Making the Case for Active Living Communities

At first glance, a dearth of sidewalks may not seem like a significant public health concern. However, the disappearance of sidewalks is one of many environmental barriers to active living that transform the health of American communities in powerful ways. Evidence shows that physical activity brings substantial health benefits to people of all ages. However, much more needs to be done to create opportunities and enhance existing community structures to support physical activity.

Environments that promote active living help us all—from children who need safe routes for walking and biking to school, to busy adults who might leave cars at home if they had pathways linking them to local destinations, to older adults who can maintain functional independence longer through routine walking. In each scenario, the critical role of something as basic as sidewalks becomes clear.

Through research and demonstration programs, The Robert Wood Johnson Foundation is focusing on active living as a top-priority health concern. This emphasis has evolved primarily in response to America’s overweight and obesity crisis, and the serious associated health risks.

THE PROBLEM

Overweight and obesity rates have grown dramatically in recent decades, affecting all racial, ethnic, socioeconomic, and age groups. Nearly two thirds of US adults aged 20 to 74 are overweight, and 31% are obese.1 Even more troubling statistics relate to our nation’s youth. Data from 1999 and 2000 show that more than 15% of children aged 6 to 19 years are overweight—double the proportion noted from 1976 through 1980.2 And diseases once seen only in adults, such as type 2 diabetes, are now diagnosed in children.3 Furthermore, overweight children are far more likely to become overweight adults who as they age face serious health problems, such as cardiovascular disease, certain cancers, osteoarthritis, depression, and other complications.

While overconsumption and poor eating habits partially account for the obesity crisis, physical inactivity is a critical contributing factor. In recent decades, changes in patterns of residence, work, transportation, and personal behavior have effectively engineered physical activity out of Americans’ lives. Communities are designed to promote increased and faster vehicle flow, with little attention to safe pedestrian and bike routes. Our dependence on cars and the distance we travel in them have grown, as has the use of labor-saving devices at work and at home.4 Collectively, these trends present major normative and environmental barriers to active lifestyles.

As a result, at least 60% of adult Americans do not meet the surgeon general’s minimum targets for physical activity, defined as 30 minutes of moderate-to-vigorous activity most days of the week.5 And regardless of body mass index, low cardiorespiratory fitness places people at greater risk of disease and death.6 To address the epidemic of inactivity, The Robert Wood Johnson Foundation, its grantees, and various partners are working to increase physical activity levels. The long-range goal is to reverse obesity trends, particularly among youth.

POSSIBLE SOLUTIONS

The disappearance of physical activity from people’s lives is a complex, entrenched problem. However, limited but growing evidence supports the effectiveness of policy, environmental, and behavioral change interventions that could improve population activity levels and related health outcomes. For instance, one study found that Japanese seniors living on walkable, tree-lined streets and close to parks outlived those with less exposure to such features—suggesting that older adults may go outdoors and get moving more when they have safe access to appealing green spaces. This holds true even when one accounts for other relevant variables, such as gender, socioeconomic status, and marital status.7

Across our own nation, cities and towns are reversing the cycle of underactivity and overweight. In Bolivar, Mo, citizens can talk to Mayor Charles Ealy without an appointment—if they keep pace with him on his weekly walks in city parks or along the local Rails to Trails path. Ealy’s Council on Health and Fitness also hopes to connect sidewalks to create a continuous walking route through Bolivar.8 And in Houston, which Men’s Fitness magazine crowned the Fattest City in America for 3 years running, the mayor has launched a “Get Lean Houston!” campaign to educate residents about diet and exercise and publicize Houston’s underused parks and recreation facilities.9 These initiatives reflect strong leadership, growing recognition of the connection between physical activity and environmental design, and creativity in delivering active living opportunities.

Robert Wood Johnson Foundation grantees and others also are working to increase physical activity by exploring critical research questions, outlining policy priorities, rethinking community design issues, and encouraging people to be more active.

Active Living Research funds studies exploring how different policies and environmental characteristics affect physical activity levels. Grantees at Portland State University, for example, are testing whether people walk and bike more in neighborhoods with connected streets rather than cul-de-sacs. The idea is to provide community designers, policy officials, transportation planners, and others with evidence for creating activity-friendly communities.

Other programs apply research and policy findings to action-based strategies within communities. Active Living by Design places health at the forefront of community design by promoting best practices in planning, transportation, and architecture that encourage physical activity. It funds community-oriented partnerships of experts in public health, architecture, development, recreation, and public safety to design and apply strategies that promote active living.

Laying the groundwork for physically active communities requires engaging the talents and perspectives of experts from diverse fields. This is the focus of a leadership coalition that works to improve health by changing environments in ways that allow kids and families to be more active. The Active Living Network engages designers, planners, engineers, recreation officials, transportation experts, and public health officials in informed dialogue, research, and project implementation. Its collaborative approach highlights how participants from each field can influence a community’s overall health.

Government leaders also require expertise and technical support to help communities become more active. Active Living Leadership spearheads a team of grantees—including the National Governors Association, Local Government Commission, and International City/County Management Association—to address this need. These groups provide state and local officials with best practices, planning expertise, and communications tools to help them create activity-friendly policies and places.

Communities also can turn to the Active Living Resource Center, a project of the National Center for Bicycling & Walking that supplies information and technical assistance on issues related to transportation, land-use planning, school location and design, recreation and trails, and safety.

As we work to reengineer physical activity back into the daily lives of all Americans, we must address a challenging question: If we build it, will they come? Realistically, the answer is probably not. Even with parks, trails, and greenways readily available, most people are not likely to use them regularly without compelling incentives. It is critical, then, to understand barriers to physical activity that are rooted in people’s attitudes and habits in order to develop interventions that will get them moving again. Toward this end, The Robert Wood Johnson Foundation supports behavior change and social marketing efforts to complement its research- and policy-oriented grants.

In West Virginia, the Wheeling Walks health education and media campaign is shaking residents out of their sedentary ways. Remarkably, 90% of Wheeling-area residents learned of the program through advertisements, broadcast promotions, and news stories. Ultimately, it spurred a 14% net increase in the number of residents who increased their walking compared with a control community.10 To date, nearly 2500 walkers have logged almost 29 000 miles, and they continue to pound Wheeling’s sidewalks and trails.

Similar initiatives are taking hold across the country. For example, Active for Life, a national effort to increase activity among midlife and older adults, tests 2 types of physical activity programs—a structured group lifestyle program and an individually tailored program supported by telephone counseling—to determine which strategies work best for older Americans. Active for Life also collaborates with the American Association of Retired Persons on an integrated marketing and media campaign in Richmond, Va, and Madison, Wis. The campaign has 2 aims: motivating participants to make physical activity a part of daily routines and encouraging them to advocate for community design changes, such as biking and walking paths. Outcomes will be shared widely so that other communities can develop effective programs for older populations.

CONCLUSION

Through these collective efforts, The Robert Wood Johnson Foundation hopes Americans of all ages will find it logical, easy, safe, and enjoyable to get out of their cars, homes, and offices and reconnect with their communities via sidewalks and trails. We are optimistic that, with better environmental tools in place, more Americans will make physical activity a seamless part of everyday living and maintain healthier lifestyles. The Robert Wood Johnson Foundation will continue to encourage leaders within and outside the traditional public health arena to focus on the need for active communities as a natural extension of their work. Developers, architects, transportation planners, school board officials, and government leaders alike must make physical activity a priority for the populations they serve. In essence, each group must commit to making the sidewalk an indispensable feature of American neighborhoods once more. Progress may be slow, and success is not assured. However, the tremendous health benefits to be gained through active living demand that we explore, invest in, and promote ways to reduce overweight, obesity, and persistent inactivity.