Friday, June 21, 2013

City Planning and Collective Health

Dear Municipalities and City Planners Everywhere,

As you, no doubt, are aware, the American Medical Association has recently decided to classify obesity, a condition which affects a large and ever increasing segment of the population (approximately 35.7% of adults per the CDC), as a disease. As the vocabulary of being fat in america changes from a health risk or condition, a state or a symptom to a disease, there are a few different ways this can go. One way, the sadly most likely way, is that anyone with a BMI of over 30 gets further stigmatized and hounded for every little decision they make. The other way is that useful policy changes open up the door to treatment options previously unavailable, increase access to the necessary tools for combating the myriad underlying causes of obesity, and, possibly most importantly, a culture of fat shaming begins to trend to a culture of challenge in which an obese person's healthcare professional takes the time to talk to him or her about their predicament and look for the underlying factors potentially complicating reaching or maintaining a "healthier weight*."

Of course, as a municipality/city planner, this has nothing to do with you, right? Wrong.

As a woman who prefers to walk when possible, I am frequently disappointed, disheartened, and disturbed that in many areas that really should be pedestrian-traffic friendly- shopping areas, hotel and food districts, neighborhoods near busy streets- there is no safe means of walking from one place to the next. Sidewalks end before the street, six lane roads lack crosswalks, and pedestrians can either Frogger it across the road (maybe at the stoplight, maybe not- after all, the crosswalkless stoplight also has the turn lanes with which to contend).

Poor municipal planning endangers the people trying to stay active by choosing to walk instead of drive. It also creates a defeatist mentality wherein people who can walk assume that they can't because they don't feel they can trust that the entire way will be safe. So, instead of walking a mile to the post office, unsure if they'll end up dodging cars or not, they hop in the car, pollute the environment, and spend what could be active minutes sitting. But that mentality seeps into daily lives until two block trips are buckle up and go adventures for no reason other than having been trained to think that way.

So let's work on this. Sidewalks. Crosswalks. Ad campaigns to remind people that you've made it safe for pedestrian traffic. Work with your chamber of commerce to promote outdoor walking activities featuring local businesses.  Look at the cities with great public transportation and pedestrian infrastructure and emulate them. Be part of the solution.

Let's get out there and remove one more obstacle to health, because I don't think they're going to really let anyone call in fat to work or take their 10 weeks of  family medical leave to go to fat camp.

I don't agree that obesity is a disease, but if we're going to call it that, then we need to take the initiative as a society to fix it. City planners aren't responsible for the health of individuals, I'm not saying they are, I'm saying municipalities have the opportunity to do something tangible to help.

An Obese Woman Who Prefers to Walk

*Healthy weight is an altogether complicated notion, because there really is such a thing as a healthy person who is also obese, well, there was until this week. Largeness does not necessarily mean high blood pressure, impaired mobility, cholesterol and blood sugar problems, and the conflation of these ideas is a huge part of the problem with the way in which our culture approaches health conversations.

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