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Toward Designing an Environment to Promote Physical Activity

Masayoshi Oka

Landscape Journal: design, planning, and management of the land,


Volume 30, Number 2, 2011, pp. 280-298 (Article)

Published by University of Wisconsin Press


DOI: 10.1353/lnd.2011.0031

For additional information about this article


http://muse.jhu.edu/journals/lnd/summary/v030/30.2.oka.html

Access Provided by UNIVERSITY OF THE ARTS, LONDON at 02/10/13 8:22PM GMT


Toward Designing an Environment to Promote
Physical Activity

Masayoshi Oka

ABSTRACT In the United States, the high prevalence of physi- those of racial /ethnic minorities living in disadvan-
cal inactivity (PI) is linked to a wide range of health implications taged neighborhoods, compared with their healthier
among urban dwellers. PI is a risk factor for many chronic dis-
eases and some cancers, and is an underlying cause of over- counterparts living in affluent neighborhoods.
weight and obesity. In response to such concerns, a growing body Public health has historically been a concern in
of research has examined ways to promote physical activity (PA) the design of human settlements. During the early 20th
and to improve subsequent health outcomes. Based on research
century, urban planners and public health profession-
ndings across disciplines, modications in physical design alone
are insufcient to promote PA. Physical design changes must be als worked closely to combat the spread of infectious
accompanied by modications in the social environment of urban diseases in the United States (US). Initially known as a
areas. Comprehensive community-based strategies are needed sanitary area in the early 1900s, the US Census Tract,
to create supportive physical and social environments and to in-
form urban policy in guiding sustainable long-term maintenance formalized in the mid-1930s, is widely acknowledged
of those environments. Since the relationship between people as a historical milestone in tracking the outbreak of
and their environments is dynamic, more research is needed to infectious diseases (Krieger 2006). Zoning and land
understand the specic mechanisms. This article compiles a
number of research-based insights as to how future efforts in use controls to promote public safety and health are
promoting PA need to address physical, social, and policy dimen- other componenets of urban planning that share a
sions of the urban environment. It aims to present a foundation close history with public health professionals in the US
to bridge the elds of urban design and public health in creating
(Schiling and Lipton 2005). Since the early 20th cen-
an environment to promote PA.
tury, zoning and various land use designations have
KEYWORDS Physical activity, physical environment, social envi-
ronment, community-based strategy, urban policy encouraged developments and offered regulations that
address public health concerns associated with urban-
ization (changes in size, density, and heterogeneity of
INTRODUCTION
cities) and urbanicity (the impact of living in urban

T he number of cities and their size has expanded


over the past two centuries. In a world of increasing
globalization, the urban environment is both beneficial
areas at a given time). Figure 1 shows key events in the
fields of urban planning and public health during the
20th century in the US (Centers for Disease Control
and detrimental to societal and individual well-being. and Prevention [CDC] 1999; Krieger 2006; Schiling and

2011 by the Board of Regents of the University of Wisconsin System


In securing food, water, and shelter for human settle- Lipton 2005).
ments, urban development has adversely impacted During the past century, the leading cause of death
natural ecosystems and public health (Foley et al. 2005). in the US shifted from infectious disease to chronic
Aspects of the physical and social environment influ- disease (CDC 1999). Improvements in sanitation and
ence urban health, which is defined as the combina- hygiene, the discovery of antibiotics, and the imple-
Landscape Journal 30:211 ISSN 0277-2426

tion of the health of cities and the health of people who mentation of vaccination programs contributed to this
reside in them (Vlahov and Galea 2002). The negative management of infectious disease. The synchronous
influence of the physical environment includes air pol- increase in death rates attributed to chronic diseases
lution, water contamination, and noise pollution. In a continues to raise questions about the adverse influ-
parallel realm of influence, the social environment af- ence of the urban environment on public health. The
fects crime and violence, race /ethnic composition, and health implications include higher risks of cardiovas-
socioeconomic status (SES, the level of income and edu- cular and respiratory diseases, overweight and obesity,
cation). As the characteristics of the urban environment heat-related illnesses, and depression and other mental
change over time and space, the spatiotemporal varia- disorders (McMichael 2000). Although urban planning
tions in the physical and social environment produces and public health professionals have worked together
health inequalities in the city. This is evident in the high in the past to serve disadvantaged populations, they
rates of morbidity and mortality among the poor and have more recently become disconnected from one
Figure 1. Key events in urban planning
and public health during the twentieth
century in the United States (CDC
1999; Krieger 2006; Schiling and
Lipton 2005).

another. In the belief that the recent estrangement of planners and public health professionals seek to better
these fields has been detrimental to the health of urban understand the influence of the urban environment on
populations, many researchers have begun studies to urban dwellers. These examples denote a potential link
review the obstacles and barriers to reconnecting the to once again bring together the two fields.
two fields (Corburn 2004). In the US, the influence of the urban environment
The influence of the urban environment on public on the prevalence of physical inactivity (PI) provides a
health is complex and dynamic. Cross-disciplinary means to reconnect the two fields. Urban design plays
work is the key approach to improve the quality of a vital role in how people interact with their residen-
urban health (Galea and Vlahov 2005). With growing tial environment. Residents living in more walkable
attention on sustainability, collaborative work has be- neighborhoods (those characterized by mixed use, con-
come the norm with which to address a complex and nected streets, and high residential density) are more
dynamic set of problems. This ongoing trend provides likely to walk and bike for transportation and generate
an opportunity to reunite the fields of urban design and less air pollution, and have a lower risk of obesity rela-
public health around areas of common concern (Hoe- tive to residents living in less walkable neighborhoods
hner et al. 2003). For example, transportation planning (Frank et al. 2006). Since human behavior responds to
and public health theory share a similar approach to the surrounding environment, changes in the urban
understanding the mechanisms that influence travel environment are likely to reduce the high prevalence
patterns and human behaviors. Similarly, both urban of PI and to improve subsequent health outcomes.

Oka 281
Table 1. Trends in the means of transportation to work between 1960 and 2000 in the
United States.
Percent (%)
Means of Transportation to Work 1960 1970 1980 1990 2000
Car, Truck, or Van 64.0 77.7 84.1 86.5 87.9
Drove alone 64.4 73.2 75.7
Carpooled 19.7 13.4 12.2
Public Transportation 12.1 8.9 6.4 5.3 4.7
Bus or Trolley Bus 8.2 5.5 4.1 3.0 2.5
Streetcar or Trolley Car 0.1 0.1
Subway or Elevated 3.8 2.3 1.6 1.5 1.5
Railroad 0.7 0.6 0.5 0.5
Taxicab 0.4 0.2 0.2 0.2
Motorcycle 0.4 0.2 0.1
Bicycle 0.5 0.4 0.4
Walked Only 9.9 7.4 5.6 3.9 2.9
Other Means 2.5 2.5 0.7 0.7 0.7
Worked at Home 7.2 3.5 2.3 3.0 3.3

Source: US Census (http://www.census.gov/population/www/socdemo/journey.html).


Note: Only the 1960 Census included a category of not reported, which accounted for 4.3 percent of
all 1960 responses. This category was omitted from the table to be consistent with those of following
years.

To achieve such a goal urban designers and planners US, the 2007 Behavioral Risk Factor Surveillance Sys-
need to work collaboratively with public health profes- tem (BRFSS) survey showed that about one-third of
sionals in developing strategies to promote physical American adults failed to achieve the minimum levels
activity (PA). of daily PA (CDC 2008). Overall, the prevalence of PI
The reconnection of the two fields will require was higher among women, elderly people ( 65 years),
time, but it will also provide an opportunity to incorpo- the non-Hispanic black population, individuals with
rate scientific knowledge into urban design practices. less than a high school education, those living in the
These collaborative efforts can create a foundation South, and those who were obese. A decline in work-
toward designing urban environments that improve related activity, transportation activity, activity in the
health outcomes. In recent years, much of the emphasis home, and an increase in sedentary activity were found
in reducing the prevalence of PI and improving health to be the major factors of PI (Brownson, Boehmer, and
outcomes has focused on making changes in the physi- Luke 2005). US Census data showed an increased de-
cal environment. In fact, encouraging people to engage pendence on the automobile between 1960 and 2000,
in PA and improve their health requires a combination while dependence on public transportation declined
of changes in the physical and social environments in during the same time (Table 1). The private car is the
conjunction with a community-based approach to ini- dominant mode of urban travel among every segment
tiate long-term maintenance of changes in both the of the US population, depriving the population of
physical and social environments. This article identifies much needed daily PA (walking or bicycling) (Pucher
important aspects of these three dimensions of change and Renne 2003).
by compiling research findings across disciplines. PI is a risk factor for diabetes, high blood pres-
These insights provide guidelines for urban designers sure, obesity, heart disease, and some cancers, and is
and planners toward designing future environments to an underlying cause of overweight and obesity (Sallis
promote PA. and Owen 1999). In the US, the National Health and
Nutrition Examination Survey (NHANES) 19992004
showed a continuing increase in both the prevalence of
HEALTH IMPLICATIONS OF PHYSICAL INACTIVIT Y
overweight in children and adolescents, and the preva-
Physical inactivity (PI) is the critical factor associated lence of obesity in adults (Ogden et al. 2006). Approxi-
with comorbidities of the sedentary lifestyle that has mately 17.1 percent of children and adolescents were
arisen from changes in society and way of living. In the overweight and 32.2 percent of adults were obese. Since

282 Landscape Journal 30:211


overweight or obese youth are likely to become over- accessibility, availability, and aesthetic attributes (qual-
weight or obese adults (Kvaavik, Tell, and Klepp 2003; ity of the amenities) of the urban environment has also
Singh et al. 2008), more Americans are expected to face been strongly associated with high levels of PA (Hum-
the health complications associated with weight gain pel, Owen, and Leslie 2002). Taken together, these stud-
(such as arthritis, cardiovascular diseases, diabetes, hy- ies corroborate the influence of physical design on how
pertension, respiratory illnesses, stroke, and some can- people interact with their residential environment.
cers) (Haslam and James 2005). The NHANES III (19881994) showed that high
To reduce the prevalence of PI and improve sub- levels of leisure-time physical activity (LTPA) were as-
sequent health outcomes, increasing the level of PA is sociated with lower risk of obesity in the US (King et al.
a key lifestyle behavior in long-term weight loss and 2001). LTPA includes jogging or running, riding a bi-
weight control (Jakicic 2009). Regular participation in cycle or exercise bicycle, swimming, aerobic dancing,
moderate-intensity PA (such as brisk walking) has been other dancing, calisthenics or floor exercise, gardening
found to reduce body weight and to lower the risk of dia- or yard work, or weight lifting. The 2001 BRFSS showed
betes (Hamman et al. 2006; Jeon et al. 2007). The Ameri- that in Georgia, the majority of PA took place around the
can College of Sports Medicine and the American Heart home (Powell, Martin, and Chowdhury 2003). The most
Association recommends moderate-intensity aerobic common places to engage in LTPA were streets or side-
PA for a minimum of 30 minutes on five days per week, walks (32.0 percent), public parks (26.8 percent), school
or vigorous-intensity aerobic PA for a minimum of 20 track (10.2 percent), gym or fitness center (7.8 percent),
minutes on three days per week (Haskell et al. 2007). walking or jogging trail (6.6 percent), treadmill at home
This is an update from earlier recommendations to add (4.1 percent), and shopping mall (2.9 percent).
15 minutes of brisk walking (or 30 minutes of slow walk-
ing) per day (Morabia and Costanza 2004).
URBAN DESIGN FEATURES TO PROMOTE PHYSICAL
ACTIVIT Y
PHYSICAL ENVIRONMENT AND PHYSICAL ACTIVIT Y
Transportation planning theory suggests that people
The physical environment influences health behaviors, are willing to walk 800 meters or 10 minutes to get to
psychological conditions, and health status (Kawachi train stations, grocery stores, and other destinations in
and Berkman 2003). Neighborhood characteristics in- their neighborhood. The accessibility to and availabil-
fluence travel behaviors and travel patterns. In general, ity of places for PA within 10 minutes walk from ones
people compare travel time and costs when making home is likely to promote more PA. These places offer a
decisions (whether to walk, ride a bicycle, use a public variety of exercise settings to engage in different types
transportation, or drive) to get from point A to point B. of exercise, and they provide a destination to which
The aesthetics of place, density and concentration of people can walk.
neighborhood, land use, street network connectivity,
transportation systems, and institutional and organiza- Public Parks
tional policies are some attributes of the urban environ- Parks can play a substantial role in increasing PA by pro-
ment that have been associated with high levels of PA viding a wide range of free or low-cost activities. They
(Saelens et al. 2003; Brennan Ramirez et al. 2006). Mixed can also contribute to sedentary behavior by provid-
land use, residential density, street connectivity, and ing a venue for socializing with friends and neighbors.
transportation infrastructure are the four main physical The effect of these disparate attributes on engagement
characteristics strongly associated with high levels of PA in PA depends on the features of public parks as well
(Gebel, Bauman, and Petticrew 2007). A combination of as the gender and age of the individuals who use them

Oka 283
(Cohen et al. 2007). Men used parks that featured com- and the number of bridges needed to connect the trail
petitive team sports, whereas women used playgrounds paths, annual maintenance costs are similar for low
where they could supervise their children. Seniors did and high-cost trails (Wang et al. 2004). The 2000 BRFSS
not use parks unless incentives (such as organized and / highlighted the importance of providing adequate
or group activities) motivated them. The difference in sidewalks, enjoyable scenery, and walking trails in the
the level of PA was related to the types of activity per- neighborhood to encourage residents to walk (Eyler
mitted in the park (Floyd et al. 2008). In general, high et al. 2003). Among trail users, physical design plays
levels of PA occurred in soccer fields, playgrounds, and a significant role in guiding preferences and choices
basketball, tennis /racquetball, and volleyball courts, about when and /or where to exercise (Librett, Yore, and
while sedentary behaviors occurred in picnic shelters, Schimid 2006). The ease of trail construction suggests
baseball /softball fields, and open-space areas. Public that designing and implementing a network of trails
parks need to accommodate various types of activities may play an important and cost-effective role in en-
for residents to engage in PA, not just open space with couraging residents to walk and/or to ride a bicycle in
benches for residents to sit, relax, and socialize. both low- and high-income neighborhoods.

Dog Parks Street Connectivity


There is growing evidence to suggest that dog own- Within a street network pattern, connectivity is the di-
ers experience physical, mental, and emotional health rectness and availability of alternative routes from one
benefits through increased exercise as well as interac- point to another. Connectivity is measured by the num-
tion with their dogs and neighbors (Cutt et al. 2007). ber of intersections per square kilometer, or by the ratio
Some of the health benefits include lower systolic blood of travel distance along the street network to the straight-
pressure and blood cholesterol level, better survival line distance between origin and destination (Figure 2).
rate after a heart attack, lower levels of mental stress, Distance between walking destinations and travel times
lower feelings of loneliness and depression, and higher are the two main attributes of high-walkability neigh-
self-esteem. Although not all dog owners are physically borhoods (Handy et al. 2002). Greater street connectivity
active, they tend to walk significantly more often and in high-walkability neighborhoods produces a grid-like
for longer times, and have more minutes of total PA street pattern with short block lengths and few cul-de-
than non-owners (Cutt et al. 2008). Dog parks provide sacs. Low-walkability neighborhoods have curvilinear
increased PA opportunities with a controlled environ- street patterns with longer block lengths and more cul-
ment for dogs to play, a space for owners to exercise with de-sacs. In comparing neighborhood designs, residents
their dogs, and a place to socialize with neighbors and living in high-walkability neighborhoods tend to engage
people with similar interests (Lee, Shepley, and Huang in significantly more PA and have a lower prevalence of
2009). Urban neighborhoods restricting the presence of obesity (Saelens et al. 2003). More pedestrian-oriented
dogs in public parks need to consider providing more street connectivity (which can be automobile indepen-
dog parks for residents to engage in PA and achieve as- dent) needs to be integrated and expanded into an ex-
sociated health benefits. isting community or community development plans to
increase accessibility and, in turn, to motivate residents
Trails to walk more in their neighborhoods.
Walking and bicycle trails are relatively low-cost urban
design features that facilitate additional PA by reduc- Opportunities
ing the barriers to convenience and accessibility. While Peoples motivation to travel in the urban environment
construction cost can vary greatly by the surface type depends upon their ability to reach a desired destina-

284 Landscape Journal 30:211


Figure 2. Street connectivity. (a) a low-
walkability neighborhood (ratio = 0.13),
and (b) a high-walkability neighborhood
(ratio = 0.65). Ratio: street network
distance/straight distance.

tion, the attractiveness of the destination, the nature Pedestrian-vehicle crashes tend to be more frequent in
of the trip, and the importance of the trip. As distance urban settings characterized by high street connectivity
between origin and destination increase, the likelihood and transit access but result in less severe pedestrian in-
of making a trip declines. In general, people are more juries (Clifton, Burnier, and Akar 2009). Concerns about
motivated to do something when they can realize a high the vulnerability of pedestrians and bicyclists to motor-
value in doing so, and are less motivated when they can- vehicle-related accidents and attention to design of safe
not foresee such values. Relatively few people walked streets are greatest in areas with low street connectivity
in a sufficient amount for their health benefits (Giles- and minimal access to public transit. Promoting PA in
Corti and Donovan 2003). This implies that people such areas will need to consider multiple traffic calming
perceive of PA as recreation, a separate activity from strategies including: more speed bumps, lower speed
an individuals daily routines. In order to change this limits, fewer traffic lanes, improved road conditions,
mindset, greater street connectivity alone is insufficient increased separation of pedestrians from the roadway,
to alter health behavior in a given environment. The increased visibility of pedestrians, better lighting, and
street network needs to be accompanied by a variety of more crosswalks with light signals.
opportunities afforded by mixed land-use, aesthetics,
and other attributes of the urban environment (Wells Summary
and Yang 2008). Distributing more opportunities for PA These research findings suggest the importance of dis-
(such as public parks, dog parks, and trails as well as tributing different types of PA-related urban features
other PA-related and /or recreational facilities) across across pedestrian-oriented streets with high connec-
a high level of pedestrian-oriented street connectivity tivity and improving traffic safety in neighborhoods as
would encourage residents to engage in PA. a means to increase the level of PA among residents.
From the health behavior perspective, such efforts are
Traffic Safety likely to create a supportive physical environment to
Traffic safety represents a major constraint to engaging promote PA.
in PA. Traffic volume and the presence of safe cross-
walks are important components of decisions about
SOCIAL AND PSYCHOLOGICAL FACTORS TO
walking and route planning (Hine 1996). Between 1997
PROMOTE PHYSICAL ACTIVIT Y
and 2007, approximately 5,000 pedestrians and bicy-
clists were killed in motor-vehicle-related crashes each While the above urban design features support PA, the
year in the US. In 2007, 73 percent of such fatalities oc- presence of such features in the urban environment
curred in urban areas (National Highway Traffic Safety does not guarantee an increase in the level of PA among
Administration 2008). The incidence of pedestrian- residents. A host of social and psychological factors also
vehicle crashes and the severity of injuries depend on influences people to be active or inactive. Dynamic in-
weather, road conditions, time of day, and street design. teractions among biological, physical, psychological,

Oka 285
and social factors shape human behaviors (Institute the protective benefits of education on health status
of Medicine 2001). The social environment influences (Browning and Cagney 2002).
human behaviors, psychological conditions, and health Since the level of collective efficacy also corre-
status (Berkman and Kawachi 2000). Over time, the sponds to the quality and quantity of physical and so-
cumulative effects of these factors either hinder or fa- cial resources in the neighborhood, collective efficacy
cilitate certain health behaviors (such as PA). Different influences residents health behavior (such as diet and
behavior patterns occur depending on social context, PA) (Cohen et al. 2006). Residents living in high collec-
including, but not limited to: social and psychological tive efficacy neighborhoods are more likely to:
factors in the neighborhood, family or home condi-
1. interact with each other and socialize
tions, school or work settings, and the organizations,
communities, or society in which people participate. 2. work together to maintain and /or to improve their
neighborhood conditions
Neighborhood Collective Efficacy 3. express approval and disapproval about a range of
Through social interactions, social ties, and other at- topics (such as neighborhood safety and availability
tributes of the social environment, high levels of social of PA-related urban features)
organization promote social cohesion (mutual trust 4. participate more in verbal interactions and
and solidarity) and informal social control (shared ex- community meetings
pectations for action) among the residents. Social co- 5. take part in addressing and improving community
hesion and informal social control are the two major concerns.
tenets of collective efficacy, which operates as a foun-
dation for improving human health and well-being Residents living in high collective efficacy neigh-
(Cohen, Inagami, and Finch 2008). Collective efficacy borhoods are more likely to control sedentary behav-
contributes to better health status through a number iors and promote opportunities for PA (such as group
of processes: shaping cultural and social norms, reduc- activities and organized sports) that take place in their
ing negative aspects of poor health behavior, providing community. Because of available neighborhood (both
supports to adopt healthy behaviors, managing per- physical and social) resources, high collective efficacy
sonal health hazards and risks, and reducing stress that neighborhoods are associated with more community-
can contribute to poor health outcomes (Berkman and level support to engage in PA.
Kawachi 2000). On the other hand, residents living in low collective
In principle, high collective efficacy neighborhoods efficacy neighborhoods are less likely to care for others
are more likely to constrain deviant behaviors among and /or to interfere with neighbors behavior. Lower lev-
residents, provide the sense of attachment to the com- els of social cohesion and informal social control lead
munity, support the tendency to take action together to lower levels of support for and motivation to engage
when trouble arises, and intervene on each others be- in PA (for both leisure and routine activities). Because
half for the greater good. As a result, residents living in of lower levels of social organization and deficiencies
high collective efficacy neighborhoods tend to have a in neighborhood resources, residents living in low col-
better health status (Browning and Cagney 2003). For lective efficacy neighborhoods are more likely to spend
those living in low collective efficacy neighborhoods, more time indoors and to be sedentary.
the lack of social ties and social networks produces so-
cial disorganization and attenuates social cohesion and
social control. These deficiencies in collective efficacy
are associated with poor health status, and can offset

286 Landscape Journal 30:211


Figure 3. Relationships between psy-
chosocial factors and physical activity
(McNeill, Kreuter, and Subramanian
2006).

Psychosocial and Cognitive Factors family, friends, and /or neighbors. Residents develop a
Psychosocial conditions (psychological development in sense of attachment and connectedness to one another
and interaction with a social environment) play an im- that motivates the use of neighborhood resources for
portant role in human behavior. Interpersonal relation- PA (McNeill, Kreuter, and Subramanian 2006).
ships and social interactions, social inequalities, and
neighborhood characteristics are some of the commu- Socioeconomic position and income inequality. People
nity psychosocial aspects that have been associated with with low socioeconomic position (characterized by in-
high levels of PA (McNeill, Kreuter, and Subramanian dividual income, educational attainment, and occupa-
2006) (Figure 3). Cognitive, vicarious, self-regulatory, tional or job status) are financially constrained to live in
and self-reflective processes are the underlying prop- poor urban neighborhoods with limited access to PA-
erties of psychosocial functioning (Bandura 1986). The related features and other neighborhood resources. The
person, the persons social environment, and the indi- uneven spatial distribution of public resources creates a
viduals cognitive processes all interact to determine gap between rich and poor neighborhoods for PA. Resi-
whether a person would engage in PA. dents living in poor neighborhoods are unable to fol-
low the recommended levels of daily PA due to the lack
Social network and social support. The collective of available neighborhood resources for PA (McNeill,
structure of social relationships within a neighborhood Kreuter, and Subramanian 2006).
and the physical and emotional comforts afforded by
others stimulate people to create walking groups (such Neighborhood deprivation. The unequal distribution
as buddy systems) to engage in PA together with their of social support and services, trust among neigh-
bors, and investment in neighborhood resources ex-

Oka 287
poses residents living in deprived areas to harmful Cognitive factors. Achieving recommended levels of PA
pollution (such as toxic air and contaminated water), has been associated with four individual cognitive fac-
violence and crime, physical and social disorder, and tors. Highly motivated people with a positive attitude
other hazards. A combination of physical and psycho- towards improving health behaviors are more likely to
social factors influences residents living in deprived engage in PA. In addition, people with an exercise part-
neighborhoods to remain inside their homes to avoid ner and for whom PA has become a habit are more likely
exposure to these hazards (McNeill, Kreuter, and Sub- to engage in PA (Giles-Corti and Donovan 2002). High
ramanian 2006). levels of self-esteem and confidence as well as knowl-
edge of health benefits and values induce people to im-
Social capital and social cohesion. The development prove their health behaviors.
of social capital (the extent of social networks, norms These research findings suggest the importance of
of reciprocity, and trust that encourages residents to increasing levels of self-efficacy and collective efficacy
act together to attain shared goals) provides a means by strengthening social organization to promote PA
to reinforce social norms for healthy behavior among among residents. From the health behavior perspec-
the residents. Similarly, the development of social co- tive, such efforts are likely to create a supportive social
hesion (the extent of connectedness among residents environment to promote PA.
in a neighborhood combined with a willingness among
residents to intervene for the common good) allows res-
COMPREHENSIVE STRATEGIES TO PROMOTE
idents to work together with their neighbors to restrict
PHYSICAL ACTIVIT Y
negative individual and social behaviors. High levels of
social capital and social cohesion within a neighbor- A combination of physical and social environments
hood encourage residents to support one another to creates a viable community and provides societal and
engage in PA as well as to maintain a social environ- individual well-being (Berkman and Kawachi 2000;
ment to encourage PA (McNeill, Kreuter, and Subrama- Kawachi and Berkman 2003). Because poor health out-
nian 2006). comes tend to cluster together within a similar geo-
graphic area, changes to the community environment
Social support and self-efficacy. People with social (both physical and social) have the potential to address
support and encouragement from family, friends, and public health concerns. Community-based strategies
colleagues in changing sedentary behaviors are more have been favored as an effective means to modify
likely to engage in PA. Similarly, people with strong health behavior at a population level (King 1998).
beliefs about their capabilities and willingness to over- A community-based PA strategy focuses on creat-
come obstacles in improving health behaviors are more ing a community organization that prioritizes PA for
likely to engage in PA (AbuSabha and Achterberg 1997). all residents and modifies negative attitudes toward PA
Both social support and self-efficacy are important fac- among the sedentary residents. Such an initiative brings
tors of PA even after accounting for other environmen- together various community stakeholders to amend un-
tal and psychosocial factors (Duncan and Mummery healthy behaviors in the community by changing physi-
2005). Providing social support in community settings, cal design, social and cultural settings, and policies and
supporting individual adaptation to health behav- legislation to sustain long-term mainenance of changes
ior changes, and creating or enhancing access to PA- in the physical and social environment (King 1998).
related urban features combined with informational Key stakeholders participating in this process include
outreach activities have shown to be an effective means public sector legislative bodies (such as city councils)
to increase the level of PA (Kahn et al. 2002). and executive departments (such as transportation,

288 Landscape Journal 30:211


planning, and public health department) as well as the perience exclusion and /or rejection from healthier
private sector (such as land and real estate developers, counterparts living in affluent neighborhoods. Racial /
consultants, and retail representatives). Community- ethnic discrimination and /or residential segregation
based strategies successful in increasing the level of are often attributes of disadvantaged neighborhoods,
PA among residents include: 1) behavioral and social and are linked to adverse effects on residents mental
interventions to improve social support in community well-being (Gee 2002). The poor and racial /ethnic mi-
settings and 2) environmental and policy interventions norities living in disadvantaged neighborhoods in the
to enhance access to places for PA in conjunction with US have a higher prevalence of PI and are at a greater
informational outreach activities (Kahn et al. 2002). risk of the health implications associated with PI (CDC
The advantage of a community-based strategy is 2008). To address such inequalities, a community-based
the involvement of various stakeholders and interest strategy is an effective means to reduce neighborhood
groups to comprehensively address inequalities in the deprivation and to improve health outcomes at a popu-
distribution of neighborhood resources and to improve lation level. The effectiveness of a community-based
human health and well-being. Significant differences strategy depends on the strength of urban policy guid-
in access to PA-related urban features (such as public ing urban development.
parks, open spaces, gyms, and fitness centers) have been Urban policies advocating modifications in the
documented in the US (Cohen et al. 2007; Crawford physical design, social, and cultural setting of urban
et al. 2008; Gordon-Larsen et al. 2006; Powell, Slater, and areas represent a first step in reducing the high preva-
Chaloupka 2004; Powell et al. 2006). Deficient neighbor- lence of PI in disadvantaged neighborhoods (Loukaitou-
hoods are linked to neighborhood racial /ethnic com- Sideris 2006). In the US, counties with strong urban
position and /or SES (predominantly African-American containment policies have been associated with higher
and /or low SES neighborhoods), and to the lack of levels of LTPA and walking /bicycling to work (Aytur,
comprehensive policy in addressing neighborhood de- Rodriguez, Evenson, Catellier 2008). The principles of
privation (inequalities in physical and social resources) urban containment are to manage the location, charac-
(Aytur, Rodriguez, Evenson, Catellier, and Rosamond ter, and timing of growth by:
2008). Improvement of these neighborhood conditions
1. directing development to occur within designated
requires an array of policy tools (such as impact fees or
urban areas
exaction fees, concurrency requirements, and transfer /
2. encouraging efficient use of infrastructure
purchase of development rights) to guide urban design
and planning efforts. Urban policy needs to advocate 3. promoting social equity
for comprehensive community-based strategies that 4. preserving farmland and natural ecosystems
address neighborhood deprivation, modify the physi-
5. mitigating environmental impacts, and /or
cal and social environments, and foster improvement
in subsequent health behaviors (Giles-Corti and Dono- 6. setting aside land for public green spaces.
van 2002).
Counties and metropolitan areas adopting these
Neighborhood and health inequalities generally
principles generally have well-developed transit ser-
arise from entrapment and displacement attributable
vices, more affordable housing, lower levels of auto-
to many socioeconomic factors (Smith and Easterlow
mobile use, and higher levels of public transit and
2005). Financial conditions may prevent migration
non-motorized vehicle use. Recent urban design move-
of unhealthy individuals to a better neighborhood,
ments (such as new urbanism, sustainable development,
restricting their ability to live outside disadvantaged
and smart growth) advocate long-term guidance for the
neighborhoods. Unhealthy individuals may also ex-

Oka 289
location, design, density, rate, and type of development ascribes importance to physical and social environ-
in urban areas and their peripheries. Community- ments and urban policy in shaping human behavior
based strategies following the principles of urban con- and pedestrian travel patterns (Badland and Schofield
tainment are the most effective means to promote PA at 2005; Frank and Engelke 2001; Hess et al. 1999; Mou-
a population level (Morandi 2009; Solomon, Standish, don et al. 1997; Southworth 2005). This indicates a stra-
and Orleans 2009). tegic consensus between the fields of urban design and
public health to increase the level of PA at a population
level, even though the two fields have been estranged
SUMMARY
for some time in the US.
These research findings suggest the importance of The fields of urban design and public health must
community-based strategies to inform urban policy in work collaboratively to find ways to create communi-
guiding sustainable long-term maintneance of changes ties with supportive physical and social environments
in both the physical and social environment as a means that promote PA. Research findings indicate that urban
to increase the level of PA among residents. From the design plays a role in the process of developing self-
health behavior perspective, such efforts are likely to efficacy and collective efficacy. For example, the pres-
create a supportive community to promote PA. ence of urban parks have been associated with higher
levels of collective efficacy, while the presence of al-
cohol stores have been associated with lower levels of
DISCUSSION
collective efficacy (Cohen, Inagami, and Finch 2008).
The high prevalence of PI in the US is the consequence In addition, the presence of trees and well-maintained
of societal changes and their associated lifestyles. It is grass contribute to a healthy social ecology in residen-
not an easy task to induce people to engage in more tial settings (Kuo 2003). In theory, the presence of urban
PA. The complex and dynamic relationship between vegetation:
people and their environments needs to be addressed
1. gives comfort and joy to the residents
comprehensively from an interdisciplinary perspective
and through cross-disciplinary efforts. In other words, 2. leads residents to use the green and shared spaces
modification in physical design alone is insufficient 3. allows residents to interact and socialize with
to change health behaviors, and to promote PA (Giles- neighbors in the green and shared spaces
Corti and Donovan 2002). 4. develops social ties and social network through
The concept of a community-based strategy in- social interaction
tended to modify both the physical and social envi-
5. creates a sense of attachment to the community
ronment and to inform urban policy in maintaining
through social ties and social network
long-term environmental changes is a social eco-
6. considers neighborhood safety by watching out for
logical approach for health promotion (Stokols 2000).
one another through social cohesion
The social ecological approach emphasizes collec-
tive initiatives among key organizations and interest 7. restrains neighborhood disorders through informal
groups in the community to address public concerns social control
and to establish a framework for implementing ur- 8. prevents crimes and violence through collective
ban policies that improve individual and community efficacy
well-being. Despite the distance between the fields of
urban design and public health in the US, this theoreti- In sequential order, these interrelated factors create
cal approach is similar to planning determinism that a viable community for residents (Kuo 2003) (Figure 4).

290 Landscape Journal 30:211


This theoretical context suggests that the potential ben-
efits of urban vegetation are likely to exceed those of re-
ducing carbon dioxide emission, energy consumption,
noise pollution, and psychological stress, while also im-
proving air quality, urban hydrology, and real estate val-
ues (Dwyer et al. 1992; Laverne and Winson-Geideman
2003). In other words, the physical design of a neigh-
borhood is likely to play a role in improving social and
psychological processes that lead to the creation of a vi-
able community. The fields of urban design and public
health have a consensual understanding of a social eco-
logical approach through which the high prevalence of
PI can be addressed. For this reason, future efforts to-
ward designing an environment to promote PA need to Figure 4. Role of arboriculture in the social environment (Kuo 2003).
be initiated from a community-based strategy: 1) to cre-
ate a supportive physical environment; 2) to provide a
supportive social environment; and 3) to inform urban of the US level while successfully maintaining lower pe-
policy in guiding sustainable long-term maintenance destrian and bicyclist injuries and fatalities (Pucher and
of changes in both the physical and social environment Dijkstra 2003). In efforts to promote PA, US cities need
(Figure 5). The key is to address community concerns to focus on:
from an interdisciplinary perspective and through
1. developing and maintaining a reliable and functional
cross-disciplinary efforts.
transit infrastructure
Although a social ecological approach may seem
2. fostering urban design that encourages non-
theoretical and impractical, there are domestic and in-
motorized vehicle use
ternational efforts that provide valuable insights toward
designing an environment to promote PA. San Francisco 3. improving safety and protection of pedestrians and
has been establishing citywide initiatives from various bicyclists from vehicle collisions
spectra (San Francisco Department of Public Heatlh 4. providing incentives to limit motorized vehicle use
2010). The spectrum of prevention approach includes:
5. improving driver training and traffic education
1. strengthening individual knowledge and skills 6. implementing traffic regulations and enforcement
2. promoting community education 7. coordinating strong partnerships among public,
3. educating providers private, and government sectors
4. changing organizational practices 8. managing financial resources to facilitate changes in
the city and community.
5. fostering coalitions and networks
6. mobilizing neighborhoods and communities; and Based on the literature presented thus far, it is clear
7. influencing policy and legislation. that future efforts toward designing an environment to
promote PA have to move beyond a focus on physical de-
Cities in Germany and the Netherlands have been sign. Health behavior is complex and dynamic; people
successful in promoting a high rate of walking and bicy- interact with and benefit from the environment differ-
cling. Both countries have kept automobile use at half ently. In order to address such a complex and dynamic

Oka 291
of a population over long periods of time) conducted to
date have followed the population at hand for a couple
of months to a couple of years. Long-term effectiveness
(for example, over 20 to 30 years) of a specific inter-
vention cannot be inferred beyond the duration of the
study (Kahn et al. 2002; Mller-Riemenschneider et al.
Figure 5. Conceptual framework toward designing an environment to 2008), leaving open the possibility that strategies effec-
promote physical activity.
tive over a short period of time prove ineffective over
the long term.
Second, sedentary behaviors are thought to be
set of problems, community-based strategies provide a intentional and planned into ones lifestyle, and deci-
platform to work collaboratively from an interdisciplin- sions to be physically active are made independently
ary perspective and through cross-disciplinary efforts. from the influence of the surrounding environment. A
These efforts may help determine how and to whom persons intention and plan (the decision and motiva-
neighborhood (both physical and social) resources need tion to act) is the determinant of human behavior influ-
to be allocated in the community to promote PA. This is enced by attitude (overall evaluation of the behavior),
a comprehensive approach likely to serve the least well- subjective norms (perceived social acceptance to en-
off population in the US and provides an opportunity gage in the behavior), and perceived behavioral control
for the fields of urban design and public health to work (overall perception of ability to perform the behavior
together once again. when motivation is held constant) (Rhodes and Dean
2009). Unless comprehensive strategies are employed
to influence a persons decision making, modifications
LIMITATIONS IN CURRENT RESEARCH
to physical design, social and cultural settings, and ur-
Despite the growing body of research on PA, the specific ban policy may be insufficient to change ones seden-
mechanisms of how the physical environment, social tary behavior.
environment, and urban policy jointly affect human Third, environmental barriers may have a dispro-
behavior and subsequent levels of PA has yet to be elu- portionate impact on different subgroups (depend-
cidated (Ewing 2005; Zacharias 2001). The dearth of ing on age, gender, race /ethnicity, and individual
successful examples is linked to several research limita- SES) within a given environment. African-Americans
tions, which need to be addressed in the future. perceived their neighborhoods as less safe and less
First, most of the research findings published to pleasant for PA than did whites, regardless of the ra-
date are based on cross-sectional studies (analysis of a cial /ethnic compositions of the neighborhood (Bo-
population at a particular point in time) where causal slaugh et al. 2004). The fear of crime and neighborhood
influences cannot be determined. For example, changes disorders have had mixed effects on the level of PA
in the level of PA have been associated with life-change among residents (Booth, Pinkston, and Poston 2005;
events (such as changes in residence, relationships, Loukaitou-Sideris 2006). This is mainly due to the dif-
employment status, health status, and family structure) ferences in peoples perceptions of and reaction to
(Allender, Hutchinson, and Foster 2008). These events crime and neighborhood disorders. While long-term
include the transition from single to married life, giv- neighborhood residents are less sensitive to the pres-
ing birth to a child, and becoming a parent, which have ence or perceived presence of crime and neighborhood
been associated with decline in the level of PA especially disorders, women and elderly people are more likely to
among women. The few longitudinal studies (analysis be fearful and to refrain from walking outside (Roman

292 Landscape Journal 30:211


and Chalfin 2008). Thus, enhancing the safety and aes- disadvantaged neighborhoods may have no effect on
thetic qualities of the neighborhood may be more im- residents health behaviors.
portant than providing new and more opportunities Sixth, tension often exists among key community
for PA. A set of neighborhood quality standards to pro- stakeholders. Most community stakeholders are aware
mote PA may be adequate for a certain population, but of the health implications of PI and agree on community-
inadequate for others. based initiatives to promote PA. However, they seldom
Fourth, there may be significantly different per- agree on who is responsible for initiating the changes.
sonal and group preferences regarding the value of This tension relates to the costs of changing the environ-
parks, recreational spaces, and other PA-related urban ment and the lack of effective communication between
features as well as the frequency of their use. The asso- professional groups, including urban planners, public
ciation between parks and recreational facilities and the health professionals, and architects (Clark et al. 2010).
level of PA varies by gender, race /ethnicity, and individ- Unless those responsible for the community planning
ual SES (Kaczynski and Henderson 2007). Urban parks and decision-making integrate diverse perspectives in
may act as green walls (barriers for use and apprecia- their grand scheme, efforts to induce changes may not
tion) or green magnets (agents to draw people and be comprehensive enough to create supportive physi-
increase interpersonal relations), depending on various cal and social environments that promote PA.
internal (such as verbal harassment and physical ges- Finally, unlike the static physical environment, the
ture or assault) and external (such as neighborhood age dynamic natures of the social environment and urban
and development density) factors that operate inside policy impose many challenges for researchers. A key
and outside the park (Gobster 1998). Modifications in challenge remains defining the relevant areas (at both
physical design, social and cultural settings, and urban neighborhood and community scales) at which under-
policy may be ineffective unless neighborhood site de- lying processes operate to influence health behavior
signs address connections to surrounding areas, resi- and associated levels of PA (Diez-Roux 2000; Subrama-
dents needs, aesthetic quality, community preferences, nian, Jones, and Duncan 2003). Since these boundaries
and cultural norms. are subject to change over time and space, qualitative
Fifth, at different levels of the SES hierarchy, dif- and quantitative studies are underway in both public
ferent mechanisms may link people and their environ- health and social science research. More research is
ments to health. Poor health behaviors and psychosocial needed to better understand how context (both physi-
dispositions have been associated with growing up in cal and social) influences the level of PA.
a poor household, having low levels of education, and
being a blue-collar worker (Lynch, Kaplan, and Salonen
CONCLUSION
1997). Among residents living in low SES neighbor-
hoods, individual-level SES factors (such as education In the US, the high prevalence of PI is evident among
and employment) were more important in influenc- the poor and those of racial /ethnic minorities. These
ing perceived value of PA than the neighborhood-level populations are at higher risk of many chronic diseases
factors (such as neighborliness and satisfaction with and some cancers, and tend to live in neighborhoods
neighborhood conditions), while neighborhood-level with limited access to physical and social resources for
factors superseded the individual-level factors for resi- PA. A growing body of research has examined ways to
dents living in high SES neighborhoods (Muhajarine address these concerns and to promote PA. However,
et al. 2008). It is possible that an individuals low SES the relationship between people and their environ-
may offset the benefits of supportive physical and so- ments is dynamic, and more research is warranted to
cial environments for PA, and any changes made in the understand the specific mechanisms.

Oka 293
Designing an environment to promote PA needs to Allender, Steve, Lauren Hutchinson, and Charles Foster. 2008.
be initiated from an interdisciplinary perspective and Life-change events and participation in physical activity:
through cross-disciplinary efforts. Despite the inher- A systematic review. Health Promotion International 23
(2): 160172.
ent limitations, the research findings presented provide
Aytur, Semra A., Daniel A. Rodriguez, Kelly R. Everson, and Di-
insights as to how future efforts need to address im-
ane J. Catellier. 2008. Urban containment policies and
portant aspects of the urban environment. Initiatives physical activity: A time-series analysis of metropolitan
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across pedestrian-oriented streets with high connectiv- Aytur, Semra A., Daniel A. Rodriguez, Kelly R. Evenson, Diane J.
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create a supportive physical environment; 2) develop graphics of land use planning: Relationships to physical
activity, accessibility, and equity. Health and Place 14 (3):
self-efficacy and collective efficacy by strengthening
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Booth, Katie M., Megan M. Pinkston, and Walker S. Poston. 2005.
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of Urban Planning and Development 131 (4): 246257. AUTHOR DR. MASAYOSHI OKA has an interdisciplinary back-
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Implications for training, practice, and policy. Behavioral and design. His research interest is to better understand the
Medicine 26 (3): 129138. complex relationship between the urban environment and public
Subramanian, S. V. , Kelvyn Jones, and Craig Duncan. 2003. health in order to promote sustainable development and human
Multilevel methods for public health research. In Neigh- well-being. His recent work includes examining disparities in the
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man, 65111. New York: Oxford University Press. research aims to better inform urban design, planning, and urban
policy to improve urban health.
Vlahov, David, and Sandro Galea. 2002. Urbanization, urbanicity,
and health. Journal of Urban Health 79 (4): S1S12.

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