November 1, 2019
By Ana V. Diez Roux, MD, PhD, MPH
As I write this, I am travelling through the outskirts of Bogotá on my way to the city of Paipa about 180 kilometers away. I sit in the back seat of a small van, my computer on my lap. Around us cars, motorbikes, and small buses weave in and out. We drive by a jumble of low brick houses, more modern tall buildings, car dealerships and small businesses including several fast food and discount stores. Up ahead there is an American style mall. We could be in any Latin American city, except that in the distance I see the hills that surround Bogotá.
The traffic is chaotic, as it is in many cities across the world. But if I look carefully, I see around me a few signs of valiant attempts to wean ourselves off our dangerous and pervasive reliance on the automobile. On my left, as we swerve onto a new avenue, I see the Transmilenio, a bus rapid transit system pioneered in Colombia nearly 20 years ago and now extended to many other parts of the world. It is horribly packed, and long lines await the next bus at some of the elevated platform stops, but it zooms by much faster than the traffic I sit in.
Beyond the Transmilenio, I also see a bike lane with cyclists zipping back and forth. Colombia is known for its passion for cycling. City leaders have pioneered the growth of bike lanes in the region and have promoted cycling through the Ciclovias program. There is a also a very active cycling advocacy community. In 2019, Egan Bernal became the first Latin American to win the famous Tour de France cycling race. The Transmilenio, and the cyclists pass us as we continue to sit in four lanes of bumper to bumper traffic, a sea of cars that moves more and more slowly and eventually grinds to a halt, then starts up again, and so on.
I am travelling to Paipa to attend a meeting of Latin American mayors convened as part of an initiative entitled “Latin American Mayors for Healthy Municipalities, Cities and Communities” supported by the Panamerican Health Organization and hosted this year by the Municipality of Paipa. The goal of the meeting is to discuss intersectoral approaches to promoting health in cities of the region.
I will speak to the mayors (men and women!) about the role that academic institutions can play in promoting health in their cities, about the role of research in proposing and supporting policies, about how we can learn from partnering to evaluate policies. I will also speak to them about how policies that are good for health also protect the environment and about how policies that protect the environment also promote health. I will highlight the critical role of equity. Many of these things, if not all, the mayors will already know well.
Knowledge and evidence can help, but the challenges the mayors face in making change a reality are enormous. The challenges are largely political and economic in nature, they have to do with the systems in which cities are embedded. How can we make the irrationality of some of the systems we have created for ourselves visible? What are the avenues for triggering the movements that will bring change? As the Mayor of Paipa later said to me “We know what to do. The challenge is how to do it.”
I am convinced that science can help, but I also know that it is far from enough. This is something public health has long recognized, sitting as we do at the intersection of science and action. It is something our Dornsife School of Public Heath, grounded as it is in our own city, Philadelphia, and committed to practice, policy and civic engagement, strives to address through partnerships and advocacy.
Now I sit in pure gridlock, six lanes of traffic all but stopped (yes, two more lanes have now been added!), inching forward, lines of motorcyclists in black helmets zig zagging through any crevices they find. A throng of pedestrians crosses the highway above us in a shiny overhead pass. It is a beautiful day and the mountains around Bogota still gleam in the distance.
I am reminded of a wonderful short story by Julio Cortazar called “La Autopista del Sur” where commuters stuck in traffic for days on end develop relationships and lives that link them to those in other vehicles close to them. Life takes over and the gridlock becomes their life (you can read it here!). But suddenly, as in the story, we move, things shift, life changes. The multiple lanes and traffic fall away, and we are suddenly travelling down an almost empty street surrounded by pastures and rolling green hills. There is still hope. And it appears I may get to Paipa in time after all...