Why Cycling Matters Philip Wu, MD Department of Pediatrics Community Health Initiative Kaiser...
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Why Cycling MattersWhy Cycling Matters
Philip Wu, MDDepartment of Pediatrics
Community Health Initiative
Kaiser Permanente Northwest
Philip Wu, MDDepartment of Pediatrics
Community Health Initiative
Kaiser Permanente Northwest
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Key MessagesKey Messages
• Much of 21st century human disease is preventable; physical inactivity is the major culprit
• Physical inactivity drives rising health care costs
• Physical activity (and cycling) should be a part of everyday life
• Cycling reduces VMT, mitigates climate change, and improves health
• Much of 21st century human disease is preventable; physical inactivity is the major culprit
• Physical inactivity drives rising health care costs
• Physical activity (and cycling) should be a part of everyday life
• Cycling reduces VMT, mitigates climate change, and improves health
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What Should You DoWhat Should You Do
Use the health message to broaden your appeal and accomplish your goals
Partner with those outside the cycling community (including the health sector)
Use the health message to broaden your appeal and accomplish your goals
Partner with those outside the cycling community (including the health sector)
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Why You Should Do ItWhy You Should Do It
Human HealthPhysical, Mental, Social, Spiritual
EconomicCosts of Medical Care, Transportation, Fuel, Infrastructure
EnvironmentClimate Change, Air Quality, Plant and Animal Habitat
RegionalQuality of Life, Branding and Tourism
Human HealthPhysical, Mental, Social, Spiritual
EconomicCosts of Medical Care, Transportation, Fuel, Infrastructure
EnvironmentClimate Change, Air Quality, Plant and Animal Habitat
RegionalQuality of Life, Branding and Tourism
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“…integrating health-enhancing choices into transportation policy has the potential to save lives by preventing chronic diseases, reducing and preventing motor-vehicle-related injury and deaths, improving environmental health, while stimulating economic development, and ensuring access for all people.”
Centers for Disease Control
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Today’s Agenda
How Physical Activity (aka cycling)…
Today’s Agenda
How Physical Activity (aka cycling)…
Prevents illness and disease Promotes longevity Improves quality of life Is a specific cost-effective intervention
Prevents illness and disease Promotes longevity Improves quality of life Is a specific cost-effective intervention
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Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
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(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
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Obesity Trends* Among U.S. AdultsBRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Obesity Trends* Among U.S. AdultsBRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Obesity Trends* Among U.S. AdultsBRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Obesity Trends* Among U.S. AdultsBRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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How Active Are We?How Active Are We?
RECOMMENDED>= 30min/day
>= 5 days/week
INSUFFICIENT>10 min/week
INACTIVE<10 min/week
WASHINGTON, DC 45.5 35.3 10.7
ATLANTA 40.6 39.3 14.7
CLEVELAND 47.5 34.6 9.9
DENVER 50.4 35.9 8.2
PORTLAND 51.9 39.7 8.4SEATTLE 50.8 36.2 8.1
SAN FRANCISCO 52.9 30.6 11.5
LOS ANGELES 45.4 32.4 13.3
HONOLULU 49.5 35.2 11.8
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Obesity-related Health Spending Reaches $147 Billion
Obesity-related Health Spending Reaches $147 Billion
91% of all medical spending Includes treatment of”
Diabetes and heart disease Hypertension Stroke Breast, colorectal, endometrial, and kidney
cancers Sleep apnea
91% of all medical spending Includes treatment of”
Diabetes and heart disease Hypertension Stroke Breast, colorectal, endometrial, and kidney
cancers Sleep apnea
42HHS Secretary Kathleen Sebelius, July, 2009
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Obesity-Related Healthcare CostsHospitalizations 2-19 yrs of age*
Obesity-Related Healthcare CostsHospitalizations 2-19 yrs of age*
Primary and secondary diagnosis of obesity and obesity-related conditions including asthma, diabetes, gallbladder disease, skin infections, pregnancy complications, depression, other mental health disorders
1999: 21,743 $126 million 2005: 42,429 $238 million
*Health Affairs, 2009
Primary and secondary diagnosis of obesity and obesity-related conditions including asthma, diabetes, gallbladder disease, skin infections, pregnancy complications, depression, other mental health disorders
1999: 21,743 $126 million 2005: 42,429 $238 million
*Health Affairs, 2009
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Healthcare Costs in California2006
Healthcare Costs in California2006
Total annual estimated cost to CA for overweight/obesity and physical inactivity: $41.2 billion
Healthcare costs: $20.7 billion
$12.8 billion for obesity
$7.9 billion for physical inactivity
Lost productivity costs: $20.5 billion
$8.2 billion for obesity
$12.3 billion for physical inactivity
*California Center for Public Health Advocacy, 2006
Total annual estimated cost to CA for overweight/obesity and physical inactivity: $41.2 billion
Healthcare costs: $20.7 billion
$12.8 billion for obesity
$7.9 billion for physical inactivity
Lost productivity costs: $20.5 billion
$8.2 billion for obesity
$12.3 billion for physical inactivity
*California Center for Public Health Advocacy, 2006
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Physical Activity Prevents Illness and DiseaseCRF and Incidence of Type 2 Diabetes in
Healthy Men
Physical Activity Prevents Illness and DiseaseCRF and Incidence of Type 2 Diabetes in
Healthy Men
Cardiorespiratory FitnessWei M et al. Ann Int Med 1999
IncidencePer1000 men
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Physical Activity Prevents Illness and Disease CRF and Risk of Incident Hypertension in Healthy
Women
Physical Activity Prevents Illness and Disease CRF and Risk of Incident Hypertension in Healthy
Women
Fitness Categories
Multivariable relative riskfor hypertension
p for trend < 0.01
Barlow CE et al. Am J Epidemiol 2006; 163:142-50
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Physical Activity Prevents Illness and DiseasePhysical Activity, and Hip Fracture Risk
Physical Activity Prevents Illness and DiseasePhysical Activity, and Hip Fracture Risk
MET hours/week
Feskanich D et al. JAMA 2002; 288:2300
Adjusted relative risk for hip fracture
p for trend <0.001
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Physical Activity Prevents Illness and DiseaseMortality in CAD-Dose Relationship
Physical Activity Prevents Illness and DiseaseMortality in CAD-Dose Relationship
Janssen I & Jolliffe CJ. MSSE 2006; 38:418
30 min.Most days
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Physical Activity Promotes Longevity Risk of Death by Fitness Groups in Women and Men
60 years+
Physical Activity Promotes Longevity Risk of Death by Fitness Groups in Women and Men
60 years+Relative risk adjusted for age and risk factors
Cardiorespiratory Fitness
Blair & Wei. Am J Health Prom 2000; 15:1-8
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Physical Activity Promotes Longevity Death Rates/1000 by Fitness Groups
Men 60 years+
Physical Activity Promotes Longevity Death Rates/1000 by Fitness Groups
Men 60 years+
Blair & Wei. Am J Health Prom 2000; 15:1-8
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Physical Activity is Cost EffectiveRelative Benefits of CVD InterventionsPhysical Activity is Cost EffectiveRelative Benefits of CVD Interventions
Mediterranean diet 65% Smoking Cessation 60% Physical Activity/weight loss 50% Blood pressure control 42% Lipid control 25% Aspirin for CAD 25% ACE inhibitor for CHF/MI 22% Beta-blockers for MI 18% Tight blood sugar control in DM2 ? Triglyceride/HDL control ? Vitamins 0 Hormone Replacement Therapy 0
Mediterranean diet 65% Smoking Cessation 60% Physical Activity/weight loss 50% Blood pressure control 42% Lipid control 25% Aspirin for CAD 25% ACE inhibitor for CHF/MI 22% Beta-blockers for MI 18% Tight blood sugar control in DM2 ? Triglyceride/HDL control ? Vitamins 0 Hormone Replacement Therapy 0
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Physical Activity is Cost-EffectiveExercise for Depression
Physical Activity is Cost-EffectiveExercise for Depression
Amount of Brisk Walking
Drug therapy and cognitive behavioral therapy produce remission in approximately 40% of clinically depressed individuals
% of patients with remission of depression
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Centers for Disease Control Recommended Strategies
2009
Centers for Disease Control Recommended Strategies
2009
Communities should: Enhance infrastructure supporting bicycling
and walking Improve access to public transportation Zone for mixed use development Enhance personal and traffic safety...where
persons are or could be physically active
Communities should: Enhance infrastructure supporting bicycling
and walking Improve access to public transportation Zone for mixed use development Enhance personal and traffic safety...where
persons are or could be physically active
Morbidity and Mortality Weekly Report, CDC, July 24, 2009
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Centers for Disease ControlMeasurement Outcomes
Centers for Disease ControlMeasurement Outcomes
Total miles of shared-use paths, bicycle lanes, and sidewalks relative to the total street miles
% of residential and commercial parcels located either ¼ mile from a bus stop or ½ mile from a train stop (including light rail and streetcars)
% zoned land in acres zoned for mixed use, i.e. residential use combined with one other commercial, industrial, or other public land use
Total miles of shared-use paths, bicycle lanes, and sidewalks relative to the total street miles
% of residential and commercial parcels located either ¼ mile from a bus stop or ½ mile from a train stop (including light rail and streetcars)
% zoned land in acres zoned for mixed use, i.e. residential use combined with one other commercial, industrial, or other public land use
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Centers for Disease ControlMeasurement Outcomes
Centers for Disease ControlMeasurement Outcomes
Number of vacant and abandoned residential or commercial buildings relative to total number of buildings
Local government includes at least one element suggested by the National Complete Streets Coalition in designing and operating streets to achieve safe access for all users http://www.completestreets.org
Number of vacant and abandoned residential or commercial buildings relative to total number of buildings
Local government includes at least one element suggested by the National Complete Streets Coalition in designing and operating streets to achieve safe access for all users http://www.completestreets.org
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RecapRecap
• Much of 21st century human disease is preventable; physical inactivity is the major culprit
• Physical inactivity drives rising health care costs
• Physical activity (and cycling) should be a part of everyday life
• Cycling reduces VMT, mitigates climate change, and improves health
• Much of 21st century human disease is preventable; physical inactivity is the major culprit
• Physical inactivity drives rising health care costs
• Physical activity (and cycling) should be a part of everyday life
• Cycling reduces VMT, mitigates climate change, and improves health
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What Should You DoWhat Should You Do
Use the health message to broaden your appeal and accomplish your goals
YOU ARE ADVOCATES FOR GOOD HEALTH!
Partner with those outside the cycling community (including the health sector)
Use the health message to broaden your appeal and accomplish your goals
YOU ARE ADVOCATES FOR GOOD HEALTH!
Partner with those outside the cycling community (including the health sector)
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“…Build relationships, encourage conversations, getinvolved. Invite a non-cyclist friend out for a ride this summer. You might just…change a person’s life in the process.”
Heidi Swift, The Oregonian, May 23, 2010
…and improve their health!!