FIRE! Part 2: 2 FIREZ 2 FURIOUS

Last week when I wrote that post about fire, I forgot that I had this buried in my archives of drafts meant-to-be-but-never-written.

You know that fun (read: stupid; read: I don't think even they believe it, they're just afraid of change) refrain you hear from opponents of road-calming measures about how the bike lane/bulb-out/crosswalk is going to kill Grandma because it's going to keep the ambulance from getting to her in time?

I'll hand it over to YMIWT guest commentator Tom Vanderbilt, author of the fabulous Traffic: Why We Drive The Way We Do and What It Says About Us.

…the risk of dying in a fire in the U.S. is roughly the same as drowning: In one year, 1 in 88,000, and, over a lifetime, 1 in 1100. The risk of dying in a car crash, according to the article, is 1 out of 6500 in a year. The risk of being killed while being a pedestrian? “A one-year risk of one in 48,500 and a lifetime risk of one in 625.”

Designing roads to meet some supposed emergency response criteria, for that dramatic last-second rescue, actually helps raise the risk of dying in a much more common way: In traffic.

Thanks, Tom.

So, it turns out not only is that blatantly wrong, but the roads that we keep as big, fast (see above) traffic sewers so all the grandmas won't burn to death?  Yeah, they're actually a serious danger to the firefighters coming to her rescue, too.

"The United States Fire Administration...cites motor vehicle crashes as the cause of death for between 20–25% of the annual line-of-duty fatalities. Motor vehicle crashes are the second highest cause of death for firefighters. The leading cause of death is stress and overexertion which accounts for approximately 50% of the fatalities"

Occupational driving injuries are a big deal.  If you drive for work, they're a big deal for you, too. Most of us don't get our hands chopped off in machinery anymore (though you might be shocked how much that still happens even in the US), but we do face significant danger from driving for work. The annual risk of dying in a road accident for drivers who average >25 000 miles per year is 1 in 7000, a figure comparable with coal mining and worse than the construction industry (Harris 2004).  Road traffic injuries cost US employers $60 billion annually, 

Shocked?  I hope not.  Some damn bike lane might keep the paramedics from rescuing you...

FIRE!

Literally.  Actually.  Car crashes are the leading cause of unintentional injury for kids.  And unintentional injury is the leading cause of death for kids from age 1 on.  Fires and burns are #6 and it's not even close.

So naturally, when I saw this article, I assumed one of the ways would be GET THOSE KIDS OUT OF THE CAR!!!!!  Car crashes are THE leading cause of death for kids!  Not to mention driving your kids everywhere contributes to our physical inactivity problem!  Whenever possible, walk or bike to your destination!

Yeeah, okay, no I didn't.  Because everyone knows loving parents move their kids to the suburbs and take them everywhere in the car.  Actually, not even a car.  An SUV.  I mean, if you're a good parent.

For what it's worth, I agree with the other recommendations.  Learn CPR--absolutely. Teach your child to swim--hey, that one addresses the second leading cause of unintentional injury death for kids!  A measly second, compared to the numbers cars are posting, but second nonetheless.

Install smoke detectors and have a fire escape plan--please do.  When we learned about fire safety plans in second grade I kept trying to get my parents to make one because even though we lived in a little ranch house, I didn't know how to get my window screens out and they kept telling me not to worry about it and then I didn't sleep for a month because I didn't have the words to tell them "don't worry" was not comforting and then I became a doctor who focuses on preventive medicine because I still don't know how to work the screens in those windows, MOM!!!!

Ahem, where was I?   Ah yes.  Car seats...of course, if you're going to put your kids in a car, have them in an appropriate car seat.

But our fears around this are so out of whack.  Stranger danger was/is a big factor in pushing kids into cars, but it doesn't even come close (how pretentious am I, linking to my own blog post....). People are getting the police called on them because they let their kids walk to the park.  And yet we also are putting our kids in cars with strangers (whaaaaat?).

This week Kevin Klinkenberg had a fantastic post about, among other things, the "false dichotomy that cities and urban life are all about excitement, action and trendiness, while suburbs are essentially about what really matters – family, safety and cleanliness." 

But the suburban lifestyle, which confines people to the car, condemns them to exposing their kids over and over, multiple times per day, to the thing which puts them at the highest risk for death. Privileging cars in crowded cities does the same to kids (and adults) even if they're not the ones in the cars.

Look at those first two pictures again.  And really think: which one is more dangerous to kids.  It's the latter.  You'd do anything to protect your kids from that big, scary housefire on top: you dress them in non-flammable clothes, you put in smoke detectors, you'd run back in there yourself to drag them out. Why don't you feel the same way about the real killer?

Low Angles, Wide Lenses: Urban Living

Reeeeeeeally low and wide.  Low enough to capture the Walk Score of this location, which is 41. Wide enough to find anything that's not a highway or a stroad within walking distance.

The New York Times on Sunday had an article about the dilution of the term "mindfulness."  As someone who recently started practicing meditation and mindfulness--my intro happened to be through improv, not some corporate lifestyle guru,but I digress--and thinks everyone else should too, I definitely see this happening.  (As another aside, if I ever start my own wellness company, it will only have 3 components--getting people out of their cars, teaching them how to meal plan and cook, and teaching meditation.  Okay...and maybe flexible work schedules and quality childcare, but let's not get too pie in the sky, here.)  And yet, we had a work session on it a few months back and the hapless chaplain trying to explain it basically described it as paying attention while you're eating your cereal.  Fe's not wrong entirely, but none of my co-workers walked out of that session talking about anything other than how they don't have time to taste their cereal because they have to get their kids to school.

I was reminded of this apartment complex I saw over the holidays, which was hung with a banner heralding it the "best of urban living" in St. Charles, Missouri.

For those of you not familiar, St. Charles is an exurb to the northwest of St. Louis.  It is your generic car-dependent suburb (and, in my experience at least, the land of cookie-cutter white-to-light beige identical siding houses.  I seriously have no idea how you choose which house within which identical suburb to live in there).  More factually, it has a population density of 2,782 people per square mile and 5 major highways.   It was, in fact, according to the Federal Highway Administration, the site of the first interstate highway project in the U.S.  In that proud tradition, the complex itself is nestled between an interstate and a megaplex movie theater.  Oh, and there's a gas station for your shopping!

In fairness, there is an Aldi half a mile away.  Which is theoretically totally walkable, but the route to Aldi looks like this.

Given that there's no way to live in these apartments without owning a car--41 is still classified by WalkScore as "car dependent"--do you really think anyone's going to choose to walk that over hopping in the car?  Of course not, which is why we Americans drive to everything even though most of our trips are under 2 miles (well that, and 'murica).

I suppose it's some sort of progress when language--in this case, the language of urbanism--gets co-opted by marketing.  It indicates where the pulse of what's currently hip and trendy is.  As we have seen over and over again, for Millennials, it is certainly in more livable, walkable communities.  Yet, it runs the risk of diluting beyond recognition the original term itself.

Is anyone choosing to live in a place like that actually fooled by this "urban living"? Moreover, is anyone who is looking here really concerned about "urban living"?  There are a few suburbs in St. Louis with semi-nice, functional little downtowns.  St. Charles is not one of them.  Why use those terms, then?   My fearful, cynical side suggests that it is because of an inability in certain parts to imagine what actual urban living or walkability is.

But advertisers are cleverer than that.  Appealing to emotion to obscure facts is hardly a new move. According to this article, "In the 18th century, when the contents of the Anchor Brewery were being auctioned off, the auctioneer said: 'We are not here to sell boilers and vats, but the potentiality of growing rich beyond the dreams of avarice.'"  In a neighborhood and country of disconnect and isolation and getting in your car to go any damn place, the idea that your apartment in a subdivision in an exurb is actually urban living where you're going to walk to get your groceries or meet friends at a bar down the street is powerful.  Powerful enough to get someone to hand over a rent check by imagining this as "urban" living.  

In another generation, this might have been sold as "pastoral" and "secluded." Today, transit-oriented, walkable, or urban are the buzzwords.  Of course, marketers don't give a crap about real changes towards walkability and urbanism. But they have the right tactics.  The tactics to reach into people's brains and sell them on something--even something as unbelievable as urban living next to an interstate and a Quiktrip.  

But we should not rest there.  There's no reason to let people settle for calling something like this "walkable" or "urban living."  So why not use their tactics to up-sell real urban living--walkable communities, bike infrastructure, bus rapid transit?  Appealing to it being good for you or for the environment is part of the story, but so often it comes off a little like nagging people to eat their broccoli.  Why not take a marketing approach and sell people on the image of who they'll be with a new bike lane or complete street in the neighborhood?  It's been working for Bigs Auto and Oil for years, getting people to ignore all sorts of ills perpetrated on them by these very companies while gladly handing over their money and defending their rights. Imagine a world where people thoughtlessly defended complete streets that way.  Only this time, the benefits wouldn't be all smoke and copywriting.

Low Angles, Wide Lenses: The Heroine Takes the Bus!

There's this show that's been getting me through Mondays.  It's called (eek) Jane the Virgin.

Now, ignore the title.  The first time I saw a subway ad for this show, I thought "Seriously?  That's a real show?!?  Please, The CW..."

Ignore the premise, please.  Just, get past it--you'll thank me.

There is much--much--that I love about this show.

It's silly.  It's earnest.  It's tearing through ridiculous amounts of telenovela-level plot ridiculousness at a rate I'm nervous it can't sustain and yet the characters often just say what they want or feel in a way that is highly refreshing.

But one thing that struck me in particular is that Jane rides the bus. This really hit me at the end of the last episode when she storms out of *redacted*'s house.  She reached for her bags, I realized I was almost mentally inserting her pulling out her car keys.

That's when I remembered that she takes the bus.  I'm so acculturated to seeing characters get in a car and drive, even when it makes no sense (why are so many Seinfeld episodes about driving?) that I just assumed she would.

Now, surely this is done as a marker of her working-class status.  I'm sure Rafael, Petra, et al are taking the bus nowhere.  But at least it's not presented as miserable. There's no "weirdos on the bus" moments.  There's no "you know why they make the windows so big" speeches.  In fact, they mostly use her bus time as time she thinks about what's going on.  Or maybe has text conversations with other characters.  That's kind of how I use my public transit time.  And isn't the freedom to do those two things one of the great things about transit?

I don't kid myself that this is done as some sort of statement.  But it's nice to see realism in how it's presented.  This character--a very practical, mature 20-something working in a hotel restaurant while attending college to become a teacher--is someone who very well might take transit rather than spend her precious money on a car, insurance, gas, etc.  And realism in that it's not miserable--sometimes she runs to catch it, sometimes she has to stand because it's full, but it's just part of her day.

It's progress.

Low angle, wide lens: the "safer" minivan.

You have to give it to the people behind this ad: they're brilliant.  They get right up to the edge of acknowledging the burden of road traffic injuries, but in a way that makes a car seem like the hero.

Is this not the perfect example of “if you don't like what's being said, change the conversation"? (I don't mean to make this entire post Mad Men reference, but the shoe fits....)  The conversation should be cars vs. other safer, more sustainable forms of transportation.  But for years, they've made it about cars versus "safer" cars.  


"They survived" but if they hadn't been in the car, or hadn't had to spend so much of their time in the car, they never would have been at risk of a crash in the first place.  And that's assuming those dents were made by other cars, not cyclists or pedestrians because I assure you, they didn't survive.

Can you imagine if we advertised "safer" cigarettes by showing pictures of resected lung tumors?  Or "safer" asbestos by...I'm getting stuck on lung tumors here.  How about safer guns by showing pictures of spent, bloodied bullets?

This is every bit as ridiculous.  The question should be cars versus better forms of transit, instead they've successfully kept it cars vs. other cars.  

So they spoon-feed us some sentimental junk food like this:

And our society is so auto-normative that we don't even ask questions.

The safest exposure is the one you never have--or the one you have only rarely, for long trips out to the country.  The safest driving is less driving.  That's the conversation we should be having.

A real "lucky man"?  One who took the subway.

Ebola

That sound you hear?  That's the whir of cranking up the old blog machine.

And what better way to orient ourselves that we're in 2014 than Ebola?

I barely have the interest or energy to write this post because it's been done so many times in the last few weeks.  Flu is worse than Ebola.  Obesity and heart disease are a bigger threat than Ebola.  And, of course, that Facebook favorite, the number of people who have died of Ebola in the US is lower than the number of people who have been married to Kim Kardashian.

But I'm starting here because, looking through all the drafts of this blog which I tucked away over the years while residency and boards and 3 moves and life intervened, this particular post was originally titled "Swine Flu" (How quaint!).

And that's true.  According to this 2012 study, reporting how the death toll from the 2009 swine flu outbreak was "10 times higher than previously thought"  the toll may be as high as 201,200.  

As of this writing, the Ebola death toll is closing in on 5,000.  

And I say this not in the least to minimize either of those diseases.  They're horrible.  I don't want any of them.  I don't want my loved ones to contract them.  I don't want anyone to.  And we absolutely need to be addressing them.

But the death toll ANNUALLY from motor vehicle violence worldwide?  1.2 million.  Why no urgency?  Not only that, but a rush to embrace this killer in developing countries and to defend it in our own?  

When I started writing this, it was swine flu.  When I finished, Ebola.  As hard as it is to imagine now, in a few months or years it will be something else.  But the motor vehicle deaths will keep coming, unnoticed--and worse, accepted.

The governor of New York is jumping the gun ahead of the CDC, ahead of the White House, to do something about Ebola.  Where's that passion, that leadership when it comes to the road traffic violence epidemic?  (with "Car-guy" Cuomo, definitely nowhere to be seen).   

It's 2014.  Aren't we going to do something?

Diabetes

I could just present you with this list, showing accidental deaths surpassing diabetes as a leading cause of death in the US.  But I wouldn't do that to you.  Because the truth behind the chart is that motor vehicle accidents account for 46,000 of the accidental deaths, so diabetes still wins at 71,000 (Congratulations, Insulin Resistance!).

I might show you this chart, in which diabetes doesn't even rank globally, while RTI's are climbing quickly. But you could claim the deaths due to ischemic heart disease are likely being contributed to by diabetes.

....At which point I'll claim both for cars!  I WIN!

How'd I do that?

Research.

We're all pretty aware at this point that diabetes is part of  metabolic syndrome, yes?  And a major risk factor for metabolic syndrome is what now?  Obesity!  And taking public transit is associated with walking 8.3 more minutes per day on average, or an additional 25.7–39.0 kcal. Hill, et al, estimate that an increase in net expenditure of 100 kcal/day can stop the increase in obesity in 90% of the population. Additional walking associated with public transit could save $5500 per person in present value by reducing obesity-related medical costs.

But there's more:   Each additional hour spent in a car per day was associated with a 6% increase in the likelihood of obesity. Conversely, each additional kilometer walked per day was associated with a 4.8% reduction in the likelihood of obesity. As a continuous measure, BMI was significantly associated with urban form for white cohorts. Relationships among urban form, walk distance, and time in a car were stronger among white than black cohorts.

If that's not enough motivation to get out of your car and walk a little, maybe this will be: a recent study conducted at the University at Buffalo and Erie County Medical Center showed that drivers who are moderately obese have a 21% increased risk of death in a crash. Worse yet, the morbidly obese have a 56% increased risk of not surviving a crash.  To account for this, they're proposing changes to the build of crash test dummies.

For heaven's sake all the time we're spending in cars is making the crash test dummies get fatter!

And just to prove RTIs are worse than diabetes without any Jedi mind tricks: 843 disability adjusted life years lost for diabetes, 1081 for RTIs.  That is, RTIs are robbing us of more healthy, productive life years than diabetes, even as we think they are helping us by getting us there faster or more.

Congratulations, cars....?