reduce overall health care costs by literally hundreds of millions of dollars. 

Shrink Rap

Demographers are projecting that population in some parts of the globe -- Russia, the Ukraine, Japan, much of Western Europe -- are set to decline over the next 50 years or so.  Of course, the talk of a shrinking population seems to send some people into a panic, which is why you occasionally see stories decrying the new "population crisis" -- not too many people, but too few.

The Economist has this to say about the doomsayers:

People love to worry—maybe it's a symptom of ageing populations—but the gloom surrounding population declines misses the main point. The new demographics that are causing populations to age and to shrink are something to celebrate. Humanity was once caught in the trap of high fertility and high mortality. Now it has escaped into the freedom of low fertility and low mortality. Women's control over the number of children they have is an unqualified good—as is the average person's enjoyment, in rich countries, of ten more years of life than they had in 1960. (Emphasis added.)

That seems just right to me.  And the article makes some other worthwhile points too -- including that economic output per capita is a far better measure of the health of an economy than total output.  Measured by total output, a place with a shrinking population could seem to be in economic decline, even if the average person is getting wealthier.  (Of course, even better than total output per capita would be a measure that looks at how the poor and middle class are faring.  Still, policymakers should keep in mind that per capita measures of economic health are more significant than total output.)

Sprawl, Health, Place: Notes from Buckley, WA

I recently attended a conference in Seattle for promoting physical activity in urban environments. Alliances between the public health and planning communities are moving out of academia and are being forged on the ground. And it was encouraging to see that what we’re trying to do in my small town in Washington with respect to walkability is what you’re supposed to be doing. 

But walkability by itself is a tough sell. First, many people in suburbs like ours don’t have the time to walk. Suburban dwellers choose to live far from the city, which makes for long commutes that reduce exercise time [another (pdfs)], Second, not everyone cares about walkability or other single-issue items. So, we’re talking about the walkability amenity as one component of a larger small-town, outdoor-recreation, and natural-environment quality-of -life ethic. This softens the impact of rapid change, allows people to see how placemaking (making spaces more attractive and compatible for human uses) benefits them, and it takes away the fear that this is some big-city scheme brought out to the country.

Another example of a tough sell: stopping sprawl. We know that wealthy societies sprawl more [pdf, pg 8] than poor societies--it’s what they do. We enable sprawl by considering land as a commodity that can be bought and sold, rather than as a place that delivers ecosystem services ( e.g. stormwater reduction, air pollution filtration, heat island mitigation, etc)[also 1, 2, 3]. It’s easy enough for property-rights proponents to argue that market forces drive big-lot subdivisions and should drive choices. Well, market forces make traffic congestion too, but never mind that. Ecosystem services--by not being counted in our economics--can’t even enter into the lot-size argument.

But out here in Buckley, people like their large lots--it’s why they live here in the first place; you won’t catch exurbanites dreaming of dense neighborhoods close to transit. But interestingly, folks living on big lots can tell you why small lots have positive qualities: commuters to downtown don’t have three hours a week to mow, weeding a half-acre garden isn’t realistic for a busy household or for seniors, houses are less expensive, etc. Our new senior housing project--to be completed in 2007--will be cottage-style, a good example.

So we’ve tried to emphasize the benefits while gently pointing out no one is asking current residents to move to smaller lots--there are still larger lots in town. When we did zoning changes in Buckley last year, people seemed to respond to the idea that small lots are to diversify our economic base and to provide affordable and senior housing (that is: housing for mom or dad), not to repudiate their life choices.

I’m finding that we stop making unhealthy communities the same way we stop sprawl: not by attacking it directly but by multiple approaches, the most important of which is pointing out sprawl is economically unfeasible to continue. Businesses like walkable neighborhoods because loyal, local customers have something to walk to. Smaller lots--a component of walkable neighborhoods--allow seniors to age in place and create opportunities for young couples to build a family. Cities (especially in Washington where you can’t even tax to keep up with inflation) can deliver services more efficiently when they are compact. Lastly, making your city attractive to a wider range of society allows you to avoid placing all your economic eggs in one basket.

And it may make your city healthier as well (.pdf).

The Kids Are All Right (In a Passenger Car)

This isn't really news, in that we've known for a while that SUVs aren't necessarily safer than cars, but a new study in Pediatrics shows that, compared with sedans, driving an SUV doesn't make your kids any safer. To some extent, bulk may give SUVs an advantage in collisions with smaller vehicles.  But because of their height and weight, SUVs are twice as likely to roll over than are cars -- and rollover accidents are particularly dangerous to kids, with three times the risk of serious injury as accidents with no rollover.  On net, the increased rollover risk cancels out the purported benefit of a heavier vehicle.

So SUVs don't make your kids safer. But there are things that will help -- including properly restraining children with car seats and seat belts. Restrained children face a 2 or 3 percent injury risk in passenger cars and SUVs respectively--not much difference there. By contrast, leaving children loose in a car or SUV quadruples their risk in a crash. And in an SUV rollover, the risk is twenty-five times higher.

Another recent study works through the physics of rollovers (pdf): SUVs with a King-of-the-road view can raise the center of gravity--especially when loaded with passengers and cargo--enough to tip on a hard turn. This same study also goes over what makes light trucks more dangerous to other cars, even when ignoring their worse handling and longer stopping distance.

Greater weight and stiffness mean that light trucks mean the other vehicle in a crash has to absorb more force. And their greater height can cause their frame to intrude more into the body of the other car. In a back-of-the-envelope calculation, the authors estimate that if all light trucks that are used only as "car substitutes" were replaced with passenger cars, it would save three to four thousand lives a year

Now, some people will argue that they need a truck/SUV for the couple of times a year they [insert heavy-duty use here]. To that, I suggest buying a well-designed, fuel efficient passenger car for most of the year while renting an SUV for that fishing trip in the summer. Your children will be just as safe, you'll spend less on gas, and you'll also save your own car the wear and tear from rutted dirt roads.

Happy 2004!

Washington state's health department just released some mortality statistics for 2004. And there's quite a bit of good news: for Washington residents, 2004 was the healthiest year ever. Life expectancy -- the number of years a newborn can expect to live, given the year's mortality patterns -- surged by more than 7 months, an unusually large jump. For the first time ever, the average infant's life expectancy in the state topped 79 years: baby girls could expect 81.6 years of life; baby boys, 76.9 years.

Another bright spot: vehicle fatalities declined. The risk of dying in a car crash in Washington is at its lowest point since the health department started keeping records: holding population structure constant, crash risk has declined by more than half since 1980. 

Of course, British Columbia maintained its health lead, with substantially higher life expectancy and lower crash risk than Washington. But the gap, at least for life expectancy, seems to have narrowed a bit.

Of course, it's worth noting that we'll have to wait another full year to find out whether these health trends held up during 2005.  And we'll have to wait even longer for information for Oregon and Idaho. Apparently, we Americans do a far better job of tracking our financial health (GDP, unemployment, wages, and the like) than our physical health. Which may be one reason that the US is among the richest nations in the developed world -- but also one of the least healthy.

All I Want for Christmas is a Sidewalk

It's the most dangerous time of year to be a pedestrian or a bicyclist: short days mean commutes in the dark, overcast weather obscures pedestrians even during daylight, and rain and snow increase the stopping distance for both drivers and cyclists. But as the Seattle Times reports, better infrastructure, such as in Washington's recently updated wish list of pedestrian and cyclist projects, can make walking and biking both safer and more convenient -- not just in wintertime, but year round.

Periodically King County compiles reports on the causes and situations surrounding pedestrian deaths, most recently for the years 2000 through 2003. In short, most fatalities occur when pedestrians either (a) do not follow traffic regulations, and/or (b) are impaired by age (old or young) or alcohol.

This suggests two things to me. First, that walking is fairly safe if you are a sober, law-abiding adult, especially if you have a safe place to walk. But in King County nearly 13 percent of the pedestrians were hit walking on a road without a sidewalk. And while people over the age of 60 made up one out of every four deaths, most were following the law and crossing in a crosswalk. With limited mobility, seniors often take more time to cross, so changes such as longer signal times and better lighting at crosswalks can make a big difference.

Second, because responsible walking is not as dangerous, building safer places to walk, and advertising them, could not only reduce pedestrian fatalities, but also encourage more walking. (And as we've reported before, there seems to be safety in numbers for pedestrians -- that is, the more pedestrians there are on the streets, the lower the odds that they'll be struck by a car.)

Reading this and other pedestrian fatality and safety studies, it seems to me that, yes, pedestrians need to be visible, follow the law, and look well before crossing the street, but they also need a decent infrastructure for walking -- including sidewalks, bike paths, streetlights, and signaled street crossings. Other countries with much higher pedestrian rates also have much lower fatality rates. We can do better, too.

Sloth: Perhaps not a sin, but still deadly

Today's Seattle Times summarizes the findings of a long-term study of how exercise improves health:

People who engaged in moderate activity — the equivalent of walking for 30 minutes a day for five days a week — lived about 1.3 to 1.5 years longer than those who were less active. Those who took on more intense exercise — the equivalent of running half an hour a day for five days every week — extended their lives by about 3.5 to 3.7 years, the researchers found.

In other words, sloth kills, and even moderate exercise can lead to a longer, healthier life.  Which is something to keep in mind next time you're in the market for a place to live -- choosing a home where it's as convenient to walk to the store as to drive could actually save your life.

Eat For Your Life

New research from the Harvard School of Public Health shows that American levels of overweight and obesity may be responsible for 10 percent of all cancers. In addition to causing elevated rates of diabetes, heart disease, and stroke, researchers believe that if no Americans were overweight or obese the United States would see a...

• 14 percent reduction in colon cancer
• 11 percent reduction of breast cancer
• 49 percent reduction in endometrial cancer
• 31 percent reduction in kidney cancer
• 39 percent reduction in esophageal cancer
• 14 percent reduction in pancreas cancer

Bowling Together, One Last Time

Today in the Seattle Post-Intelligencer, a sweetly-sad story about the closing of a bowling alley in north Seattle. There's nothing terribly profound, of course, about one business closing down, but columnist Susan Paynter does a terrific job of characterizing the place as a nexus of social capital, though she doesn't use the term herself. In light of the recent dialogue on this blog about the role of density, gentrification, and community, I thought I'd toss out this article as food for thought.

"You should start the day off with a little bit of laughter," Wayne Luders told me. He and wife Ruth come from home a few blocks away for the friendship, the circle of acquaintances they count on around the tabletop, and down-to-earth servers like Louise Adams who, Wayne admits, sometimes calls him worse names than "Sweetpea."

Like the other regulars -- the serious night-league bowlers with monogrammed bags, the daytime senior señoritas sporting matching shirts, and the every Tuesday and Thursday railroad retiree -- they dread March when they'll loose their moorings.

That the business closing is actually a bowling alley, gives a certain literal heft to the worry that social capital is declining, a worry that is most commonly connected to Robert Putnam's book Bowling Alone. But more to the point, Leilani Lanes is not closing because business is slow (though it's worth noting that league bowling there has declined sharply, as it has almost everywhere). No, the alley is closing in part because real estate values have gotten so high that it's hard for the owners to justify the building's current use.

There's much more money in re-developing the alley into apartments, condos, retail outlets, or more profitable businesses. It strikes me that the closing of this alley--like the passing of many timeworn elements in any city--should not just be shrugged off as a matter of amoral invincible "market forces." It's truly regrettable when places of close community pass away, but it's a problem that's damnably hard to fix.

I'm certainly not a no-growther. I believe, for instance, that much of the new development in Seattle over the last two decades has made the city healthier and better in a thousand and one ways. A profusion of new commercial districts, walkable neighborhoods, and even farmer's markets is breathing a great deal of life into the city. But at the same time, there's something lamentable about the loss of "great good places" like the bowling alley--places where the community has gathered for years--places that forge the bonds that keep cities vibrant and may even keep people healthier too.

Waldal worries it will be the end of social contact for many. That they will sit, immobile and isolated by their separate TV screens.

Longtime bowling-league secretary Mary Pelan, a self-described senior citizen, started bowling at age 17. She guesses she'll walk for exercise -- probably alone -- when the place shuts its doors. "So many connections will be shredded and that's just a shame," she said.

But what to do? In the face of a growing population and the practical need for increasing density (not to mention the environmental and social needs), how do we preserve the "great good places" that make the places where we live worth living in?

Thoughts?

Geography of Fast Food

An article in the Seattle Times today highlights another link between land use and obesity: access to healthy food. By overlaying maps (pdfs) of house prices, grocery stores, and fast food restaurant locations, UW researchers demonstrate that lower income areas, such as Kent and Auburn, have fewer grocery stores and more fast food restaurants per square mile than higher income areas, such as Ballard and Redmond. Obesity rates show a similar pattern: 27.8 percent of Auburn residents are obese compared to 7 percent of Capitol Hill/East Lake residents.

Access to safe places for exercise may be another factor. Lower income people who don't feel safe walking in their neighborhoods may not be able to afford a gym membership or even bus fare to a community center.

This is just one more link coupling poverty and obesity. Previous research has demonstrated that energy dense foods (like burgers) are generally cheaper than nutrient dense foods (like fruits and vegetables).

Healthy choices have long term benefits, but fast food is easiest in the short term especially if the grocery store is harder to get to. I'd be tempted by the grease too if the kids were hungry now, three fast food joints were closer than the grocery store, plus they're cheaper and I wouldn't have to cook or clean up.

Seems to me that a healthy lifestyle is really a choice only when your life is not overly constrained by time, money, and geography.

Out of Sight, Out of Mouth

New research indicates that we eat more candy when it's close by and visible--and then we underestimate how much we've eaten. But on the other hand, according to the researchers, "If we move food away from us, even 6 feet, we eat less and we overestimate how much we have eaten."

I wonder if this lesson can be broadened to include the larger urban environment. Do we eat more fast food if it's accessible and visible? In light of the growing obesity epidemic, can we realize health benefits simply by making it harder to get to unhealthy food?

Personally, I think our behavior--or at least mine--is often powerfully affected by subtle forms of suggestion. In fact, even as I type this I'm munching on my third or fourth handful of candy corns that someone put in a bowl in the office kitchen. I don't even like candy corns.

A Beacon in the Smog

I doubt that most residents of leafy suburbs paid a lot of attention to air quality when they chose their homes.  But it’s not hard to believe that, when suburban commuters return home from work each night, they breathe a little easier in the belief that they’ve escaped the smog and fumes of the city.

Only, maybe they haven’t.  At least, not in the greater Puget Sound, anyway.

The Puget Sound Clean Air Agency maintains a network of air monitoring stations throughout the region.  Some are in central Seattle, some in smaller cities, and some in suburbs and rural locations.  And--perhaps surprisingly--there doesn’t appear to be a decisive air quality advantage to living in the suburbs.  (See this pdf for more details.)

Or, to be a little more accurate:  air quality tends to be both highly variable and very localized.  Monitoring stations in the neighborhoods surrounding Seattle’s downtown tend to report that the air is pretty clean -– cleaner, in some cases, than at more suburban monitoring stations in Bellevue, Lynnwood, or Lake Forest Park.  On the other hand, the air in Seattle’s industrial zones can be pretty dirty; but then again, so can the air in Kent and Marysville.

The Beacon Hill monitoring station, a mile or so southeast of downtown Seattle, is worth a special mention. 

The Beacon Hill neighborhood is just to the east (i.e., downwind) of I-5, the heavily trafficked West Seattle Bridge, and the Port of Seattle; to the north it's bordered by I-90.  Given its location, you might expect the air quality on Beacon Hill to be pretty bad.  In fact, if you had to pick one residential neighborhood in Seattle that’s likely to have outdoor air quality problems, Beacon Hill might well be it.

But Beacon Hill’s air is, surprisingly, pretty clean. For fine particulate matter (i.e., soot, largely from diesel vehicles), it does moderately well: 3rd best of 7 regional monitoring stations by one measure, 7th of 16 by another, best among 5 by yet another.  It has less ozone than any other monitoring station in the region (not surprisingly, as concentrations of ground-level ozone are typically lower in city centers than in leafy suburbs and exurbs).  And its carbon monoxide levels were the lowest among 7 stations.  I'm not sure why Beacon Hill does as well as it does -- perhaps it's just a function of altitude and prevailing wind patterns. But whatever the reason, it's good news for the people who live there.

Clearly, the monitoring station results don't offer definitive proof that Beacon Hill residents have nothing to worry about from their air.  But it does mean that a move from Beacon Hill to, say, Lynwood or Bothell or Lake Forest Park or Marysville—all suburban locations—won’t necessarily buy cleaner air.

Three more points are worth mentioning here.  First, as we mentioned in this post, the air in your car is typically among the worst you’ll breathe all day.  Second, for most pollutants, indoor air is more polluted than outdoor air –- and most people spend 90% or more of their time indoors.  And third, outdoor air quality seems to have improved pretty substantially since the early 1980s; King County has had no “unhealthy” air quality days since 1999, and only 31 days in 6 years in which the air has been “unhealthy for sensitive groups.”  That’s not a perfect record, obviously, but it does represent a substantial improvement from where we once were.

To me, these facts suggest that at this point improving the air that you breathe depends, in large measure, on keeping yourself off the highway, and keeping hazardous products out of your home.  Obviously, clean outdoor air matters too -– it’s just that living in the suburbs doesn’t necessarily guarantee that you’ll get it.

Update:  I should mention that "A Beacon In The  Smog" is, or at least was, the official tag line of Grist Magazine.  Plagiarism, like imitation, is a sincere form of flattery.

Biomonitoring Bill Terminated

In California, Gov. Schwarzenegger just vetoed a bill that would have required the state to begin monitoring synthetic chemical pollutants in the bodies of California residents, and to explore the connection (if any) between such chemical "body burdens" and human health.

To me, what seems notable here is the reason the governor gave for the veto:

"While the intent of the measure is worthy...the bill will only provide a partial snapshot of chemicals present in tested participants without proper context of what the presence of (a) specific chemical means or how it interacts with other health factors.

Translation: it's better to keep flying blind than to start opening our eyes.   According to the Oakland Tribune, the governor has pretty much lifted this argument from the chemical industry's talking points -- so I'm sure it won't be the last time we hear it.

Of course, it's not quite true that we're flying blind here.  Plenty of people are doing biomonitoring, including the US Centers for Disease Control.  But those programs have pretty definite limitations -- biomonitoring studies by academics, state labs, and public interest groups tend to be one-off affairs, rather than long-term, coordinated efforts; and the CDC data provides a useful baseline for some contaminants, but doesn't look at chemical combinations or health effects.  Those are gaps the California program could have filled.  Too bad it was Terminated.

Pedestrian Safety in Numbers

Pedestrians: be safe, flock to Portland!

In the past 6 years pedestrian crash rates have fallen by 38 percent, according to a report on Oregon Public Broadcasting. The decline is especially impressive because there are likely more pedestrians today because more people (32 percent more) are using Portland's public transit. And similarly, while the number of bicyclist injuries has remained fairly constant, the total number of cyclists has gone up so that, on average, bicyclists are safer than they were 6 years ago.

Crash rates don't increase directly in line with walking and biking rates because there's safety in numbers. A study that looked at walking, biking, and crash rates in several cities found that individual pedestrians and cyclists are safer when traveling in cities with greater numbers of pedestrians and cyclists. The study's authors estimated that if the number of pedestrians were doubled, then the total number of pedestrian injuries would increase by only a third, but the rate of pedestrian injuries would actually decrease by a third. The theory is that the more often drivers encounter walkers, the more they expect to encounter them, and the more cautiously they drive.

Of course, infrastructure for pedestrians and cyclists, as well as traffic regulations and customs, also greatly affect safety. I suspect that Portland's reductions are due to both safety in numbers and infrastructure improvements because the number of car crashes dropped as well. But it seems as though investments in pedestrian and cyclist safety could generate a feedback loop of benefits: if a city increases safety with better intersections and more bike lanes, then more people feel safe to walk and bike, so walking and biking become even safer, so more people feel safe to walk and bike. Eventually it would reach a plateau, of course, but we have a long way to go to match pedestrian rates in other countries.

Do Good Communities Make Liberals?

While studying the connections between social capital and health I stumbled across something rather odd. States with high social capital--strong connections between people and their communities--tend to vote democratic.

Harvard researcher, Ichiro Kawachi, one of the leading lights on social capital and health, has performed several studies that make state-by-state comparisons; and he's shown that, on average, states with higher social capital also have better health outcomes. But as I was peering over some of his charts I couldn't help but notice that states with higher social capital also tended to be "blue" states--they voted for John Kerry in the last presidential election.

Unfortunately, Kawachi reports the results for only 36 states (the others did not have sufficient data to support his study) so my little "finding" here refers only to those states, though they do include all the big ones. That's just one of the limitations, but I still think it's interesting that 6 of the 10 states with the highest social capital voted for Kerry in the 2004 elections. Meanwhile, 8 of the 10 states with the lowest social capital voted for George Bush in '04. Don't believe me? Here's the rank-ordered list....

(In keeping with prevailing media norms, republican-voting states are coded red; democrat-voting ones are blue.)

1	North Dakota
2	Iowa
3	Washington
4	Minnesota
5	New Hampshire
6	Rhode Island
7	Utah
8	Wisconsin
9	Oregon
10	Wyoming
11	Ohio
12	Colorado
13	New Jersey
14	Indiana
15	Michigan
16	Illinois
17	Massachussets
18	Kansas
19	Pennsylvannia
20	California
21	Missouri
22	Arizona
23	Connecticut
24	Texas
25	Kentucky
26	South Carolina
27	Alabama
28	New York
29	Maryland
30	Georgia
31	Arkansas
32	Mississippi
33	North Carolina
34	Tennesse
35	Oklahoma
36	Louisiana

As the list here shows, the relationship is certainly not comprehensive--there's a lot of muddle in the middle--but on the extremes there does appear to be a correlation between low social capital and voting for Bush.

While Kawachi never mentions the voting comparison, in a separate study he offers a plausible explanation in the context of health outcomes. He suggests that high social capital leads to more civic engagement and, in turn, to more investment of resources, money, and concern into the community at large. For Kawachi, that investment is a partial explanation for better health outcomes--places with high social capital care more about the welfare of others.

So I wonder whether--to the extent that democratic voters favor more public investment in the community and republicans less--that Kawachi's explanation fits. Places with higher social capital reflect their preference for community in their voting habits. In other words, good communities foster democratic voting.

Just a thought.

A couple of notes and caveats are in order...

*** Kawachi's measurement of social capital is, in this instance, a shorthand. It's the percent of people responding "yes" when asked whether most people would take advantage of them if given the chance. Most researchers think this is a reasonable, if abbreviated, way to assess social capital.

*** My list is extrapolated (read: eyeballed) from Howard Frumkin et al., Urban Sprawl and Public Health (Island Press: Washington, DC: 2004), p 167.

VOCs Populi, or that New Car Smell

Love that new car smell? You may not get that smell from the next new car you buy, and for good reason. Japanese auto makers are planning to reduce the new car smell that comes from fresh glue, paint, plastics because it contains volatile organic compounds (VOCs). Short-term exposure to VOCs like benzene and formaldehyde can cause headaches, nausea, and dizziness, while long-term exposure can cause cancer. Studies (pdf) show that most people get their most concentrated dose of VOCs in cars of all ages when caught in traffic or refueling, and the new car smell just adds to the problem. Because the smell generally dissipates after 6 months, it probably won't give you cancer. But, still, kudos to Japan for tackling another air quality problem.

King of Sprawl

Does sprawl kill?  Looks like it.  This study found that people who live in sprawling counties -- places with low population densities and poorly connected street grids, and with rigid segregation between stores, businesses and residences -- are more likely to die in a car crash. 

Apparently, living in the sort of place where you can't get anywhere without a car makes you drive more.  And people who drive more tend to crash more.  (When you put it that way, social science seems pretty simple, no?)

But, of course, the question remains:  how much?  How much more accident risk do residents of sprawling places really face? The answer is surprisingly straightforward: according to the model developed by the study's authors, residents of Washington's King County (relatively compact and urban) should face a 20 percent lower risk of getting in a car crash than the people who live in neighboring Snohomish County (relatively sprawling).

That's the theory at least.  And in this case, the theory matches up pretty closely with reality.  Over the last few decades, the age-adjusted traffic fatality rate in King County has averaged about 20 percent lower than the rate in Snohomish.  (See table E-8, here.)

Or, said another way: if King County sprawled like Snohomish, about 800 additional King County residents would have died in car crashes since 1980.  And since the National Safety Council estimates that each traffic fatality is associated with 54 non-fatal injuries, King County residents also avoided more than 40,000 injuries, just because of how its urban and suburban areas are laid out.

Now, just imagine how many fatalities could have been avoided if King County looked like greater Vancouver, BC.

Read This Outdoors

Is it possible that today's children suffer from Nature-Deficit Disorder?

At least in our imaginations children and nature are as inseparable at Tom Sawyer and Huck Finn. Kids seem born to run through the woods, fish, build forts, and explore their natural surroundings. But according to a new and, I think, rather intriguing theory, children are increasingly constrained by sanitized and regimented activities that alienate them from nature. The result may be worsening psychological problems for kids and may help explain the pervasiveness of that bogeyman of contemporary child development, Attention Deficit Hyperactivity Disorder (ADHD).

I have no idea whether there's any empirical merit to the case, but a new book, Last Child in the Woods by Richard Louv, argues that children are more estranged from nature today than ever before. And because contact with the natural world can be a powerful remedy for ADHD, children's alienation from nature may be contributing to the prevalence of ADHD.

I won't blather on further now (I haven't read the book), but it is worth pointing out a good book review in Orion Online that explains Louv's reasoning and offers a glimpse of his research context. Seriously, it's fascinating. If that's not enough, read an interview with the author at Salon.com (free access if you watch a short ad).

Girth vs. Growth

In 2004, total health care spending reached roughly $30 billion in Washington state.  In Oregon, that total was $16 billion; In Idaho, about $5.5 billion.  That's not chump change:  health care now absorbs about one-eighth of the total output of the Northwest states' economies.

And, based on the results of these national studies, and these state-level estimates, at least a tenth of all medical spending in the Northwest is related the ailments (diabetes, hypertension, colon cancer and the like) caused by obesity, overweight, and physical inactivity.

These are, of course, round numbers.  Unless I'm mistaken, there just aren't good, up-to-the-minute estimates of health care spending in the Northwest.  And multiplying the confusion, it's hard to separate out the costs of obesity, overweight and physical inactivity. 

That said, it looks pretty likely that the total, direct medical costs of the obesity-overweight-inactivity nexus top $5 billion for the three Northwest states combined.  And that's just the direct medical costs; it doesn't account for lost worker productivity, worker's compensation, and all of the other indirect costs of poor health brought on by inactivity or overweight.  This report suggests that those indirect costs top $4.6 billion per year -- for physical inactivity alone, and just within Washington state.  That number seems mighty high.  But if it's anywhere close to being accurate, it could mean that promoting exercise and eliminating excessive body weight might boost the region's economy by, oh, about 3 percent.

Or, put differently:  reducing the size of our people might be a pretty good strategy for increasing the size of the economy.

Friends for Life

There's no question that our social environments help determine how healthy we are. In fact, I have now in front of me a small mountain of studies to that effect. Rather than bore you with the particulars of their findings, I'll simply summarize this way: study after study shows that close social relationships--a spouse, loved one, or a close friend--help people live longer.

Interestingly, social bonds don't appear to prevent the onset of a disease. There's no association, for instance, between social isolation and sudden cardiac death. But for survivors of a life-threatening event or disease, social connectedness significantly increases average longevity and functioning. One study even suggests that the effect of social isolation "is comparable to the effect of cigarette smoking on total mortality reported in some studies." 

In other words, close relations with friends and family are really, really good for your health.  Or--stated in the converse--loneliness kills.

Perhaps more intriguing, an emerging body of research is pointing out that suburban sprawl is an impediment to social networks. Does sprawl erode social networks which are critical for health? Is sprawl bad for our health because it diminishes our personal relationships? Well, that's where things get confusing.

I've already aired my skepticism that sprawl erodes social capital. (Or more precisely, I'm skeptical that the existing research proves it.) But for the moment, I'll abandon my skepticism and go along with the multitude of voices arguing that sprawl is bad for social capital. And indeed, there is some compelling research showing that traditional city neighborhoods are better at fostering incidental contact between neighbors and promoting loose associations that may be important for well functioning civil society and even democracy. Plus, it's clear that declining social capital over the last several decades has been coincident with ever-more dispersed suburbs and highways.

One might be tempted to conclude that if sprawl is bad for social capital (which is good for health), then sprawl must also be bad for health. One would even have plenty of company among researchers who have claimed just that. But one would still have to convince me. Here's why.

My reading of the available literature suggests that there's a pervasive equivocation at work. The term "social capital" (or, variously "social networks" or "social ties") is used in at least two different ways. In one sense the term(s) refers to informal neighborhood associations, participation in civic life, or belonging to a church or community group. I'll call this "loose social capital." In the other sense, the term(s) means the presence of close supportive individuals, such as a spouse. I'll call this "tight social capital."

The research makes it clear that tight social capital is good for health, but I haven't heard of anyone arguing that sprawl reduces tight social capital. Moreover it's not at all clear that loose social capital--the kind that is allegedly eroded by sprawl--has anything at all to do with health outcomes. But because the literature's terminology for both tight and loose social connections are the same--social capital--it's easy to assume that they are the same thing and have the same effects.

Now, admittedly, there is some evidence to suggest that people with more friends are healthier (and this is especially true for men for some reason). But that, of course, doesn't mean that having friends makes you healthier. And it's also true that at least one study shows that too many social connections can actually be inimical to health--interpersonal conflicts cause stress-related diseases (and, again, this is especially true for men for some reason).

I do think there's probably a link here--that is, a link from sprawl to loose social capital to health--but I'm not quite convinced yet. The best research I've seen is from Ichiro Kawachi, a Harvard researcher. On a state-by-state basis he examined the results of two simple questions that have been found to be closely correlated with loose social capital---Do you think most people can't be trusted? and Do you think most people would take advantage of you if given the chance?

States where people thought they couldn't trust others also had worse rates of self-reported health. And states where people felt that others would take advantage of them had higher mortality rates. So Kawachi's study makes me think that there must be some connection between loose social capital and health. And if sprawl does indeed weakens loose social capital, then it may be to blame for worse health outcomes. I'm hoping there's more research emerging that will document these connections, if they exist. In the meantime, I'm also hoping not to find more research that seems to equivocate between loose and tight social capital.

Postscript: In a curious though unrelated side note, one study found that among spouses, husbands had a higher risk of depression if their wives suffered a cognitive disability. On the other hand, if their husbands suffered a cognitive disability, wives were at no greater risk for depression. I'm not really sure what to make of that.

Chain of Evidence

From CNN, a story suggesting that Oregon's emphasis on pedestrian and bike-friendly cities has helped it keep obesity in check.

According to a study released Tuesday by the Washington, D.C.-based Trust for America's Health, the percentage of overweight Oregonians held steady at 21 percent last year, a sharp contrast to Alabama, where the rate of obesity increased 1.5 percentage points to 27.7 percent.

What makes Oregon different is its emphasis on urban design, which encourages outdoor activities like biking to work, the study's authors said.

Now, obviously, only a small share of Oregon residents walk or bike to work; and many people who do so have farily short commutes. But that's exactly the point:  when it comes to obesity, even a little bit of exercise can make a big difference.  On average, adults put on a pound or two a year -- but a pound of extra weight per year averages out to just 10 calories per day.  That's less than a teaspoon of sugar, or a daily stroll of about a tenth of a mile.  So even though Oregon cities' neighborhood design may have only a small effect on walking and biking, that effect could very well have been enough to keep Oregonians from putting on as much weight as Alabamans.  And by curtailing the growth of obesity, Oregon may have helped keep its citizens healthy, while stemming health care costs--which now account for about one out of every eight dollars Oregonians earn.  Which is one way of responding to people who question whether sidewalks and bike lanes are really worth the cost.

Obesity Grows

Obesity rates are growing in every state but Oregon, according to a new report by Trust for America's Health based on data from the CDC. (Read the Seattle Times article here.) While Oregonians can be proud of their accomplishment last year, they are not the trimmest state in the country, nor in the Northwest.

Interestingly, every Northwest state has lower rates of obesity than the national average. Montana residents are least likely to be obese; Alaskans are most likely. As Jessica pointed out recently, it's worth paying attention to obesity trends, not only because of their health consequences, but because it can absorb a lot of money.

Here's the skinny on obesity in the Northwest states...

Percent of state residents who are obese, 2004

	Percent of residents who are obese, 2004
Alaska	23.5
California	21.5
Idaho	20.9
Montana	19.1
Oregon	21.0