How COVID-19 is threatening our health in more ways than one

Increasing “drive-through” lifestyles have already fueled a dramatic rise in obesity-related illnesses, and the pandemic could make it worse – or we could do something about it

Car culture meets pandemic, a story by the US news channel CBS, explores how drive-through lifestyles are being encouraged by the COVID-19 pandemic, notably with drive-through testing.

Richard J. Jackson, M.D., M.P.H. and Michael Mehaffy, Ph.D.

One of the great dangers of the coronavirus pandemic is that it is exacerbating the worst tendencies of increasingly car-dependent cities and towns – the encapsulated, sedentary habits that have already left many communities more isolated and less healthy. As we move toward a post-COVID world, too many neighborhoods offer too little choice, except to continue and even increase this drive-through lifestyle.

Among other things, that is an unjust burden on those who are unable, because of income or age or illness, to own and operate a car. It seems that, as with so many other aspects of the pandemic, we are being forced to confront the structural inequalities and other failures of our existing ways of doing things.

One of those failures is an alarming growth in obesity — itself a risk factor for COVID-19 death, and also a problem that falls disproportionately on low-income and minority communities. In the past 50 years, worldwide obesity rates have tripled, and today in the USA — often a trend-leader — 70% of adults are overweight or obese.

The trend in children is especially ominous: in 1960 in the USA, for example, fewer than one in 10 children were overweight or obese, but today, that number is one in four. Formerly very rare (and very serious) childhood diseases like Type 2 diabetes have become increasingly common.

For adults, the increase is no less alarming. From 2000 to 2018, the prevalence of obesity in the USA increased from 30.5% to 42.4%. That’s contributing to soaring health costs – over $190 billion a year in the US alone, or 21 percent of all health care spending, according to a Cornell University study.

The pandemic is not helping. A recent international survey by Web MD indicated that 55% of men and 34% of women had gained weight during the lockdown. Of US respondents, 25% said they had gained 10 pounds or more. As we emerge from our lockdown, we need active living again – not sedentary drive-through lifestyles in drive-through-only neighborhoods.

Of course, there are other factors that contribute to the obesity epidemic, including the growing consumption of junk food and the lure of sedentary activities online. But there’s also evidence of a close correspondence between obesity and unwalkable, car-dependent neighborhoods. People in these neighborhoods are likely to be heavier, more sedentary and less fit, a deadly pattern that begins when we are young.

For those over 40, a little experiment is telling. In our talks, we often ask our audiences how many of them walked or biked to school. Most hands usually go up. Then we ask them how many of their kids, grandkids or friends’ kids now walk or bike to school. Almost no hands go up. We have wrought a huge change in the lifestyles of our children, one that is taking a tragic toll. We chose to do it when we created unwalkable (and unbikable) suburban environments. No wonder our kids stay indoors on their screens, with too much junk food and too little activity.

Safe, walkable neighborhoods are not just an amenity, they’re a matter of life or death. Not only do we need to be safe from injury and violence – and pathogens, with proper social distancing – but we need to be in walkable environments where we can live active, engaged lives. As the sociologist Eric Klinenberg has pointed out, these neighborhoods create “social infrastructure” that can be a life-saver in a crisis (including a pandemic). And more walking brings more social interaction, more time outdoors, more recreation, more smiles and more “life” in every sense.

But in modern times, aren’t we stuck with these car-dependent neighborhoods? No, we aren’t. As the PBS series Designing Healthy Communities showed, there are plenty of good examples of neighborhoods that point the way. More walkable, transit-oriented suburban neighborhoods such as Oregon’s Orenco Station prove that it’s possible to offer places where people will choose to walk more. At Orenco Station, a study by the sociologist Bruce Podobnik showed that in 2002, 17 percent of residents reported walking to shopping 5 or more times a week, a remarkably high number. By 2007, that number was up to an amazing 50 percent. Neighborhoods can change – for the better.

We suggest that it’s time to “retrofit the suburbs,” adding living streets and centers for humanity – young and old, rich and poor – to formerly sprawling areas. That’s what happened in Orenco Station (left), showing what can be done. These places are not just healthier, they offer a better quality of life, and if they have a mix of services and public transit, monthly transportation costs can be lower, too. Livability, affordability and health can go hand in hand.

The idea is not to “take away people’s yards,” or any other choice. The idea is to provide more choices, for more people, in how to get around and what to do outdoors. Especially it’s about offering more healthy choices. You might still live in your current suburban house, if you want, but find that you can now walk to a small town center nearby, offering a small park for recreation, a market and other shops, and lots of ways to get around by foot, bike, transit or car. As a result, you can get a quart of milk and don’t have to burn up a quart of gasoline. Along the way, you might see a neighbor, exchange some news, or bring the kids for a walk or bike ride.

And you might not just be improving your life: you might be saving it.

Dr. Richard J. Jackson is Professor Emeritus at the Fielding School of Public Health at UCLA, and former Director of the National Center for Environmental Health at the Centers for Disease Control. Michael W. Mehaffy, Ph.D. is an urban researcher with the Centre for the Future of Places, KTH Royal Institute of Technology in Stockholm, and Executive Director of the Lenanrd Institute for Livable Cities and IMCL.

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