To improve America’s health, there’s a lot that should be learned from well-managed cities. Kyoto, the former Japanese capital of a thousand years, is an interesting mix of high tech companies and traditional neighborhoods. Within its precincts are 1,600 major temples, numerous universities, lush bamboo and pine forests, and some of the most famous gardens in the world.

      A densely populated city of about two million, some years ago Kyoto took the radical step of widening city sidewalks. In a city with very little room, in a country where the average family of four lives within 400 square feet, where average street widths would not qualify as alleyways by American standards, Kyoto has a vibrant and entertaining urban transit.  

      Bicyclists and pedestrians share the same space. People get where they want to go swiftly and often under their own power, helping assure Japan’s spot as the world’s longest-lived national population. We can do the same thing here, saving lives, preserving our environment — and getting where we want to go swiftly.  

      For long distance trips, Kyoto offers a variety of services. There are trains and subways, an extensive bus system, and if you can afford the costs, a car. Yet parking is a huge problem. Parking spaces exist, but are often small. I did see a rare SUV on my recent Japanese visit, but far more common were station wagons and vans only slightly larger than a Smart Car.  

 However, for most trips in Kyoto, you walk or take a bicycle. A new friend and old citizen of Kyoto loaned me a bike.   Off we went, riding along the wide sidewalks. Stops at intersections often must be quick. Most daunting are young student bikers, a cell phone in one hand and tennis racket in the other, zooming by as if there were no other bicycles or walkers. Yet distances are quickly traversed, and everyone, pedestrian, biker or driver, gets along well.  

      There are problems. Parking is a problem for bicyclists just as it can be here for cars. When we reached a major shrine and decided to stop, a local shrine attendant politely motioned us over to the bicycle park in the woods. At first we could see hardly any free space. Then we saw some, and realized to it was an alleyway where we could get in or out — bicycling, of course.  

      Biking through Kyoto was liberating. Having walked through major Japanese cities, it was amazing how fast one got around, and how amusing the experience was. Once you reached a destination, there was no downtime. Find a spot, hit the kickstand, turn the key in the lock, and you’re there.  

      Such a system works in a country where cooperation is normal and the car is not emperor of the road. Japan is not a country where running a red light is routine, as a recent study showed is true in Sarasota. Nor is it a nation where pedestrians are viewed as exotics unable to afford a car, or potential road kill. In a country so tightly packed, virtually everyone has to walk. Prime ministers and corporate presidents are also pedestrians.  

      I did not see more than a single jogger in my recent trip to Japan. Japanese foods were often laden with trans fats, and frying was routine. Yet the average Japanese lives more than seven years longer than the average American. Going FAR is part of it; food – activity - rest is a constituent of national life. Yet self-consciously “athletic” activities are relatively rare. People walk routinely. Their daytime patterns are consistent. These most ordinary activities preserve their increased lifespan.  

      New housing tracts lack sidewalks. As someone who walks each day from my office to the Sarasota Memorial Sleep Lab, people often comment on my “bravery” for “taking my life in my hands,” and daily crossing route 41.  

      They’re right. It is dangerous. Right in front of the region’s major hospital, cars often cut me off when I have the right of way. Right in front of the hospital entrance I watch people in wheelchairs cut off by cars, patients running so they won’t be run over.  

      Never have I seen the police enforce a pedestrian violation near the hospital. Instead you can study the flowers left for the dead pedestrians and motorists at street corners. Many tell me they feel walking in Sarasota is unsafe. Yet when I discuss enforcement, people often stare blankly.  

      With these attitudes we can look forward to an increasingly sick, diabetic, and obese population. This increasingly ill population will then fight for treatment as skyrocketing health care costs threaten to bankrupt the government and many companies. By not paying attention to measures like pedestrian safety, we harm our health and shorten our lives. For every pound of weight Americans gain, a recent study declared we need an extra 39 million gallons of oil a year – just to get people around in their cars.  

      When are we going to wake up? When are we going to pay attention to our real health costs, and the deeply embedded relationships between our health, environment, and national security? Perhaps we can start by looking at places that have figured out what to do for hundreds of years, and continue to do it better.  

Dr. Matthew Edlund, M.D., M.O.H., director of The Center for Circadian Medicine, is an expert on applied public health, sleep medicine and psychiatry. A former professor at Brown and University of Texas medical schools, he can be reached via email to DocME@DoctorEdlund.com. And CLICK HERE to subscribe to our new Fitcast, via the iTunes Store.