Our health is determined by a great number of factors, including our genes, our lifestyles, the quality of our medical systems and our socio-economic status. Improving our wellbeing and, possibly, reducing healthcare costs may thus be realized through a great variety of measures. Somewhat overlooked in this perspective, is the role that (urban) infrastructure plays in this and how parks, sidewalks and cycling lanes can stimulate healthier lifestyles.

Our observations

• According to the U.S. Centers for Disease Control and Prevention, obesity has doubled over the past 30 years among American children (ages 6-11) and quadrupled among adolescents (ages 12-19). In 2014, 5% of children and 20.5% of adolescents were obese and prevalence is even higher for low-income groups. The medical costs for these children are estimated between $3 billion and $14 billion. Adding a park to a neighborhood may cut obesity by an estimated 3-6 percentage points.
• Parks may also help fight other healthcare issues. That is, an inactive lifestyle leads to a greater risk of developing diseases ranging from heart disease to diabetes and several forms of cancer. Parks are said to stimulate people to engage in physical activity and spend more time outdoors (i.e. relevant for vitamin D production), and to enhance psychological health directly through increased contact with nature and indirectly because parks tend to strengthen communities, thus social contacts.
• Infrastructural investments in improved sidewalks or separate bicycle lanes may provide health benefits as people start walking or cycling more and, as a welcome bonus, could reduce air pollution because fewer cars are needed.
• Infrastructure may change function over time. While many roads were hijacked by cars in the early 20th century, cyclists and pedestrians are reclaiming old railroads and other infrastructure (e.g. the High Line in NYC) and industrial heritage sites are turned into parks and experiences (e.g. in the German Ruhrgebiet).
• Green roofs, roofs covered with plants, are associated with energy savings, reduced air pollution, retaining water and, possibly most important, with reducing the so-called heat-island effect; cities absorb much more sunlight than their surrounding areas, which leads to higher temperatures (from 3 degrees Celsius during the day to up to 12 degrees difference in the evening). Among other detrimental effects, too much heat can directly lead to (fatal) health problems.

Connecting the dots

Healthcare costs are rising and account for as much as 10-17% of GDP in developed nations. As we have noted before, growth is mostly due to ageing and the fact that the older we get, the more we suffer from expensive chronic diseases. Some of these are avoidable by means of preventive medicine or healthier lifestyles. The latter may be achieved through public information campaigns, tech-enabled gamification of exercise, or steep taxation of cigarettes and unhealthy foods. These measures may be effective in their own right, but they overlook the fact that our everyday (urban) environments often discourage us from leading more active lifestyles.In the early- to mid-20th century, our once multi-functional urban roads were hijacked by cars, ousting other healthier means of getting around. Later on, new (sub)urban areas were sometimes designed exclusively for cars, trucks and buses and were hostile to pedestrians or cyclists. Also, ever denser cities lacked space for parks and other forms of urban nature that invited people to spend time outdoors and get some casual exercise. In other words, for people to lead healthier lives, they need the appropriate infrastructure that allows and triggers them to become more active and improve both their physical and psychological health.This calls for infrastructural investments, in parks, cycling lanes and (connected) sidewalks, but funds are not always available and space is naturally limited in urban areas. In the end, it’s all about seeing the bigger picture and so-called social-cost-benefit analysis may help in this respect. These encompass estimates of the broader monetary costs and benefits of these investments and they could make it easier to argue for healthier infrastructure. Moreover, one could conceive a reshuffling of political priorities and budgets. When, for instance, the value of a separate cycling lane is appreciated as a health-benefit, and not just because cycling is fun or hip, it may be feasible to shift funds from healthcare to infrastructure.

Implications

• Health Insurers may want to invest in, or sponsor healthier infrastructures which present positive health effects.
• One could also imagine a double-sided approach in which sugar taxes and other forms of health-centric price-incentives are used to finance infrastructure that enables and triggers us to lead more healthy lifestyles.
• The rise of the sensor-based economy will provide us with more insight into the actual use of these infrastructures and possibly also into their (direct) impact on health and wellbeing.