Impacting Health Outside the Physicianís Office
ďMedical school taught me about caring for the patient, but it took me years to learn the key role of caring for the community in maintaining health. As a general internist, Iíve seen the dramatic rise in obesity in the face of more sedentary lifestyles over the past several decades. Like most primary care physicians, Iíve worked with many patients suffering the complications of obesity such as diabetes. An increasingly large portion of my job includes collaboration with patients on chronic disease management. I talk to patients every day in the office about the need to eat less and exercise more.
As of 2003, 6% of the stateís total medical expenditures for adults were attributable to obesity, and this has certainly risen since then. Diabetes prevalence has more than doubled in NC since 1995, the year after I started in my practice. Iím not a policy wonk, but I know that promoting healthy lifestyles for individuals often involves much broader interventions than those that can be accomplished only in the physicianís office. For example, patients often respond that they donít have the opportunity to incorporate exercise in their daily routine in the face of more demands at work. Through some unexpected events over the past few years, I have had the good fortune to become involved in a project with the potential to promote healthy lifestyles by targeting policy and environmental barriers to physical activity.
Iíve lived in West Raleigh for 18 years and have had the rare privilege of working within walking distance of my house. Iíve found this to be a nice form of exercise as well as a stress release (except at the points where vehicles and pedestrians intersect). I work on Blue Ridge Road, the eastern border of an approximately 2000-acre parcel known as the Blue Ridge Corridor comprised of primarily state-owned land with surrounding (but not central) residential development. My part of town is also home to a number of major employers of regional and statewide significance, including Rex Healthcare and the NC Museum of Art (NCMA) as well as the NCSU College of Veterinary Medicine, NC State Fairgrounds and PNC Arena (formerly RBC Center). As former director of the PRIME (Pulmonary/Renal/ICU) service line at Rex Hospital and an active member of the NCMA, I was aware a number of years ago of Rexís plans to expand their footprint in West Raleigh on existing undeveloped land as well as the Museumís intention for a new building. Additionally, as not only a resident and worker but also as a pedestrian in the Blue Ridge Corridor area, it was clear to me that the infrastructure was not keeping up with the level of development.
In 2008, I became chair of a group of stakeholders concerned with planning for the Blue Ridge Corridor. Initially comprised of only the Rex and NCMA executive teams, the Blue Ridge Stakeholders Advisory Group subsequently expanded to include all the major institutions along the Corridor. The goal of the stakeholder group was to create sustainable, integrated development through a partnership among State, City, and private property owners that emphasized collaboration and master plan integration and enhancements. In view of the economic potential for development, the City of Raleigh planning office has worked closely with the Blue Ridge Corridor stakeholder group. After obtaining the input of hundreds of area residents and employees, a plan for the Corridor was recently submitted to and approved by the Raleigh City Council to support urban infill in this area.
So, whatís health got to do with it? At its most fundamental level, implementing the Corridor plan can result in increasing utilitarian physical activity. Although there is east-west connectivity in the Corridor through a nationally recognized greenway system, Blue Ridge Road itself has remained unconnected and in fact along most of its north-south length is generally hostile to non-vehicular traffic. The Blue Ridge Corridor plan was designed to integrate access along the Corridor for bicyclists and pedestrians as well as incorporate public transportation. The introduction of mixed use development (including workforce housing) will result in people living closer to their workplaces and being more active. Increasing urban density has the potential to decrease dependence on single-use vehicular transit to get to every destination.
Does this have any health impact outside the Corridor? In fact, the Corridor plan has statewide implications for at least two reasons:
Health Impact Assessment. According to the National Research Council definition, Health Impact Assessments (HIAs) are designed to consider the health implications of a proposed policy, plan, program or project and to provide recommendations on monitoring and managing health effects. No HIAs had been carried out in NC prior to 2010, and the Blue Ridge Corridor HIA represents one of the first in concert with a planning project. The Blue Ridge Corridor HIA, led by Dr. Jackie MacDonald Gibson of the UNC Gillings School of Global Public Health, is designed primarily to quantify health impacts of adding sidewalks, trails and pedestrian improvements in the Corridor. Quantifying these impacts will provide policymakers additional information on potential savings to the health care system by such improvements in relation to other projects in the future.
Complete Streets. NC DOT has adopted a new mission statement within the past year:
Connecting people and places safely and efficiently, with accountability and environmental sensitivity to enhance the economy, health and well-being in North Carolina
This policy mandates interdependent, multi-modal transportation networks that safely accommodate access and travel for all users. Essentially, cars will not be the only consideration for future transportation planning as ďhealth in all policiesĒ incorporates public health concerns. The Blue Ridge Corridor is likely to be a pilot project for this policy.
Developing healthy and sustainable communities will require silo-busting through the collaborative input of experts from the fields of public health, urban planning and transportation as well as primary care physicians and other concerned citizens. As I have found out, physicians have the capacity, if not the training, to impact health-related decisions outside of the health sector. Sometimes it just takes a few steps outside your office...Ē
óStuart Levin, MD, Wake Internal Medicine Consultants, Inc.