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  • Active Voice: Finding a Cure for the Plague of the 21st Century

    by Guest Blogger | Dec 15, 2014
    By Robert Sallis, M.D., FACSM 

    I recently represented Exercise is Medicine® and the Every Body Walk! Collaborative at Walk21, the 15th Annual Conference on Walking and Walkable Communities. The meeting was held on October 21-23 at the Luna Park Conference Facility located alongside the beautiful harbor in Sydney, Australia. Walk21 2014 was a remarkable meeting that brought together a wide variety of stakeholders interested in the development of healthy and sustainable communities where people choose to walk. In addition to those from the fields of medicine and public health, the bulk of the attendees were involved in city planning, transportation, education, urban design and architecture. All of the attendees were passionate about the importance of walking for health and quality of life. In addition, the premier of New South Wales and the lord mayor of Sydney also attended and spoke, underscoring the importance of this meeting at the highest levels of government in Sydney and beyond.

    I came away from this meeting with an enhanced appreciation for the importance of walking and how we might best get citizens of the world to do it. My focus has primarily been from a medical perspective and on assessing and prescribing walking to patients, using physical activity as I would a medication. However, I came to realize that it does little good for me to prescribe exercise to my patients if they have nowhere to do it. On the contrary, if patients have inviting walking trails and green space nearby where they live and work, they are much more inclined to walk. Furthermore, if they live in a city that places an emphasis on public transportation, with safe sidewalks and crosswalks that make getting around easier, they are much more likely to walk than take a car. So it became clear to me that we, as health care providers, need to partner with urban planners to improve the health of our urban populations.

    I also realized there is a long history of city planners coming together with public health professionals to prevent and cure disease. The bubonic plague of 14th century Europe was cured when urban planners developed effective means of collecting and disposing of garbage in order to eliminate rats carrying fleas that transmitted the disease to humans. Cholera was also essentially eliminated when urban planners figured out how to keep sewage separated from water, food and the environment. These simple measures to improve sanitation in our cities, brought about by astute urban planners, saved more lives than any medicine or vaccine could.

    Today the major causes of death around the world are no longer infectious diseases, but non-communicable diseases (NCD’s) which are mainly related to inactivity and poor diet. Lately, the news has been filled with hysteria over Ebola, but almost nothing on the biggest global threat, which is a sedentary lifestyle. The plague, cholera and TB have been replaced by diseases closely linked to a sedentary lifestyle such as heart disease, diabetes and cancer. What we now understand is that this has occurred because we have engineered physical activity out of our daily lives. The consequences have been catastrophic, but really quite predictable. And, once again, we need to call on our urban planners to rescue us from the epidemic of NCD’s by making our communities more walkable so people are able to walk every day.

    Stamping out disease is a role that our urban planners have played before and must play again. We must design cities built for walking and physical activity so that everybody can gain the health benefits achieved through an active and fit way of life. While NCD’s are the plague of today, our response has been much more indolent than was the case for the bubonic plague of centuries past. Yet, these NCD’s are just as deadly and must be taken just as seriously. We all need to work together to ensure this happens.

    Editorial Note: Dr. Sallis spoke at this conference, representing ACSM, Exercise is Medicine®, and the Every Body Walk! Collaborative. His participation in Sydney was supported, in part, by a grant ACSM received from Kaiser Permanente -Improving health through clinician-to-patient conversation on benefits of walking.

    Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Robert E. Sallis, M.D., FACSM, is a past president of ACSM and currently is chair of the Exercise is Medicine® Task Force. He originated the EIM concept and has been its leading advocate from the beginning. Dr. Sallis earned an M.D. from Texas A&M University and completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, Calif. He has continued his medical career with Kaiser and now codirects their sports medicine fellowship training program. Dr. Sallis is the founding editor-in-chief of ACSM's Current Sports Medicine Reports journal.

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