Health, equity and the curb cut effect

In the years following the Second World War, the increased numbers of veterans with impaired mobility due to injuries led to changes in the way curbs were constructed. Prior to the war, most curbs had a continuous raised edge forming a step between the pavement and the road, potentially hampering access for wheelchairs or those with disabilities.  A pilot project in the US led to inclined ramps being cut into the curb at street intersections and other key points. This was initially to facilitate the movement of wheelchairs on and off the pavement. Soon, however, these ‘curb cuts’ were found to benefit not just veterans with impaired mobility, but parents with prams, as well as those pushing trollies, and people on bicycles or skateboards. The benefits of improving access for one group had much wider flow-on benefits to society as a whole. This has been called the ‘Curb Cut Effect’.

This concept is often used to refer to the benefits of universal design. Examples we are likely to have encountered include the benefit of subtitles when watching the news in a noisy airport. Additionally, students have reported that watching videos with subtitles aids in acquisition and retention of information. It is likely that we have all been beneficiaries of the Curb Cut Effect in one aspect of our lives or another.

This concept can be applied to many different issues. Some of the mitigation measures for climate change include improving walkability, increasing usable neighbourhood green spaces and improving access to public transport. The potential results are not only a reduction in greenhouse gas emissions but also a reduction in obesity. Improving shading from vegetation also results in a reduction in average temperatures and urban heat islands. This is especially significant when we consider that heatwaves are a bigger killer in Australia than floods and bushfires put together. The same mitigation measures for climate change can benefit health in multiple ways.

At a health systems level, improving the integration of healthcare services has wider benefits. Integrated care programs have been shown to reduce admission rates, emergency presentation rates and costs. By using existing health infrastructure more efficiently, we can improve outcomes for patients individually and the system as a whole. Each year, we are seeing record-breaking numbers for emergency department presentations. It is only sensible to start looking at ways to address this trend.

The same principles apply to measures to address gender equity. While we talk about trying to improve the representation of women at all levels in the medical workforce, steps to improve this will have benefits for all. While we need to measure where we are at and set appropriate targets, we cannot ignore some of the structural issues impeding progress. Improving access to parental leave and improving flexibility of working conditions benefits both men and women directly and indirectly.  Parental leave for one partner helps to mitigate the career disruption for the other. Measures addressing equity for one group have benefits for all.

Health is a complex system where actions taken at one level have downstream effects.

Measures to mitigate the effects of climate change have potential benefits to health as a whole. Measures to improve the delivery of healthcare at one level have the potential to improve not just the health of the immediate recipients but improve the capacity of the system to deliver higher quality care. Better integration of health services across the different parts of the system can lead not just to better health outcomes, but improved access and capacity across the whole system through more efficient service utilisation. Measures to address gender equity address far more than gender equity alone.

It’s the Curb Cut Effect.