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Kai Ryssdal: If it's anything right now, the health care story is one that's got about a million different angles to it. Earlier we talked about how insurance companies are adapting to the new rules. Now a story about how places are changing. There's $15 billion in the health care bill to pay for healthier communities. To lower health care costs and fight disease by creating places to live that are better for you.
If you grew up in the South Bronx in New York City, your chances of being overweight or having diabetes or being hospitalized for heart disease are frighteningly high. From the Marketplace Health Desk at WHYY, Gregory Warner took a walk around town to see what changing that might take.
GREGORY WARNER: When he was 25 years old, Javier Lopez had a revelation. Growing up in the Bronx he'd played basketball as a kid, but...
JAVIER LOPEZ: Once you hit a certain age, you know, basketball stops. Mom stops taking you to the little gymnasium right there, and then the destination points are either the corner store bodega, or maybe, going to a fast food restaurant.
Javier started gaining weight. A lot of it. He was on track to getting heart disease and early diabetes like his dad.
LOPEZ: My cholesterol went really extremely high. And my doctor had told me you have to start taking better care of yourself.
And he did. Last week he ran his first half marathon. Now 29, Javier directs the New York City Strategic Alliance for Health. The Alliance sends federal funds to local pilot programs to fight obesity in Harlem and the South Bronx, like a plan to close residential streets for a couple of Saturdays so kids can bike and play outside.
The new health care reform law includes $15 billion of prevention money over the next 10 years to help pay for local infrastructure projects to make it easier to be healthy. Things like bike paths, playgrounds, new sidewalks and street lights.
Because it's hard to get people to be active when just walking to a park means crossing several busy intersections.
LOPEZ: This is chaos right here.
SHIN-PEI TSAY: Well this is an expressway going through a residential neighborhood.
That voice you hear belongs to Shin-pei Tsay, an urban planner and deputy director of Transportation Alternatives. We're on the corner of Willis Avenue and 135th Street. The plan is for the three of us to try to walk from here in the Bronx to the ball fields on Randall's Island, a mile away.
TSAY: If you were a kid in the housing project, and you heard about new ball fields on Randall's Island, wouldn't you want to try to get over there?
Randall's Island is an oasis of green in the middle of the East River surrounded by Manhattan, Queens and the Bronx. The whole thing is owned by the New York Parks Department. It's got baseball fields, bike trails, tennis courts, even a golf course.
TSAY: We go over? Or is it that way?
LOPEZ: It's that way.
I follow Javier and Shin-pei for seven deserted blocks, on broken sidewalks, no sidewalks, past auto bodyshops and the backs of warehouses with names like the Industrial Environmental Pollution Controls Corporation.
LOPEZ: This is it, this is the fun part!
WARNER: What is the fun part?
LOPEZ: Well, uh...
TSAY: We're going to go on the highway, basically. We're going to be a pedestrian on the highway.
We climb up a concrete ramp and onto the Triborough Bridge. Actually it's a little walkway on the edge of the bridge. Steel girders separate us from the eight lanes of cars. We walk with the Bronx Kill river below us.
Finally, the green fields of Randall's Island come into view.
LOPEZ: If folks could see this right now, there are like six fields to our left that are totally unoccupied. And how many kids did we just see, bouncing a ball, shooting hoops, playing double dutch. What do we need to do to get you out here? Because this is all yours. This is yours for the taking. It's convincing them that that's the case, that's going to be the challenge that we have.
The challenge of making Randall's Island a part of peoples' lives is going to take more than building a safer way to get there. Behavior needs to change, too. And so, some of the funds in the health care bill will pay for programs that get people moving because all the walking paths in the world aren't going to force people off the couch.
LOPEZ: Because sometimes I think we put the excuses in their mouths, and saying, it's not safe, it's not this, it's not that, but sometimes it could be as simple as: I just don't want to go.
That attitude is hard for any public health program to overcome.
LOPEZ: Let's say we're doing a biking program in East Harlem. And all the adults get a coupon to Pathmark. Right? The biking program runs through the summer, it ends, coupons end, the next summer, people don't come out! The first thing they ask you is where are the coupons? We can't do that no more.
Walking around the island this afternoon, it's pretty empty. There's a guy blasting music from his car, a girl's softball team warming up, a dad teaching his daughter how to ride a bike.
LOPEZ: We're not trying to tell people how to be parents or how to live their lives. We're just trying to make it as easy as possible to be healthy.
Because ultimately, Javier believes in his own transformation. And in others' ability to do the same.
In New York, I'm Gregory Warner for Marketplace.