America faces two enormous domestic challenges– the cost of health care and the need for infrastructure improvement – which are seen as separate when they should be viewed as interrelated. Such a connection would enable the nation to save money and live in better health, while making both systems more sustainable.
The costs are extraordinary. According to the Congressional Budget Office, U.S. spending (public and private) on health care totaled $2.9 trillion in 2014. The infrastructure repair backlog is $4.6 trillion, according to the American Society of Civil Engineers (ASCE).
Yet we can anticipate even more dramatically rising health care costs if the epidemic of obesity and chronic diseases continues trending upward. About half of all adult Americans has one or more chronic health conditions, according to the CDC. Based on current trends, the Milken Institute projects that by 2023 chronic disease cases will increase by 42 percent, to 230 million, costing $4.2 trillion in treatment and lost economic output.
At the same time, our infrastructure system will have significantly more pressure placed on it as our population grows. The Census projects that the U.S. population will grow by nearly 100 million between 2014 and 2060.
All of this argues for a new approach–one that funds infrastructure improvements in order to enhance health, thereby reducing the cost of health care and freeing more funding for infrastructure. There are three categories where this could take place: systems, like water, that are vital to healthy living; pollution control systems that reduce disease; and improvements that enhance alternative modes of transportation and other forms of exercise.
But these are the very systems that are currently in jeopardy. America’s drinking water, for instance, received a D grade from the ASCE, yet nothing is more important to ensuring healthy living. As one example, industrial hubs–like those in Flint, Michigan and Knott County, Kentucky–have had well-documented instances of industrial runoff polluting their drinking water.
The American Water Works Association report, “Much of our drinking water infrastructure, the more than one million miles of pipes beneath our streets, is nearing the end of its useful life.” They estimate that restoring and expanding our existing water systems will cost at least $1 trillion over the next 25 years.
Along the same lines, America’s wastewater and hazardous waste systems both scored a D+ grade from the ASCE—and there’s no question that these too are absolutely critical to our health. Currently, 53% of Americans live within three miles of a hazardous waste site. Demand on wastewater treatment plants is expected to grow more than 23% by 2032, and an estimated $271 billion is needed to meet current and future demands. Just this past week, The New York Times cited an ongoing water crisis in Long Island, where Suffolk County’s issues perfectly illustrate why 610 sewage treatment plants in New York are operating past their useful lives.
The areas of infrastructure that may offer the most creative opportunities for improving health are roads, transit, and parks, and even these systems are failing. Public parks scored a D+, roads scored a D, and transit rated D-, the lowest single score in the entire ASCE report card.
Public parks offer respite from daily pressures but are also venues for exercise and rejuvenation. Transit is crucial to getting people out of cars, encouraging walking, and, of course, reducing pollution and congestion. Roads, when they contain sidewalks and bike lanes, also provide opportunities for increased exercise.
Our nation simply cannot afford to sit back and allow the costs of health care and infrastructure to continue ballooning without trying to reduce the pressures on both systems. We should create a vision to increase healthy living that starts with infrastructure improvements, and encourages Americans to utilize them to enhance their own health.
With better drinking water, less pollution, and more alternative transportation routes, we are preventing disease through the right infrastructure–a wise investment with a high return for all of us. It’s time to develop and advance that vision. It’s essential to controlling health care costs, and it won’t happen without infrastructure improvements being at its core.