Let’s commit infrastructure funding to help older Americans lead healthier lives

According to the Centers for Disease Control and Prevention (CDC), 83 percent of U.S. adults over 65 did not meet the minimum standards of physical activity to stay healthy and decrease the risk of premature death from chronic disease. In response, the Office of Disease Prevention and Health Promotion has set a goal of decreasing this to 70 percent of adults over the next 20 years, but that still leaves almost 40 million older Americans at risk. 

Given the potential for devastating health and financial ramifications from physical inactivity — one estimate published in The Lancet put the cost at $24 billion annually — it’s time for federal, state and local governments to increase opportunities and access to physical activity for all adults. That could result in billions of dollars in cost savings and, more importantly, healthier lives. 

In October, after four years of work by a multidisciplinary coalition of researchers engaged with 85 United Nations member states, the World Health Organization provided a road map for how communities can improve physical health for older adults on a large scale. 

The first order of business is for governments and other health-minded organizations to improve the messaging. Both the federal government and for-profit entities already broadcast advertisements encouraging the public to be active and make the right choices for good health, showing images of perky, smiling people running and biking and sharing yoga classes on tree-lined streets, in beautiful green spaces and flashy gyms and spas. In reality, however, most people do not have access to such environments. 

A sizable number of Americans live in distressed neighborhoods and do not have green spaces, gyms, or exercise classes. Physical environments for many people have uneven sidewalks, dark streets, and walkways that may require navigating stairs to access. Messaging about physical activity geared to people in these communities needs to include information about safe, accessible locations for exercise where they actually live.   

The next step is to create environments for healthy behaviors that are free from emotional barriers such as fear and worry. Garbage-strewn streets and other poorly maintained public spaces discourage physical activity. Large, ongoing studies that examine the physical environments of older adults, such as the Alameda County Study (initiated in 1965) and the Health and Retirement Study (begun in 1992),  have found that people who live in areas with vandalism, graffiti, poor lighting and other neighborhood problems are at higher risk of falling and have reduced walking ability. People living in poor, urban communities are much more likely to encounter these deterrents, rendering them less able to get the physical activity they need.

Age-friendly planning and infrastructure support can make neighborhoods more conducive to physical activity, but money for these projects is not evenly distributed across communities. Now that Congress has passed the massive Infrastructure Investment and Jobs Act, which provides funding for street grids and parks, local and state legislators soon will decide how to spend the money. Creating safe, barrier-free spaces for older adults to exercise should be an imperative. Actualizing the CDC’s goals for adults — moving 15 million inactive Americans to doing some moderate-intensity activity every day, such as brisk walking, and helping 10 million moderately-active adults meet minimum guidelines — can improve the quality of life for a huge swath of our population and possibly save billions of dollars in health care by preventing the negative effects of chronic problems such as obesity, diabetes and heart disease.

A third major step we can take to increase physical activity among older adults is to fund community-based campaigns and programs.

Since 1972, the federal government has operated the Congregate Meal Program to provide meals to low-income adults. The program enables county-supported senior centers to provide meals, transportation, social activity, and medical and nutrition screenings to thousands of people.

Miami-Dade County, where I work, the seventh-most-populous county in the U.S., serves congregate meals at 19 sites across its 2,400 square miles. One county-funded site near the center of the city sponsors a wide range of daily classes including Zumba, yoga and aerobics in a bright, spacious room. Seniors have access to an adjacent park with paved walking paths, public transit and free parking. Just two miles away, in Little Haiti, residents who want to exercise have access to two county-run centers, but these sites are equipped only with outdated, hand-me-down exercise equipment in a cramped room, and there is no regular exercise programming or safe outdoor physical activity. Although these senior centers are located in adjacent neighborhoods with similar median household incomes, the opportunities for exercise are not the same.

Because the meal programs have successfully improved nutrition and social engagement, it would make sense to fund exercise programs at these places where older adults are gathered. In 2021, the federal government allocated $70 million for health promotion and prevention programs — less than 4 percent of the $1.9 billion it allocated to nutrition services in the same year. Even a small boost in funding to support physical exercise could have a dramatic impact on keeping older adults healthy. 

Being physically active is, to some extent, a choice that people make. But we need to make sure that everyone has safe, healthy and accessible choices. By committing dollars, spaces and people to facilitate physical activity and exercise programs, public and private institutions potentially could save billions of dollars in medical care and enable millions of Americans to live healthier lives.

Neva Kirk-Sanchez is an associate professor and chair of the Department of Physical Therapy at the University of Miami Miller School of Medicine. She is a Public Voices Fellow of The OpEd Project.