Just Read: The Third Mode: Toward a Green Society, (how engineers impact our health as much as doctors)

When I walked around New York City with Jeff Olson, one of the pinciples of Alta + Planning (@altaplanning), famous for the bike sharing systems that are transforming city life, he mentioned that those of us interested in designing environments to promote physical activity should read his book. So I did.

I had no or a limited idea that

  • While I was learning about gram negative bacteria with pathologists, Jeff was working on producing health through sustainable mobility, far before it was fashionable
  • Engineers can impact our health as much if not more than doctors can in society
  • As in health care, there are amazing paradoxes that produce outcomes fit for the systems that create them, but not for the people served by them 

The book is a great primer for someone like me, or someone like you, who is peering into the world of transportation from another industry. While it might be assumed that transportation leaders, engineers, and advocates are all working in concert to support people in sharing streets and getting where they want to go efficiently, that’s really an assumption. This is where “third mode” comes from, which is about a new paradigm where transportation is more than “vehicles” and “mass transit”, and the two are not competing. As Jeff says in the book, we only need to bike or walk 10 percent of the time to make a significant impact in society.

As usual, I see tons of parallels to health care. We have something similar in the “primary care” and “specialty care” realm, and like Jeff, I don’t see these things at odds. I work in a multispecialty medical group, where collaboration is in our DNA – for us it’s just “health.”

This is what our patients expect of us. The same can be said for the transportation industry; we the people expect full collaboration in support of our safety and ability to move in the most efficient, healthy way possible, and yet…

The Manual of Uniform Traffic Control Devices (MUTCD) signage and pavement marking committees don’t meet together – which explains why a pavement marking for bicyclists can show a person on a bicycle, but the signs included in the MUTCD just show a bicycle without a rider. After a decade of requests, the MUTCD national committee still has not developed a guideline for bicycle traffic signals.

And sure enough, on a recent bike ride through our nation’s capital, the paradox is now visible. I also grabbed images from the MUTCD itself to verify that this is the case. At the same time, the National Association of City Transportation Officials (NACTO) created its own Urban Bikeway Design Guide which is now being used, screenshot also below, click any to enlarge. As Jeff states:

The American Association of State Highway Transportation Officials (AASHTO) produces the “Green Book” that is considered the Bible of the transportation infrastructure profession. The Federal Highway Administration is responsible for the Manual of Uniform Traffic Control Devices (MUTCD), which regulates signage and pavement markings. Since neither document contained a wide variety of the innovative bikeway treatments being developed in cities, NACTO decided to create its own guidelines.

Does this ever happen in medicine? Maybe 🙂

Is safe movement a human right?

More parallels to health care. We speak of patient safety as something that should be assured in our health system, and assume the most basic measures are taken at all times. And yet,

It is common to hear people say that somebody was “hit by a car” when what they really mean is that somebody was “hit by a driver with a car.” We say that there was an “accident” when a “crash” or “collision” is what has occurred. A “closed street” is actually a street that has been “opened” to people. The “design vehicle” that engineers frequently use for streets is usually a huge tractor trailer truck, when in urban areas the design vehicle should be a grandparent pushing a child in a stroller. Imagine the difference if your street was designed by somebody whose highest priority wasn’t moving big motor vehicles through your community, but instead was focused on ensuring that parents and children can move safely.

Third Mode solutions

Throughout, Jeff talks about solutions that allow organizations and people to coexist, for the health of communities. The narrative is told through the lens of the significant projects he’s engaged in over the past 20+ years. It’s all very impressive to me, and makes me feel even more humble to have spent time with Jeff as one of his team’s shining achievements played itself out in front of our eyes in New York City. And yet, the book only discusses bike share systems in passing – I’m hopeful there will be a book about those in the future :).

Doctors believe in third-mode thinking, too.

A story – I recently facilitated a panel on livable communities at the National Building Museum (see the video: Livable Communities: Healthy Neighborhoods). When we asked if there were any physicians in the audience, an individual raised his hand. He is a neurologist. When I asked what a neurologist was doing at an event on livable communities, he said he was with us because he was caring for a patient with a traumatic brain injury, suffered in an intersection with known safety issues. It’s quite possible that in another venue, advocates for our specialties (mine is family medicine) might be worrying about which branch of the profession deserved greater reimbursement. And yet, here, we were both concerned with the health of the people we serve. It’s what our community believes we’re focusing on, and we can do it, in collaboration.

Jeff was kind enough to quote me in his blog at TheThirdMode.com – I’m the “participant from a major health care provider that he refers to. I am doing the same here. As he mentioned in his blog post about my blog post, A Walk Through New York – Designed to Move – is this our 1968 moment in creating active cities? | Ted Eytan, MD, I think this is our 1968 moment. Active transportation is back, and it’s not just doctors focused on health anymore. Finally.

Transportation Techies meetup in 2014

Speaking of thinking third-mode, technology and the built environment are not at odds. The Center for Total Health is hosting the March, 2014, meetup for “Transportation Techies,” which will focus on transportation and health, in collaboration with nationally awesome Mobility Lab, in Arlington, Virginia. That’s mobility as in movement.


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