Bipartisan agreement seems to be emerging in this rancorous election season around the need to improve America’s decaying infrastructure. This is an opportunity for us to think about it in a new way, ensuring that needed funding improves not only safety and efficiency but our health as well.
Both Hillary Clinton and Donald Trump have said that they would spend at least $275 billion on infrastructure over five years. Congress is taking action, too: the U.S. Senate recently passed by a vote of 95-3 its version of the Water Resources Development Act, which would create a water infrastructure fund, among other components. The House of Representatives passed its version by 399-25.
What’s typically missing in the discussion of infrastructure improvement is recognition of the broad role it plays in our health—and the additional benefits and savings that can be generated by approaching it with that lens. This is all the more important at a time when this country’s infrastructure is rated D+ by the American Society of Civil Engineers and the cost of healthcare is increasingly a result of the health of the our general population.
The relationship of infrastructure and health has made national headlines recently with the evidence of lead contamination of the water supply in Flint, Michigan. That case underscored the relationship in two fundamental respects: first, the availability of safe drinking water is a key component of health and, second, the lack of appropriate investment in best practices for water safety poses grave health consequences, all the more tragic because they are preventable.
And Flint is not the only example. As Carl Pope, former Chairman and CEO of the Sierra Club writes, “The average water pipe in Washington, DC, is 79 years old, meaning half are past their useful life. Cities as diverse as Washington, DC, Philadelphia, Atlantic City and Cleveland have suffered lead poisoning from water just like Flint.”
But the public health implications of infrastructure go far beyond the safe provision of basic needs. They serve a much broader purpose: often determining whether individuals have the opportunity to live healthy lives.
Crucial to physical fitness, for instance, are sidewalks along streets and thoroughfares. Key to limiting air pollution is decreasing car use because we have alternatives in public transit and the availability of bike paths. Similarly, walkable, navigable access to a range of services and safe places to exercise and socialize makes aging in place possible.
With proper planning, infrastructure improvements can be designed to increase public health at no additional cost to the public—and will likely save money. That’s possible for two primary reasons:
First, the cost of poor health, much of it borne by Medicare and Medicaid, is extraordinary. The estimated annual medical cost of obesity alone is $147 billion, according to the Centers for Disease Control and Prevention, because more than one-third of American adults are obese. The CDC notes that “the medical costs for people who are obese were $1,429 higher than those of normal weight.” Obesity is a consequence of diminished opportunity for walking and other physical activity, as well as change in diet, and inhalation of some of the components of our pollution. The result—our nation becoming overweight or obese—costs us nearly three times more than the $55 billion that would be spent on America’s infrastructure—an enormous opportunity for savings, particularly since it reflects only expenses from obesity and not other chronic conditions.
Second, improvements to infrastructure are often one-time expenses but the benefits to public health are recurring. One new sidewalk benefits an entire generation of walkers and runners. A bridge built to accommodate rapid transit and walking and biking will build new opportunity for health. Recent analysis by my colleague at Columbia’s Mailman School of Public Health, Babak Mohit, shows that every $1,300 invested in building bike lanes in 2015 resulted in benefits equal to an added year of life at full health over the lifetime of all New York City residents.
The bipartisan agreement now coalescing should be taken one step further. Public health should be factored into the improvement of America’s infrastructure. If it is, a consensus could be built around an exciting vision of a sounder and healthier America. We must see infrastructure improvement as more than fixing roads, bridges, tunnels, and water mains. Instead, we need to consider it an opportunity to create health at low cost.
Infrastructure is key to health, and enhanced infrastructure is key to improved health. It’s time that Americans unlocked the potential of both.