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Why I never walked to school: the impact of the built environment on health

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

kids walking to schoolMy California-acclimated body was a little shocked by the 15-degree weather I encountered while visiting my Kentucky hometown over winter break, but I was still determined to bundle up most days and to get outside for long walks with my mom and daughter. One day as we were struggling to catch an opening in traffic to cross the blindly curving road leading out of our subdivision, it occurred to me that the cold was the least of our barriers to getting a little exercise.

“I don’t think I could design a more dangerous place to walk if I tried,” I observed in frustration. Another car whizzed by within a couple feet of my daughter’s stroller. “This town was definitely built for cars, not people.”

For most of my childhood, my family lived right in the middle of town, within about a mile of many of the places a young family might visit on a daily basis. Grocery stores, school, church, the public library, restaurants, the park where I played softball, and my grandmother’s house were all close enough that they should have been an easy walk. But that one mile might as well have been twenty, and I can count on one hand the times I walked to those destinations. I tried a few times, but to get there on foot I’d have to navigate roads lined by steep hills or ditches with no sidewalks or crosswalks. There is one underpass that would require a pedestrian to climb onto a narrow strip of gravel and inch along the wall, close enough to the fast-moving traffic to be unbalanced by gusts from each passing car.

Because of these real physical barriers, the local cultural wisdom took it as self-evident that cars were the only reasonable way to get around. Walking and biking were recreational activities to be done in endless circles around the cul-de-sac, not viable modes of transportation. The risk of walking wasn’t just a theoretical one: Our roads were decorated with a couple of makeshift roadside altars made by the families of teenagers who had died while trying to cross the street. More recently, I was disappointed to read an article confirming my suspicions that cycling in the Southeastern U.S. is drastically more dangerous than in other regions.

In writing this I’m not trying to pick on my town in particular (it was actually a wonderful, nurturing place to grow up), but to highlight an important problem that is common to hundreds of communities across the country. No matter how compelling you may find the potential health benefits of physical activity or the negative environmental impact of having the car engine running most of the day, those concerns become irrelevant in light of the immediate reality for many Americans that walking or biking is always inconvenient, usually unsafe, and sometimes physically impossible. A couple months ago, Akhilesh Pathipati wrote on SMS Unplugged about Walking School Bus initiatives and mused about why they haven’t been more widely adopted despite their proven success. Based on my experiences, the lack of Walking School Buses unfortunately doesn’t surprise me. If I were raising my child in my hometown, I wouldn’t let her walk to school until my community took it upon themselves to make the streets safer and more accessible for pedestrians.

Since leaving Kentucky for college a decade ago, I’ve had the privilege of living in places where walking and biking are enjoyable, convenient, and safe ways to get around. While at Harvard, one of my favorite parts of the day was my three-mile walk to the lab, which took me along a well-traveled pedestrian and bike path along the Charles River, and then through beautiful Boston neighborhoods with plenty of sidewalks and crosswalks. Now that I’m at Stanford, the campus and many nearby neighborhoods are built in a way that makes it easier and faster to get around by bike than by car. Being physically active through my day-to-day routine has made me a healthier person both physically and mentally - compared to the alternatives of either complete inactivity or spending lots of time cloistered in the gym.

As a medical student, I often find myself recommending that my patients increase their physical activity by incorporating walking or biking into their normal daily routines. But my experience braving my hometown streets over winter break reminded me that many of my patients live in built environments that nudge them in the opposite direction - and it may even be dangerous or impossible for them to follow my advice. For now, I’ll try to be mindful of the barriers my patients face, and get more creative in helping them figure out how to adopt more active lifestyles. But more importantly, this experience reminds me that making lasting change in our patients’ behaviors and health may require going beyond one-on-one patient encounters, and advocating for change outside the walls of our clinics.

Jennifer DeCoste-Lopez is a final-year Stanford medical student applying to residency in pediatrics this year. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo by Nicola Jones

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