Active Living Promoting a Healthier U'S' Through the Built Environment

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Active LivingPromoting a Healthier U.S. Through
the Built Environment
Rich Killingsworth, Director Active Living by
Design National Program Office University of
North Carolina School of Public Health
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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

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Focus of Todays Discussion on Active Living

• History
• Assumptions
• Terminology
• Public Health Burden of Physical Inactivity
• Research Needs
• Policy Needs
• Practice Opportunities
• Calls to Action

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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
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The Emergence of a Sedentary Society

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

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Recommended Physical ActivityU.S. Adults,
1986-2000
Source Centers for Disease Control and
Prevention Behavioral Risk Factor Surveillance
System
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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
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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI ? 30, or 30 lbs overweight for 54
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI ? 30, or 30 lbs overweight for 54
person)
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Explaining the Epidemic

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

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Syndemic
Two or more epidemics, interacting
synergistically, contributing to excess burden of
disease in a population.
http//www.cdc.gov/syndemics/index.htm
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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

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Transportation, Land Use and Health in the News

• Taking Back the Street
• Suburbias Road to Weight Gain
• Link Between Sprawl and Obesity
• Pedestrians Pushing Back
• Land Use Discourages Walking

The Detroit News
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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
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Leveling Atlanta
Metro Atlanta loses 58 acres of forested land a
day to development, Source Georgia
Department of Natural Resources.
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1973
1979
1987
1997
25 Years of Urban Growth in Atlanta
Source Scientific Visualization Studio, Goddard
Space Flight Center
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Low Density
Big, Segregated Single-Use Zones
Sparse Street Network
Lack of Centers
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Non-Motorized Trips 1977-1995Nationwide Personal
Transportation Survey - USDOT
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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
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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
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Children Are Walking Less and Becoming
Increasingly Overweight
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Transportation
Alternative Transportation
Healthy Environments and Active People
Physical Activity
Healthy Places and Spaces
Health
Environment
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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

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Promoting Physical Activity in the Built
Environment
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Advancing the Concept of Active Living

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

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Theoretical Foundations

• City Planning
• Urban Design
• Environmental Psychology

Normative Theory describe, explain and predict
phenomena gtgtgt prescribes Explains how things
ought to be
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Good City Form

• Kevin Lynch
• City form guides function
• Christopher Alexander
• The pattern of the city develops the language
  (behavior) of how people communicate
  (move/function)

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The Life of Cities

• Jane Jacobs
• .the need of cities for a most intricate and
  close-grained diversity of uses that give each
  other constant mutual support, both economically
  and socially.

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The Life of Streets

• Donald Appleyard
• More traffic means smaller networks, less
  neighboring, less interaction, and more isolation

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The Life of Public Places

• William H. Whyte
• Intimate scale of public spaces invites
  socializing, activity, and neighboring.

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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

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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.

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The Influences on Behavior
Source Promoting Physical Activity A Guide for
Community Action, 1999. US DHHS, CDC
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Personal Environmental Barriers to Physical
Activity

• PERSONAL BARRIERS
• Lack of motivation
• Perceived lack of time
• Weather
• Family obligations
• Fatigue

• ENVIRONMENTAL BARRIERS
• Lack of exercise facilities
• Lack of sidewalks, bike lanes, nearby public
  parks, hiking/biking trails
• Topography
• Perceived low levels of safety of ones
  neighborhood

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Social Ecological Model
Society/State
governor
legislators
state agency staff
Communities
countycommissioners
ministerial alliance
superintendent
mayor
planners
county/city agency staff
schoolboard
Organizations
principals
pastors
business ownersmanagers
cafeteriamanagers
teachers
CEOs
Family/Friends
parents
Individuals
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Core Assumptions of the Social Ecological Model

• The health and the well being is influenced by
  multiple facets of the physical and social
  environments
• Human environments are multidimensional and
  complex
• People and environment transactions are
  characterized by cycles of mutual influence
  (Reciprocal Determinism)
• People and environments should be studies at
  various levels of influence

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Recreational and Utilitarian Walking/bicycling
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Recreational/Utilitarian Matrix
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Factors that Influence Active Transportation

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

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Impact of Community Design on Activity
Sources Cambridge Systematics 1994 UNC-Highway
Safety Research Center 1994 EPA/CDC Greenstyles
Survey 1999 Nebraska Social Indicators Survey
1999
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The Influence of Location on Non-Motorized Travel
Behavior
Location
of Trips Walk/Bike

• Urban 17.7
• 2nd City 6.2
• Suburban 4.5
• Rural 3.9

Data Source 1995 NPTS - 40 metropolitan
statistical areas
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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?id205)
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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
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Socio-Environmental Influences on Physical
Activity

• The physical activity literature has given little
  attention to ecological determinants
• There has been minimal empirical research on the
  impact of facilities and environmental factors,
  such as recreational facilities, PE programs, and
  neighborhood crime

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Core Findings Environmental and
Sociodemographic Determinants

• Sociodemographic factors have strongest impact on
  physical activity
• Physical education matters, but few participate
• Community facilities may offer a key intervention
• Presence of crime and unsafe pedestrian
  environments gravely impacts physical activity
• Need for greater exploration of
  environmental/contextual determinants

Gordon-Larsen P, McMurray RG, Popkin BM. 2000.
Pediatrics 105e83.
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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.

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Active Living Strategies

• Preparation
• Promotion
• Programs
• Policies
• Physical Projects

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Strategy 1 Preparation

• Build diverse partnerships
• Build a vision
• Assess policies and environments
• Build a plan of action
• Identify a champion

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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

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Strategy 3 Programs

• Safe Routes to School
• Commuter Choice Programs
• Incentive Campaigns Bicycle Friendly Communities
• Parks and Trails Events
• Walking / Bicycling Clubs

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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

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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

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Heritage Rail-Trail, York, PA

• The York County Heritage Rail-Trail, a 21-
• mile trail, was awarded 1million in TE
• funds. The trail runs adjacent to an active
• rail line, links multiple communities,
• connects
• to a 20-mile
• rail-trail in
• Maryland.

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Douglas, GA Streetscape

• With 850,000 in TE funds, Douglas
• transformed six intersections. The new
• sidewalks,
• benches, and
• landscaping have
• contributed to a
• revitalization of
• Douglas
• downtown.

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Rhode Island Bike/Ped Safety

• The Rhode Island Dept.
• of Health used 48,000
• in TE funds for a 3-year
• safety program. The
• money funds education
• and training in schools
• communities, and
• promotions such as t-shirts
• helmets.

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Denver, CO Bike-n-Ride

• Denver added bike
• racks to 700 buses
• and installed 100
• bike parking racks
• with 301,500 in TE
• funds and a
• 100,000 match,
• greatly enabling
• and expanding
• bicycle commuting
• options.

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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 doesnt always have a plan
and its not linear. David Kessler, Former
Administrator Food and Drug Administration
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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

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RWJF Active-Living Projects
Creating Models And Increasing Capacity
Building the Evidence
Creating Demand
ALPES Community Indicators Urban Form/Public
Health Transit Use/Public Health Safe Routes to
School Policy Tracking       
National Programs - Active Living by Design -
Active for Life           Community
Projects Toolkit Development Bicycle-Friendly
Communities Walkable Communities
Micro-scale Projects Partnership
Building Clearinghouse Leadership for Active
Living Scholarships Media Series Reports /
Publications Incentives                  
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Active Living by DesignNational Program OfficeA
National Initiative Supported byThe Robert Wood
Johnson Foundation
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Active Living by Design - Mission

• To provide leadership in creating communities
  that will support, encourage, and sustain active
  living.

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Active Living by DesignTarget Groups

• 25 geographic areas with readiness to implement
  active living programs, policies, and
  communication strategies
• Special emphasis on low and mixed income
  communities

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Settings and Scale

• Buildings
• Public Spaces / Places
• Streets / Corridors
• Neighborhood /Community
• Town / City
• County / Region
• State / National

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Populations

• Irregularly Active
• Youth
• Adults
• Older Adults
• Women
• Low Income
• People of Color
• People w/ Disabilities

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Active Living by Design Goals

• Increase access to diverse and affordable
  individual opportunities for physical activity.
• Reduce built environment and policy barriers to
  physical activity.
• Develop effective communication and marketing
  tactics.
• Establish community models that can be replicated
  nationally.

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Active Living by DesignStrategic Domains Years
1 and 2

• Infrastructure Develop an effective,
  collaborative, results oriented team and an
  infrastructure that supports its work.
• Marketing Communications Build awareness of
  Active Living issues and opportunities and
  identify ALbD as a key organization for
  information and resources.
• Education, Outreach and Partnerships Expand
  awareness and knowledge base through education,
  outreach, and partnerships.
• Grant Making and Technical Assistance Develop
  Call for Proposals and identify 25 diverse
  communities as a vehicle for testing, evaluating
  and replicating best practices

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Active Living by DesignBrief Proposal Applicants
by Region
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219
211
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196
200
3
6
Representation from all 50 states, Washington, DC
and one (1) U.S. Territory (PR)
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Active Living by DesignFull Proposal Applicants
by State
Seattle, WA (2)
Norwich, VT
Somerville, MA
Cambridge, MN
Paterson, NJ
Jackson, WY
Buffalo, NY
Bronx, NY
Lansing, MI
Winnebago, NE
Chicago, IL
Wilkes-Barre, PA
Sacramento
Cleveland, OH
Philadelphia, PA
Omaha, NE
Denver, CO
San Francisco
Baltimore, MD
Cincinnati, OH
Oakland
Washington, DC
Columbia, MO
Tustin, CA
Louisville, KY
Charlottesville, VA
Chapel Hill, NC
San Diego, CA
Nashville, TN
Albuquerque, NM
Charleston, SC
El Paso, TX
Orlando, FL
Rio Piedra, PR
Kodiak, AK
Honolulu, HI
Representation from 27 states, Washington, DC and
Puerto Rico
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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.

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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.

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Come my friends, Tis not too late to seek a
newer world.
Alfred Lord Tennyson, Ulysses, 1842
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We must become the change we seek. M. Ghandi
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Active Living by DesignContact Information

• www.activelivingbydesign.org
• 919-843-ALbD (2523)
• rich_killingsworth_at_unc.edu