“We associate this type of disparity with third world countries,” said Roshan Bastani, director of UCLA’s Kaiser Permanente Center for Health Equity. “We don’t realize the same thing is happening in our own backyard.”

Bastani was joined by LaVonna Lewis of the USC Price School of Public Policy and Tracie McMillan, author of The American Way of Eating, for a discussion about the broad social and economic forces that limit low-income Americans’ access to the organic vegetables and yoga classes enjoyed by wealthier people. What factors are holding the poor back? And what can be done to level the playing field?

Moderated by Kaiser Health News senior correspondent Anna Gorman, the conversation began by addressing the still-bleak state of health in America, and the various barriers that keep low-income people unhealthy.

McMillan, who spent extensive time in impoverished communities to do research for her book, said that the problem she encountered wasn’t a lack of grocery stores, but rather the challenge of subsisting on so little money.

She described spending a lot of money stocking up on grains for cheap meals, but then realizing she didn’t have enough to pay her rent. As a farmworker making $2 an hour, she added, “I was so hungry, and had all these crazy ups and downs because of it, that I found myself always making the easiest choices, which were bad for my health.”

Gorman mentioned a family she knew from her own reporting who would treat themselves to a nice dinner at the beginning of each month when cash aid came in, but then struggle to make up for the expenditure for the next 30 days.

Despite recent studies that suggest Americans are beginning to eat less and childhood obesity rates are decreasing, Bastani said that low-income families and children aren’t following the trend. “It’s no time to celebrate,” she said.

McMillan addressed widespread misconceptions about health and poverty—that poor people don’t want to be healthy, that they’re not willing to spend their money on proper nutrition. “I hear again and again that people aren’t spending money on food, so that means they don’t care about it,” she said.

In fact, she pointed out, low-income households on average spend 20 to 30 percent of their incomes on food, whereas families making more than $70,000 annually only spend about 8 percent. “No one has ever said to me, ‘You know what’s awesome? Diabetes,” she said. People want to make healthy choices, but things like health problems and transportation issues limit their ability to do so.

So, Gorman asked, what can be done to change these misguided perceptions?

Lewis, the USC professor, said that it’s all about “making the invisible visible,” particularly when it comes kids. “If you don’t drive through a particular community, it’s hard for you to know what’s going on there. So you have to let people know that this is the future. If you don’t invest in young people—if they can’t go to school because they’re chronically sick—then that affects all of us.”

The challenge, she elaborated, is “making connections between things that people don’t want to think about on a day-to-day basis,” and mobilizing entire communities to begin to untangle the knot of entrenched disadvantages faced by low-income families.

The panelists agreed that the first step is to understand and address these wide-ranging social determinants that impact an individual’s health. Beyond exercise and healthy eating, these include the quality of housing and crime rate in a person’s neighborhood, the type of work she does, and her access to healthcare.

The next step, Bastani argued, is actually providing the means to make healthy changes. “You have to know what you need to do to stay healthy, but you also need to have the resources, in terms of money and time, to be able to take advantage of healthy choices.”

The expansion of Medicaid under the Affordable Care Act has given more people access to resources, but transportation to and from healthcare visits, paid time off, and simple health insurance literacy need to be improved for the expansion to be truly effective.

Lewis said that if we could convince parents to bring apples to preschool parties instead of cupcakes, it would be “heaven” for her. “We need to get the idea out there that you can have fun eating healthy,” she argued.

McMillan went even further and said she’d support “radical home economics” that teaches every child how to cook in the early grades. She admitted the idea was “totally impractical,” but challenged the audience to think about it: Schools teach kids how to read, and as a society, don’t we just as badly “want people who are literate about their food?”

In a question-and-answer session, an audience member asked the panel what sort of progress they’ve seen. Is there reason to hold out hope we can all be healthy?

Absolutely, Gorman said. She receives pitches for stories all the time about innovative projects, from taco trucks offering healthy options to schools opening up over the weekend as parks. She’s even heard about people who offer tours of grocery stores to teach uninformed shoppers how to read labels.

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But just because all these waist-thinning options exist doesn’t mean everyone has access to them. Fresh produce, fancy gyms, and habit-tracking technology are expensive, and cost is one of many prohibitive factors that keeps millions of people from taking good care of themselves.

The obesity rates in America are staggering; more than a third of adults deal with the disorder, with demographics that reflect a complicated web of cultural and socio-economic influences. So how do we even the playing field? In advance of the Zócalo/The California Wellness Foundation event “Is Healthy Living Only for the Rich?” we asked medical experts and others invested the public’s well-being: Given the structure and demands of everyday life in America, what can be done to make healthy living more accessible across classes?

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I’ve mused for a long time about creating an urban opera involving scenes of bus riders spontaneously starting to hurl their arms in the air and beat their chests at stops. Living in Tokyo almost 20 years ago, where I spent countless hours on the train, helped me imagine alternate scenarios for my opera: Fierce old ladies in football helmets elbowing their way through the morning crowds, or salary men and office ladies crossing their legs and opening their newspapers one by one in a choreographed line dance. Stuck in Los Angeles traffic these days, I conjure up surreal and humorous moments that could literally break up stagnation and spread happy vibes.

So when Anne Bray, the executive director of the media arts project Freewaves, invited me to create health videos for Los Angeles County Metro buses, I was ready with my qigong opera idea.

The invitation awakened an old dream of mine. When I was studying photography at Bennington College in Vermont, the school shut down during the bitter winter months, and I spent my winter work terms in San Francisco and New York. In these cities, I depended on public transportation and dreamed of exhibiting my photographs on the buses and trains. I was convinced that art was not something just for privileged gallery goers. This is probably one of the reasons I became a filmmaker, which gives me flexibility to make videos that can be more educational or less formally experimental.

I like that qigong is not something exclusive, either. I first encountered qigong through my brother, an acupuncturist who is a devotee of the practice. I took it up when I sought out ways to cope with my own hormonal roller coaster during pregnancy a few years ago. And now, as I have been caring for my 93-year-old parents and teaching them simple qigong exercises like the ones in my bus videos, I am reminded how it is an equal-opportunity practice that even elderly, weak, or disabled people can do, and everybody can reap the benefits of increased circulation, mobility, and energy.

Since the Metro bus video project was designed to promote health, I contemplated the possibilities. What if I could show bus riders simple movements and stretches in a way that didn’t feel “New Age” or like boring qigong how-to videos on the Internet? What if I could show the riders doing exercises instead of being slumped over a phone texting? And what if I could do this in a way that would get an entire bus doing breathing exercises? Or bobbing their heads?

So much of bus riding seems to be about maintaining anonymity, and I wanted to give people the courage to be different and not worry about being laughed at. I remembered a brief but funny incident when I was riding the train in Tokyo. An old woman in her 60s, dressed in a traditional gray, silk kimono, began doing what seemed like pull-ups on the hanging straps on the train. Did no one tell her that someone might see her? This was Japan, where conformity was supposed to rule. But maybe her status as an older matriarch gave her a pass to do as she pleased. I smiled and admired how she could be oblivious to everyone else who pretended not to see her.

To set my videos on a bus, I called all the local municipal bus lines to inquire about renting a bus for a few hours. (The bus wouldn’t even have to move, I promised.) It turned out that insurance was the biggest cost. And only the city of Gardena would give us a break on the permit and waive some of the general liability insurance, automobile liability, and workers’ compensation since the bus was going to stay stationary.

Then I had to gather a group of willing subjects who would agree to play bus riders in my grand experiment, which I had a whopping three hours to shoot. I recruited from everywhere I could: I sent out a massive e-mail blast to friends and professional contacts; I posted an event on the Meetup web page for my qigong class; I left flyers at the local acupuncture school; and I offered extra credit to my class at Hollywood’s Art Institute of California. Freewaves posted on Facebook and tweeted to their fans.

With shot lists, diagrams, and schedule in hand, I arrived on set not knowing how many people I had—and knowing that I had to keep everything very simple. Fortunately, about 15 participants came, the perfect number to fill the bus, but not so many that it was unwieldy. Henry Lee, my qigong instructor, taught the bus riders the simple tapping exercises and explained what the practice was. Although many had no qigong or acting experience, they were a willing and enthusiastic bunch who let go of their inhibitions. During the shoot, I knew that I had to respect the spirit of the practice—keeping the energy flowing, making it positive and fun. It was not just about getting through my shot list, which is often the main aim of many directors who don’t care if they’re stressing actors out.

Because I was trying to produce videos tailored to the specific, noisy, uncontrolled environment of a bus of commuters, I knew subtlety would not necessarily be the best approach: Bright and bold colors would clearly read better on TV screens I knew were going to be small, just slightly larger than the size of a sheet of paper. Since Los Angeles encompasses so many different cultures and languages, I put text such as “Feeling sluggish?” and “Keep the energy flowing” in the top three languages among bus riders—English, Spanish, and Chinese. Even though I knew sound would only be barely audible, I also chose cheery, upbeat music to break up the monotony of the ride.

In the video “Stiff,” a woman with a sore neck sees the guy next to her rolling his head. Another woman sees the man sitting next to her pump his heels up and down. After both women give a kind of “What the heck are these people doing?” kind of expression, they mimic their neighbors.

In “Sluggish,” we see a man begin to thump his belly and get a quizzical look from the lady next to him. Pretty soon, everyone is thumping body parts on the bus—arms, shoulders, chests—and cracking up. Both of these scenes play out against 1960s cha-cha-inspired music punctuated by people moving their bodies.

I tried to document how my videos have played on busses, but it wasn’t easy. The videos were played on tiny monitors mounted near the front and back doors. Many monitors weren’t working on the buses I got on—and when they were, the audio was sometimes drowned out by the bus engine. Plus, the sun often created a glare on the monitor that made it hard to see what was happening on-screen. Also, my videos only ran once an hour, with ads or MSNBC playing at other times. When I did find a bus that played my video when I was on it, I felt shy about breaking the customary bubbles of isolation that passengers create around themselves when they ride the bus. I also tried not to call attention to myself or my camera gear after one bus driver warned me that I wasn’t supposed to shoot on the buses. However, the bus riders I did manage to chat with said that they loved seeing art on the buses. My friends who are bus riders have told me that the videos have motivated them to breathe a little deeper and do some stretching.

As an artist and filmmaker, I straddle a lot of different kinds of video-making, and this project was a pleasure compared to the arduous process of fundraising, shooting, and editing a feature-length documentary. But it isn’t always easy making something that will necessarily appeal to thousands of bus riders. While documenting the project, I traveled through many colorful neighborhoods, jostling with homeless people blocking the aisles with loads of bags, high school students toting skateboards and books, gray-haired ladies burdened with groceries. Young or old—they all looked tired, stressed, and bored, and in need of some relief. I am glad that that my videos are not preaching to the choir as I might be in a gallery or a theater. And if I can get just one person to sneak in a head roll, then I’ll be happy to have helped someone out.

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In Los Angeles, a city with no shortage of obscenely fit people, new yoga studios crop up as frequently as pot dispensaries, and spa-like gyms with names like “Equinox” or “Spectrum” teem with beautiful people shrink-wrapped in Lycra. I do not belong to such clubs. I am a member of a Koreatown branch of 24-Hour Fitness. It would be on anyone’s short list for the worst gym in Los Angeles—possibly in all of the United States.

The dues at this club are not high. Thanks to a work discount, my annual membership probably costs less than a single chakra realignment. It’s a debatable bargain. Yelp gives my gym one and half stars, with evocative reviews like “The dirtiest and ugliest gym I have ever seen in my life!” and “What. A. Dump.” and “Locker room smelled how I imagine Satan’s ***hole to smell.” (Asterisks not mine.)

24 Hour Fitness in Koreatown occupies the bottom floor of an office building on Wilshire Boulevard between two iconic spots—the art-deco Wiltern Theatre and the former site of the Ambassador Hotel. The area is one of strip malls, blaring neon digital billboards, low-slung apartment complexes and a smattering of impressive high-rises. Kids on skateboards careen along the sidewalks and curbs. It’s crowded, which means the first challenge is parking, a process that usually requires a few passes around a six-block radius.

What awaits me after I’ve found a space is a gym that’s cramped and poorly ventilated, with liberal wafts of sweat and damp socks. The bottom floor is a din of clanking free weights—the domain of a cadre of tattooed hombres in muscle t-shirts. There’s also a large group exercise room painted in greenish pastel and peach accents straight out of 1986. It looks like the set of an Olivia Newton John video.

Upstairs are the cardio and weight machines, most of which also appear to date back to Grease 2. About a third of them are reliably broken. A couple of battered television screens hang in front of the treadmills and spew out telenovelas and fuzzy episodes of Jeopardy! I scrupulously avoid ever letting my bare feet touch the floor of the locker room. Plenty of older Asian ladies stride about completely naked, however. They do not know fear.

The Koreatown location is one of two 24-Hour Fitness clubs in Los Angeles that fall under the category of “Active,” a rung below “Sport” and two rungs below “Super Sport.” Yes, believe it or not, 24-Hour Fitness has a caste system. “Super Sport” clubs offer “towel service and plenty of equipment.” My “Active” club offers four walls and a roof. When I told a friend of mine who frequents the Super Sport level club on Sunset Boulevard where I work out, he wrinkled his nose and simply said, “Eww.” There are few experiences as humbling as being pitied by a fellow member of 24-Hour Fitness.

But here’s my confession. I’m fond of my gym. It’s the modern-day Los Angeles version of the Alamo—the place where body fat makes its last stand. Here, the bar for splendor is set agreeably low, and the mirrors are coated with a forgiving film of fog and condensed perspiration. I won’t say that I cherish being scoped out by the oversized guys on the weight machines, but I can’t honestly claim it’s the worst part of the day, either.

Tucked away in K-Town, my gym brings together a genuine cross-section of the city. There are lots of Asians, many Latinos, a handful of blacks, a few whites, some Indians, and even the occasional Borat-like patron of mysterious origin. You might even say that my gym is the city of Los Angeles. It’s a place of nearly constant frustration where diverse people are peacefully forced together, united primarily in their sourness and irritation. And yet we dimly suspect, despite the hassles, that this is exactly where we want to be.

I usually go to cardio classes in the Olivia Newton John studio a couple of times a week, and I’ve gotten in the habit of chatting with a fellow club member, a middle-aged Asian lady who’s usually accompanied by her teenaged daughter. After about a year of brief exchanges, we figured out that we live just one block apart. Her husband has been the mailman in our neighborhood for the past 20 years.

My favorite weekly class is Bollywood Dance, taught by a lithe Indian man with a posh (to my unschooled ears) British accent. He blasts the music so loudly that it rattles the grungy mirrors on the walls. Every once in a while, one of the muscled weight lifters will wander in to join the fun. Everyone looks ridiculous. No one cares. Then we pour out, a little healthier, into the pungent night of smog and flashing neon lights and go our separate ways.

Meghan Lewit is a freelance writer and recent graduate of the University of Southern California Master of Professional Writing program.

*Photo by Megan Greenwell.

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