Biker, on your Left

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It is health care week here in the District of Columbia and the Supreme Court protest tourism business is booming. I just hope they are better drivers than the cherry blossom peepers.

I don’t get to present at PWPB2012; I will be much too busy to actually enjoy the conference. One of the perks I do enjoy is reading all the proposals and getting inspired. Today I am inspired, so I will indulge in a few words about my interests…

Today we publish CenterLines #301. In it is a story about Minnesota’s Statewide Health Improvement Program (SHIP) which caught my attention for a few reasons: 1) Minnesota is where I am from; 2) SHIP is the progeny of an active living program NCBW’s worked on; and 3) SHIP represents an interesting/innovative model of an apolitical federal/state/private sector collaboration–until now, at least.

Background: SHIP is administered by the Minnesota Department of Health; it reaches into all counties where it focuses on nutrition, tobacco prevention, and/or physical inactivity. The regimen a county selects is based on its unique needs, and interventions are drawn from The Guide to Community Prevention. This stuff works: it is peer-reviewed, and evidence-based.

Republican Governor Pawlenty signed SHIP into law, and did so with the enthusiastic support of Blue Cross Blue Shield (BCBS) of Minnesota, the state’s largest health insurer. The two year $47M program began in 2010 and promised $1B savings in avoided health care costs. You don’t get much better ROI than that. Well, maybe if you walked around picking up banana peels from the sidewalk, you would get a greater public health benefit.

The $47M sum sounds like a windfall when compared against the small amount we spend prevention programs; it pales when compared to the $6,913 spent providing health care for each Minnesotan the year SHIP was passed. SHIP amounts to $4/person.

Alas, even in the great state of Minnesota, the program slipped on a political banana peel:

I don’t believe, and have not seen, any evidence that the money being spent has any measurable effect on anything,’ said Sen. David Hann, R-Eden Prairie, who chairs the Health and Human Services Committee. ’Is it the duty of the state government to provide bike racks to people?’…”

Maybe we should take a moment to revisit the reasons active living programs are a good idea. BCBS’s self-interest is evident: healthier people will save it $. The political case is a bit murkier, and a bit like a Rorschach test: we see what we want to see. I see economic competitiveness as a really good reason to support active living programs.


CDC produced this map with 2008 data. This is a map of obesity rates, but–watch–in five years or less, this will represent an economic competitiveness map of the United States. It may already. The reason I say this is what I heard at last week’s National Bike Summit:

Health care costs are the single most volitale item on our balance sheet.

That was stated by the president of QBP, a 450 person company. Should he, or any other CEO be looking to expand his company’s operations, there are any number of considerations to weigh including a state’s regulatory environment, workforce quality/availability, schools, community amenities, tax incentives, etc. Tax incentives are going to be about the same wherever you go, so the pitched battles will be over the quality/availability of the workforce–a business’s most important input.

Now if a state or community can tout a healthier, happier, and less expensive workforce, then that’s a huge competitive advantage. That sounds like a irresistible rationale for public investment in complete streets, SRTS, workplace wellness, transit, bicycling infrastructure, and programs to support all these things.

Another depiction of economic competitiveness: percentage of family income going towards health insurance premiums. 

Now consider the aggregate effect of these savings on a company’s bottom line.

Source: Commonwealth Fund

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