I’ve often thought of population health as “Macro-PT”. This was brought home to me on a trip to Philadelphia in September of 2017.  The concepts of universal design and health-oriented city planning have had a huge impact on my life, both by their presence and by their absence.

I grew up in a town about an hour north of the city, and I later moved to the city for both school and work.  Ten years later I moved away from Philly to Arizona; the primary reason was due to my health.  My increasingly less-cooperative body could no longer hack the daily walking and the public transit which had originally been relatively easy to navigate.  I moved in 1994, the same year as the passage of the ADA.

You see, I have an inordinate love for cities in general, and for Philadelphia in particular. Aging issues convinced me, reluctantly, that moving to a less pedestrian environment was a good idea.  I was returning to Philly with significantly more hardware and less balance and stamina than when I left.

I knew I would have to train for this visit. For two months DPT student Jake Kelso and DPT Eric Christensen and I worked on my goals, involving balance training mostly, and a little strength training.  And I needed every bit of it to make this latest trip work.  Following are a few observations for you population health geeks.

  1. Not all cities are alike, and neither are all public transit systems. Are you city planners dealing with primarily buses, subways, taxis, ride-sharing companies? Do you have kneeling buses and elevators to the subway platforms? Are these public spaces well-lit and safe?
  2. Surfaces are huge. In addition to the asphalt and concrete in most cities, older cities frequently have brick, slate, and cobblestone, sometimes within inches of each other. What may be safe for a wheelchair user is a bit scary for people like me. Transitioning from one surface to another is difficult and it ups the balance concerns.
  3. After working hard to train for this visit I was comfortable walking in Philadelphia in large part because its citizens really do look out for those needing help. This needs to be encouraged in all cities, in perhaps the same style as the “if you see something, say something” campaign to combat terrorism. Some may argue that my deficits make me a bigger target for crime in a city environment. While that is certainly possible, it also makes me a bigger target for the kindness of passersby. Doors opened, directions given (with a ‘welcome home’), packages tucked neatly into my backpack upon request, the cab driver who hit the 4-way flashers so he could help me get in the cab with a lot of stuff but a minimum of drama. And, my personal fav, the forklift driver who rolled happily into traffic so that I would have a little more time to cross the street.
  4. My hotel was great about providing an accessible room. My personal experience has been that while other hotels often have the required accessible accommodations per ADA law, their understanding of the importance of this accommodation is somewhat lacking. While grab bars are great, installing one does not absolve a hotel from further modifications which are often needed.  No amount of apologies and comps is going to turn a bathtub into a walk-in shower.  When you need one, you need one.
  5. Bike lanes and bike-sharing programs are great. Has anyone ever thought to include a couple trikes in the mix? Maybe with baskets for downtown shopping?
  6. In talking with a SEPTA employee about the elevators now installed at some subway platforms in Center City she advised me that they were also good for moms with baby strollers. A good point for a city planning sales pitch. Moms need and buy a lot of stuff. Cities need to expand the number of elevators to include all subway stops, and provide for their maintenance.

As a not-insignificant aside, my cost for this trip was just under my budgeted 2000.00 USD.  Non-disabled tourists are not the only ones with money to spend.  We can support the local economies that support us.  That’s not even addressing the fact that if I had been physically able to do so I likely would have stayed in Philly.

It’s unlikely I will ever live in Philadelphia again, but I am grateful to my friends in PT for making my short visit possible.  It was very tiring, but I was able to do all the things I used to do: ride the subway, the buses, the taxis, and to eat far too much while seeing the sights in my historic city.  I plan to do it again soon, and to keep the gains that I made in PT in order to be able to visit the city I love.


Lisa Maczura is a resident of Arizona and a friend of the Physical Therapy profession often providing (much needed) insight from the “client’s perspective”. Find her on Twitter – @LisaMacNCheese