The Common Thread

Transportation, land use, tobacco use, and seat belt use all share a very similar thread. Advocates in each of these areas ultimately worked and/or are working toward the same goal – they all want to see an increase in public health levels. These four areas are just a drop in the bucket – there are many other issues out there, that although very different in approach and issue are all working toward the same goal of increasing the health of the public. Each of the areas I’ve noted above for some reason stick out to me. It could be of personal interest or the thinking that each area plays an important role in our long-term health – especially when thinking about tobacco use, land use, and transportation issues. In a very retrospective way I often think to myself how did we ever go without policies and laws in these areas? At one time people didn’t think twice about not wearing a seat belt? In some states people can still smoke in public, enclosed places? How can we move forward and reverse that thinking – in that we make changes right on time, not five/ten years in a very reactive process?

It seems to me these four areas can be grouped into two larger categories. Transportation and land use are two issues that are just starting to gain momentum in really understanding how they interface with public health. Seat belt use and tobacco use are a little farther along – both are seeing and/or have seen policy and law changes for the betterment of public health. Seat belt use is now mandatory and many states/cities/counties are banning smoking in public places. So how do we get from the underdeveloped with little momentum to semi-to-fully developed with full public momentum? In short the answer is simple – you have to transform social norms. There has to be a clear distinction between what is good and what isn’t good for public health. There has to be buy-in from the public, and you have to get people where they’re at. Fifteen years ago was it socially acceptable to not wear a seat belt?…And now? Five years ago was it socially acceptable to have a smoking section in a public restaurant? …And now?

How do we get transportation issues and land use issues to where tobacco use and seat belt use are? It is for certain a multi-pronged approach that includes changing social behaviors, creating health focused policies and laws, and making these things easy for others to do and/or overcome obstacles to their success (i.e. NY – Smoking Ban = State Gov’t offers help for residents to discontinue smoking habits).

In many places there haven’t been any connections between where you live and how healthy you are or how you travel and your risk of chronic disease. These connections need not only be raised to the common public, but especially to elected officials. One way we get change is through policies and laws. How do we encourage more bicycle travel – through safe streets with proper sized bike lanes, through policies of complete streets. How do we change social behaviors? Through social marketing tactics that get people where they are, that hit on their needs and wants. We have to make urban living and alternative transit look friendly, fun, and most of all acceptable. And lastly, and probably most important we have to meet encouragement and support with options and opportunities that people will accept. We can make riding your bike to work look fun but if you have to ride on a 55mph road with no bike lane, we probably won’t see any change. How do we get people to ride the bus verses taking their car when it takes an hour longer to arrive? The approach to change will incorporate all of these ideals – engaging the public and elected officials, using social marketing, and giving people realistic options – all three of which have been used to change seat belt use and tobacco use for the better.

Day-to-day life can be thought of as a big quilt. Public health is the thread that should be woven throughout the entire piece. In every decision we make public health should be connector that brings everything together, it should guide how we make decisions – not only today but for the long-term future.