Let us start with the very simple way that public transportation makes people healthy. Public transportation lets you walk or bike instead of driving. Walking or biking contribute to health, driving does not. Walking the half-mile to and from a bus stop provides the exercise a person needs to stay healthy (it is estimated we need about 22 minutes a day of steady exercise; a half mile walk is about 8 minutes on average). Walking the several feet from front door to car does not. Whereas joining a gym requires money and time, which many people are short on, walking and biking as part of commuting can be easily integrated into daily life. To do so, however, requires help from government to create the necessary infrastructure. One cannot choose, in other words, to walk to a bus or train if there is no bus or train, or if public transportation is insufficient to get one to work or school on time.
There are several things the Greenprint holds as self-evident:
- All people have the inalienable right to pursue healthiness. While health cannot be guaranteed, the opportunity to be healthy must be.
- It is a misconception that people “choose” to be unhealthy. Lack of health usually comes from lack of options. Put another way, it is presently too easy to be unhealthy and too hard to be healthy.
- While many things can augment health; there are certain tools that are necessary for health. Without them, illness is likely. They are:
√ Daily exercise
√ Emotional well being
√ Quality sleep
√ A safe and toxin free environment
- It is the government’s role to protect access to these “tools of health”, primarily by removing barriers.
The tools of health listed above are each critically important, but some, such as “emotional well being”, are more complex than others. However, not having a solution to the problem is no reason to ignore its existence, so I mention it as a goal for further investigation. Closer at hand are the two urgent tools, healthy diet and daily exercise. Urgent, because they are the keys to curing obesity. We cannot underestimate the enormous impact obesity is having and will have on our country and its well-being. We also cannot ignore the incredibly simple and straightforward cure for obesity—diet and exercise. Finally, we must face, head on, that the problem is not that we don’t have a cure to obesity: the problem is that we have not yet wrapped our heads around delivery of the cure.
What would the medical system look like?
We have the mistaken belief that we need more doctors. We do not need more doctors. Doctors are expensive, and highly trained to diagnose and treat. Right now there is more and more burden on doctors, especially primary care doctors, to do it all—ask about diet, smoking, guns in the home, family history, and so on. Furthermore, doctors’ waiting rooms are filled with people with chronic illness—illness that doctors are helpless to treat, since we cannot provide diet and exercise.
The Greenprint is designed to reduce the burden on doctors so that we need fewer of them, and so that they can focus on what they were trained to do—treat illness when it happens. What we need is a system that helps people know when they do and do not need a doctor.
It does not make sense to expect doctors to be the primary educator of health and illness. The system would identify all the ways we can get information to people: schools, employers, community groups, and online sources. We should consider it a goal to have 100% of Vermonters understand health and illness as it pertains to them.
Screening is a technique that in itself needs further examination. It is not entirely clear what kinds of screening work. Be that as it may, it does not make sense to have doctors perform screenings. A person’s risk factors are determined by personal and family history, employment, and exposures. These are things that can be determined through interviews by nurses, teachers, employers, and questionnaires.
The doctor’s role
- Respond to abnormal screening tests
- Respond to acute and chronic illness
What the future would look like
Lack of access to doctors is one of the biggest complaints people have. And yet doctors are overwhelmed with the numbers of patients they see. There are artificial barriers placed between doctors and patients to try to manage this tension. Perhaps the tension is because doctors are available for the wrong things. In the ideal situation we would have
- People who are able to stay pretty healthy on their own . . . that’s a fact, and if they are empowered to do so, it will become an even more accepted way to be.
- Access to the tools of health (70% of healthcare costs presently go toward chronic illness, so it stands to reason that reducing chronic illness will reduce the burden on physicians).
- Taxes and other disincentives on things recognized as unhealthy, the money used to treat the illnesses these things cause .
- People who are educated about illness so that they can for themselves identify good reasons to see the doctor.
- Reimburse doctors not per patient seen, but consider them a fixed asset like firefighters or police, pay them to be there and then design the system so that we need them less. The reduced cost would be not because we pay doctors less but because we need fewer of them.
- Generously staff urgent care centers with easy access for people. Rather than fighting peoples’ tendency to use emergency rooms for their medical care, learn from it. ER visits are expensive forms of medical care because they are designed to respond only to the most severe emergencies, and are staffed accordingly. Instead, design medical care around use patterns and decrease costs through efficiency.
- People go to ER’s for earaches and sore throats because these are acute illnesses, and because they do not have primary care doctors or because their primary doctor is inaccessible.
We want a medical system that
- responds to our urgent needs
- that helps keep us healthy and reduces our need to see a doctor and
- educates us on when we do and do not need a doctor, or medical intervention.
Presently we have a system that uses cost and unavailability as barriers, encourages chronic illness because of lack of regulation in the private sector (unhealthy food, cheap fuel, transportation designed around cars) and lack of sufficient contemplation of the real causes of chronic illness; and leans on its most expensive component, doctors’ time, to “solve” the medical problems. Meanwhile, doctors are unable to actually solve the problem.
Check out our Tools for Transportation link for what a walking, biking, rail and commuter system will look like.
And this is just the beginning . .