Public health is a mess. The water is corrupt.

The cabdrivers harbor TB. HIV is rampant. Restaurants go

uninspected. Every day, just living and

working in the District puts your health at risk.

You awake, still dreamy from the night before. What a surprise your new friend was—gorgeous, mysterious, and self-effacing—a refreshing departure from the typical, C-SPAN-addicted Washingtonian. Condoms would have been a good idea, but you really only regret oversleeping. Running late, you grab a taxi. The driver arduously battles traffic even though he has a hell of a cold; he coughs as if tiny tornadoes were ripping through his chest. Ignoring him and the misty clouds he’s spewing, you stare out the streaked cab window at the gray morning. Finally, the cabby deposits you in front of the gleaming brass doors of your portentous downtown D.C. office, but you skip to the coffee shop across the street so you can bring a latte and a pastry to your desk. A homeless man stirs from a bench, sidetracking you. Even though you’ve lived in the city for years, you press a dollar bill into the man’s curled and rotting fingers.

At last you settle in at your desk to get started, but the fact of the matter is that you’ve already had a busy day from a biological perspective. In the first hour of your workday, you have been exposed to multidrug-resistant tuberculosis, hemorrhagic fever, salmonella, and HIV. Not only did your cabdriver have active TB, but his sedan was contaminated with rodent feces carrying an exotic hantavirus brought in by the previous passenger, who arrived from the Far East. But who’s to notice? The D.C. Taxicab Commission is a sham. The homeless man may have looked benign enough, but invasive strep—of the flesh-eating variety—was gnawing away at his hands. Salmonella raged through the milk in your morning cappuccino; District health cops haven’t inspected the corner cafe in the past year because of the budget crisis. And did you really buy your date’s line about “being tested”?

The health risks of living and working in the midst of civic infrastructure collapse are real and growing by the hour—not just for average stiffs like you and me, but for the leaders of the free world who live, work, and visit here as well. D.C. is filthy, its water is defiled, and health oversight has been shredded.

Just by running the course of a typical day, Washingtonians cross paths with a flurry of pathogens that could lay them out or even kill them. Massive ruptures in the health care system have left much of D.C. biologically compromised, its citizens awash in a gargantuan petri dish ridden with bacteria and viruses, its wards poised to erupt into a Richard Preston–style Hot Zone. Think we’re making this up? Check today’s daily paper. Chances are it will have a story about the water system tipping over in some new and splendid way, or an update about a local institution riven with unsanitary conditions, or a chronicle of local disease rates that make Rwanda look healthy by comparison.

In fact, D.C. is the nation’s disease capital—the sickest American city of them all. The crisis is so endemic you can’t escape; it’s in the water, and it’s in the air we breathe. The modern plagues of AIDS and TB have the District in a stranglehold. AIDS continues to spread faster here than in any other American city—and 20 times faster than the national rate among the city’s adolescents. D.C.’s infant mortality rate continues to lead the nation. Pick just about any disease category and the District likely harbors some of the nation’s sickest populations. Every year, the city sees abominable death rates from heart disease, cancer, diabetes, liver disease, and pulmonary disease. In the District, more people die from more causes more frequently than any other place in the country. For a long time, the city’s overlords have remained comfortably numb in the belief that the health crisis was ghettoized, confined to the poor and the underclass, but the problem may be about to boil over in unforeseen ways.

“D.C.’s public health affects everyone,” says Sam Seeman, executive director of the Metropolitan Washington Public Health Association. People who live in Maryland and Virginia’s well-to-do suburbs are only kidding themselves if they think they are protected from the perils: “Unless you live in a cocoon, which we don’t, it makes a difference,” he says.

Internationally, a lot of attention has been focused on emerging viral threats like Ebola, but a more prosaic—though no less deadly—onslaught is already under way in the District. Known conditions and known pathogens—growing more virulent and resistant all the time—are stalking the local population. Fundamental weapons like immunization, decent nutrition, clean water, and preventive health care have been erased by civic mismanagement. In a city full of doctors and institutional icons of Western medical genius, the citizens’ atrocious health status and the drag of D.C.’s mind-blowing number of uninsured and underinsured—nearly a quarter of its 550,000-strong population—have put the city in the ICU.

Just a year ago, the mayor’s blue-ribbon report on health care in the District, which followed on the heels of at least 17 other such studies in the past decade or so, concluded that the “continuing failure to address these problems threatens to contribute to the bankruptcy of the city, and to allow public health problems of epidemic proportions to continue to grow unchecked.” Even allowing for bureaucratic hyperbole, the message is not a comforting one.

The city juxtaposes chronic dysfunction with international savoir faire in some unfortunate ways. Twice in recent decades, external threats have lurched the Washington area toward biological disaster. In 1976, health professionals at George Washington University barely contained the spread of Lassa fever—a highly contagious and highly fatal disease characterized by fever, profound bruising, difficulty in swallowing, and mental disorientation, which often culminates in cardiac failure. The disease came close to invading when a 43-year-old Peace Corps volunteer imported the arenavirus through Dulles after returning from work in a small, agricultural town in Mobai, Sierra Leone. In the end, despite more than 550 exposures, only one other passenger developed symptoms.

Another close call occurred in 1989 when an Ebola virus lethal to nonhuman primates was brought into the country. Coolheaded researchers at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) based in Fort Detrick, Md., quickly contained the virus, a close cousin of the ever-deadly Ebola Zaire. The effort brought a fortuitous end to the now infamous incident in Reston, Va., that spawned the movie Outbreak. It isn’t just cinematic fantasy—keep in mind that 33,000 international passengers fly in and out of Dulles everyday, and that D.C.’s profile makes it a textbook target for biological terrorists.

“It could happen again, and it might not be the tame Reston strain,” says Peter B. Jahrling, the USAMRIID virologist who isolated Ebola Reston. Outbreaks in Africa of Ebola Zaire, known to cause profuse bleeding and hemorrhaging, have seen mortality rates of 88 percent. The Reston biological event temporarily alerted the nation to the threat of emerging infections, but many simply rolled over and went back to sleep when they found out that only monkeys were affected. “At the time it was a crisis; had it been the grim reaper, I think we would have seen sick and dead people,” Jahrling says.

Jahrling says D.C.’s conditions are currently ripe for the emergence of a new strain of hantavirus. “When a city is having problems with trash pickup and it’s got a healthy rat population, you’ve got all the right conditions for a hantavirus.” Hantaviruses, rooted in rodent populations, are spread when the virus particles contained in rat droppings become airborne. Some strains, like the Muerto Canyon one that emerged in the southwestern United States in the summer of 1993 and caused an outbreak of severe respiratory illness, are known to kill more than 50 percent of their victims. Others have been linked to kidney disease.

But the betting scientist will tell you not to worry about such exotic killers. The District’s impotent public health infrastructure has already permitted common and resurgent pathogens to infiltrate the region. D.C. is quickly reverting to a time when the city was long on open sewers and short on potable water. Neither D.C.’s sewage-treatment plant nor its water system have fully met the Environmental Protection Agency (EPA)’s safety standards for several years, despite the fact that the EPA’s top regulatory dogs are housed right in the District’s back yard. The management at Blue Plains, once a model system, is so screwed up that the EPA and FBI have launched formal investigations. The EPA has even warned that raw sewage could overflow into the Potamac at any time.

As a matter of fact, deadly bacterial con-taminants linked to the malfunctioning treatment plant have made their way into the drinking water at least three times in the past three years—most recently in early November 1995. After confirming the presence of coliform bacteria in the water supply, officials warned the eldery and the immunocompromised to boil their water before drinking it. But myriad problems—from corroded pipes fulminating with pathogens to insufficient storm overflow systems to improper water sampling procedures—persist. Just about anybody in the know in the District government won’t drink the city’s water. Funds, some collected from other jurisdictions, that were supposed to go toward holding the line on water quality have been diverted to other uses by the cash-strapped District. Observers familiar with the state of the city’s infrastructure say it’s just a matter of time before D.C. sees a confrontation with cryptosporidium—the protozoan that killed more than 100 people in Milwaukee, Wis., in 1993 and made nearly 400,000 others sick.

There are no bright spots. Even though the District has a nonexistent industrial base, its air quality puts it among the 10 worst urban areas in the country, along with the likes of Los Angeles, Denver, and New York. “People are not aware of it—or its significance,” says Councilmember Jack Evans. Just this summer, D.C.’s ozone levels exceeded federal standards a handful of times—the result of a combination of high air pollution concentrations and high temperatures.

“It’s like the domino effect,” says Dr. Bailus Walker, a health policy analyst and Howard University researcher. “You have to look at the whole system. You can’t cut trash collection without thinking about how many kids will get bitten by rats.”

The city’s top health guardian is appalled at the District’s lack of vigilance. “The public’s health could well be at risk if we don’t correct these services,” says Dr. Harvey Sloane, D.C.’s commissioner of public health. It doesn’t take the best and brightest of wonks to determine that if a city can’t afford to pick up trash, inspect restaurants, and enforce standards, public health will inevitably suffer.

The latest symptom of D.C.’s fiscal problems—a bacterial outbreak, most likely of shigella, that afflicted more than 500 inmates at the D.C. Jail because management couldn’t afford to replace a defective dishwasher—demonstrates how rifts in other parts of D.C.’s infrastructure can wreak havoc on the community’s health.

“Recycling and trash pickup are very unpredictable, and I needn’t tell you about snow removal,” observes Charles Bimba, whose apartment overlooks the raunchy alley behind the 300 block of Pennsylvania Avenue SE, the dumping grounds of Thai Roma, Ta-verna–the Greek Islands, and the local Kinko’s. Kitchen grease and oil seep from open barrels and plastic containers that line the alley. Unbagged trash overflows from the dumpsters. Litter is scattered about the recycling and trash bins, while a stale stench chokes the air. There are hundreds of blocks like it in every part of the District.

“It could be a heck of a lot better, but it’s what I’ve come to expect from restaurants,” says Bimba, who is now studying political science at George Washington University, but has worked in his share of food establishments. “Rats will hang out here; there’s not much to do about it,” he adds, spitting tobacco juice atop a heap of litter. Bimba’s dog, Spector, as an evening ritual chases the rats at night from the other side of his master’s wooden fence. There may come a time when some of the viruses hosted by the rats start chasing us.

The situation inside the restaurants may not be much better. In the past four months, only nine restaurants have been shuttered for unsanitary conditions in D.C., compared to an average of nine a month in years prior, according to Rich Siegel, program manager of the Department of Consumer and Regulatory Affairs business inspection division. Siegel says his department is chronically understaffed.

D.C. General Hospital’s executive director John Fairman says that the lack of inspection is bound to have negative health effects. “It’s very common if health inspectors are not out and about, food preparers will take shortcuts. That’s a critical piece.” The lack of inspection means that in addition to picking up trendy meals, D.C. residents might be getting hepatitis, salmonella, or other food-borne illnesses at local restaurants.

Ironically, at one time D.C. led the nation in consumer protection. The District was the first to establish a truth-in-menus program, the first to require food service people to be trained and certified, and the first to inspect health care facilities, Howard University’s Walker says. Now restaurant owners are left to police themselves.

The “thirdworldization” of the District is starkly rendered in the black-and-white numbers of the already emerged and resurgent epidemics of AIDS and TB. Nationally, HIV-infection rates are topping out. Not so in D.C., where HIV continues to spread at an alarming rate. More than 15,000 of the city’s 550,000 residents, including 3,000 of its adolescents and about 1,600 of its 11,000 inmates, are estimated to have contracted the virus. That means one in every 40 people you come across in the District may carry the AIDS virus. Try that math on at closing time.

AIDS has replaced homicide as the No. 3 hangman for Washingtonians. After heart disease and cancer, AIDS is the leading cause of death in D.C. overall and the top killer of men aged 25 to 44 in Washington, Alexandria, Arlington, and Baltimore. So far AIDS has claimed more than 4,400 lives in D.C.—that’s more than the total of all D.C. homicides over the past decade. Approximately 7,600 full-blown AIDS cases have been reported, with about 300 cases occurring among D.C.’s 15-to-24 age group. Officials estimate that treating D.C.’s AIDS patients will cost more than $3 billion over the next 12 years—enough to pin the city in bankruptcy.

D.C. plays host to several populations that threaten its fiscal and public health. For starters, D.C.’s inmates are among the sickest in the nation. Because there is no money, once they are incarcerated, they are left to fend for themselves. Prison officials believe in distributing condoms, but D.C.’s money problems have undermined such prevention measures. Prison medical staff often neglect prisoners with advanced cases of AIDS—one was so mistreated, in fact, he died in his own feces and urine while prison doctors let his severe opportunistic infection go practically untreated. But most important, after inmates’ health is allowed to slip on the inside, the vast majority are released to the outside, where their health problems once again become the community’s. Jonathan M. Smith, executive director of the D.C. Prisoners’ Legal Services Proj-ect and D.C.’s leading prisoners’ rights advocate, says the inmates’ impaired health status may represent a bigger threat to the future of the District than their criminal propensities.

“When infectious agents are not controlled in prisons, they not only spread in the community after prisoners are released, but virtually everyone who comes out of prison is poor, so the burden is going to fall on the public sector to treat them—and the burden will be increased if their conditions have been exasperated by a lack of care,” Smith says. In fact, he says, “I would be shocked if any consequences of criminality were found to have greater economic costs than the District’s failure to address prisoners’ health.”

People who cycle through the criminal justice system eventually bring their habits and health status with them. The kaleidoscopic face of D.C.’s flourishing sex trade—from its countless crack whores to its showy transvestites to its high-class hookers—accounts for much of the spread of HIV. Beyond HIV, D.C.’s gonorrhea and syphilis rates are five times the national rates. Some of the diplomatic corps might want to take those numbers into account when they are considering an impulse buy near Logan Circle.

Along with the new invaders like HIV, common microbes are developing resist-ance to conventional treatments faster than new drugs are being developed, and wending their way toward D.C. citizens. TB—once thought to be vanquished—is showing amazing resistance to the standard set of treatments. D.C.’s TB rate is twice the national average. More alarmingly, 12 percent of D.C.’s TB cases are resistant to at least two first-line drugs, and 16 percent are caused by bacteria of foreign origin. Multidrug-resistant strains kill about 70 percent of their victims by shutting down their lungs.

D.C.’s efforts to control TB have ranged from sketchy to absent. D.C.’s central

reference lab lags weeks behind on returning cultures taken to confirm the disease and identify drug-resistance. The TB Clinic, adjacent to D.C. General, runs out of film and developers from time to time and has had to forgo chest X-rays. The TB Clinic has run out of front-line drugs several times in the past year, allowing the disease to gain momentum as untreated carriers continue to spread the bacteria. Meanwhile, D.C.’s corrections facilities don’t even report their cases.

The fact that D.C. is faring better on the TB front than New York City, whose rate is four times the national average, offers little consolation. Worldwide, TB is not only the top killer among infectious diseases, it’s now the leading cause of death among HIV-infected people, leaving the virus and the bacterium to dance a deadly tango in the District.

Add in another co-factor, namely D.C.’s hepatitis B rate of three times the national average, and you have a large afflicted population, some of whom drive cabs, make salads, and even treat patients.

Alarming as the numbers are, even the available statistics may underrepresent the District’s real vulnerability. “You don’t get a real feel for the situation, because everything is not reported,” says Dr. Martin Levy, chief of D.C.’s bureau of epidemiology and disease control. Levy says his agency is ridiculously short-staffed and ill-equipped. Often, the bureau doesn’t have the resources to do the desired type of follow-up investigations after a salmonella outbreak, for example—let alone have the capability to track the various emerging strains of resistant microbes. Given the lack of tactical public health resources, Washington, D.C., could turn into a swirling hellhole of disease if something went really wrong.

In a sense, the District is just an epic urban indication that the triumph of modern medicine over infectious disease is a myth. New and resurgent pathogens—AIDS, TB, cryptosporidiosis, and Lyme disease—have surfaced worldwide thanks to population growth, urbanization, natural disasters, environmental degradation, and the increased mobility of recent decades. Meanwhile, fewer and fewer dollars are being delegated to fight these vectors; misguided public complacency has helped to dismantle the public health infrastructure nationwide. The tight fiscal times have straightjacketed efforts by the Centers for Disease Control and Prevention to get a reliable barometer of the superbugs. And D.C.’s efforts to track and suppress them are, unsurprisingly, pathetic.

Most of the folks whose job it is to take the city’s temperature will tell you that the District is sicker than hell and getting sicker every day.

“Merely because you don’t see people dying in the streets doesn’t mean the system is working,” says Walker.

The District is an unhealthy place to be a grown-up, but it’s positively deadly for infants. The District’s infant mortality rate is the highest of any city in the United States—twice that of New York and more than twice the national rate; it’s four times the rate of other industrialized nations, like Japan and Switzerland, and even approaches that of some developing countries.

In 1994, there were 180 infant deaths out of D.C.’s 9,911 live births, a 9-percent increase over 1993’s rate. More than 1,400 babies were born with low birth weights—a leading cause of infant mortality, according to D.C.’s Department of Human Services (DHS). Though decreasing, teenage births continue to comprise about 15.6 percent of all births, and about 9 percent of mothers receive inadequate prenatal care.

DHS Director Vernon Hawkins attributes the recent surge in the rates, which had tapered off in 1993, to the city’s fiscal crisis. “We were unable to pay vendors who could not continue a myriad of services, ranging from bedside medical service, family planning, and counseling to high-risk women.”

Things don’t necessarily get that much better for those who make it through the first year of life. D.C.’s children are underserved and are unprotected from infection and disease. In some of the city’s wards there is only one physician for every 8,000 kids. And the lack of a coherent immunization policy and the funds to execute it means that kids are at risk.

“Children are always the first to suffer and the most vulnerable,” says Dr. Joseph Sherman, who runs Georgetown University’s mobile pediatric van. Over the past 10 weeks, 77 of 223 kids who turned out for checkups were referred for counseling for delayed development, meaning they showed signs of problems with language, behavior, or learning.

The lion’s share of D.C.’s public housing was built before lead-based paint was banned from residential uses, making D.C. one of the nation’s most dangerous cities for lead poisoning, which depresses mean IQs among children, in addition to other effects. In fact, about 81,500 of D.C.’s housing units are deemed at risk, according to the Alice Hamilton Occupational Health Center. D.C. law requires that children have their blood lead levels screened by age 6, but the compliance rate hovers around 35 percent.

At this stage, D.C.’s disease database is only beginning to hum. Beyond the city’s viral history and risky behaviors, the so-called common killers have a field day amid the people of the District. In eight of the top 10 disease categories, D.C.’s death rates lead the nation. As a group, District residents drink and smoke far too much. D.C.’s death rate from cirrhosis and septicemia are three times the national average; its deaths from lung cancer nearly double the national average, according to recent figures.

Hop on a bus in any part of the city and you can practically watch the walking risk factors go round town. A large chunk of the people on board are obese, incapable of exercising regularly, and smoke—all accomplices in the onset of heart disease and stroke. A visit to a public health clinic yields similar results: About 75 percent of the regulars at one of D.C.’s clinics suffer from at least one of the following ailments: chronic hypertension, diabetes, or arthritis—the first two, of course, put their victims at increased risk for a massive coronary.

“We’re in the nation’s capital, and we’re so far behind the curve,” says D.C. General’s Fairman.

The decaying national health infrastructure is festering most vividly in stressed urban areas like the District. Yet D.C. is taking the Humpty Dumpty story to new depths: There isn’t a piece of the system that hasn’t shattered or fragmented.

“Already, the public health service in the District is disastrous,” says Randi Abramson, medical director of the Zacchaeus Free Clinic, one of the city’s private-sector nonprofits. “HIV, TB, and immunization are not being addressed properly in the District.”

Grim health care outcomes haven’t stopped Congress from asking the mayor to cut another $250 million from D.C.’s budget—about $200 million of which is slated to come out of D.C.’s health care labyrinth. In the past year alone, budget sculptors have closed down five of the District’s public health clinics and another handful are targeted to follow in 1996. Since the closings, Zacchaeus has had more people clamoring at its doors for service than ever before, and it has had to turn many needy patients away. If too much of the burden is dumped on the private sector, many of the city’s nonprofit clinics will collapse, Georgetown University’s Sherman maintains. “If the system is left to itself, all those clinics are going to bleed out their income.”

Abramson empathizes with what the government health doctors are up against. “I wouldn’t work here [at Zacchaeus] if it were hopeless, but I wouldn’t work for the public health commission. It is hopeless.”

A lack of supplies and skilled workers is giving many District medical facilities the look and feel of pre-glasnost Russia. In November, D.C. General came within 24 hours of running out of its special fuel oil. If help hadn’t arrived, the city’s morgue would have closed, the D.C. Jail would have been without heat, and then the hospital itself would have been inoperable. D.C. Village, the District-run nursing home, has run out of essentials like soap and toilet paper many times. St. Elizabeths mental hospital has run out of many crucial drugs from time to time, and so have D.C.’s public TB and STD clinics. And when the District stopped paying its paging service, physicians at D.C. General simply stopped receiving calls to care for patients, according to Dr. Arthur Hoyte, who chairs the hospital’s advisory committee.

Inside the odious, lime-green walls of the Walker-Jones Clinic at 1100 1st St. NW, the apocalyptic breakdown of D.C.’s public health system is palpable. The floors are sticky and unkempt, clinging to patients’ feet as they walk in. The orange bus-terminal chairs grouped around a chipped counter decorated with hand-painted signs offer an unsettling tableau of a dying system. Everyone here seems very sick.

Day in and day out, the poorly ventilated and aging public health clinic sees D.C.’s homeless, Medicaid, and uninsured patients—outcasts from D.C.’s private health care sector. Many walk in slowly, eyes down, shoulders slouched, in no apparent hurry to get anywhere. “Sometimes it seems like D.C.’s entire homeless population comes here,” says Lorraine James, the clinic’s supervisory community health nurse. But the lack of wellness among the underclass goes beyond a political issue. The inexorable decay in the health of the poor increases the ambient illness of the District as a whole.

Beneath the dusty and deadened surface at the clinic, health professionals chip away at the mountain of underserved patients. There is healing here—the type of nurturing ambience and character that radiates in a dive bar or a country inn. Even the most bereft patients seem to come to life after getting verbally goosed by medical clerk Angela White. The smiles usually disappear after she tells them they may have to wait up to four months for their next appointment.

Just as D.C.’s populace has gotten used to settling for less, so have the people who look after them. “We try to do our best,” says Dr. Robert Casas, an obstetrician and gynecologist who has practiced at the clinic for 20 years and worked for nearly 30 in public health in D.C. “You can never get to the ideal stage.”

Pediatrician Evangelinn Ecarma says the fundamentals are completely out of whack among many of the mothers in the District. “It’s routine that young mothers feed their babies potato chips,” she says. “You wouldn’t believe the things they feed them.”

At a time when so many of their patients come in with so many problems, triage can be endlessly complicated. Just about the time the clinic’s doctors figure out a 16-year-old girl is nauseous because she is pregnant, they also realize that she has been infected with HIV. More and more people keep showing up who are sicker and sicker.

Nurse James is proud that her staff does so much with so little, but says, “It’s almost like we’re hostages. But it’s been that way for a long time.”

In its earliest days in the 19th century, Washington was home to more than its fair share of the poverty-stricken, and quickly earned a reputation as an unhealthy place, a rap it has never really shaken. D.C. has long been renowned for its infant mortality rates, atrocious alleys, and prostitution. In the late 1800s, for example, fewer than a third of Washington’s homes, including those in Georgetown, were connected to the sewer system, and tens of thousands of citizens lived in primitive alley tenements, according to historian Constance McLaughlin Green. Not only did raw sewage flow in the middle of town, but by 1913, D.C.’s red-light district extended from two blocks away from the White House’s black gates to the edge of Capitol Hill. By 1934, D.C.’s infant mortality rate ranked second-highest in the nation at 66 deaths per 1,000 live births, comparable to that of many third-world countries today. Even during the heyday of the New Deal reforms, which emanated from the capital city, D.C.’s health problems abounded, Green says.

For literally centuries, neither Congress nor the nation has shown much concern about D.C.’s public health. Funding cycle after funding cycle, the nation’s power brokers have blundered through the low-stakes politics of the District while hedging their serious career bets with more prestigious issues and better-heeled interest groups, Green asserts. As a result, the story of D.C.’s public health quickly became a repetitive tragedy of too little too late, Green writes. Even the most basic improvements could be squashed or stalled by a whimper of opposition, or a whim.

Metropolitan Washington Public Health Association director Seeman has watched the arc of public health in the District for 45 years. “I don’t think it was ever a model system, but it was not the crisis it is now.”

Your grueling day at the office comes full circle. As you exit your building, you breathe deeply, exhilarated to live in a city free of industrial pollution. You swing by the nearby Lawson’s to pick up your special vegetarian order for dinner and climb on the Metro en route to your favorite gym. You’re tired, but you don’t want to forgo a workout. After all, keeping fit ranks as your top priority this year, and staying healthy is one New Year’s resolution you have vowed to keep.CP

Art accompanying story in the printed newspaper is not available in this archive: Audrey Niffenegger.