We Need Healthier Communities to Overcome COVID-19

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Preparing for and overcoming any disaster, such as the current coronavirus pandemic, requires healthy and resilient communities.

However, after age, obesity is the biggest risk factor for being hospitalized with COVID-19.

And the U.S. has one of the highest obesity rates in the world, with drastic disparities among racial/ethnic groups, including the highest rates among Latinos.

To beat COVID-19, we need healthier communities that prevent obesity and leaders who prioritize equitable access to healthy food, housing, and safe spaces to walk and bike instead of space for cars.

“We in the U.S. have not always identified obesity as a disease, and some people think it’s a lifestyle choice. But it’s not,” said Dr. Matthew Hutter, director of the Weight Center at Massachusetts General Hospital and president of the American Society for Metabolic and Bariatric Surgery, according to the New York Times. “It makes people sick, and we’re realizing that now.”

Obesity Linked to Worse COVID-19 Outcomes

In the U.S., 42 out of every 100 adults are obese.

Obesity is strongly linked to chronic diseases, but researchers are still learning about the link between obesity and infectious diseases.

Emerging data on COVID-19 show patients with a BMI of 35 or higher were twice as likely to be admitted to the hospital and three times as likely to end up in the intensive care unit, according to researchers with the Department of Infection Prevention and Control at NYU Langone Health.

The vice president of a health system with 41 hospitals in Louisiana and southern Mississippi said that 60% of patients hospitalized with COVID-19 had obesity. Obesity appeared to nearly double their risk of requiring a ventilator.

“It means that as clinicians, we should be thinking a little more carefully about those [COVID-19] patients with obesity when they come in — we should worry about them a little bit more,” said Dr. Leora Horwitz, director of the Center for Healthcare Innovation and Delivery Science at NYU Langone, according to the New York Times.

We should ALSO worry about how community environments contribute to obesity.

Obesity is a Disease, Not a Lifestyle Choice

In the U.S., one’s Zip Code is a better predictor of quality and length of life than their genetic code.

Why?

A history of discriminatory policies, such as redlining, have created impoverished neighborhoods that lack access to healthy food, housing, transportation, and safe places for physical activity. The COVID-19 pandemic is exacerbating these health inequities.

Latino communities specifically are marked by both unsafe streets and a lack of green space, according to Salud America!’s Research Review.

Thus, Latinos have higher rates of physical inactivity, chronic disease, and premature death.

Source: Strong Towns

Roughly half (49.5%) of Latino adults are physically inactive compared to 38.9% of non-Latino Whites. Latino children ages 2-19 had the highest obesity rates (25.8%) among all racial/ethnic groups.

Unfortunately, the mechanisms connecting obesity to other diseases aren’t fully understood. So obesity is sometimes used as proxy for lack of physical activity or poor diet.

There is abundant evidence connecting physical activity and health.

For example, regardless of weight loss, 150 minutes of physical activity per week drastically reduces risk for disease and premature death, and improves mental and physical health.

However, walking and biking are difficult at best and dangerous at worst in many communities. This leaves families dependent on a vehicle or at risk on the streets just to reach health-promoting assets, like jobs, parks, schools, and doctor’s appointments.

Moving Around During COVID-19 Outbreak

In addition to testing, tracing, and treatment strategies to overcome COVID-19, known as T3, city and state leaders need to think about how residents move around their city.

They need to imagine a new normal post-pandemic. One where people are prioritized over cars.

“Whenever feasible, consider riding bicycles or walking,” recommended the World Health Organization (WHO).

Prioritizing People Over Cars During COVID-19

Across the country, vehicle travel is way down and walking and biking are way up. This is crowding trails and sidewalks in time when people should be practicing social distancing.

Sadly, it has also led to a spike in reckless driving and pedestrian fatalities.

A community is not resilient if more people are killed or seriously injured on streets during a pandemic.

In response, cities across the world, from Paris to Portland and Auckland to Oakland, are launching initiatives to prioritize people over cars.

Many U.S. cities closing streets in parks and residential areas to car traffic and opening them to people walking and biking. Cities also are adding pop-up bike lanes to help people get to essential destinations.

Oakland prioritizes people over cars Share Streets
Photo: City of Oakland

There are some questions about how equitably U.S. cities are implementing these types of initiatives:

  • Were people and groups across the community consulted to determine the right solutions for each neighborhood, particularly historically disadvantaged people and groups?
  • Before looking to create space in the streets for recreation, can space in the streets address immediate transportation needs, particularly along dangerous corridors or for people without a vehicle?
  • Can street space be allocated for walk-through testing for COVID-19 to serve residents without a vehicle?
  • Beyond improvements in residential areas, can improvements be made along busy streets and in business districts to increase access to essential destinations and transit hubs?
  • Can the street changes be made without increasing police and enforcement?

Operating, insuring, and maintaining a vehicle is expensive. It may be the difference between health and hardship for many families during this crisis.

“The bicycle, being an individual means of transport, represents one of the most hygienic alternatives for the prevention of the virus, especially in this first preventive stage in which it is recommended to avoid close contact and crowds,” said Bogotá Mayor Claudia López, where thirteen miles of temporary bike lanes were converted from travel lanes overnight.

With equity considerations in mind, health advocates should push cities to make these temporary initiatives more permanent after COVID-19 to improve the health and resilience of their community.

Active Living Initiatives After COVID-19

Beyond the pandemic, city leaders should consider how to reallocate street space to people to improve community health, particularly cities with poor health and a history of racial/economic segregation.

Berlin gets pop-up bike lanes.
Berlin gets pop-up bike lanes. Photo: Joerg Carstensen

Safe options will help families and communities remain resilient through and recover economically after COVID-19 while improving health and reducing obesity.

Here are some resources to get you started prioritizing people over cars:

You can also sign the Rails to Trails Conservancy petition to ask local elected officials to close select streets to car traffic to equitably create safe places to walk and bike during this global pandemic.

By The Numbers By The Numbers

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Pedestrians survive when hit by a car at 40 MPH

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