The Link Between Obesity, Transportation and Land Use
There was a story tonight on the CBC TV news Vancouver at 6. It is about an important shift in the advice given to doctors. “The Canadian Task Force on Preventive Health Care released recommendations for family physicians …on prevention of weight gain and treatment of overweight and obesity.” The emphasis is shifting from treatment – which mostly does not work – to prevention, which might. As is now the practice, after the news story from back east, Andrew Chang sat down with a local expert to talk about this some more. She was a doctor from Children’s Hospital and it was all about what we teach our children to help them keep the slim figure they have in their adolescence. It wasn’t until right at the end of the interview when she used the word “environment”, and it was left mostly unexamined. But without doubt it was the most important word in the discussion.
The shift in obesity statistics for the Canadian population occurred at the same time as it did for the American and a bit later for the UK. People have become less physically active partly due to their jobs changing – but mainly due to their commuting. Most of us used to stand to do our jobs, which usually involved some muscular exertion. And we either walked or biked to work. These days we are much more sedentary both at work and at home. And we tend to drive between the two. At the same time, we have stopped cooking for ourselves and rely heavily on processed food or prepared food from commercial outlets. This was not mentioned at all and is a bit of distraction, but basically when you do your own food prep you are much more likely to control salt and sugar. Processed food contains all kinds of preservatives and flavour enhancers to prolong shelf life – and long distance shipping. When you eat out, or buy a pizza, there’s a lot of fat and carbs on your plate.
It is not at all coincidental that the people who are now getting involved in long term planning for transportation and land use are Medical Officers of Health. They were largely absent during my career as a regional planner and transportation economist but in recent years they have noticed that people who live in walkable (and bikeable) neighbourhoods have lower levels of adult onset diabetes, heart disease and obesity. Also known as “metabolic syndrome” even though it has nothing to do with metabolism and everything to do with living in suburban sprawl and driving to do anything at all.
You will not hear anything about this from Jordan Bateman or the No lobby in general. They are the people who have no intention of changing anything. They want a ground oriented house with a two car garage, in a residential area far distant from any other land use apart from schools and churches. Jordan Bateman was a Councillor in Langley. This is still his constituency. The people who listened to the “drive until you qualify” mantra. They shop once a week, spend much of their time taking their children to and from school or after school activities and will tell you they have to drive. They cannot conceive of using a bus or a bike to live like they do. And as they age their weight increases steadily and inexorably.
The Yes campaign is driven by the concept of increasing transportation choice. That phrase was key to the Livable Region Strategy, written by Gordon Campbell, and intended to guide the pattern of development in Greater Vancouver. You cannot have a Protected Green Zone and a Compact Region with Complete Communities unless you Increase Transportation Choice. Wendell Cox does not understand this. Neither do Christy Clark, Todd Stone or Kevin Falcon. The two solitudes in Greater Vancouver are the people who live in the parts of the region where they can reasonably decide for themselves which mode to use for their trips – and switch between them at will – and those who can only drive for every purpose imaginable. The second group see nothing odd at all about driving to the dog park. Or driving to the gym or community centre to walk on a treadmill or ride a stationary bike. If you suggested to them that they walk or ride a bike for any other purpose than recreation, they would tell you “it isn’t safe”. And they would be right. We equate safety with belts and airbags in cars, designed to have crash resistant crumple zones. They demand everyone wear helmets – on the ice, down the hill, on the bike. Fear of head injury – actually not that frequent in adults especially once you have deducted car crashes – vastly outweighs fear of the diseases that kill most people. All of which can be traced to weight gain in adulthood. And the study that was used to justify BC’s compulsory helmet law has since been repudiated by its own authors.
The biggest challenge we face – after climate change – is the increasing cost of healthcare. Actually if we had sensible economists advising politicians, that would also be manageable, but we have built our own box to get locked into by insisting on tax cuts as the policy nostrum for every problem. As the baby boomers – people my age – retire and continue to live long after any generation that preceded them, the cost of taking care of them will balloon. Correction, is ballooning. Since we now live in nuclear, rather than extended, families that cost is borne by the public health system, not the daughters and granddaughters of the former wage earner.
I think the healthcare benefits of increasing our ability to walk, bike and take transit – every transit trip involves more walking than any driving trip – vastly outweigh the terrible burden of an extra 0.5% sales tax. If we still believed in cost-benefit analysis (nobody has paid me to do one of those in the last twenty years) then we could show that the costs of paying the tax for more transit would be more than made up in the savings in healthcare costs alone.
Of course, just increasing existing bus service frequencies will not be enough on their own. Just as we really cannot expect to see any reduction in congestion from the sales tax funded expansion alone. We need to do something radical about mixed use developments, increasing density, safe routes to school and all the rest. Just as we will need some fiscal sticks – fees and charges that change behaviour – as well as increased capacity and attractiveness of alternatives to driving. But making Vancouver and its suburbs better places to live features nowhere in the No campaign. Even sensible people like Laila Yuile have been caught up in the fallacy that somehow not paying more taxes will produce better run institutions.
Anyone who talks about transit – or transportation – as though it were a free standing issue is spouting nonsense. Transportation and land use are two sides of the same coin. The best transportation plan is a land use plan. Better land use is measured by the reduction achieved in motorised trips over business as usual. Not only that but Charles Marohn and his Strong Towns movement have shown that this form of development is actually financially more responsible and actually sustainable – in the sense that we can afford to pay for it. Which is quite clearly impossible in motordom with its freeways and sprawling single use subdivisions.
When I ran for the provincial legislature for the Green Party, I started every speech with what I thought was an unarguable truism. We know that capitalism and communism have both failed. Neither paid the slightest bit of attention to the environment or the limits to growth. While the Liberals (federal) and NDP pay lip service to these truths, their policies are still based on economic growth and more jobs. I think it is equally obvious that we cannot continue a pattern of urban growth predicated on increased car use. It also seems to me that enough people agree or have been forced by economic realities (read huge student loans and no prospects of full time permanent employment) that car use is actually declining. But our provincial politicians are still stuck on increasing the extraction of fossil fuels – and other limited natural resources – while widening highways and building ever bigger bridges.
The anger you can hear from the No campaign is the refusal to accept the necessity of change. No-one in their right minds should be proposing dedicated taxes – or a new imposition of yet more regressive taxation. But on the Yes side, we have no choice. If we want to see transit expansion – more bike routes, safer walking, more HandyDART for the aging population – more CHOICE in transportation – this is the only way we can do this right now. Not our doing, but those who set the rules for this thing. She Who Must Be Obeyed. She who never thinks of a plebiscite for the Massey Bridge or dualling some more highways in the heartlands. I do not think that an increase in sales tax is a Good idea at all. It is simply the easiest of the available options. No one is now talking about road use pricing. More gas tax or more carbon tax would work quite well as the price of oil is falling but we don’t get that chance either. I do know that I could more easily deal with an open house on the sales tax increase than those I had to face back when we were proposing a vehicle levy.
I also know that the No side will not deal with any of these issues as they are not in the solutions business. They have a coalition of the unwilling. It is a diverse and motley band and includes a lot of people who think of themselves as progressive and find the whole process repulsive. It has been imposed on us by someone who thinks she can control the outcome. The Yes side is similarly heterogeneous, but what unites us is the desire to prove her wrong. We do not want the future she imagines. We don’t want this plebiscite or this sales tax either, but it is the only game in town, and it has to be won if motordom and sprawl are to be defeated. And if our waistlines are to start shrinking and our health to improve.
More on this topic can be seen on PriceTags with all sorts of references and sources
Stephen Rees's blog 
You make some good points, but the problem is that when you drill down on these issues it all becomes quite overwhelming and discouraging. Its no different that the difficulties encountered in the climate change arguments. At the end of the day, humans as a species do not respond well to threats that are not immediately tangible. Get chased by a tiger…humans can deal with that. A slow eroding change that will take you out in 20-50 years time, humans will fail miserably each and every time. It is the way we have evolved and despite our impressive advances, we may be no better at warding off our ultimate fate than the dinosaurs were.
So to make any headway here we have to bring things back to achievable, tangible terms. Unfortunately the referendum puts things in a very difficult predicament. Very much like medicine that tastes yucky that children fight. It’s good for you in the long run. The transit referendum faces the same uphill battle as trying to make broccoli everybody’s favorite vegetable.
The only solution is to take the high stakes off the table. A sales tax is not a great way to raise the funds, but it is what is on the table. What about property taxes? Raising property taxes is not ideal, yet is it any worse than a sales tax? Here’s the thing. Raising property taxes is within the power of the Mayor’s Council. Correct me if I’m wrong…but could not property taxes be raised by $250 a year per household (the same amount the sales tax is projected to bring in)? Could the Mayor’s not do this without a referendum or Provincial approval?
Again, not ideal but desperate times call for desperate measures. Take the fate of the plan off the table. The plan will go ahead regardless. The referendum becomes more about how you want to pay for it. A yes brings the sales tax to life. A no means you’ll pay for it in property taxes. What sense does it make to put the future of the region up for grabs?
Ultimately yes, comprehensive road pricing is the solution. One key thing that nobody seems to have picked up on this week with all the fuss over declining traffic over the Port Mann is the power that tolls have to shape traffic patterns! How many of those trips were optional trips that never happened at all instead of just diverting to a toll free crossing? Would be interesting info. Good road pricing policy would go very far to make the most efficient use of the road network and shape travel patterns while also raising the needed money for transit expansion. Unfortunately that still remains a dream although this fuss over the Port Mann would again throw more credibility to the idea.
We are already at a point where we have to compromise ideals just to make basic inroads. I think the Mayor’s Council should be challenged to throw the property tax solution back on the table should the referendum fail. Again, far from ideal….but is it such an odious option that its worth risking the next decade of progress? Yes, I know that is what the Province wanted all along. You can barge across a crosswalk and assert your right as a pedestrian and be dead for not using an ounce of common sense. You’d be right…but dead. Sometimes you have to capitulate for the greater good. It doesn’t take all the better options off the table. They remain to be battles to be fought again on another day. What we need to do is take the weapons of mass destruction off the table. Another 3-5 years of status quo in terms of transportation options is a time bomb in its own right. How big do we perceive that threat to be? Not sure that forsaking the minimum needed expansion over the next decade just for the luxury of being “right” about the property tax issue cuts it any more.
John
January 26, 2015 at 10:52 pm
John
The Mayors have made it clear – no increase in property taxes and no plan B. The province has always wanted more from property tax (no matter which party was in power) and has often succeeded by promising that this increase will be the last one while we come up with something better. Except, of course, they never do.
The province also has access to other sources of funds but prefers to spend it on roads, mines, LNG, Site C and so on. They are also worried about rising healthcare costs but have yet to join up the dots.
The Mayors will not concede on property tax as long as the Province gets to set priorities. The province is currently saying in effect, you hand over the revenue, we decide how to use it, you take the flack if anything goes wrong, but you don’t get to control the authority. The only way I could envisage property tax getting back on the negotiating table is if the province concedes that the current governance model – which it created – is broken. But I would expect that as a condition of the Mayors taking control of the future no longer to be called Translink, the Mayors will want their own dedicated funding source and a commitment to enable road pricing. Though given that the province made a promise about a vehicle levy and then bailed, don’t think that one is actually likely either.
Also note that the referendum/plebiscite is not binding. “Yes” could still win but be told that province cannot agree to an increase in sales tax regionally. This is easier to do the narrower the margin of victory and the more concentrated the No votes are geographically. That is to say “we know this will be unpopular in some places, but we were never going to win those seats anyway”.
Stephen Rees
January 27, 2015 at 8:03 am
Joel Wood left a comment on twitter which points to his blog
http://www.joelwood.ca/hopefully-coherent-thoughts/doesurbansprawlcauseobesity
To summarise he concludes “we shouldn’t be using public health to justify promoting density and chastising sprawl” because the research doesn’t show a causal relationship.
I worked in public policy in the realm of land use and transportation between 1974 and 2004. I am not sure that we always had the sort of research that showed causal linkages before policies were adopted. Indeed, most times, the decision was made at the political level. That means if a politician can be satisfied – and they have the votes in the leg. – then the thing happens. The researchers argue about it later.
I just hope that Larry Frank is reading this as I am pretty sure his research supports the idea that better places produce healthier people. And after all, this all goes back to the sort of people who made good decisions about building better cities – clean water, fresh air, access to parks and so on – with only (in those days ground breaking) correlations to support the idea that public water pumps were the source of cholera.
I am also convinced that if the place where you live does not have short, direct routes that are safely walkable to the things/services/people you want to visit, then you will probably drive. If the bus is infrequent, unreliable and overcrowded you will be less inclined to use it. We also know for a certainty that requiring helmets for adult cyclists by law has reduced the propensity to cycle and the health outcomes from that are worse than the head injuries avoided. As we became car oriented, and walked and cycled less we became fatter, less fit and less healthy. Some of that was also due to manufactured food, some due to the spread of tvs and computers. None of those things are going to go away any time soon. And anyway are outside of the ability of municipal governments to do much about.
We also know that people who live in mixed use walkable neighbourhoods are happier (see the works of Charles Montgomery). Designing places for cars seemed like a Good Idea at the time, and plenty of people are reluctant to give up that idea. They were also reluctant to give up smoking. And lots of obfuscation was used by the tobacco industry to support that. Dangerous advocates of sprawl like Wendell Cox are pushing hard to cover over the ALR with development because all he cares about is the ability of the 1% to keep on piling up huge profits – preferably tax free.
I am satisfied that refusing to expand transit – or make walking and cycling more attractive – is not going to do anything good for public health. Adopting the Mayor’s plan is all we are arguing about. It isn’t perfect, but then nothing in public policy has to pass that test. It is doable, and it is better than doing nothing. It will help to make places fit for people which also means less attractive for car use. See Point Grey for a useful recent demonstration.
It works in practise: now we have to get someone to show that it works in theory too.
Stephen Rees
January 27, 2015 at 12:33 pm
This is an important and well-articulated post. Thank you Stephen.
MB
January 28, 2015 at 12:45 pm
Stephen,
I appreciate the reply and also appreciate the points you are making. I guess my point is that the Mayors need to be careful over the politics they are choosing. They cry that the situation is desperate and that the plan must go ahead or all sorts of dire consequences will come. On the other hand, they have the tools to ensure that the plan could in fact go ahead without this referendum nonsense yet choose not to use them. Exactly then how bad and desperate do they feel the situation is?
Again, I appreciate the stance they are taking on this. Instead of hiding it like some dirty little secret, why not come out with it? Trust is the main issue in this referendum. Do you trust TransLink and the Mayors that they will get this right if you give up an extra 0.5% on everything you purchase from now to infinity? You can’t trust someone when they are only putting half the cards on the table. Particularly when TransLInk is struggling to gain trust on the best of days to begin with.
I can appreciate the lack of a Plan B avoids the issue of people going for a half way solution. Look at the stakes though…we’re putting 3-4 years of construction and investment on the back burner and likely will see yet another iteration of TransLink that could very well devolve into a urban vs suburban battle that will tear TransLink in two. It would be nice if there was a Plan B of some form or another somewhere so that not all transit growth is stalled out while another 3 years of political drama unfolds. I can appreciate that might be something to keep in the back pocket at this juncture.
Certainly no easy way forward and no argument that the Province has created this untenable situation and is pulling all the strings. Not sure what the solution is to get the Province to rid itself of its parochial interest in local matters that are not their purview as most of the other Provinces seem capable of doing.
John
January 29, 2015 at 10:35 pm
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