The Public Health Prescription for Walkable Communities
description
Transcript of The Public Health Prescription for Walkable Communities
![Page 1: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/1.jpg)
The Public Health Prescription for Walkable
Communities
Deb Spicer
NYS Department of Health
Healthy Heart Program
![Page 2: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/2.jpg)
Impact of Transportation and Land Use Patterns on Health
• Physical Activity and Obesity
• Asthma
• Injuries
• Loss of Function in Older Adults
• Heart Attacks
![Page 3: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/3.jpg)
Underlying Causes of Death (US)
0%2%4%6%8%
10%12%14%16%18%20%
1993
2003
While most of the preventable causes of death declined, diet and physical inactivity increased 33%.
![Page 4: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/4.jpg)
Source: Behavioral Risk Factor Surveillance System, CDC
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
![Page 5: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/5.jpg)
Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10.
Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS, 1990,1995 and 2001
1990 1995
2001
No Data <4% 4%-6% 6%-8% 8%-10% >10%
![Page 6: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/6.jpg)
Overweight and Obesity Among NYS Adults (2003 BRFSS)
42%29%
35%
21%
21%21%
0%
10%
20%
30%
40%
50%
60%
70%
Males Females Total
2000 BRFSS New York State
BMI >30BMI 25-30
63%
50%
56%
56% of NY Adults are Overweight or Obese
![Page 7: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/7.jpg)
Obesity Among NYS Adults, By Ethncity2003, BRFSS
35% 38% 36%
20%30% 22%
0%
20%
40%
60%
80%
100%
White Black Hispanic
BMI > 30
BMI 25-30
55%68%
58%
![Page 8: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/8.jpg)
Trends in Overweight and Obesity Among NYS Adults, BRFSS
10% 13% 14% 15% 16% 18% 20% 21%
33%34% 35% 38% 35%
39% 36% 35%
0%
10%
20%
30%
40%
50%
60%
1990 1992 1994 1996 1998 2000 2001 2003
OverweightObese
57%
42%
![Page 9: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/9.jpg)
Obesity Rates by Ethnicity and Gender, US, NHANES 1999-2000
White Men 27.8%
African American Men 28.7%
White Women 30.8%
African American Women
50%
•Based on actual height and weight measurements (BRFSS is self-reported)
•Rate among AA women predicted to be 57% by 2010.
![Page 10: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/10.jpg)
Estimated Medical Costs of Obesity in NYS
Total Pop Medicare Medicaid
% of Costs 5.5% 6.7% 9.5%
Estimated Annual Costs
$6.08 Bill $1.39 Bill $3.54 Bill
25% of increase in health care costs due to obesity
![Page 11: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/11.jpg)
Current Recommendations for Physical Activity
• Adults– At least 30 minutes a day of Moderate activity, at
least 5 days a week.– Can be in 10 minute segments
• Elementary-Age Children– accumulate at least 60 minutes of activity on all
or most days of the week– up to several hours of intermittent activity every
day
![Page 12: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/12.jpg)
What’s Moderate Activity?
• Brisk walking (3-4.5 mph)• Bicycling - on level terrain• Playing frisbee• Swimming - recreational (doesn’t have to be laps)• Dancing - anything but slow• Coaching a sport• Handling uncooperative young child (chasing,
dressing, etc.)
![Page 13: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/13.jpg)
BRFSS Questions on Physical Activity
Through 2000• Two most frequent
types of leisure• Time/day; days/week• Appox 26% met
recommendations• No leisure time PA
After 2001• Moderate (other than
work); days/week, total time/day.
• Same with vigorous• Approx. 45% met
recommendations• No leisure time PA
![Page 14: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/14.jpg)
Physical Activity Among NYS Adults, (BRFSS 2001)
% of adults meeting recommendations
45%38%
46%
29% 33%
0%
20%
40%
60%
80%
100%
MALES FEMALES WHITES AF AM Hispanic
![Page 15: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/15.jpg)
Trends in No Leisure Time Physical Activity, NY
35% 35%39%
32% 32%30% 29%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1990 1992 1994 1996 1998 2000 2001
![Page 16: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/16.jpg)
Percent of Adults With No Leisure Time Physical Activity 2001, BRFSS
26%34%
0%
10%
20%30%
40%
50%
60%
State NYC
![Page 17: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/17.jpg)
Cost of Physical Inactivity in NYS
• Inactivity costs NYS $3 billion a year
• A 5% increase in physical activity rates in adults would save NY $180 million a year.
• Inactive adults have $330 more per year in direct medical costs than active adults (in 1987 dollars).
![Page 18: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/18.jpg)
Most Frequent Leisure Time Physical Activities – NYS, 2000
Percentage Number
Walking 38% 5,215,725
Running 7% 966,023
Weight Lifting 6% 895,708
Gardening 5% 728,594
Bicycling 4% 602,380
![Page 19: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/19.jpg)
Health Benefits of Walking
• 3 hrs/wk of brisk walking (3mph) reduced heart disease risk in women by 35-40%
• Older adults who walked at least 4 hrs/week were 31% less likely to be hospitalized for heart disease or stroke.
• Women who walked at least 1 hr/wk reduced risk of CHD by 50%. (amount more important than pace)
![Page 20: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/20.jpg)
Health Benefits of Walking
• People with diabetes who walked for exercise at least 2 hours a week lowered their mortality rate from all causes by 39 percent.
• Older women who walked the most had 40% less cognitive decline over 6-8 years.
![Page 21: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/21.jpg)
![Page 22: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/22.jpg)
Successful Long Term Weight Loss
• National Weight Control Registry• Lost 66 pounds and maintained for 5.5 years• During weight loss:
– 89% used both diet and activity– 92% exercised at home
• During maintenance– walking most common type of activity
![Page 23: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/23.jpg)
Walking Trips, US, 1977 - 1995
9.38.5
7.2
5.5
012345
6789
10
1977 1983 1990 1995
Per
cent
of T
rips
![Page 24: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/24.jpg)
Why Don’t We Walk
• No place to walk• Can’t cross the street• Too far• Unpleasant• Dangerous• Time
![Page 25: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/25.jpg)
Speed Kills
0% 20% 40% 60% 80% 100% 120%
20 mph
30 mph
40 mph
50 mph
Veh
icle
Spe
ed
% of Hit Pedestrian Who Will Die
![Page 26: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/26.jpg)
Average Annual Hospitalization Costs for
Motor Vehicle Injuries, NYS, 1994-96
# % Total Cost %Bike 5,971 15% $45.7 M 10%Ped 12,964 33% $221.7M 49%Bike +Ped
18,935 48% $267.4M 59%
TotalMV
38,991 $452.3M
![Page 27: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/27.jpg)
Healthy People 2010 Objectives
to at least 25% the percentage of trips of 1 mile or less that adults make by walking.
to at least 50% the percentage of trips to school (less than 1 mile) that youth make by walking
![Page 28: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/28.jpg)
Making it easier to be active = Environmental Changes :
• Sidewalks and shoulders along roadways• Destinations to walk and bike to• Community trails - for walking, bicycling,
in-line skating, pushing a stroller.• Safe neighborhood playgrounds and parks
for kids and adults• Schools and malls open for walking• Attractive, well lit stairwells
![Page 29: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/29.jpg)
Guide to Community Preventive Services – Promoting Physical Activity
• Insufficient Evidence– Classroom-based health education– Mass media (alone)– College health ed and PE– Family-based social support– Physician counseling
![Page 30: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/30.jpg)
Guide to Community Preventive Services
– Promoting Physical Activity
• Recommended– Community-scale urban design and land use policies *– Street-scale urban design*– Community wide campaigns– PE– Social Support Interventions– Individually adapted health behavior change programs– More opportunities for PA
*to be published, fall 2004
![Page 31: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/31.jpg)
Source: Switzerland Federal Office of Sports
Switzerland• Over 60% of adults meet PA recommendations• Daily commuting
– 32% walk (NY - 7%)
– 14% bicycle (NY - <1%)
• 20,000 miles of signed walking trails• 8 major bike routes (in a small country)• Town centers with pedestrian only zones• Bikes allowed on trains and buses
![Page 32: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/32.jpg)
Impact of Environmental ChangesStair Use - 2000
• Baltimore subway station
• Observed 10,700 commuters (54% AA) choice of stairs or escalator
• Intervention: culturally specific sign - “No time for exercise? Try the stairs”
• Results: Increased stair use among AA from 10.2% to 16.2%.
![Page 33: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/33.jpg)
Impact of Environmental ChangesTrail Use - 2000
• Telephone survey of adults in 12 rural counties in Missouri
• Trails associated with 8% overall increase in physical activity.
• Of those with access to a trail - 21% reported increased activity.
• Increase more likely among women, those with less education.–
![Page 34: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/34.jpg)
Sprawl and HealthCompact Counties
(vs. sprawling)
Extremely compact (e.g. NYC) (vs. extreme sprawl)
Minutes walked per month
+14 min. +79 min
BMI - .17 -1.0
Weight - 6.3 pounds
Obesity – Odds Ratio
.90
Hypetertension .95
Ewing, 2003
![Page 35: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/35.jpg)
Impact of Environment on Physical Activity in North Carolina (2003)
Odds Ratios
Any Activity Meets Recomm
Sidewalks 1.42 NS
Trails 1.62 1.49
Street Lights 1.57 NS
Access to PA 2.94 2.28
Huston, AJHP, 2003
![Page 36: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/36.jpg)
Destinations and Physical Activity in Older Women in Pittsburgh(2003)
# of Destinations Within 20 Minutes Walk
Steps per Day
0 2745
1 3281
2-11 5714
King, AJHP, 2003
![Page 37: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/37.jpg)
Obesity and Community DesignAtlanta, 2004
• Land use mix, residential density, street connectivity
• Land use mix most strongly correlated with obesity– ↑ 1 quartile → ↓ obesity risk by 12%
• ↑ car time by 1 hour → ↑ obesity by 6%• ↑ walk by 1 km/day →↓obesity by 5%
Frank, AJPM, 2004
![Page 38: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/38.jpg)
Asthma and Traffic
• Atlanta - Summer Olympic Games, 1996, Reduced auto use by 22.5%
– Reduced hospitalizations for asthma by 41.6% among children 1-16 years old
• Erie County, 1990-1993.– Children living within 200 m of state road 2x as
likely to be hospitalized for asthma
![Page 39: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/39.jpg)
Neighborhood Environment and Loss of
Physical Function in Older Adults
• Alameda County, CA; 55+; healthy at start, followed for 1 year; rated neighborhoods
• Living in problem neighborhoods - 2x as likely to have loss of overall function and 3x as likely to have loss of leg function.
• Noise, inadequate lighting and heavy traffic created highest risk.
![Page 40: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/40.jpg)
Other Benefits of Walkable Communities
• Less reliance on cars – less traffic congestion, air pollution, noise
• Less crime – “Eyes on the street”, CPTED
• Better sense of community
• Economic benefits
• More independence for youth, seniors, people with disabilities, poor.
![Page 41: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/41.jpg)
The Vision
• A Walkable Community is one where, on a hot summer’s day, a couple of 8-year old children can walk by themselves to a corner grocery store to get a popsicle.
![Page 42: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/42.jpg)
Components of Walkable Communities
• Safe places to walk - sidewalks, shoulders, trails (engineering)
• Safe crossings - crosswalks, medians, signals, street design (engineering)
• Pleasant environs
• Safer driver and pedestrian behavior - (enforcement, education)
• Safe neighborhood (enforcement)
![Page 43: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/43.jpg)
Components of Walkable Communities (cont)
• Traffic calming - narrow streets, on-street parking, trees, medians (engineering)
• Destinations - mixed land use, higher density housing, infill develop.,location of schools and parks, vibrant downtowns
• Attitudes - accepting walking as a viable means of transportation (encouragement)
![Page 44: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/44.jpg)
Lewiston, NY - Before and After
![Page 45: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/45.jpg)
Community Structure and Physical Activity
![Page 46: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/46.jpg)
Growth of the Movement
• Initial focus on transportation
• Land use may have more effect
• Health and Built Environment
• Health Impact Assessments
![Page 47: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/47.jpg)
Role of Public Health in Walkable Communities
• Don’t have to be technical experts
• Use our current skills
• Create Demand - for walking– Normalize Walking– Change social norms around walking
![Page 48: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/48.jpg)
Role of Public Health (Cont)
• Create Demand - for walkable environments– educate public and decision makers– develop/nurture pedestrian advisory groups– policies and ordinances– hold events– get media attention– get walkers to public hearings
![Page 49: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/49.jpg)
Walkable Community – The Role of Public Health
Increase Walking Walkable Communities
(Opportunities)Local Decision Makers
Influential Citizens
Trained Professionals
BC Walks
Long Term Outcomes
Intermediate Outcomes Short Term OutcomesHealthy Heart Program
Normalize Walking
(Attitudes)
State Policies
•Walkable Communities SlideShow• State Pedestrian Conference•Walk to School Week•Presentations•Walkable CommunitiesWorkshops•Communication campaign•Healthy Heart Contractors•Initiative for Healthy Infra.•Parks & Trails NY• Umbrella for pedestriangroups
![Page 50: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/50.jpg)
NYS DOH Initiatives to Promote Walkable Communities
• 17 local Healthy Heart Program contractors-many work on bike/ped issues– Initiative for Healthy Infrastructure (SUNY Albany), Parks and Trails
NY, Transportation Alternatives• 9 new worksite and school contractors• 4 Steps to a Healthier US counties – Chautauqua, Broome, Rockland,
Jefferson. • Cardiovascular Health In NYS – A Plan for 2004 – 2010• Developing a state Obesity Prevention Plan • Walkable Communities Workshops• Walk to School Week/Safe Routes to School• State Pedestrian Conference• BC Walks, America on the Move• NYS Physical Activity Coalition (www.nysphysicalactivity.org)
![Page 51: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/51.jpg)
Healthy Infrastructure Symposium, 2005
• Propose solutions to key issues that support improved environments
• Friday, March 18; 9:00 – 4:00, SUNY Albany
• Pre-symposium workgroups
• www.albany.edu/~ihi
![Page 52: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/52.jpg)
What You Can Do
• Join local bike/ped task force
• Attend training sessions
• Attend public hearings on street redesigns
• Link with “smart growth” groups
• Organize Walk Our Children to School Week event
• Get on my Electronic PA Newsletter list
• Check out web sites
![Page 53: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/53.jpg)
Walkable CommunitesWeb Sites
• NYS Physical Activity Coalition: www.nysphysicalactivity.org
• National Center for Bicycling and Walking: www.bikefed.org
• Pedestrian Information Center: www.walkinginfo.org• NY Parks and Conservation Assoc (trail maps):
www.nypca.org• Walk to School Day: www.walktoschool-usa.org• Active Living by Design: www.activelivingbydesign.org• America Walks (advocacy groups):
www.americawalks.org
![Page 54: The Public Health Prescription for Walkable Communities](https://reader034.fdocuments.us/reader034/viewer/2022051401/5681528c550346895dc0b014/html5/thumbnails/54.jpg)
Summary
• We need to be more active
• Walking is the easiest way for most people to be more active
• Walking has many benefits
• We need to have safer, more pleasant places to walk.