Table 8.

Recommended actions to create active environments.

RECOMMENDED ACTIONS TO CREATE ACTIVE ENVIRONMENTS	WHAT WORKS?	KEY ACTORS
Walking, rolling and cycling network infrastructure: Ensure provision of walking, rolling and cycling infrastructure to enable and incentivise greater physical activity and access by walking, cycling, and mobility-assist devices	It is important to take account of the needs of LMICs when assessing suitability of interventions. Road safety is an important consideration for mixed zoning in LMIC communities. Congestion is an important contributor to road crashes and resulting deaths and injuries. Walking and cycling safety need to be primary considerations when planning for commercial and mixed zones. Active transportation policies operate at three levels to provide for a comprehensive approach: Macro-scale – City planning, land use policy, urban and transport planning. Where decision makers create and enable environments to ensure access to destinations required for daily living by walking or bicycling, and mixed-use zoning with a diversity of destinations thereby reducing vehicle dependency. Medium (meso) scale – Pedestrian and bicycle networks, and infrastructure such as Complete Streets policies and Safe Routes to School initiatives. Where city planners need to create networks of facilities and infrastructure that provide safe and attractive places for walking and bicycling, ensure high-quality and high-frequency public transit, and ensure there is safe cycling infrastructure within 5km of public transit, shops, services and schools.	Governments at national, sub-national and local levels Transport authorities Transport and city planning professionals and societies Health professionals
	Micro-scale – Local design interventions and place-making such as building orientation and access, street furnishings, and safety and traffic calming measures. Where local elements of communities are designed to support physical activity such as streetscapes with sidewalks/footpaths of adequate width, safe places to cross streets, trees or awnings to protect pedestrians from weather, curb ramps and other features for the benefit of people with disabilities and parents, traffic calming, speed reductions, protected space for bicycles, parks with facilities that support multiple types of physical activities and sports, and that appeal to people of all ages, and complementary programmes such as walk to school, or walk to work programmes, car-free days, bike hire/purchase schemes and public education. Low income should not be a barrier to active transport. Fiscal incentives such as subsidising the cost of public transport or bicycles can reduce inequity and drive demand for active modes of transport. Use of the WHO HEAT tool is recommended to support economic assessment of investment in walking and cycling networks and new infrastructure (WHO HEAT Tool).
Healthy urban planning policies: Prioritise compact, mixed-land use that integrates cities, towns and villages, including those in rural communities, with safe and accessible walking, cycling, public transport, sport, recreation, and public open space infrastructure	Promote compact, mixed land use to create connected and walkable neighbourhoods and enable greater accessibility to schools, shops and key services. In LMIC countries ensure that mixed land use policies are accompanied by prioritisation of safety, comfort and desirability for walking and active transport are prioritised. Improve access to public transport, particularly for disadvantaged or vulnerable populations. Physical activity levels are higher in neighbourhoods with higher residential density, a more connected street network, a good public transport network, and more parks (Sallis et al., 2016). Diverse and affordable housing with high enough residential density to support many nearby shops and services and frequent public transit service. Connected street networks that allow direct routes to destinations. These design principles apply similarly in big cities and small towns, though they may not be directly applicable to truly rural and remote areas.	Governments at national, sub-national and local levels Urban planning authorities Urban planning professionals and societies Health planners and health professionals Health professional societies
Public and green open spaces: Strengthen access to well-designed public open spaces, green spaces, play spaces, parks and nature, especially in LMIC settings	Regulation that requires connected networks of green spaces and places that ensure equitable access. Nearby parks and public open space (see below) that have amenities such as shade trees, toilets, water fountains, and benches for resting whenever possible. Shopping areas, transit stops, schools, and workplaces should be designed to facilitate access by walking, bicycling, and public transport by providing end-of-trip facilities. Provision of safe and accessible green spaces in low-income areas which tend to have lower access to public open spaces (Astell-Burt et al., 2014).	Governments at national, sub-national and local levels Urban planning authorities, professionals and societies Parks and gardens authorities and professionals Health professionals and societies
Road safety: Increase policy and environment actions to ensure safety for all walkers and cyclists with a particular emphasis on vulnerable road users (children, the elderly and people with disabilities)	Policy actions that improve road safety and the personal safety of pedestrians, cyclists and others using mobility devices/aids with wheels (wheelchairs, scooters and skates) consistent with the WHO and UN Decade of Action on Road Safety (WHO and UN 2011). Reducing traffic volumes and speeds, and introduction of traffic calming measures, prioritizing local neighbourhoods where people walk and cycle to local services and settings. Ensuring bike lanes separated from road vehicles, and pedestrian crossings. Policy priority is given to environments and settings where actions can reduce risk for the most vulnerable populations (e.g. children, the elderly and people with disabilities). Partnerships with road safety planners and agencies. Teaching road safety skills to children of all ages, including in the school curriculum.	Governments at national and local levels Transport and road safety professionals and societies Health, safety and injury prevention professionals and societies Police Schools/education
Reduce air pollution: Implement policy actions and strengthen infrastructure to minimize exposure to traffic related air pollution	Note synergy of actions with walking and cycling network infrastructure, and healthy urban planning policies. Policy actions and investments in safe and green active travel alternatives to car travel. Ensuring well connected infrastructure to increase usability. Ensuring transport policy gives due consideration to minimizing any risk of increased exposure to traffic related air pollution, especially in locations with high concentration of air pollution. These areas are often also underserviced and socioeconomically disadvantaged areas. Providing disincentives (e.g. low-emission zones, vehicle and fuel taxing, parking charges) and incentives (e.g. bike-to-work schemes). Use of no-idling/no vehicle access at schools at start and end of the day. Communication campaigns highlighting the co-benefits of active travel (for health, air pollution and climate change).	Governments at National and city levels Environment professionals Civil society organizations Health professionals and scientific societies