Active Living A New Public Health Paradigm: Promoting Physical Activity Through Design

Rich Killingsworth, Director

Active Living by Design National Program Office

University of North Carolina – School of Public Health

Active LivingA New Public Health Paradigm:

Promoting Physical Activity Through Design

Focus of Today’s Discussion on Active Living

• History• Assumptions• Terminology• Public Health Burden of

Physical Inactivity• Research Needs• Policy Needs• Practice Opportunities• Calls to Action

“The individuals who will succeed and flourish will also be masters of change:

adept at reorienting their own and others’ activities in untried directions to bring about higher levels of achievement.”

Rosabeth Moss Kanter

The Changing Face of Public Health 1950 - 2003

• Pre-1950: Improving Sanitation– Change zoning, clean-up slums and industrial pollution

• 1950s: Eradicating Infectious Diseases – Polio, Typhoid, Malaria, etc.

• 1970s: Removing Toxic Environments – Improve Air/Land/Water Quality, Love Canal, Asbestos

• 1980s: Preventing Risky Lifestyles – Decrease Smoking, Drug Use, Drunk driving, etc.

• 21st Century: Creating Healthy Environments– Physical Activity and Healthy Eating

The Emergence of a Sedentary Society

• Automobile• Television• Computers• Convenience Engineering• Built Environment• Human Nature

Recommended Physical ActivityU.S. Adults, 1986-2000

Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System

The Burden of Physical Inactivity

• The Problem– 27% of adults are sedentary– 70% do not achieve recommended dose

• The Public Health Burden– 64% overweight and 1 in 3 obese– CVD, Cancer, Diabetes– Physical inactivity is a primary factor in

over 200,000 deaths annually.

• The Economic Burden– Medical costs associated with physical

inactivity may exceed $76 billion annually.

Data Sources: 2000 BRFSS, 2000 NHANES, Powell 1994, Pratt et. al. 2000

Obesity* Trends Among U.S. AdultsBRFSS, 1985

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%-14% 15-19% 20%



No Data <10% 10%-14% 15-19% 20%



No Data <10% 10%-14% 15-19% 20-24% 25%

Explaining the Epidemic:

• Genetic• Medical Care• Behavioral Choices• Social Circumstances• Environmental Conditions

Syndemic

Two or more epidemics, interacting synergistically, contributing to excess burden

of disease in a population.

http://www.cdc.gov/syndemics/index.htm



Consider the Possibility That...• the pattern of growth has

upset the balance of human behavior

• the social costs of development may be far more reaching than traffic congestion

• most new communities we have developed may not be “safe” and “healthy”

• there may be another way

Promoting Physical Activity in the Built Environment

Advancing the Concept of Active Living

Active Living is a way of life that integrates physical activity into daily routines.

We Are Where We Live

• There is a dynamic interplay of social and individual factors in a mutual and complex system

• Behavior is guided by settings, socio-cultural scripts, and cognitions of the environment

Health

Environment

Transportation

Healthy Places and Spaces

Alternative Transportation

Physical Activity

Healthy Environments and

Active People

The Detroit News

Transportation, Land Use and Health in the News

• Taking Back the Street• Suburbia’s Road to Weight

Gain• Link Between Sprawl and

Obesity• Pedestrians Pushing Back• Land Use Discourages

Walking

The Burden of an Asphalt Nation

• $200 Million Per Day spent constructing new roads

• $22 Billion Per Year on routine maintenance of roads

• $7 Billion Per Year for interest and debt retirement

• Yet the dependency continues– 73 minutes per day in our cars– 25% of all trips within a mile, but

75% of these trips are auto-based

Source: Federal Highway Administration Transportation Data 1995

Non-Motorized Trips 1977-1995Nationwide Personal Transportation Survey - USDOT

0123456789

10

1975 1980 1985 1990 1995 2000

% o

f Tot

al T

rips

Bike Trips Walk Trips

Physical Inactivity and Overweight Trends Among Youth

• 1 in 6 Youth ages 6-19 is Overweight

• 1 in 3 high school youth do not engage in vigorous physical activity

• Less than 30% attend daily physical education

• Children watch more t.v. in a year than attend school

Data Sources: 2000 YRBSS, 2000 NHANES, 2002 National TV Turnoff Week Data

The Disappearing Walk to School

• 1 in 4 trips made by 5-15 year olds are for the journey to and from school.

• Only 10% of these trips are made by walking and bicycling.

• Of school trips one mile or less, about 28% are walk-based and less than 1% are bike-based.

Source: Federal Highway Administration Transportation Data 1995

Children Are Walking Less and Becoming Increasingly Overweight

Barriers to Active Living in Low Income Communities

• Crime

• Poorly maintained infrastructure– Poor streetscapes

– Abandoned or unsafe parks

– Disconnected sidewalks

• Absence of service facilities – Grocery, post office, library

• Neighborhoods divided by highways– Limited access to destinations of interest

– Isolation from the larger community

Potential vs. Effective Environments

• Physical Fallacy– If you build it will they come?

• Function and Meaning– Is it designed to be used the

way it is understood to be used?

• Social and Cultural Norms– Targeting the facility to the

population who will use it, but also to those who need it most.

Factors that Influence Active Transportation

• Land Use Mix• Network Connectivity• Street Design• Site Design• Density• Beliefs

– Crime

– Safety

The Influence of Location on Non-Motorized Travel Behavior

• Urban17.7%• 2nd City 6.2%• Suburban 4.5%• Rural 3.9%

Location % of Trips Walk/Bike

Data Source: 1995 NPTS - 40 metropolitan statistical areas

1973 1979

1987 1997

25 Years of Urban Growth in AtlantaSource: Scientific Visualization Studio, Goddard Space Flight Center

Metro Atlanta loses 58 acres of forested land a day to “development,”

Source: Georgia Department of Natural Resources.

Leveling Atlanta

Low Density Big, , SegregatedSingle-Use Zones

Sparse Street Network Lack of Centers

Impact of Community Design on ActivityVariable Outcome

Mix of Land Use 19% increase in walk/bike trips in areas with appropriate land use mix

Presence/Proximity of Convenience Services

27% increase in walk/bike trips in areas having high presence and good proximity

Perceived Traffic Safety 88% increase in walk/bike trips in areas perceived as more safe

Perceived Aesthetics 50% increase in walk/bike trips in areas perceived as more aesthetically pleasing

Development of Bikeway 57% increase in bicycling in areas with dedicated bikeways

Availability of Parks and Trails

75% of inactives believe there are too few parks and recreation facilities. 56% of respondents would use trails if provided in their community

Policy Support 55% support more bike paths, 62% more sidewalks, 60% for improved connections to destinations, and 57% improving mass transit.

Sources: Cambridge Systematics 1994; UNC-Highway Safety Research Center 1994; EPA/CDC Greenstyles Survey 1999; Nebraska Social Indicators Survey 1999

Americans Want to Walk More

• 55% of Americans would like to walk more throughout the day for exercise or to get to specific places.

• 40% would choose walking over driving.

• 63% would like to walk more to do errands.

• 54% say there are too few shops or restaurants within walking distance.

Source: Belden Russonello and Stewart: Research and Communications. “Americans’ Attitudes Toward Walking and Creating Better Walking Communities,” 2003. (http://www.transact.org/report.asp?id=205)

The Impact of Activity-Friendly Environments

• An average 150 pound person living in a activity-friendly environment could prevent weight gain of 0.85 to 1.75 pounds per year, which approximates the average adult weight gain in the U.S.

Source: Jim Sallis Ph.D., San Diego State University

Designing Activity-Friendly Buildings

• If the average person spent only one more minute per day going upstairs, they would burn an extra 2900 kcal per year, or .8 pounds.

• For only 2 minutes per day, that’s more than 1.5 pounds per year.

Source: Jim Sallis Ph.D., San Diego State University

Is There a Solution?

• Strategies to increase physical activity and promote active living through transportation and activity-friendly design must become a priority for national, state and local governments, leaders and citizens.

Active Living Strategies

• Preparation• Promotion• Programs• Policies• Physical Projects

Strategy 1: Preparation

• Build diverse partnerships

• Build a vision

• Assess policies and environments

• Build a plan of action

• Identify a champion

Strategy 2: Promotions

• Utilize mass media for awareness and public education

• Utilize mass media for policy advocacy

• Develop key messages for target groups and settings

Strategy 3: Programs

• Safe Routes to School

• Commuter Choice Programs

• Incentive Campaigns: Bicycle Friendly Communities

• Parks and Trails Events

• Walking / Bicycling Clubs

Strategy 4: Policies

• School Siting - provide pedestrian accessible elementary school sites

• Update codes to encourage density and mixed land use

• Reexamine parking policies and fees

• Develop health impact statements for new development

Strategy 5: Physical Projects

• Build safe and well-connected pedestrian and bicycle networks

• Encourage mixed-use developments

• Adopt traffic calming measures to reduce speed, noise & volume

• Create pleasant and beautiful pedestrian and bicycling settings

Heritage Rail-Trail, York, PAThe York County Heritage Rail-Trail, a 21-mile trail, was awarded $1million in TEfunds. The trail runs adjacent to an activerail line, links multiple communities, &connects to a 20-mile rail-trail inMaryland.

Douglas, GA Streetscape

With $850,000 in TE funds, Douglastransformed six intersections. The newsidewalks,benches, andlandscaping have contributed to a revitalization ofDouglas’downtown.

Rhode Island Bike/Ped Safety

The Rhode Island Dept.of Health used $48,000in TE funds for a 3-yearsafety program. Themoney funds educationand training in schools &communities, andpromotions such as t-shirts& helmets.

Denver, CO Bike-n-Ride Denver added bikeracks to 700 busesand installed 100bike parking rackswith $301,500 in TEfunds and a$100,000 match,greatly enablingand expandingbicycle commutingoptions.

Creating an Active Living Movement

• Foresight

• Picking the Right Target

• Having Strategic Acumen

• Building Synergy

• Framing the Issue and Delivering the Appropriate Message

• Looking for Pressure Points

• Discipline, Conviction, and Perseverance

“Driving social change doesn’t always have a plan and it’s not linear. “

David Kessler, Former Administrator – Food and Drug Administration

The Robert Wood Johnson FoundationActive Living National Programs

• Active Living Policy and Environmental Studies– www.alpes.ws

• Active for Life– www.activeforlife.info

• Active Living by Design– www.activelivingbydesign.org

• Leadership for Active Living– www.leadershipforactiveliving.org

http://www.alpes.ws/

http://www.activeforlife.info/

http://www.activelivingbydesign.org/

http://www.leadershipforactiveliving.org/

Active Living by DesignNational Program Office

A National Initiative Supported byThe Robert Wood Johnson Foundation

Active Living by Design - Mission

To provide leadership in creating

communities that will support,

encourage, and sustain active living.

Active Living by DesignTarget Groups

• 25 communities with readiness to implement active living programs, policies, and communication strategies– Special emphasis on low and

mixed income communities

Active Living by DesignBrief Proposal Applicants by Region

Representation from all 50 states, Washington, DC and one (1) U.S. Territory (PR)

196 76

211

200

21954

3

6

Active Living by DesignFull Proposal Applicants by State

Representation from 27 states, Washington, DC and Puerto Rico

Bronx, NY

Somerville, MA

Seattle, WA (2)

SacramentoSan Francisco

Oakland

Kodiak, AK

Jackson, WY

Winnebago, NE Omaha, NEDenver, CO

Albuquerque, NM

El Paso, TX

Chicago, IL

Cambridge, MN

Honolulu, HI

Rio Piedra, PR

Orlando, FL

Charleston, SC

Chapel Hill, NC

Louisville, KY

Lansing, MI

Cleveland, OH

Buffalo, NY

Wilkes-Barre, PAPhiladelphia, PA

Nashville, TN

Paterson, NJ

Norwich, VT

Columbia, MO Charlottesville, VA

Baltimore, MDWashington, DC

Cincinnati, OH

Tustin, CA

San Diego, CA

Summary

• Transportation and land use patterns strongly influence Americans ability to be physically active and healthier.

• The tools and resources exist to realize the potential of Active Living for improving the health and quality of life of Americans.

• We must be willing to take responsibility and work together to make our communities more supportive of healthy lifestyles.

Calls to Action

• Reach out to different partners and discover new approaches to solving challenging problems.

• Develop better practices and key policies to build and support activity friendly environments.

• Identify data that working in this area is important and mutually beneficial.

• Work to build synergy.

“Come my friends, ‘Tis not too late to seek a newer world.”

Alfred Lord Tennyson, Ulysses, 1842

“We don’t inherit the land from our ancestors we borrow it from our children.”

Native American Proverb

“We must become the change we seek”. M. Ghandi

Active Living by DesignContact Information

www.activelivingbydesign.org

919-843-ALbD (2523)

[email protected]

Active Living A New Public Health Paradigm: Promoting Physical Activity Through Design

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