The Cleveland Clinic's Preventative Health Blind Spot

Cleveland Clinic CEO Toby Cosgrove made a big show a few years ago about how serious his hospital is about preventative health by saying he would refuse to hire smokers. Then, he went further and said he’d really prefer not to hire fat people either.

A lot of people were, rightly, offended. But you had to admire Cosgrove’s chutzpah. It would be nice to see the healthcare industry take a bigger role in helping prevent some of the lifestyle choices that have contributed to expensive epidemics of bad health in America.

Given all that though, it’s surprising the Cleveland Clinic hasn’t taken a more proactive role in what is one of the hottest areas of preventative health — sustainability planning, or smart growth.

Right now a hero named Dr. Richard Jackson, of the CDC, is crusading on PBS for reform in the way America plans its cities and suburbs. You’ve probably heard about “food deserts,” and that concept comes from this line of thinking. Lack of access to health foods — namely grocery stores — and overaccess to unhealthy foods — namely fastfood restaurants — contributes to obesity problems in low-income neighborhoods, is the essential premise. It is fairly widely understood and accepted that neighborhood conditions can influence health profoundly.

But there’s more to it than that. Sprawling communities built entirely around automobile travel, without sidewalks, public transportation, safe biking routes, discourage physical activity. This is especially concerning in children. For example, 48 percent of children walked or bike to school in 1969. Now, just 13 percent do so.

Slate magazine recently reported that American walk fewer steps in an average day than any other industrialized nation. Americans walk about half as many steps per day as Australians and Swiss. That has everything to do with the way we’ve engineered walking out of our cities, garage to suburban office parking lot. And it’s costing us an average 150 calories per day over our Aussie counterparts.

Dr. Jackson on his PBS series says it’s not that Americans are necessarily lazy, it’s that our built environment discourages movement:

We have built America in a way that is, I believe, is fundamentally unhealthy. It prevents us from walking. It inhibits us from socializing. It removes trees and the things that make our air quality better. We could not have designed an environment that is more difficult for people’s well being at this point.

What does all this have to do with the Cleveland Clinic? Well nothing — and that’s the problem. The Cleveland Clinic, despite its reputation as one of the nation’s most innovative hospitals, despite the fact that its gone out of its way to demonstrate its commitment to preventative health, has yet to leave any physical indication in greater Cleveland that they are aware of this problem or working to address it in any way.

The Cleveland Clinic is fond of building hospitals in the middle of forests, next to highway interchanges. This is a rendering of its Twinsburg hospital.

In fact, quite the contrary. The Cleveland Clinic is one of the region’s most enthusiastic sprawl pioneers. The interchange that’s being built on undeveloped land in Avon — yup, the Cleveland Clinic, a tax-exempt nonprofit mind you, is helping pay for that. Think about that, an interchange. Our hospital is building an interchange in undeveloped land.

Why? Well it wants to build hospitals close to the region’s wealthier residents that have been progressively moving farther from the urban core for decades. I guess I wouldn’t blame them either. Seems like a perfectly logical business strategy.

But if the Cleveland Clinic is nothing more than a profit seeking business, I would like to see them paying a fair tax rate like the rest of us. Being that it is a tax exempt nonprofit, we would expect the Cleveland Clinic to give some consideration to the public interest in the region — and the last thing this shrinking region needs is a new interchange on undeveloped land.

It would be one thing if the Cleveland Clinic were providing a lot of free or subsidized healthcare. But it’s not. According to a Plain Dealer report, the Clinic devotes just 2 percent of its energy to providing free healthcare to those who can’t afford to pay.

The Clinic’s sprawl hospitals appear next to forest 25 miles any direction from Cleveland, in transit and pedestrian inaccessible locations surrounded by massive surface parking lots. That appears to be a larger part of the Clinic culture that undermines active transportation and active communities.

I called the Cleveland Clinic a few months ago to schedule an appointment. Mind you, I was planning to bike to the main hospital in University Circle. Before I got a chance to explain the operator was telling me she’d set up my appointment in Independence so I wouldn’t have to pay to park. Consider that for a second. This woman was going to send me 15 miles out my way so I could save a few dollars on parking (driving costs 62 cents a mile, on average). She, of course, assumed I’d be driving. When I got there, there weren’t any bike racks for me to use, but there was one the city of Cleveland had installed on Euclid, despite millions invested in car parking. (I understand there is bike parking for employees but apparently no one ever thought a patient might want to bike there.)

This is supposed to be an institution on the cutting edge. From the perspective of an average resident of its home region, I just don’t see it. How about a little leadership, guys?

No other institution in greater Cleveland has a better opportunity to promote healthy development than the Cleveland Clinic. Instead they are doing the opposite.

-A.S.

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