Nov. 21, 2005

Livable communities and health

Notes: Executive Sims spoke in San Francisco Nov. 19, 2005 to the National Association of Counties meeting on how land use decisions can create healthy communities and curtail the rise in obesity, diabetes and other illnesses. More than 100 government leaders from across the nation meet for the Health, Human Services and Workforce Conference "Generations in Transition."

Good morning county officials!

First, I would like to thank the NACo Center for Sustainable Development and the Robert Wood Johnson Foundation's Active Living Leadership Program for sponsoring this session and inviting me to come speak to you on one of my great passions – creating healthier communities.

I am feeling particularly good today to be with my fellow county officials just two weeks ago I was reelected to my third term as King County Executive. And, why a third term?

Because, counties are where the action is if you want to ensure your region's ability to impact or protect your economy, your environment and your residents' quality of life. Many of us oversee the public activities critical to these outcomes -- roads and transit, public health, trails, parks and open space, criminal justice and public safety, to name a few. We provide many of the essential services our businesses and residents count on in their daily lives.

We in county offices see the connections between these activities and a greater outcome for our residents -- a better, healthier and more satisfying life.

Introducing the puzzle

I want to talk to you about three separate and seemingly intractable problems confronting us today. Each of these problems is often talked about in isolation. But recently I have come to view them as three pieces of a much larger puzzle.

A puzzle that if properly solved will dramatically improve our health and raise the quality of life for all of us.

To all of you in this room who are charged with managing the common wealth for the common good, solving this puzzle should be a top priority.

The three pieces to the puzzle are well known. They are:

• Global warming
• the health care crisis
• and sprawl

King County

I'll get to the subject of how we might solve this puzzle in a minute. But first, we need some context. And since my context is the Pacific Northwest, I want to tell you about my home.
Contrary to popular belief, where I live is not all about coffee and software.

King County is astoundingly beautiful. It's a place where the importance of environment and quality of life run strong. In roughly two thousand square miles of county (nearly twice as large as the average county in the United States) we have:

• 1.8 million people (the 13th most populous county in the nation)
• A number of major businesses like Microsoft, Starbuck's, Amazon, and Nordstrom,
• 2 major international airports, SeaTac International Airport and King County International Airport
• 4 major river systems
• 100 miles of marine coastland
• 1,000 square miles of forestland
• We can boast 80 live music clubs, 16 symphony orchestras, and 18 major museums
• And finally we are home to the Mariners, Supersonics, and our first place superbowl contender Seahawks

We are home to Seattle, the largest city in the region. We are home to a sweeping suburban crescent; including 38 incorporated suburban cities and an unincorporated population of over 218,000. But King County is also rural. We have thousands of farms, vast open spaces and we are the seventh largest timber producing county in the state.

Our environment is rich and diverse and our strong conservation ethic is a reflection of our love for the landscape.

But, we are fighting hard to preserve our natural resources and the fabulous quality of life that is intimately connected to that landscape. Just last week the federal government declared Puget Sound orcas "endangered," since they were evaluated as the most contaminated whales in the world. Our salmon runs are threatened by pollution and habitat degradation. And while ten years ago you could see our Rainier mountain clearly on a warm summer day, today the brown haze of smog too often obscures the view.

Gloabl Warming

This brings me to the first piece of the healthy communities puzzle—Global Warming.

Last month, I played host to a major conference on global warming. There I was reminded of some shocking facts. I learned that, as a result of global warming, my Pacific Northwest is experiencing the most rapid increase in average temperatures – in the world. You heard me right, I said "The World."

I was reminded that - by 2050 - the snow pack that feeds our rivers, streams and watersheds will be half of what it is today. I was reminded that there will be a marked increase in coastal erosion. I was reminded that global warming will profoundly affect our environment and the people who live in it. Mother Nature has given us clear signs that she is sick and we need to "literally" clean up our act to get her healthy.

As you may know, international climate negotiations are about to commence in Montreal, Canada. The Kyoto Protocol is now in effect and countries will be negotiating over the next round of greenhouse gas reductions. U.S. States and cities have stepped up to the challenge and made declarations to reduce emissions to Kyoto levels and beyond.

My friend and Seattle Mayor Greg Nickels has led the charge on climate change for cities. And here in California, Governor Schwarzenegger has the led the charge for states. Counties are next. We cannot avoid this challenge and we must step up to the plate.

Over the next few months, I will be exploring what this challenge means for King County and other counties. The challenge is not simply to reduce our own emissions as corporate governments, but to reduce total emissions within our geographic boundaries. I encourage all of you to consider Kyoto-type goals for your counties. Perhaps we can secure time at our next conference to explore this in more detail.

Health

The second piece to this puzzle is improvement of our collective and individual health. As the leader of a $3.4 billion dollar government with 13,000 employees, I knew the growing cost of health care is a problem that cannot be ignored. Facing projections that the health care costs of King County as an employer would double in less than seven years, I launched the King County Health Reform Initiative— an innovative internal program designed to focus on reducing costs and improving health care quality by helping employees make better and more informed health care decisions.
Understanding that the problems associated with growing health care costs are much bigger than any one organization, I also led the formation of the Puget Sound Health Alliance: a public-private partnership with purchasers, insurers, health care providers and health care professionals.

I am proud to report that as of today, the Alliance is made up of nearly 75 member organizations covering more than 730,000 individuals. These members are committed to a partnership in managing health, making health care decisions based on what has been proven to work and slowing the rate of increase in health care costs. Among the first to join the Alliance were the State of Washington, Washington Mutual, Starbucks and Group Health Cooperative. Each member of the Alliance is determined to help build collective market power and financial resources so that we can make our health care system safer, less costly and more accessible. Now, via King County's internal "demand-side initiative" combined with this work of the "supply-side" strategies of the Alliance, King County is helping to build the foundation of a innovative, world class health care system.

Through this work, I learned that obesity rates – especially among young people - are up. Way up. I learned that chronic conditions such as diabetes are also on the rise. I learned that the cost of providing health care in the United States is higher than what other industrialized nations pay per person, and that costs are accelerating far faster than inflation.

Unfortunately, I also learned that reforming the health care system, as critical as that work is, is not the only necessary step toward improvement of our health. In fact, as I will discuss in a minute, good health has even more to do with a healthy environment and a healthy lifestyle than it does with an efficient health care system.

Sprawl

The final piece of this puzzle is how we use our land.

As many of you know, poorly planned development can lead to uncontrolled outward expansion and can create severe economic disparities between localities.

Moreover, Sprawl results in the inefficient use of our limited public dollars—and our precious time-- consuming vast areas of farmland and other critical resources, while forcing us to spend more time in our cars.

Time spent in our cars means we spend less time with our families. Time spent in cars also means less time for recreational activities such as neighborhood walks or bike rides.

King County faced this problem of sprawl early on.

Ten years ago, over 15% of all growth in King County was going into the rural area.

Today, I am proud to say that growth in the rural area accounts for less than 5% of overall growth in the county.

Unfortunately, however, the story does not end there. Despite our concerted improvement, we have learned an important lesson about fighting the long term battle against sprawl. Our lesson learned is that sprawl can only be contained if our urban areas are comfortable, safe and attractive places to live. Otherwise, there is no urban boundary strong enough to contain the constant push for more and more land.

Solving the puzzle

So there you have it: global warming… the health care crisis… and sprawl. Three seemingly disparate challenges - each one a critical piece of a puzzle that if properly solved will dramatically improve our health and quality of life.

So how do we solve this puzzle?

We connect the pieces.

Last month we released a report titled the "King County Land Use Transportation, Air Quality and Health Study" -- LUTAQH for short.

This study examines in depth the factors influencing the livability of our communities. The study was the first of its kind for a local government. It shows that land use policies enabling sprawl also encourage more congested traffic, dirtier air, fewer pedestrian amenities and, as a result, unhealthier people.

Copies of the LUTAQH executive summary were handed out today. It is built on a solid and growing body of evidence. It represents a policy mandate for the next 95 years of this century.

Take a look at the findings relating to air quality. LUTAQH shows that combining good pedestrian and public transportation connectivity with a mix of land reduces vehicle emissions per capita. Lower emissions make for healthier communities and reduced greenhouse gases.

The study also finds that increasing the kinds of transportation options in a community - everything from bike lanes to rapid transit - means many fewer miles driven in automobiles; up to 26 percent fewer miles driven per person in the most connected areas. The more alternative modes of transportation, such as rapid transit -- the more walk-able an area, and the higher level of physical fitness in a community.

The LUTAQH study thus brings an important body of evidence to bear on our policymaking as we all work to support healthier living, thereby reducing the burgeoning costs of health care.

Indeed, LUTAQH complements our efforts in the area of health care reform – including our groundbreaking Healthy Incentives program at King County - and our regional effort encompassed by the newly formed Puget Sound Health Alliance.

Ultimately, the LUTAQH report is a tool that we at King County are using to build stronger, healthier and more prosperous communities.

The study lends support to our regional commitment in the Pacific Northwest to build the nation's finest network of bicycle and pedestrian trails: trails that increase connectivity and improve health.

Institutionally, the LUTAQH Study also demonstrates with hard data that breaking down disciplinary barriers -- that hinder comprehensive solutions -- must be a paramount concern for civic leaders everywhere. We need methods to encourage interdisciplinary cooperation; methods of sharing knowledge and getting to the creative answers.

In short, LUTAQH underlines the importance of experts and policymakers working together to connect the pieces of our "Quality of Life" puzzle.

It outlines our job as civic leaders in this dynamic, challenging new century: to convene experts of extremely different disciplines and mindsets to the same table, to examine difficult issues, and inform good public policy.

So I say to you: let us as county leaders take up this charge. Let us get the best people we have in our governments; let us seek out the best people we don't have - from the private and non profit sectors and academic institutions. Let us bring them together and challenge them to meet problems in a team environment with the goal of covering all the bases in solving the great challenges of our time.
The physicist and visionary Freeman Dyson once said that "there is a great satisfaction in building good tools for other people to use." I couldn't agree more.

The approaches that we have employed to build community and protect our environment and natural resources are universally useful. The individual incentive programs, partnerships and other tools we employ can apply to everyone, everywhere.

I believe that success on our civic assignments -- big or small -- requires that we as regional leaders see beyond the conventional wisdom of any given problem -- and look for the connections that link our major challenges. In doing so, we can begin to find comprehensive solutions.

After nine years as leader of one of the most innovative organizations in one of the most dynamic regions in the country, my experience tells me that – with this type of comprehensive approach to improving the quality of life for all our people, there is nothing we can't accomplish.

Thank you for asking me to speak with you today.