Second Hand Health Care Costs - Messaging & the Big Soda Ban

As with almost everything, there's the soft sell, the hard sell, the dumb sell and the smart sell.  In NYC, Mayor Bloomberg banned the BIG GULP to fight obesity in what many observers see as the hard, dumb sell.  Aside from public health practitioners, the general reaction has been Nanny-state negative, including Jon Stewart.

To complicate an already-complex issue, a new video circulating shows a newscaster taking down a viewer email as an example of bullying.  Without a doubt, the email used a hard, dumb sell:

So is Bloomberg a bully?  Not at all - he broached the subject in the right way by (1) picking the right object in super size sodas and (2) framing it as a budget issue. 

In fact, health care costs are the budget issue of our time, and obesity is a main reason.   An obese person incurs medical costs that are $2,741 higher (in 2005 dollars) than if they were not obese, according to the newest study on the topic. Nationwide, this translates into $190.2 billion per year, or 20.6 percent of national health expenditures (this is up from 17% two years ago).  Moderate obesity increases health care costs by 30% compared to those at a healthy weight; severe obesity more than doubles health care costs.  How are we going to have a conversation where, on the one hand, pointing out a person's extra weight is bullying, but on the other hand, if she and I share the same health insurance company, I am paying.  To borrow a phrase from smoking campaigns, I am experiencing second hand health care costs. 

This conversation is already evolving. To whit:
1) Last month, a group of former military leaders joined forces to begin attacking childhood obesity as a national security issue.  They cannot find healthy recruits.  This begins to put the obesity fight into a conservative frame, where to date, public health admonitions on obesity have been viewed skeptically as nanny-statism. 

2) The Robert Wood Johnson Foundation is so frustrated, their latest report just comes right out and says it in the title: "F is for Fat"

3) Supporters of active living and better neighborhood design have a huge role since we are the smart sell.  Even people with genetic predisposition for obesity benefit from low impact activities like walking. Those of us who work hard to make functional, walkable communities are not just public health promoters, but deficit hawks as well.  Time to start making that point harder because, to quote Bill Clinton, it's arithmetic. 

 Halloween's coming!Happy Halloween

Update on Friday, October 5, 2012 at 08:02AM by Lisa

I just found this other gem from NYC from May of this year called "Reversing the Epidemic."  The obesity crisis hits lower income families harder for a variety of reasons.  Because of this, the efforts to bring fresh food, community gardening, urban gardens, green carts are incredibly important and part of building respectful, effective solutions.

Walkable Urbanism Tour of Sarasota

Last week, the Florida Chapter of APA, the Myakka Branch of the Florida Green Building Council and the Florida House (I am a Board member of the latter two organizations) sponsored a walk tour of two local projects, Citrus Square and Janie’s Garden.   Both have won awards for design and are wonderful examples of architecturally excellent, mixed use projects.

First, here is a digital booklet of the trip.  The tour provided the 30 participants a chance to critique the project designs for aspects of walkable tourism.  We used several checklists, including LEED for Neighborhood Design, to look at the various aspects of site design and location.

Citrus Square

I’ve written about Citrus Square before (see here).  It is a privately financed project with 20 residential units above first floor retail.  The details on the tour that garnered the most attention were:

• Financing – HUD, Fannie Mae and Freddie Mac have caps on gross square feet of commercial space allowed in a mixed use project (from 15-25%).  The taller the building, the less the effect.  However, with two and three story buildings like Citrus Square, these caps make first floor retail in vertically mixed-use project difficult if not impossible.  The Congress for the New Urbanism has a task force called Live/Work/Walk to address this barrier to better redevelopment. 
• Parking – Parking is distributed throughout the site, both on-street and on-site. 
• Unit size – the size of the units are small, with the smallest units (550 ft2) among the most popular.
• Cost – the cost of the highly detailed molding added about 10% to the project costs, lower than typically assumed.

Janie’s Garden

First, we were joined by Vice Mayor Willie Shaw, who happened to be biking by (at the top of every walk tour leader’s wish list when showing off walkable, bikable communities) Janie’s Garden is a multi-phase, Hope VI mixed use project.  Bill Russell, head of the Sarasota Housing Authority led the tour, and the following points were highlights

• Financing – the financing was different from Citrus Square, instead using tax credits, which are a common mechanism for financing affordable housing.   The developer and manager of Janie’s Garden is the Michael’s Company, a national leader in affordable housing development. 
• Use mix – The first business, is now open in The Market Place in Phase 2 of Janie’s Garden along Martin Luther King Jr. Blvd. 
• Transportation – The route for Sarasota’s bus rapid transit project is currently planned to serve this area, with a stop at Martin Luther King Jr. Blvd. and Lemon Street.  There is some discussion on moving the route three blocks west to US 41, given the existing business and infrastructure there and new rules from the Federal Transit Administration that now favor economic development over speed.   No matter where the route eventually runs, Janie’s gardens would benefit from better links to US 41 via infrastructure, commercial activity and interaction with institutions along US 41.  For example, the retail and housing at Janie’s Garden could help support artists in the area.

Two conversations emerged that will be further explored in any future tour:

• Building Articulation – This may seem like an oddball term to non-architects.  The best way to think about articulation is the opposite: continuity.  Next time you are at a big box store, the flat walls flush doorways and lack of ornamentation are continuous design which gives the impression of large blank walls and canyons.  Walkable urbanism thrives on the opposite, where molding, windows, doors awnings and the like break up the buildings visually while still maintaining a sense of a coherent built environment. 
• The Underside of Balconies - One of the unexpected focal points from both tours was the attention to the undersides of balconies. Pedestrians are always looking around, including up.  The undersides of balconies are just one more opportunity to make the walk that much more interesting.

This was not so much new attention to balconies, but rather an important lesson in designing for slower speeds.  At 50 or 60 miles an hour, there is little need for detail.  However those who are walking and driving slowly will need to be engaged, even delighted, with what they encounter.  Quality materials, quality and interesting detail are critical not just the grist of design manuals, but your transporation and economic plans as well.

A-Park-olypse Sarasota

I have a soft spot for angled parking.   Maybe it’s the way more spaces are “found” in downtowns, or that parallel parking seems overly-complicated compared to the simple nature of yanking a shifter into “R” once, and only once.  For that reason, I supported the downtown merchants’ opposition to replacing angled parking with parallel spaces - that is until about 9 am last Thursday. 

That’s when I attended a presentation by SRQ Media Group on its recent Downtown Consumer Study (the must-read powerpoint is here).   The survey was conducted before the latest parking brouhahas erupted – metered parking, adorning a garage with (gasp) murals, and now a proposal to replace angled parking with parallel parking to increase sidewalk widths.  

As the February 9^th breakfast presentation unfolded, Ms. Angled Parking’s “Aha” moment came from this observation: Downtown has a very low attraction rate exclusively for shopping: 8.5%.  Before we can fully appreciate this statistic, let’s consider a couple of points about parking and downtowns:

• The sidewalk widening would be of most benefit to restaurants in the form of more outdoor dining.
• From the presentation, 91 % of people come mostly for dining.  The Farmers Market is also a big draw.
• While parking and garages are often viewed as downtown vibrancy killerers, for Sarasota it is essential.  Approximately 80% of Sarasota respondents came from outside downtown.  Add in tourists, and downtown Sarasota’s market is anything but local.
• Our new, year-old parking garage added 743 vehicle parking spaces, 20 motorcycle spaces and 80 bicycle spaces in the same block where owners are most upset. 
• Finally - the restaurants will have to rely on more than sidewalk width to achieve a fully functioning downtown.  A recent study found "a more critical factor (than street geometry) is the concentration of business activity in a compact commercial center." 

Instead of focusing so much energy on one block of Main Street, we should instead figure out how to move from a downtown where survey respondents come “for dining” to one where locals, visitors and workers are downtown equally for working, dining and shopping.

It seems like a there couple of key points.  First, we need to, at least in the short term, pay more attention to matching diners and Farmers Market patrons to the ability run other errands downtown.  We have a hardware store, banks, health food stores, opticians, services and a new Staples opening soon.  What does a marketing campaign to get all your trips taken care of downtown look like? We need to convince Joe from Palmer Ranch that he can get that hammer while his wife gets the veggies. Second, it's worth noting that Miami Beach has gained a lot of attention by celebrating, not whining about, its garages. Our own garage was recently included in an articleon the trend of parking garage architecture as sculpture.  Finally, the SRQ survey breaks down how people get information on downtown.  Instead of letting the medium drive the message, there seems to be really good information to help targeting or shape further studies needed.

Sarasota is holding a Parking Forum on February 23 from 5:30 pm to 7 at Selby Library where meters, pricing, and other topics are sure to come up.  For more information about the forum, please contact the Parking Services Management Department: 941-954-7057.