To lower the cost of health care, many state and local governments are implementing programs that encourage residents to choose healthy lifestyles, starting with public employees. Also, health-conscious cities are designing neighborhoods that encourage people to walk and use public transportation.

After Men's Fitness magazine named Philadelphia the nation's fattest city in 2000, Mayor John Street appointed Gwen Foster, a former radio talk show host and health enthusiast, as the city's “health and fitness czar.” Foster then created the “Fun, Fit and Free” initiative, which promotes healthy lifestyles through activities and competitions. Although Street could not dedicate city money to the program, Foster received funding from grants and donations. “I had to create something that was cost effective and could still get the attention of most people in Philadelphia,” Foster says.

“Health Journeys” is a part of Foster's program in which participants track their healthy activities, such as exercising, drinking water and eating healthy foods, using faux passports to earn “frequent activity miles” to fictitious destinations such as “Fit-adelphia” and “Hon-A-Lose-It.” After 76 days in the program, participants exchange the miles for prizes. Foster, who initially started the program for city employees, found it reduced absenteeism and saved each employee $1,300 in health benefits. Now, Foster is beginning to spread the program into the community through support groups, churches, after-school programs and block captains.

For nearly one year, the Arkansas Department of Health and Human Services has offered a program similar to Philadelphia's for state employees. The Healthy Employee Lifestyle Program (HELP) is part of Gov. Mike Huckabee's plan to reduce chronic adult obesity in the state.

Like the “Health Journeys” program, participants earn points for healthy activities and redeem those points for prizes, says Becky Adams, associate branch chief for the department's Center for Health Advancement. For example, one point is awarded for each serving of healthy food or every 10 minutes of physical activity. “It's designed so you'll maintain a lifestyle for a year of physical activity and eating fruits and vegetables,” she says. Employees also earn points for not smoking and for completing a health risk assessment.

Some local governments organize athletic events to promote healthy lifestyles among residents. In May, seniors from around the Atlanta area joined some of their local mayors for the Atlanta Regional Commission's (ARC) 20th Annual Mayors' Walk, an event that promotes walking as a form of exercise among seniors, says ARC spokeswoman Grace Trimble. Participants can choose between a one-mile walk and a three-mile walk.

Palmetto, Ga., Mayor Clark Boddie, who has participated in the Mayors' Walk since it began, says the whole community benefits from maintaining seniors' good health because healthier seniors can remain in their homes longer without seeking health care services from the county or state. “We've always had a waiting list [for those services],” Boddie says. “The more people we can keep off that waiting list, the cheaper it will be for the taxpayers.”

The drive toward creating healthy communities also is affecting how cities are designed. The Washington-based American Institute of Architects (AIA) is conducting a $2 million federally funded study of the benefits of community transportation projects, including the health advantages of transit-oriented developments that encourage people to walk and take public transportation, says David Downey, managing director of AIA's Center for Communities by Design. “Through a well-designed transportation system, people can access [commercial services such as grocery stores and restaurants] in a healthy way,” he says. Along with providing more exercise from walking, Downey says that providing alternative means of transportation improves air quality and reduces stress.

Foster has begun promoting a healthier design for Philadelphia. She meets regularly with city planners to encourage them to cultivate neighborhoods with residential and commercial buildings close together, and several projects are currently in development. They also have added more walking paths in the city's parks. Thanks to the city's new health consciousness, Foster says, Philadelphia is now number 23 out of 25 in the Men's Fitness poll.