How North America Can Learn from Europe's Active Lifestyle: Insights from My Recent Trip to The Netherlands

The global physical inactivity crisis is not just a health issue—it’s a societal and environmental one. While North America grapples with rising obesity rates and an escalating incidence of cardiometabolic diseases, many European nations have cultivated environments that seamlessly integrate physical activity into daily life resulting in reduced rates of these conditions. Having just returned from a trip to The Netherlands, it was glaringly obvious that physical activity is not seen as a chore or a burden, but rather a staple in everyday life. This stark contrast with North America underscores the need for a paradigm shift in how we approach physical activity, not merely as a health intervention but as a fundamental aspect of daily living embedded in our society.

I’ve thought about this problem a lot in the past, but it’s been on my mind more than ever since returning home. Unfortunately, this is a multi-layered political, environmental and infrastructural problem, and big problems require big solutions. In this week's newsletter let's dive into what differs between North America and The Netherlands. I hope that at minimum this can stimulate some thought and reflection as to how we may all collectively contribute to combating the burden of disease that comes from widespread physical inactivity.

Physical Activity: A Cultural and Structural Divide

In the Netherlands, cycling is deeply embedded in the culture – it’s a way of life. Approximately 27% of all trips are made by bicycle, with larger cities like Amsterdam seeing figures as high as 38%. However, this doesn't just happen overnight or without thought. These high rates are facilitated by a well-crafted network of over 35,000 km of dedicated cycle paths, making biking not only safe but also convenient and accessible. Whenever I've been to The Netherlands, I'm in awe of the quality and the quantity of these paths, present in the deepest of urban centres as well as traversing farmers’ fields in the northern part of the countryside. This infrastructure is the result of cycling and physical activity being a priority for the Dutch for decades. In contrast to this, in North America there is a lack of dedicated cycling infrastructure, outside of perhaps some major city centres. In certain regions in Canada the number of cycling lanes is actually being reduced! What?! This lack of infrastructure leads to reduced cyclist safety, further reducing the likelihood of people taking part in active forms of commuting. In the U.S only about 12% of trips are made by active transportation, such as walking or cycling. This disparity between The Netherlands and North America ultimately stems back to decades of urban planning, infrastructure development and funding which has subsequently shaped their respective societies and how our populations contextualize physical activity.

Obesity Rates: A Growing Concern in North America

We all know that obesity rates in North America are alarmingly high. Although physical activity levels are just one piece of the complex puzzle as to why this is the case, the barriers to physical activity are increasing. Rising cost of sports and sporting equipment, reduction of green spaces, and the reduced physical education in schools are all contributing to the rise in obesity and the development of other non-communicable diseases. The lack of normalization of physical activity in childhood is also leading to the increased number of physically inactive and obese adults. In the United States, approximately 40.3% of adults are classified as obese, with severe obesity rates increasing from 7.7% to 9.7% between 2020 and 2023 . This trend is mirrored in Canada, where obesity rates have been steadily climbing. In contrast, in the Netherlands, 16% of adults were classified as obese in 2023.

Cardiometabolic Diseases: The Silent Epidemic

The prevalence of cardiometabolic diseases, including type 2 diabetes, hypertension, and cardiovascular diseases, is notably higher in North America. A study analyzing data from 1999 to 2018 found that only 6.8% of U.S. adults had optimal cardiometabolic health. In contrast, while these diseases are also present in Europe, the rates are generally lower which can be attributed to healthier diets, more active lifestyles, and robust healthcare systems that emphasize prevention and early intervention. Lots to unpack here, but I think I'll save that rabbit hole for another day.

European Infrastructure and Policy

As I mentioned, one of the key factors contributing to higher activity levels in Europe is the infrastructure and policies that promote physical activity. In the Netherlands, cycling is not just a recreational activity but a primary mode of transportation that takes priority over automotive transport. I'll give you an example. A good friend of mine in the Netherlands is an attorney. He travels 35km to and from work each day, rain or shine, by bicycle. His children, who are in middle school and high school, each travel 12-20km to and from school each day. When winter comes, they dress warm, leave earlier, and still cycle to and from work and school without thinking twice about it. It's just how they travel and this is established early in childhood.

Now I want you to picture yourself tomorrow morning reaching for your bike instead of your car keys and trying to cycle 30km to and from work? Firstly, you'd need at least another hour on each end of your work day. Would you feel safe? Depends where you're riding. Surely there aren't dedicated bike paths the whole way. What happens if you have a mechanical issue with your bike? You'd probably be stranded, whereas in the Netherlands every town, village and city have multiple bike repair shops and stations. My point here is that it takes personal commitment as well as buy-in from federal down to local municipal governments to make these big changes realistic and to have a positive impact on our society. Although a daunting task, we can't just throw in the towel and say "it's too late to make these changes". We've known for a long time that the downstream consequences of deteriorating public health are significant, so what will it take to induce a commitment to change?

Take home Lessons for North America

I realize that there is much larger discussion to be had here between people who have more influence on the matter than I, but as I said in the beginning, I hope that at minimum this newsletter can trigger you to reflect on how you may approach and structure your day to make physical activity more automatic and less of a chore. I challenge you to walk or ride to work tomorrow morning, or even later this week. It takes planning, I get it, but you're going anyways, aren't you? What happens when work gets too busy and you feel the need to skip out on the gym in the evening? Do you just scrap your physical activity all together? Don't do it. Normalize regular movement by embedding it within your day. It starts with one but you may influence others. Also, your heart, your family, and the environment will thank you.

Here's some final lessons that North Americans can learn from the Dutch:

1. Invest in Infrastructure: Developing safe and accessible cycling and walking paths can encourage residents to choose active transportation options.

2. Urban Planning that Prioritizes Physical Activity: Designing cities that prioritize pedestrians and cyclists over cars can make physical activity more convenient and appealing.

3. Cultural Shift Towards Activity: Promoting the idea that physical activity is a natural part of daily life, rather than a scheduled task, can lead to lasting behavioural changes and a positive influence on our healthcare system.

4. Policy Support: Implementing policies that support active transportation and provide incentives for physical activity can drive systemic change.

   
   

   Yours in good health,

   
   

   Andrew

   
   

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