Last week, America’s top doc, US Surgeon General Dr. Vivek Murthy, launched Step It UP! - a welcome call to action promoting walking and walkable communities.  Step It Up! calls for “improved access to safe and convenient places to walk and wheelchair roll, and encourages creating a culture that supports these activities for people of all ages and abilities” says Dr. Murthy. He noted that seven out every ten deaths in America are caused by chronic diseases like diabetes, cancer and heart disease and one out of every two Americans lives with at least one of them.  Diabetes for example, is the leading cause of kidney failure, lower limb amputations, and new cases of blindness in the U.S.  It is not breaking news that among other factors, increased physical activity reduces the risk of these diseases.

Dr. Murthy remarked that in modern times, “where we live can be an all too real indicator of how healthy we are”. Community design, land use, public infrastructure, and transportation systems all play an important role in how easy or difficult it is for Americans to simply walk more.  Step It Up! follows two recent Canadian studies presented to the American Diabetes Association on the links between neighborhood walkability and diabetes, overweight, and obesity.  People who live in neighborhoods that are conducive to walking experienced a substantially lower rate of each of those conditions than those who lived in more auto-dependent neighborhoods, according to the studies.

Conducted in the Toronto area, the studies showed that over a 10-year period, people who lived in neighborhoods with a high level of street interconnectivity, and abundant parks, community facilities, stores, and services within walking distance, had a lower risk of developing diabetes.  “How we build our cities matters in terms of our overall health,” said lead researcher Gillian Booth, MD, Endocrinologist and Research Scientist at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto. “This is one piece of a puzzle that we can potentially do something about. As a society, we have engineered physical activity out of our lives. Every opportunity to walk, to get outside, to go to the corner store or walk our children to school can have a big impact on our risk for diabetes and becoming overweight.”

The studies found that “people living in those Toronto area neighborhoods with the greatest walkability experienced a 13% lower development of diabetes over 10 years than those living within the least least walkable neighborhoods.  Not only was the rate of diabetes lowest in the most walkable neighborhoods, but incidences of the disease actually fell 7% over the 10 years.

Alternately, those neighborhoods rated least walkable saw a 6% rise in rate of diabetes over the same period. Following the same pattern over the same decade, overweight and obesity were lowest in the most walkable and highest in the least walkable neighborhoods - falling by 9%, and rising 13% correspondingly. The study also noted that people who lived in the most walkable neighborhoods were three times more likely to include walking or bicycling to the mix of how they get around their community (American Diabetes Association).

These issues are relevant in every community in America, especially in the San Antonio area that we call home. In 2013, the countywide prevalence of diabetes was 13%, which was greater than both the statewide (10%) and national (9%) averages.  Rates of overweight and obesity, which have been on the decline since 2010, are still unacceptably high in this community at 65%. Please see more in these infographics on diabetes and weight (San Antonio Metropolitan Health Department).

In a 2013 Kaiser Permanente study here in the U.S, nine in ten Americans surveyed agreed that walking was an effective way to maintain healthy weight, lose weight, and prevent chronic conditions like diabetes and heart disease. Yet while we seem to appreciate the health value of walking more, few of us are actually doing it.  Less than a third of those surveyed are spending at least 150 minutes per week walking (the recommended minimum threshold for healthy physical activity set by the Centers for Disease Control). 

So why aren’t we walking?  When asked, those in the Kaiser Permanente study cited time and energy and not living in “live, work, play” communities as a hurdle. Four in ten say their current neighborhoods are “not very” or “not at all” walkable.  Here in our home of San Antonio, the seventh most populous city in the nation, only 14% of our neighborhoods are walkable says City Planning and Community Development Director John Dugan (The Rivard Report).



San Antonians, like many other Americans, have been taking our health challenges more seriously in recent years. We are reminded daily of the havoc that these chronic diseases wreak on the lives of our loves ones and the governor switch it places on our economic productivity.

In 2010, through the SA2020 community visioning process championed by then Mayor Julian Castro, citizens declared by the thousands that by the end of the decade, their city would be among the healthiest in America. We identified obesity and diabetes as key indicators to move the needle on.  Additionally, San Antonians said we wanted to live in a city of neighborhoods known for their cohesiveness, and compelling and unique personalities. Among the measures of success citizens established for that goal were significant increases in both pedestrian oriented neighborhoods and overall walkability.

In 2014, Current Mayor Ivy Taylor launched SATomorrow, an intensive city planning initiative aimed at developing the San Antonio area’s first comprehensive plan in modern times.  SATomorrow build’s on the community’s SA2020 vision, and responds to the projections that by the year 2040, there will be 1 million new heartbeats calling the San Antonio area home, along with hundreds of thousands of new jobs and housing units.

How, as a community, we prepare our city for that growth, continually improve the quality of life for those of us here today, and ensure that public policy and resource allocations advance the citizens’ long-term vision is part of the hard work ahead. In the years ahead, there will be as many distractions, potential diversions, and competing priorities as there will be future new San Antonians.

Ed Whitacre, former chairman of General Motors and AT&T, when helping with the kick off of SA2020 in 2010, remarked that good planning is “knowing where you want to go, and getting there on purpose”.  The strength, soundness, and community ownership of priorities and policy imperatives embedded into the DNA of the final comprehensive plan, scheduled to be complete in 2016, will in many ways answer the question:

“Between now and 2040, will the designs of (1) our new neighborhoods and the improvements within those that exist today, (2) our evolving transportation system, and (3) our future public infrastructure investments, powerfully support the desire of San Antonians to live within one of America’s healthiest cities?










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