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

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

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 Activity U.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

(*BMI 30, or ~ 30 lbs overweight for 54 person)

Obesity* Trends Among U.S. Adults BRFSS, 1985

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1986

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1987

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1988

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1989

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1990

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1991

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1992

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1993

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1994

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1995

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1996

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1997

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1998

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 1999

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 2000

(*BMI 30, or ~ 30 lbs overweight for 54 person)

No Data

<10%

10%-14%

15-19%

20%

Obesity* Trends Among U.S. Adults BRFSS, 2001

(*BMI 30, or ~ 30 lbs overweight for 54 person)

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

Transportation
Alternative Transportation

Healthy Environments and Active People

Physical Activity Healthy Places and Spaces

Health
Environment

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

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 1977-1995

Nationwide Personal Transportation Survey - USDOT
10 9 8 7 6 5 4 3 2 1 0 1975 1980 1985 Bike Trips 1990 Walk Trips 1995 2000

% of Total 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 walkbased 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

Location

% of Trips Walk/Bike

Urban 2nd City Suburban Rural

17.7% 6.2% 4.5% 3.9%

Data Source: 1995 NPTS - 40 metropolitan statistical areas

1973

1979

1987

1997

25 Years of Urban Growth in Atlanta

Source: Scientific Visualization Studio, Goddard Space Flight Center

Leveling Atlanta

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

Source: Georgia Department of Natural Resources.

Low Density

Big, Segregated Single-Use Zones

Sparse Street Network

Lack of Centers

Impact of Community Design on Activity

Variable Mix of Land Use Presence/Proximity of Convenience Services Perceived Traffic Safety Perceived Aesthetics Development of Bikeway Availability of Parks and Trails Policy Support Outcome 19% increase in walk/bike trips in areas with appropriate land use mix 27% increase in walk/bike trips in areas having high presence and good proximity 88% increase in walk/bike trips in areas perceived as more safe 50% increase in walk/bike trips in areas perceived as more aesthetically pleasing 57% increase in bicycling in areas with dedicated bikeways 75% of inactives believe there are too few parks and recreation facilities. 56% of respondents would use trails if provided in their community 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, thats 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 activityfriendly 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, PA

The York County Heritage Rail-Trail, a 21mile 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.

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.

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.

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.

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

The Robert Wood Johnson Foundation

Active 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

Active Living by Design National Program Office

A National Initiative Supported by The 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 Design Target 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 Design Brief Proposal Applicants by Region

54 211 196 200 3 6 76

219

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

Active Living by Design Full Proposal Applicants by State

Seattle, WA (2) Somerville, MA Paterson, NJ Jackson, WY Buffalo, NY Lansing, MI Bronx, NY Winnebago, Chicago, IL Wilkes-Barre, NE Omaha, NE Cleveland, OH Philadelphia, PA PA Denver, CO Cincinnati, Baltimore, MD OH Washington, DC Columbia, MO Louisville, KY Charlottesville, VA Chapel Hill, Nashville, TN Albuquerque, NC NM Charleston, SC El Paso, TX Cambridge, MN Orlando, FL Kodiak, AK Honolulu, HI Rio Piedra, PR Norwich, VT

Sacramento San Francisco Oakland Tustin, CA San Diego, CA

Representation from 27 states, Washington, DC and Puerto Rico

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 dont 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 Design Contact Information

www.activelivingbydesign.org 919-843-ALbD (2523) rich_killingsworth@unc.edu