The Way America Is Designed Makes You Sick

About 15 years ago, I was living in the U.S. and noticed my body was changing for the worse. I was commuting 60 - 80 minutes every day by car. And by the end of the day, I was barely able to keep my eyes open. I definitely couldn’t bring myself to exercise, so it wasn’t long before I looked down for the first time in my life and felt something, let’s say, a little squishier above the belt.

This is how it happens. This is how an otherwise healthy 20-something can blink and find themselves dealing with an array of weight and health issues by the time they hit their late 30s and early 40s.

But it’s not their fault this is happening. They’re doing the best they can in a poorly designed system. Because this country simply isn’t designed to keep you healthy and active, like I’ve found in Europe during my 10 years of living year and traveling across the continent.

Europe, I’ve found, is designed to keep you moving. America is designed to make you sick.

My name is Joe Baur, an American-German immigrant from Cleveland, Ohio. And I’m going to show you how the way much of the United States is designed is making us sick—and what the U.S. can learn from the other side of the pond.

Not Enough Steps

I grew up in what I now know to be a pretty typical American suburb where everyone drove a car to do anything and walking was a rarity outside of the mall and… Well, that’s about it. In fact, I made a video linked above about how growing up in such a car-oriented area radicalized me to loathe cars and pushed me to live someplace where I’d never need a car to do anything. Ipso facto, I live in Berlin now.

But not everyone can move their lives overseas or even to a more walkable American city, for that matter. I know this because I get comments from people complaining that they feel stuck where they live. And to be fair, no body should have to uproot their lives to, you know, be able to go for a walk that actually leads somewhere.

Out of curiosity, I did some digging to paint a picture of where the average American lives. Interestingly, there’s no clear data that says X% live in a suburb, X% in a city, and X% in a rural area. That’s partly because there is no federal definition of what makes up a suburban area. Researchers mostly rely on how people describe where they live.

And by that measure, 52% of Americans describe their neighborhood as suburban based on the latest data. 27% say urban and 21% say rural. So it’s safe to say that the average American is a suburbanite living in single-family homes connected by roads that lead to a mix of retail centers and low-rise office buildings. I think it’s fair to say that all of those suburbanites and their rural counterparts rely on using a car to get around all or a majority of the time. It’ll surprise precisely no one that nearly 92% of Americans own at least one vehicle. (It’s about 77% in Germany, considered a car country by European standards, but as you’ll see, Americans use their cars far more often.)

I was one of the weirdos who didn’t own a car the last time I lived in the States, which is the closest to the 1% I’ll ever be.

To be clear, I don’t blame Americans for owning a car. I’ll sometimes get defensive comments from folks explaining all the reasons why they need a car. I get it, man. I lived there. I know the pressure—whether it’s familial, social, or structural—to own a car.

I try not to blame individuals and rather look for the root cause of a societal problem, which in this case I’d say is too much driving and not enough walking. After all, the average American only walks roughly 4,000 - 5,000 steps a day. Compare that with another study that found the average American makes fewer than half the walking trips per day compared to the average Briton. When it comes to driving, Americans hit roughly 13,000 miles per year. The average Briton? 7,100 to 7,400 miles per year.

This is also the part where someone storms the comments and says: The U.S. is whatever times bigger than Great Britain! You can’t compare the two!

Well, I can and I did. There will never be an apples to apples comparison between the U.S. and another country, because every country and culture is different. But the overarching truth remains the same—Americans don’t walk very much, but they drive a lot.

Designed to Drive

So why do Americans drive so much?

Well, they’re designed to drive. Sorry, I mean, America is designed for driving, not Americans themselves. Americans are humans just like anyone else, built exceptionally well for walking and running.

Thanks, evolution!

But the places Americans live are designed to push us into a car as often as possible. And it’s that heavy imbalance favoring driving against more active transportation that is making us sick.

If the average American is a suburbanite, then the average American is living in an environment designed around car-dependent layouts featuring low-density development with a separation of land uses, essentially meaning you can’t build a business and residential area on top of one another. This spreads everything out, making walking a less appealing mode of transportation.

Of course you could ride a bike instead, which would be a much healthier form of transportation both for the rider and passersby who prefer breathing fresh air instead of the poison cars are spitting out. But this is how many suburban roads are designed with wide roads that make speeding easier, usually without separate infrastructure for bikes. Sure, some have gotten better about adding painted bike lanes. But as we’ve seen time and time again, paint isn’t infrastructure and isn’t likely to stop assholes from being assholes.

Seeing as you’re a reasonable person who doesn’t want to get killed or put up with a threatening 4,000-pound weapon, you adopt a ‘if you can’t beat ‘em, join ‘em’ mentality. Because even if you wanted to move into a more walkable area, those places are becoming prohibitively expensive. A truly walkable American neighborhood where you can access everything you need, safely, by foot or bike is such a rarity, that homes, condos, and apartments in these areas go for a premium.

Since you can’t individually upend roughly 70 years of car-oriented development overnight, you join the club of average Americans who live in a suburb and own a car. You are a victim to American design. And we haven’t gotten to the worst part yet.

A Sedentary Problem

Most adult Americans are living in the suburbs by their late 20s and early 30s, if they ever left in the first place. This is around the time Americans start gaining noticeable weight compared with their college years.

Now most will chalk it up to a changing metabolism. But here’s the thing, a 2021 study found that our metabolism is actually stable throughout our 20s, 30s, and 40s. Our metabolism doesn’t really begin to slow down until about 60.

But it is true that the average American gains noticeable weight during those decades. A BYU study found that on average, Americans gain 17.6 pounds between their 20s and 30s, 14.3 pounds between their 30s and 40s, and 9.5 pounds between their 40s and 50s.

The study doesn’t say specifically why this weight gain is happening, but I can’t help but notice that the largest weight gain the average American experiences in their adult lives coincides with the same time period most are moving to the suburbs. This is also when most are starting their careers, maybe even getting married and having kids.

Suburban life as an adult is wildly different than when you’re a kid. Sure, I was driven everywhere where I grew up. But I was playing sports almost all the time. Even in the States, where most kids are either driven to school or take a bus that picks up right outside their house, there are many opportunities to be active.

As an adult, you have to earn a living. And because of how the U.S. is designed, earning that living often involves upwards of 290 hours of driving a year. That’s the equivalent of seven work weeks.

So what does all that driving do to your health? In short, it’s not great.

When you’re walking, muscle contractions in your legs help pump blood back up to your heart. That’s why walking generally feels refreshing and help wake you up. But sitting in a car immobilizes you, lowering your blood flow, dropping oxygen to the brain, and fatigue starts to settle in. That’s one of the physical consequences of being sedentary, something that’s already unavoidable in many of your jobs.

But at the same time, driving is a highly demanding cognitive task without physical stimulation. It’s pretty much the opposite of walking, which is physically stimulating with low cognitive demand and is associated with reduced stress and mental fatigue.

Having lived both sides of this, I can tell you the difference is night and day. I felt so drained after my car commute, all I wanted to do was be a slug on the couch. When I had to get to the office in Berlin or Düsseldorf, I felt energized because I was walking on both ends of my bus or train ride or I was cycling.

So to recap, the U.S. is designed to make you sick because American city planners and governments have worked hard over the past 70-some years to push us into cars by designing entire communities around car use. According to a study published in the National Library of Medicine, the average American spends nearly eight hours of the day in a sedentary position. And that same study ties sedentary behavior with a wide-range of health issues, including cardiovascular disease mortality, cancer risk, and risks of metabolic disorders such as diabetes, hypertension, and then depression and cognitive impairment.

There’s also an increased risk of all-cause mortality. I’ll admit, I have no idea what that is. It sounds vague, but also… scary and like something I very much don’t want.

And the cherry on top of all of this, is that once the U.S. makes you sick by its design, you’re thrust into one of the world’s most expensive and notoriously exploitative health care systems. After all, medical debt is one of the leading causes of personal bankruptcy in the country.

It’s not all bleak in the U.S. As I’ve covered before on this channel, Americans do want more walkable communities. The data shows this. We just have to advocate for them and not be NIMBYs about it when proven solutions are brought to the table. We all know that driver with the gargantuan SUV who says they’re okay with bike lanes in theory, but when it takes up a car lane they sometimes drive on, they suddenly feel their rights are being trampled upon.

We also need to get out of our own way. A new bike lane or transit project will get scrutinized to the point of haggling over every last detail until the idea is killed, whereas new highways or highway expansions tend to get rubber stamped, because… Well, there’s traffic! (Even though we already know for a fact that more lanes don’t alleviate traffic, it just exacerbates the problem.)

Some people think it’s only possible in a bit city like Chicago or New York to live a healthy, walkable life. But in this video, you can join me in my beloved hometown of Cleveland, Ohio to see how I lived car-free for four years in the city—and how things are only getting better.