Over drinks earlier this year, a good friend of mine asked what I thought was the most cost-effective way to improve health care. I thought back on the plethora of new drugs, diagnostics and other innovations I learned about in my medical school classes, and nothing jumped out at me. I told him I’d think about it more and get back to him.
Throughout the year, I explored many different technologies, workflow innovations, public health programs and more to try to answer my friend’s question, and to quench my own curiosity about where I can make the biggest impact to improve health care. The more I dug into the studies, the more I became convinced that serious investments in bike lanes are likely the most cost-effective way to improve the health of the over 80% of Canadians living in urban areas.
Growing up in the Toronto suburbs of Scarborough and North York, it was as rare to find bike lanes nearby as it was to find palm trees. Bike lanes, bike locks or any other bike infrastructure were almost non-existent. No wonder almost no one in any of the neighborhoods I lived in commuted or did errands by bike. Even after I moved to the downtown core, the bike lanes that existed were few and discontinuous, and rarely separated from vehicle traffic. Without separated bike lanes, getting from Point A to Point B is a constant game of survival – dodging parked cars, turning cars, speeding taxis and cars opening their doors or switching lanes without checking their blind spot. When I tell non-biking friends that I bike to get around the city everyday, they often think of me as a daredevil.
However, commuting by bicycle is often the easiest way for people to stay healthy. This is because studies show that the vast majority of people who commute by bikes get the over the 30 minutes of exercise per day that is needed every week for optimum health benefits. Currently, only 15% of Canadians get the minimum 150 minutes of exercise a week recommended to obtain optimum health benefits. This is largely because exercise is not built into the fabric of people’s daily lives.
The health benefits of 30 minutes of moderate cardiovascular exercise per day are astronomical. This level of exercise is associated with a 45% reduction in the risk of coronary artery disease, up to 69% reduction in the risk of stroke, 50% reduction in progression to dementia and Alzheimer’s in elderly patients, 47% reduction in depression rates, 30-40% reduction in the risk of colon cancer, and 58% reduction in progression to Type II diabetes in patients at high risk, just to name a few. It is important to note that many of these numbers come from single studies, and that other similar studies may not show as large of an effect. In addition, diet or another similar factor may also be common to exercisers, and therefore contribute to part of the effect. While one could debate the exact numbers, however, there’s no question that exercise has a dramatic impact on one’s overall health.
The illnesses in which regular exercise reduce the risks of are some of the most common illnesses plaguing Canadians, and thus the Canadian health care system. Bike lanes can significantly help change that.
In many European cities, more than half of all commutes are done with bikes. This is compared with the abysmal 1.7% of commutes in Toronto. One might argue that this might be due to Toronto’s colder winters, but compared to Canada, more people in Nordic countries bike to work – despite the harsher winter. As a very flat city, Toronto could become a cyclists’ paradise. However, Toronto only has 17km of separated bike lanes per 100,000 people, compared to 500km in Amsterdam, 28km in Montreal 38km in Vancouver. Since the vast majority of people in a city are not willing to commute by cycling unless they can do so safely on designated bike lanes physically separated from cars, this is the key bottleneck to creating a city where people bike to work and school, and are healthier because of it.
So where do we go from here? Toronto can double its bike lanes for only around $5 per person per year over 10 years through the city’s proposed cycling plan. In my view, this cost far pales in comparison to the health care cost savings that this would bring through vastly reduced rates of heart disease, high blood pressure, diabetes, Alzheimer’s, depression and other illnesses. More bike commuters also reduce pressure on our overly congested transit system and roads, and bring more vibrancy to Toronto’s streets! Other helpful policies include harsher fines on cars that park on bike lanes, and increased investments on other bike infrastructure such as bike parking, pumps and repair stations. Studies have shown that every $1 invested in bike infrastructure leads to an average of $13 in health benefits!
Let’s invest more in the most cost-effective ways to improve health care. Let’s add urban design to the health conversation!
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Li, good article. Don’t forget walking!
http://www.theglobeandmail.com/news/toronto/in-toronto-its-difficult-for-seniors-to-cross-the-street-both-slowly-and-safely/article33688567/
I live near Montréal (in Longueuil) and commute by bike and do many house calls by bike (I work in a CLSC). I’m lucky to have nice bike lanes around. I hear that in Montreal bike lanes are crowded and used by high speed cyclers and my cousins prefer to bike to work on well-known calm streets. I’m sure the fact that many people in Montreal don’t have a private parking space is as much a shove toward cycling (or public transport) as the bike lanes are. The hassle of shovelling snow out of a new space to park along the street when arriving home after work (because someone is parked in the one you shovelled yesterday) just cuts down on the pleasure of owning a car.
As a cyclist and a doctor I empirically agree, but I would like to see some bibliography to back with studies what is stated here. Thank you!
Your article is truth, accurate and honest. Ive been living in Copenhagen for 15 years, was born and grew up in Rio de Janeiro. My experience is that life is healthier here in Cph due to the urban planning particularly the bicycle lanes infrastructure, among others, compared to Rio despite its nature and good weather.. but I just think there is a clash in your article when you start with “Over drinks..” to talk about health care :-/ ;-) :-)
Does this factor in the health care costs from bicycle accidents? Recent reports in Toronto indicate something like 10 bicycle accidents a day. What is needed is separated bike lanes and not bike lanes adjacent to any stopped or parked cars – dooring is significant and lands many people in hospital and often ends their cycling.
I completely agree, we need separately bike lanes instead of mixed traffic bike lanes. This article argues that the risks from bike accidents are far less than that of the health benefits of biking, although it is done in the Netherlands where biking is a lot safer due to their bike infrastructure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920084/
Dear Danny. Fantastic article which clearly and succinctly makes the strong argument as to what and why our city needs to do to step up to better support the health of our citizens and become the international city it should be. Would love to meet with you to discuss further how to make this happen. Patricia Houston Vice Dean MD Program U of T
Hi Dr Houston, thank you so much for reading my article and the kind remarks! I would love to meet with you – let me know what time works best for you. My email is danny.liang@mail.utoronto.ca
Awesome
Thumbs up for this write up…I researched a similar topic as an undergraduate (though among high school kids) and I reached similar conclusions to yours, namely that the potential benefits accruing from physical activity are enormous and that active commuting is a very cheap and almost non-cumbersome way to get the recommended daily dose of exercise. Would love to see this message blared from every bulletin, billboard and electronic screen.
you’re sure right.
What an interesting perspective! I agree with you that most challenges facing our health care system can be overcome by implementing small changes in our lifestyles because as you implied, our health is ultimately in our hands. And the best way to allow people to lead healthier lifestyles is to provide them with the necessary resources to do so. Thanks for sharing your unique take on this topic!