So, You Want to Know More About the Motor City?

(Ed. Note: Dozens of links are provided below, after the introduction.)

Miichigan Central Station

Miichigan Central Station

Detroit’s unwanted celebrity status nationally and internationally continues to fascinate me. Detroit is now known as a failed American urban experiment. For the more cynical or the painful realists, it represents the dark end to America’s middle-class dream, and the embodiment of the decline of American power and even its civilization.

Detroit rose like a phoenix at the beginning of the 20th century and then experienced the near death of the American automobile industry at the start of the next one, culminating in the taxpayer-funded bailouts of General Motors and Chrysler during the Great Recession. Once the nation’s fourth largest city, the population has fallen from 1.8 million to less than 800,000 in 50 painful years.

Since the violent Detroit riots of 1967 that killed 43 and burned more than 1,000 buildings, the community has transformed into a nearly all-African-American city. Sadly, it now ranks as the country’s murder and arson capital. Multiple factors, well beyond Detroit’s control, spurred these changes. These include white flight and suburbanization, along with national racial politics and globalization.

From a public health perspective, there are not many major cities doing worse. Entire neighborhoods have been vacated. Burnt out shells of homes and businesses dot the urban landscape that now is turning to seed. Nearly half of the city’s children live in poverty. Once glorious buildings that were testament to the confidence in industrial capitalism, notably the ghostly Michigan Central Station, stand vacant as monuments to a past glory. They are our America’s modern-day Roman Colosseum, symbol of a dying or dead empire.

Detroit is also my home town, where some of my family have long roots as Michiganders. It is the place where my life story began, at the intersection of two stories of my adoptive and biological families, who all eventually fled or simply moved away.

To help others understand Detroit Motor City and why it matters, now more than ever, I have compiled some of my favorite links to resources, films, books, and online content that I have uncovered recently. Take a moment to learn more about this famous place that once was the world’s greatest industrial city.

Detroit, Enduring Icon of Decline and “Ruin Porn” CelebrityAndrew Moore Book Cover

  • Detroit Disassembled, photo book by photographer Andrew Moore (highly recommend)
  • The Ruins of Detroit, photo book by Yves Marchand and Romain Meffre (highly recommend)
  • James Griffioen, Detroit photographer of decay (recommend)
  • Five Factories and Ruins (web site)
  • Lost Detroit: Stories Behind the Motor City’s Majestic Ruins, by Dan Austin and Sean Doerr, provides historic and architectural background
  • American Ruins and The New American Ghetto, by Camilo José Vergara, depict dereliction and abandonment in cities like Detroit, Camden, N.J., and Chicago
  • Julia Reyes Taubman, socialite ruin photographer of Detroit and subject of some blowback for photographing decay while protected by a wall of money
  • Detroit 138 Square Miles, website that accompanies photographer Julia Reyes Taubman’s photo book
  • Beautiful Terrible Ruins, art historian Dora Apel examines ways Detroit has become the paradigmatic city of ruins, via images, disaster films and more and notes that the images fail to show actual drivers in the downward spiral, such as globalization, neoliberalism, and urban disinvestment
  • Diehard Detroit, a time lapse video of many of Detroit’s famed architectural ruins, abandoned factories and homes, monuments, buildings, and freeways, with absolutely no perspective on the meaning behind the mayheim, just titilating entertainment with great technique and a cool drone toy (it is stunning visually, and thus classic “ruin porn”)
  • Detroit’s Stunning Architectural Ruins, and Why Documenting Its Faded Glory Matters (an article by the Huffington Post, a liberal blog which exploits unpaid “contributors” more than Henry Ford ever did his factory workers)
  • Urban Ghost Media, photos of the much-photographed and now infamous Eastown Theater

Detroit and Media Coverage

Must-See Detroit Documentary Film: Burn

The great documentary about arson in Detroit and the men who fight it.

The great documentary about arson in Detroit and the men who fight it.

  • Burn, a documentary film by Tom Putman and Brenna Sanchez, tells a year-long story of the year in the life of Detroit firefighters, who battle uncontrolled arson against all odds (amazing filmmaking!!! … from the firefighters interviewed: “That is how you burn a city down. One at a time.”)
  • Interview with filmmakers Putnam and Sanchez on their documentary Burn (great read on scrappy filmmaking with a purpose)
  • The Making of Burn—so, you want to make a great film no one in power gives a crap about, but you have to do it anyway

Must-Read Books on Contemporary Detroit

Detroit, The Former Glory

Pro-Detroit Media Coverage and the “Re-Birth” Branding

Detroit, Industrial IconDiego Rivera Mural, at the DIA

Nice Photo Essays of Before and Now:

Detroit Stories and Research of Interest

Viktor Frankl and the simple secrets to living a meaningful life

Viktor Frankl Photo

This photo of Viktor Frankl was taken shortly after his liberation from the Nazis in 1945.

Renowned psychiatrist, philosopher, and writer Viktor Frankl stands as a giant among 20th century thinkers. The Austrian-born Frankl (b. 1905, d. 1997) was a psychiatrist whose life was transformed by his experiences as a Jewish prisoner who survived the Holocaust and internment at the Auschwitz death camp and three other German concentration camps.

With the exception of a sister, all of his immediate and extended family and his beloved wife were murdered by the Nazis. From the aftermath of this horrific experience, he embarked on a life’s work that provided deceptively simple but remarkably clear ideas that literally provide a framework on how all people can live meaningful lives.

Frankl survived his brutal internment, which should have killed him, by seeing a purpose in his ugly reality and by taking control of his responses to that experience with positive actions and a mental attitude that ensured his survival and also his outlook on life and his fellow man and woman. His simple ideas offer no shortcuts, and they uncomfortably place each person in control of how they choose to respond to life’s challenges, even ones as unforgiving as genocide and mass murder.

Frankl proposes all of us are motivated to seek a higher purpose, even when our circumstances are as cruel as a death camp surrounded by barbed wire and vicious men armed with machine guns. Frankl writes: “Man’s search for meaning is the primary motivation in his life not a ‘secondary rationalization’ of instinctual drives. This meaning is unique and specific in that it must and can be fulfilled by him alone… .” More than pleasure, more than material things, meaning motivates us all. It is our purpose for being.

Man’s Search for Meaning, a book that changed modern thinking

Cover Man's Search for Meaning

Viktor Frank’s seminal 1946 Holocaust memoir, Man’s Search for Meaning, has been translated into more than 20 languages, has sold more than 10 million copies, and is considered one of the most influential books among American book readers.

Frankl published those principles in his highly acclaimed and influential 1946 memoir, Man’s Search from Meaning, which today has been translated in more than 20 languages and has sold more than 10 million copies. It is considered among the most influential books in the United States, according to a Library of Congress survey.

He originally developed the framework for his sparse set of powerful ideas when he was practicing psychiatry in Vienna before the Nazi occupation and saw how he could help patients overcome their suffering by making them aware of their life’s calling. His treatise, stashed in his coat, was literally lost when he was imprisoned.

Later in his life, when he had achieved global recognition because of the widespread popularity of his bestseller, he was asked by a university student: “…so this is your meaning in life… to help others find meaning in theirs.” His reply was as clear and direct as the theory behind his therapy, “That was it, exactly. Those are the very words I had written.”

As one writer influenced by Frankl, Genrich Krasko, points out, Frankl’s ideas are more prescient today, given millions have no meaning in their lives, particularly in affluent societies: “Viktor Frankl did not consider himself a prophet. But how else but prophetic would one call Frankl’s greatest accomplishment: over 50 years ago he identified the societal sickness that already then was haunting the world, and now has become pandemic? This ‘sickness’ is the loss of meaning in people’s lives.”

Logotherapy, Frankl’s foundational theory

Frankl called his system logotherapy, derived from the Greek word “logos,” or “meaning.” It has been called existential analysis, which may over-simplify its scope. The philosophy and medical practice boils down to providing treatment through the search for meaning in one’s life. Its utterly basic but ultimately powerful foundational ideas are easily summarized:

  • Life has meaning in all circumstances, even terrible ones.
  • Our primary motivation in living is finding our meaning in life.
  • We find our meaning in what we do, what we experience, and in our actions we choose to take when faced with a situation of unchangeable suffering.

Frankl notes, “Most important is the third avenue to meaning in life: even the helpless victim of a hopeless situation facing a fate he cannot change, may rise above himself, may grow beyond himself, and by so doing change himself. He may turn a personal tragedy into triumph.” This latter point is particularly poignant, as it calls out the role that adversity can have in shaping us and our destinies and improving our character and our life’s narrative.

In short, no matter what circumstances we find ourselves, so long as we have a purpose, we can find fulfillment. What’s more, we are fulfilled by right action and by “doing,” not through short-term pleasure or narcissistic pursuits.

Frankl argues that meaning can be found in meaningful, loving relationships, in addition to finding it through purposeful work or deeds. In fact, it was the strong love of his first wife that kept him alive amid the unspeakable horrors of Auschwitz. He felt her presence in his heart and it literally let him live when others around him perished.

Frankl’s core ideas at odds with more ‘accepted’ health and mental health paradigms

Frankl’s ideas collide with behaviorist models, which show that conditioning will determine one’s responses—the proverbial Pavlovian dog or Skinnerian lab rat. By contrast, through his own experiences and those he observed treating depressed and suicidal patients before and after the war in Vienna, Frankl claims that “everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.”

When faced with a situation, we all chose. But our power is defined by our actions. “Between stimulus and response, there is a space,” he claims. “In that space is our power to choose our response. In our response lies our growth and our freedom.”

The concept of personal choice conflicts with extensive research that clearly documents how one’s environment, race, socioeconomic status, and more—the so-called social determinants of health (SDOHs)—shape one’s life more than one’s individualistic decisions.

A model explaining the social determinants of health.

A model explaining the social determinants of health.

Viktor Frank photo 1947

This photo of Viktor Frankl was taken two years after his liberation from the Nazis, when he returned to psychiatric practice to help people through his principles called logotherapy.

For two years, while earning my MPH at the University of Washington School of Public Health from 2010 to 2012, I found myself frequently and painfully at odds with current research and literally thousands of studies that proved to me that SDOHs will impact our lives in the most profound ways.

Yet I found the field and its most ardent practitioners lacking an explanation that showed the real power people have in controlling their personal outcomes. This is something that the public health field and my faculty sharply criticized by showing the medical model, which tells persons to control their health, has largely failed to promote wider population health metrics.

While I do embrace a “policy and systems” approach, I even more strongly believe that every person has the ability to make life-changing choices, every minute of every day—from the food they put in their mouth, to devices they watch daily, to the people they associate with, to the jobs they take or do not take (however awful often), to the way they manage their personal emotions. They have choices, and often they are cruel and brutally unfair choices, which often favor the privileged.

Frankl was famous for meeting with some patients, asking them to reflect on finding meaning in their lives over their entire life span, and providing the mental treatment they needed to take control of their lives without future interventions or drugs, which predominates the American model of mental health treatment. Some of his patients only required one session, and they could resolve to deal with life’s circumstances without any further intervention.

This is a radically and in fact dangerous model that challenges how the United States is grappling with mental illness nationally, though many practitioners use Frankl in their work. One psychiatrist I tweeted with wrote me back saying, “I’m far from the only one [using Frankl]! There’s a large humanistic community in the counselling/psychotherapy world.”

Frankl’s ideas continue to be studied, refuted, debated, and argued by learned and well-intentioned academics, which I think would amuse Frankl. He was more interested in the practical work of day-to-day living and less with becoming the subject of a cult following.

As one commentator I saw in a documentary who knew Frankl noted, Frankl was not interested in fame, otherwise he would be more famous today.

Paul Wong is one of many academics who have analyzed the ideas of logotherapy and mapped them in published work.

Paul Wong is one of many academics who have analyzed the ideas of logotherapy and mapped them in published work.

Here is just one example showing how theorists explain logotheraphy; see the table by Paul Wong on life fulfillment and having an ideal life.

Why Frankl’s thinking profoundly inspired me and thousands of others

For more than three decades, I have been wrestling with the concept of personal responsibility and the influence of our environment and systems that impact our destinies. Such factors include one’s family, country, religion, income, the ecosystem, our diet, and political and economic forces, among others.

I also have been fascinated by examples of people choosing hard paths in dire circumstances as the metaphor that defines successful individuals’ life narratives. In Frankl’s death camp reality, this ultimately boiled down to choosing to be good, and helping fellow prisoners, or choosing to partake in evil, which many prisoners did as brutal prisoner guards called kapos.

No one gets a free pass in this model, and all people of all groups, can be one or the other, Frankl says. “In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints,” writes Frankl. “Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions.”

I had not been able to order these two lines of thinking into a coherent set of principles, as Frankl so perfectly did. When I stumbled on him quite by accident or maybe design this summer, while reading books by Robert Greene and even management guru Stephen Covey, I had that most rewarding and delicious feeling of “aha.” It was more like, “Wow, what the hell was that!”

It felt like a thunderclap. I almost reeled from the sensation. I then began to tell every single person I know about Frankl, and I learned many of my colleagues had already read him. I felt robbed not one teacher or academic, at three respected universities I attended, had covered or even mentioned Frankl, when his ideas are foundational to our understanding of the fields of psychology, public health, business, organizational behavior, religion, and the humanities in the 21st century.

Frankl deserves vastly more attention then he is given by health, mental health, and social activist thinkers. That is a shame too, because as a speaker, Frankl brimmed with enthusiasm and could convey complex ideas in the simplest ways to reach his audience. Watch his presentation at the University of Toronto–a brilliant performance.

Frankl’s ideas matter to each of us, in everyday life

Photo courtesy of PBS, showing a pensive and thoughtful Viktor Frankl (http://www.pbs.org/wgbh/questionofgod/voices/frankl.html)

Photo courtesy of PBS, showing a pensive and thoughtful Viktor Frankl. Click on the photo for a link to the web site.

One my most satisfying feelings is discovering that one’s personal life experiences and ideas on issues as big as the meaning of life also resonate profoundly with millions of others—those who have read his work. Even more gratifying is discovering that the core principles to living life amid hard choices can be grounded in principles that can help everyone, even in the most dire of personal experiences.

My own travels in the developing world stand out for me. I met countless people facing vastly more painful, difficult, challenging lives than I have faced. Yet, the wonderful people I met had nothing but smiles and treated me with genuine sincerity. I had to ask myself, why is it that so many people are clearly content when their surroundings indicate they should be experiencing utter despair and even violent rage. Why is there kindness in their hearts and peace with their reality.

Photo of Coptic Youth, Egypt by Rudy Owens

These young men, all Copts, a persecuted minority, highlight for me the depth of goodness one finds in the world, even when many have no material foundation that suggests they should be happy.

I understood at all levels what I was experiencing. But Frankl’s framework ties this rich set of personal experiences to all of us, and to larger existential ideas of what we are meant to do with our time.

For Frankl, the answer is just doing what life needs us to do. As Frankl wrote nearly 70 years ago, “Life ultimately means taking responsibility to find the right answer to its problems and to fulfill the task which it constantly sets for each individual.”

With that point, I now must ask you, the reader, What are you doing with your life, and are you doing what you are being asked to do? You cannot escape this question, and if you avoid it, you will always have the pain and emptiness of not listening to your own calling. The choice of course is your own.

The enduring influence of Bernd and Hilla Becher

Photography is a highly personal artistic and communication medium. I have found that those who are successful in this arena achieve that status because their work is clearly recognizable. Success is never by accident, and the photographers I greatly admire remain consistently clear and compelling over time, and usually with great impact on others in the field.

Sebastião Salgado comes to mind for me in the field of visual storytelling with a clear vision. His impact can be seen widely in imitators and co-travellers. The same can be said with the husband-wife duo Bernd and Hilla Becher.

Lime kilns, by Hilda and Bernd Becher.

Lime kilns, by Hilla and Bernd Becher.

The German couple photographed industrial architecture in Europe and North America for nearly 40 productive years, until Bernd’s death in 2007. Their easily recognizable subjects include water towers, blast furnaces, gas tanks, timbered homes, and other industrial features.

The pair published books with their images, grouped together in what they called “typologies,” or sets of images of the same objects from different geographic locations, usually in sets of say nine or 21 images. Each image would be photographed identically, with direct frontal composition, no lens distortions, and with a neutral density skyline that did not distract the viewer from the subject.

These ordered collections had almost no captions and simply conveyed the form of the objects, letting the similarities of the objects communicate the meaning without any of the often absurd and blabbering arts-speak that is usually associated with art and photography commentary. (I imagine the Bechers would find such nonsensical writings absurd.)

Their books of photographs, such as Industrial Landscapes and Typologies of Industrial Buildings, compile their work into compelling sets of images. The influence of their aesthetic can be seen in numerous imitators and students, including this series I found recently on abandoned homes in Detroit.

Toward the end of his career, Bernd taught at the Kunstakademie in Dusseldorf, leading to a crop of photographers and a style of picture-taking that is is known as the “Dusseldorf School of Photography.” Bernd’s well-known and accomplished students include Thomas Ruff and Andres Gursky, one of the most celebrated photographers of the world who has sold the world’s most expensive photographic print.

Bernd and Hilda Becher, Blast Furnaces, at the St. Louis Art Museum.

Bernd and Hilla Becher, Blast Furnaces, at the St. Louis Art Museum.

I may have stumbled over the Bechers’ work without knowing it. However, I do recall feeling trapped in a hypnotic trance when I discovered a collection of their blast furnace images, or typology, in the new wing at the St. Louis Art Museum in December 2013.

I felt a deep kinship with their interest in industrical landscape, perhaps because I grew up in St. Louis and was surrounded by similar forms in a city the was dying as an industrial center during my years there. I also felt a connection because I sensed something profoundly post-World War II about their work.

Their work is distinctly German to me, and their images are imbued with the personal experiences of two people who were in their adolescence during the Nazis’ brutal reign in Germany, when the world turned upside down, where the Holocaust and slave labor on a mass scale were engineered, and where killing and death were woven into the DNA of every German as a result of the country’s destruction that followed the country’s efforts to conquer Europe and beyond. (Bernd was born in 1931 and Hilla in 1934.)

Like it or not, they were a product of that experience, and I can feel it having also traveled widely in Germany on several trips and having studied this period of history intensely.

What is strikingly odd to me is I do not believe I was influenced by either of them. Yet the way I chose to explore my photographic project documenting concentration and death camps in five European countries closely mirrored the style of the Bechers. Even the way I chose to layout my photographs of crematoria, where murdered prisoners bodies were burned, bears an eerily familiar resemblance to the Bechers’ amazing work.

I don’t know what more to make of this except to say that I feel satisfied that my presentation style and methods are not singular. I also feel that the effect of combining similar images of strikingly mundane but complex objects can have greater weight in the format of a typology.

With that heavy photographic pontification complete, I present a screen snapshot of my crematoria series on my web site, followed by two screen snapshots of the Bechers’ typologies that I found online and also captured as a screen snapshot.

Rudy Owens' series on crematoria at Nazi concentration and death camps in Europe.

Rudy Owens’ series on crematoria at Nazi concentration and death camps in Europe.

Bernd and Hilla Becher, Gas Tanks.

Bernd and Hilla Becher, Gas Tanks.

Screen snapshot of the Bechers' many typologies and series, taken from Google's "image" tool.

Screen snapshot of the Bechers’ many typologies and series, taken from Google’s “image” tool.

The crowded, congested, contested road: unsafe at nearly every speed

Seattle traffic

Seattle traffic is among the worst in the nation, and it can be downright deadly, according to those who track road-related fatalities.

Every day that I drive to work, I am literally putting my life on the line. I commute roughly 80 miles daily, round trip, from Seattle to Tacoma, navigating one of the most harrowing urban traffic corridors in the Untied States, on Interstate 5 and two state highways. (My story why I am commuting this way will be for another day, but there are good reasons.)

Routinely, erratic drivers dangerously pass me, putting our lives at risk, in order to gain a few extra minutes by speeding. I have seen many accidents, some fatal, on this route over the years, and I am glad that I have my will and living will in proper order in case a truck jack-knifes near me in the rain—and yes I’ve seen that happen twice before on the freeway system around Seattle.

Seattle Road Kill 2001-2009

How deadly are roads in the Puget Sound–take a look at the roadkill on this data map showing types of mortality by form of transportation for 2001-2009.

Judging by this map, we get a fair share of road kill in the metro area I call home.

The Centers for Disease Control and Prevention (CDC) put the number of road deaths annually in my home state at nearly 500 (2009). Nationally, in 2012, the United States reported that 34,080 people died in motor vehicle traffic crashes in 2012, a 5.3% jump over 2011. This ranks as 10th leading cause of death in the United States, if one pulls this form of death from all accidental deaths, in which it is grouped by the CDC epidemiologists.

So by all counts, getting in one’s car (or on one’s bike or in a bus or other form of transportation) and hitting the road can be deadly business in my country, especially given the proliferation of mobile-device users and drunk drivers.

In 2011, cell phone use in the good ole’ U.S.A. was a contributing factor in more than 3,300 deaths and for the previous year, in 387,000 motor vehicle injuries. These are very sobering numbers, and I actually expected there would be more given that I have seen far too many texters during peak travel times in vehicles moving 70 mph. Normally I move over a lane or lay on my horn to snap them out of it.

But this is nothing compared to the perils that passengers and drivers experience globally. According to the World Health Organization (WHO), road accidents claimed 1.2 million lives globally in 2011, ranking as the No. 10 cause of death, on a list that has some pretty nasty company, including respiratory infections (3.5 million), tuberculosis (1.3 million), and the big killer of children ages 0-5 years, diarrhea (2.5 million).

The Institute for Health Metrics produced this data table showing how road deaths globally compared to other causes of death (it's No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

The Institute for Health Metrics produced this data table showing how road injury globally compares to other burdens of disease (it is No. 10); go to: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-heatmap

A typical story that one sees with mind-numbing frequency overseas are bus collisions with motorcycles and motor scooters. This November 2012 story, 19-yr-olds crushed to death by bus, notes two aspiring young men were run over by an errant bus driver and dragged 40 feet in Chandigarh, India; the driver then fled the scene. Both of the men’s heads were crushed by the bus’s wheels.

I saw no less than three similar road maulings on the island of Java in 2009, when I visited Indonesia. That island, one of the most densely populated locations in the world, is overwhelmed with low-income and middle-income residents on  scooters competing for space with trucks and army of loosely and unregulated van taxis and buses.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation's infamously unsafe and crowded roads.

Indonesians who use these highly efficient and inexpensive 100-125cc motor scooters are frequently killed on the island nation’s infamously unsafe and crowded roads.

Road accidents alone in Indonesia account for more than 48,000 deaths annually, the 9th leading cause of death in the world’s largest Muslim nation.

The United States Department of State offers this stern warning to would-be American visitors to Indonesia–a country I really loved by the way: “Air, ferry, and road accidents resulting in fatalities, injuries, and significant damage are common. … While all forms of transportation are ostensibly regulated in Indonesia, oversight is spotty, equipment tends to be less well maintained than that operated in the United States, amenities do not typically meet Western standards, and rescue/emergency response is notably lacking.”

During my two-week visit in 2009 to the island nation, I rode about a dozen different buses and equally as many microbuses, not to mention the country’s crash-prone domestic air carriers once, their local train service (also unsafe at times), and the far less safe inter-island ferry services. I saw about a half dozen crashes from my bus window, most fatal and usually with motor cycle riders as victims, and from my hotel room I heard one multi-vehicle crash in the middle of the night that clearly claimed many lives. I learned the next day it was between a bus and truck. The bus was totaled.

Roads can really kill you overseas, and so can planes, boats, and trains too

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

Buses like these are cheap in Indonesia, but your life can be as some locals would say, insha-Allah, or at the mercy of God.

The writer Carl Hoffman, author of the book The Lunatic Express: Discovering the World… via Its Most Dangerous Buses, Boats, Trains, and Planes, documents the horrendous conditions of ferries, public transportation, trains, planes, and other forms of transport. The book’s online promotion notes that it offers a “harrowing and insightful look at the world as it is, a planet full of hundreds of millions of people, mostly poor, on the move and seeking their fortunes.”

Anyone who has travelled in developing or “middle-income” countries (like, say, Chile or Turkey) knows their life is literally in the hands of drivers who may have no proper training, in busses with no proper maintenance or even reliable brakes. Worse, the drivers of buses and microbuses in countries from Uganda to India to Mexico may trust their fate to Allah, Saint Christopher, the Virgin Mary, or Krishna. Those who have travelled in such places know this to be true, by the many religious deities dangling at the front of public transportation by the drivers’ seats.

Worse, the drivers will often play chicken with their competitors by speeding into oncoming traffic at high speeds while passing other vehicles or simply to “have fun.” I swear I thought I would die on many occasions in: Mexico, Guatemala, Nepal, Peru, Uganda, Indonesia, Egypt, Turkey, Chile, Argentina, India, and other places that I’d rather forget just now.

accident or more by Birn

When is an accident really an accident, or when it is linked to larger systems issues? This analysis is provided by Anne-Emmanuelle Birn in her description of the social determinants of health (SDOH).

Three separate times, after I lived through the near mishap, I swore I would never, ever take a bus again in a developing nation. Yet I threw caution to the wind, as I needed to get around, and I could not afford to get around any other way. Not seeing the country I was visiting was not an option.

Is it really  “just an accident” or something more?

Anne-Emmanuelle Birn, international health professor at the University of Toronto, and co-author of the widely used global health tome called Textbook of International Health, points out the deeper connections that road-related deaths have to poverty and social inequity in undeveloped and middle-income countries. Birn writes that road traffic accidents are the second-leading cause of death for children between 5 and 14 years of age globally, and that poor and working classes are disproportionately affected in most countries. In high- income countries, most of those killed are drivers and passengers, whereas in low- and middle-income countries pedestrians, cyclists, and public transport passengers make up nine out of every 10 road-related deaths.

In Haiti, for instance, the word for local transport is molue (“moving morgue”) and in southern Nigeria locals say danfo (“flying coffins”).

Duncan Green, an Oxfam policy adviser and development blogger, recently wrote an article asking when road traffic injuries would finally be recognized as a priority by the international development community.

In fact a major report released in June 2013 by the Overseas Development Institute, the United Kingdom’s leading development think tank, notes that transportation is not recognized as a human right like access to water, yet it still is a fundamental factor for many to achieve basic human rights. Well-run transportation systems, for people and for goods and services, promote benefits, while unsafe and weak transportation systems harm the most vulnerable citizens.

Given the debate emerging now for future sustainable development post-2015, the deadline set for the Millennium Development Goals, road safety may finally find a way into the broader public health, development, and environment agenda, as a way to tackle this clearly documented major global killer. Perhaps the threat may finally be treated as the international epidemic that is is, globally or closer to home in the United Sates. For me, this includes the roads in the Puget Sound where I spend more than two hours daily to and from my public health job.

Cheap energy poses a threat to Americans’ health

One of the most talked-about initiatives taking place in public health, with funding supports from the Centers for Disease Prevention and Control (CDC), is policy, system, and environmental change to address the rise of chronic disease in the United States, the country’s leading cause of death. According to the CDC, chronic diseases are responsible for seven out of 10 deaths of all Americans annually, and one half of all Americans have at least one chronic illness. Worse, three-quarter of the $2.5 trillion (yes trillion) dollars spent annually on health care in the United States goes to battling chronic diseases. The CDC’s grant funding is being disbursed to health departments to undertake a range of interventions. But none of these interventions is going after what some say is one of major sources for the rise of obesity and chronic disease—the cheap price of energy in the United States.

According to Ian Roberts of the London School of Hygiene and Tropical Medicine, the overall obesity rate is highest in the United States among all other nations because the price of gasoline is very low. “So where gasoline is really cheap, we over-consume it, it’s bad for the environment and actually because we should be using food energy for human movement – if we use gasoline for human movement, then we store the food energy and you know where we store it.” And there are other costs associated with being a fat nation, says Roberts. “So there’s obviously an increased demand on food supplies, but also there is an increased demand on everything. You know, bigger people need more energy to move them. Airplanes take more energy to get off the ground. It takes more of the shares that, you know, of the Earth’s resources to actually support all that extra weight.”

In the United States, the U.S. Energy Information Agency estimates we use 317 million BTUs per person a year. In this country, nearly half of all of our energy comes from petroleum and natural gas, and the country ranks seventh globally in terms of per capita energy use, trailing Canada and some smaller nations like Luxembourg and Trinidad and Tobago. However, the United States is  No. 2 (19% of global demand) in terms of global consumption of energy after China (20.3% of global demand), which just took the No. 1 slot.

Feeder pipelines gather crude oil produced at Prudhoe Bay, which is eventually shipped to the lower 48 for consumption on the West Coast.

A significant negative outcome can be seen in the widening waistlines of Americans. Charles Courtemanche of the Department of Economics at the University of North Carolina at Greensboro published a study in 2009  (A Silver Lining? The Connection Between Gasoline Prices and Obesity) that found increases in gas prices were associated with an uptick in walking or bicycling and public transportation use (and more people walking to bus and subway stops) and a drop in the how often people eat at restaurants, all impacting weight. Courtemanche estimates that:

– A $1 rise in the price of gasoline would reduce overweight and obesity by 7% and 10% in the U.S. The reduction in obesity would save approximately 11,000 lives and $11 billion per year, savings that would offset 10% of the increased expenditures on gasoline.

– An 8% of the recent rise in obesity from 1979 to 2004 can be attributed to the decline in real gasoline prices during the period.

According to Dr. Brian Schwartz, professor at the Johns Hopkins Bloomberg School of Public Health’s Department of Environmental Health Sciences and co-director of the School’s Program on Global Sustainability and Health, cheap energy also is responsible for creating our built environment, which is exacerbating our poor health trends. Schwartz argues that since World War II, the United States and other developed countries “have invested in large tracts of low density, non-compact, single use developments, which are highly reliant on the automobile and often lack public transit options.  This type of housing and transportation system is totally reliant on cheap and plentiful oil.”

The built environment of U.S. suburbs has been shaped by the relatively cheap price of petroleum paid by U.S. consumers at the pump.

Schwartz argues the average foodstuff in the United States requires about 10 units of fossil fuel-based energy input for each unit of food energy derived from the food, and that ratio jumps to 100 to 1 for many meats. Less energy would lead to declines in food calories too, as many kinds of food would become too expensive to produce and too expensive for consumers. What’s more, Schwartz suggest that this unsustainable suburban lifestyle would change dramatically after peak oil, that future and historic moment when global production of both oil and natural gas reaches its historic peak and begins to decline, setting off chain reactions impacting every facet of our life to what we eat, how we work, how goods and people move about, and how nations respond on a massive scale. (Go here for a summary of peak oil and its health impacts, as explained by Schwartz.)

Schwartz also notes that our entire health care delivery system, on top of our suburban-sprawl development pattern, food production systems, and supply chains, also is tied to unsustainably cheap energy in the form of cheap fossil fuel. “Large energy-inefficient health care facilities are staffed by health care workers living in distant suburbs who require large quantities of paper, plastic, and electronics to do their work. Systems for provision of care will need to be completely redesigned to adapt to the new reality of more expensive energy.”

Portland, Ore., that oh-so progressive Northwest city that has become a beacon of contemporary planning that tries to vaguely resemble what they do in Netherlands or Denmark, for instance, already has assembled a Peak Oil Task Force, back in 2006. The group prepared a report and drafted a resolution, passed by the City Council in 2007. That resolution sets out an ambitious goal to “reduce oil and natural gas use in Portland by 50 percent in 25 years and take related actions to implement recommendations of the Peak Oil Task Force.” It may be no surprise Portland was recently ranked the No. 1 biking community in the United States.

What continues to baffle me is how unengaged or willfully silent the United States’ professional public health system is to the connection between cheap energy and health, notably obesity. I just did a keyword search today (Sept. 3, 2012) on the word “obesity” for the upcoming American Public Health Association (APHA) Annual Meeting and Exposition to be held in San Francisco in October 2012. There were 797 hits for the word–many for papers being presented on the topic. When I typed in the word “oil” I yielded 33 hits, some on the Deep Horizon oil spill and its impacts and others on shale gas development, such as a paper being presented by Dr. Roxana Witter of the University of Colorado called “Comprehending health implications of natural gas development through public health research.” But I saw no papers on any linkage between the so-called “obesygenic environment” and energy prices tagged under the word “oil” in the searchable database of presentations and papers. I did a search for the word “energy” and got 82 hits, but most related to topics like high-energy drinks, not on oil, gas, or energy policy issues impacting human health.

Seattle like other cities is entirely dependent on relatively cheap petroleum, and as a consequence suffers from some of the worst traffic congestion of any metro area in the country, as well as a sprawl development in the city and throughout surrounding King County.

I dream of the day when public health professionals will organize their advocacy less around what kids eat at school and talk more about what our state and national lawmakers are doing to create meaningful tax policy that prices energy–making it more expensive while using revenues to promote renewable energy sources–to create larger downstream impacts. To completely cede this issue to supporters of cheap energy and the status quo and to deny that there are serious public health implications by doing so is to turn one’s back on best available evidence and the duties those in the field have to promote healthy outcomes for the U.S. population.  I did try to raise this issue in one of my classes at the University of Washington School of Public Health, and was met with unusual silence. I hope one day perhaps UW faculty in the economics department, school of business, and schools of public health and public affairs get together one day to pursue research examing negative health impacts of national energy policy.

Welcome to Kent: Washington state’s melting pot

First, scroll straight to the bottom to see the photos (I really like these) if you don’t want to read this long-winded introduction, but I think this background gives these photos context.

In February, I worked on a community health assessment project in Kent, Wash., one of the most diverse cities in the state, if not the United States. Located in South King County, the suburb community of 92,400 residents is a lot like other suburban cities that are now the melting pots for immigrants and recently arrived residents to the United States. During my visit to Kent a day ago, I saw Sikhs, Somalis, Latinos, Ukrainians, Burmese, a diverse mix of South Asians, Cambodians, Vietnamese, and more, and that was just at a local lake where I was photographing a swim race.

Today, more than 130 languages—from Afrikaans to Yoruba—are spoken in the Kent School District, the 4th largest in Washington State. Kent has become a prototypical “melting pot suburb.” Nationally, minorities now represent 35% of all U.S. suburban residents. And many new suburbanites come from abroad. According to a 2010 report by King County, a full fifth of King County residents identify as “foreign born,” and many are choosing to locate in South King County communities like Kent. Today, only 56 percent of residents are white, the rest all other minorities, the largest being Latinos/hispanics.

In terms of urban design, Kent is like many other exurb or suburb towns—entirely and slavishly devoted the internal-combustion engine. Decades of development in Kent have created pockets of  cul de sac streets and multifamily units, as well as a pattern of major thoroughfares 4-6 lanes wide, literally preventing people from moving safely across the street or getting out by foot or bike. It’s incredibly hostile to anyone who isn’t in a vehicle, and unsafe (lots of deadly crashes here). A prevalent design feature is the strip mall, which caters to the car. One is Benson Plaza, at a main intersection in the city’s East Hill on SE 104th Ave, which reflects the city’s true diversity. Punjab Sweets, owned by local leader Harpreet Gill, is de facto hub on East Hill for many south Asian residents and many other residents. Harpreet also helped launched Kent’s annual International Festival. If you visit Kent’s East Hill, be sure to stop in her shop and buy some Indian sweets. (They also serve dinner.)

The photographs were taken at Benson Plaza on Aug. 17, 2012. I’ve never eaten Indian pizza. I may have to go back and try one.

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