How Big Do You Think? Health Care or Health?

Having coffee with some public health policy consultants, the discussion meandered to public health policy. Now that in itself is not too surprising but the path that the conversation took was interesting.

We started talking about public transit, and how people got to work. One man had recently bought a new house and had chosen the location partially because it was near an LRT (ie. subway, light rail transit) stop. Another mentioned feeling unsafe at a particular bus mall even though it was only 8:30 in the evening - the mall was poorly lit, there were few people about, and the isolation was unnerving. Another mentioned being late for work because a scheduled bus didn't arrive, and the next one didn't show up until a half-hour later. Several people then chimed in about similar experiences, all of which contributed to them rarely taking public transit any more.

Conversation then drifted to morning routines and one lady mentioned the new gym she was going to. Discussion centered on different gyms and workout regimens for a while, with comparison of pilates, weights, cardio and kick-boxing.

Then, in discussion about what was happening at work, one mentioned a policy initiative to try to get people exercising more, with discussion about yet another study showing the positive contribution of exercise to heart disease and diabetes. As part of the policy initiative, there was a focus on trying to get more people to take public transit because of the incidental, incremental increase in walking that public transit encourages. People walk to the bus stop, then walk from the destination bus stop to their workplace.

Unfortunately, most health debate focuses on trying to provide better health care, reducing the cost of hospital stays, pharmaceuticals, and direct labour in the medical system. This is all well and good, but providing better lighting and social design of transit malls, more regular and convenient bus schedules, and less convenient destination parking could dramatically decrease the need for health care services by producing more walking. Perhaps health care is so expensive because it is focused so much on health care, and not enough on systemic ways to improve health.

Think bigger than health care; think about how our public policy can create structures from which better health naturally emerges.