Active Living through Planning and Education:

Physical Activity (PA), the Built Environment and Active Transportation (AT)

Glyn Bissix, PhD.School of Recreation Management and Kinesiology

andEnvironmental and Sustainability Studies

Acadia University

Atlantic Medical Officers of Health, St. Johns, NLAugust 2010

Training, Education & Experience• M.Sc. Oregon. Physical

Education; exercise physiology, biology and health education.

• PhD. LSE Natural Resources & Environmental Management

• City of Eugene, Oregon• NS Culture, Recreation and

Fitness (now HPP)• Acadia University.

The Trend!

• To engineer physical activity out of all aspects of our lives – home, mobility, work and play.

• In western society advances in medical care have paralleled declines in population health (at least the potential for real decline).

Planning and Public Health:the Historic Connections

• Physician Reformers in the 19th Century.– Dr John Snow, London, 1854

• Health and Morality Movement: Housing Reform, 1900-1914– New York Tenement Buildings -

Twenty Teens• Zoning for Health, Safety and

Welfare – 1907-1926• Health and the Garden City, 1898-

1930.

Is there a New (Increased) Role for Medical Officers of Health

and Public Health Officials in Urban and Regional Planning?

• Can population health be improved by a combination of appropriate planning and education?

• Is this worth your time and effort to make this a priority?

• Can you be an effective and positive change agent?

Is there a relationship between your choice of mobility mode and BMI?

Is there a relationship between the place where you live and your BMI?

The Unequivocal Evidence?• Taking as a given that increased BMI (health) and

physical activity are highly correlated I’d like to tell you that the evidence is unequivocal that retrofitting the built environment to encourage physical activity will have substantial health benefits.

• I can’t do that but there is increasing evidence that a positive (but not overly strong) relationship exists between the way we build and retrofit our villages, towns and cities, and rural areas for physical activity and population health.

• Let’s look at the evidence.

A Review of Methodology

• Ross C. Brownson, PhD, Christine M. Hoehner, PhD, MSPH, Kristen Day, PhD, Ann Forsyth, PhD, and James F. Sallis, PhD. Measuring the Built Environment for Physical Activity: State of the Science. Am J Prev Med. 2009 April ; 36(4 Suppl): S99–123.e12. doi:10.1016/j.amepre.2009.01.005.

• Three categories of built environment data are being used:– (1) perceived measures obtained by

telephone interview or self-administered questionnaires; (19 questionnaires reviewed)

– (2) observational measures obtained using systematic observational methods (audits); (20 audit instruments) and

– (3) archival data sets that are often layered and analyzed with GIS (50+ studies).

• This study is the first comprehensive examination of built-environment measures

• demonstrates considerable progress over the past decade,

• showing diverse environmental variables available that use multiple modes of assessment.

• Most can be considered first-generation measures, so further development is needed.

• In particular, further research is needed to improve the technical quality of measures, understand the relevance to various population groups, and understand the utility of measures for science and public health.

Evidence from Canadian Research• Physical Activity.

• Conclusion: This study suggests that PA promotion strategies should be tailored to enhance – people's confidence to engage in PA, motivate people to be more

active, – educate people on PA's health benefits – and reduce barriers, – as well as target different factors for men and women– and for differing socio-economic and demographic groups [seniors,

children, minority groups] .

• Sai Yi Pan*1, Christine Cameron2, Marie DesMeules1, Howard Morrison3, Cora Lynn Craig2,4 and XiaoHong Jiang1. Individual, social, environmental, and physical environmental correlates with physical activity among Canadians: a cross-sectional study. BMC Public Health 2009, 9:21 doi:10.1186/1471-2458-9-21.

Policy Barriers for Local Government Investments in PA Infrastructure for Youth –

Atlantic Canada• Participants consistently identified four categories of

barriers. – Financial barriers – Legacy issues – Governance barriers – Cultural factors and values

• Conclusion:

Participants indicated that health issues have increasing profile within local government, making this an opportune time to discuss strategies for optimizing investments in the built environment. The focus group method can foster mutual learning among professionals within government in ways that could advance health promotion.

• Jill L. Grant, PhD,1 Kathryn C. MacKay, MPlan,2 Patricia M. Manuel, PhD,3 Tara-Leigh F. McHugh, PhD4. Barriers to Optimizing Investments in the Built Environment to Reduce Youth Obesity: Policy-maker Perspectives. CANADIAN JOURNAL OF PUBLIC HEALTH • MAY/JUNE 2010.

34th Conference of New England Governors and Eastern Canadian

Premiers in Massachusetts July 11 to 13, 2010.

Find the full text at: http://tinyurl.com/2cwlhb3

Public Health & the Built Environment: Literature Review 2006.

• 1. INTRODUCTION.• 2. RESPIRATORY AND CARDIOVASCULAR HEALTH.• 3. FATAL AND NON-FATAL INJURIES.• 4. PHYSICAL FITNESS. • 5. SOCIAL CAPITAL.• 6. MENTAL HEALTH.• 7. SPECIAL POPULATIONS.• 8. SUMMARY CONCLUSIONS.

Understanding the Relationship between Public health and the Built Environment: a Report prepared for the LEED-ND Core Committee. Design, Community & Environment: Dr. Reid Ewing, Lawrence Frank and Company, Inc; Dr. Richard Kreutzer. May 2006.

Air QualityModeling the Built Environment & Health

Conclusions

• The chain connecting the built environment, driving, vehicle emissions, air quality & public health is somewhat complex.

• Researchers still conclude that community design is one important factor in improving health.

• Despite critiques, federal & state agencies including the EPA conclude that evidence justifies building more compact, mixed use development around transit to reduce air pollution.

Fatal and Non-Fatal InjuriesTraffic Fatalities vs. Stranger Homicides

Conclusions:

• Traffic accidents with fatal and non-fatal injuries closely related to Vehicle Miles Traveled (VMT), auto speed & traffic volumes. Characteristics linked to design, street networking & land use distribution especially those that increase VMT, speed and traffic volume.

Physical FitnessPhysical Activity & the Built

Environment

• Extensive literature linking health & physical activity (PA).

• Last 15 years a literature linking PA & the Built Environment has emerged.

• From a PA & health perspective, mean difference between high & low walkability neighborhoods is roughly equivalent to meeting one day dosage of PA guidelines.

• 1996 US Surgeon General Physical Activity & Health – PA reduced risk of several chronic diseases. Moderate activity works - brisk walks for 30 mins (even in 10 min blocks).

• 25 % of our trips are easily walkable - 63% Bikable <5 miles

• Land-use mix, residential density, & intersection density walked more than low walkability neighborhoods.

• There is the problem of inconsistent measures, insufficient data, determining causality, and substitution.

• General consensus that changes in the built environment can make walking and biking more attractive.

Social Capital• Robert Putman “Bowling Alone”.• 10% decrease in social capital since

the sixties attributed to suburbanization, sprawl and commuting.– Prolonged life,– Better health overall,– Cardiovascular health,– Faster recovery,– Improved mental health– Other Benefits

Mental Health

• Sprawl predicts physical health and quality of life but no relationship with mental health (Strum & Cohen, 2004 – large geographical area which may have washed out incidence in some neighborhoods).

• Stress and driving – road rage.• Conclusion – little is known about

the direct relationship between urban form and mental health.

Special Populations• Conventional development patterns that rely on

driving present more health risks for some than for others. Women, children, older [citizens], people with limited incomes and disabled [people] all are disproportionately affected in various ways by the current urban environment.– Women– Children– The Elderly– Low Income Communities– People with Disabilities

• Conclusions – plan for 6 - 86

Literature Update

• Bibliography Provided• Scanning of recent studies shows more of the

same (as per the LEED-ND Study, 2006)

My Own Research Efforts

• GIS and Physical Activity literature Review (NSHPP)

• Comparing Youth Activity in Glace Bay and Kings County.

• Glace Bay Neighborhood Study (Unpublished GIS Study)

• Wolfville Postal Code Study (In Progress)• Wolfville Interactive Mapping Calorie and GHG

Counter (In Progress).

GIS and Physical Activity Literature Review (NSHPP)

• 43 Papers reviewed (1977-2005) in 2 categories– physical environment (PE) on physical activity (PA) (n=34) & GIS Facility Distribution: equity and Impact

– Overall - revealed various degrees of positive associations between proximity to facilities and/or supportive physical environments (PEs) and levels of physical activity (PA).

– Accessible facilities were found to be insufficient alone for individuals to achieve recommended exercise levels, they were nevertheless necessary (Giles-Corti & Donavon, 2002)

– Giles-Corti and Donovan (2003) looked at environmental supports for walking behaviour and noted the odds for reaching recommended levels of walking were 2.13 times higher for people who lived in the most highly rated physical environments.

• GIS in relation to social policy and understanding facility distribution and/or accessibility within the context of health and/or recreation that promoted physical activity.

– Social Networks more important than proximity.– Safety is a major issue (for urban populations) – using pathways and parks, and getting to PA facilities.– Little attention given to private facilities.

Robert Pitter, PhD; Glyn Bissix, PhD; Jennifer Ezard; and Lindsay Fenton, BKIN (2005). USING GIS TO STUDY PHYSICAL ENVIRONMENTS THAT PROMOTE HEALTH THROUGH SPORT AND PHYSICAL ACTIVITY: a Literature Review . Centre of Lifestyle Studies, Acadia University prepared for the Nova Scotia Department of Health Promotion.

Comparing Youth Activity in Glace Bay and Kings County, NS.

• Used Evans and Stoddart’s [Ecological Health] framework.

• Two distinct communities provide insights into the role of place on health and well-being - largely urban (Glace Bay) vs largely rural (Kings) & lower SES vs. higher SES.

• No difference in the communities in youths’ physical activity at work or school, but Kings County youth more active in sport and active recreation, walking or riding a bicycle to work or school, and doing errands than their Glace Bay peers.

• Found no substantive relationship between PA and self reported health

• There is clearly something else at work in determining the relationship between self-reported health and physical activity in these two communities.

Bissix, Glyn; Darren Kruisselbrink, Liesel Carlsson, Peter MacIntyre and Tracey Hatcher, (2005). Active Lifestyle, Physical Recreation and Health Outcomes of Youth in Two Contrasting Nova Scotian Communities. In Sport for Young People. Editors: Peter Bramham, Anne Flintoff, Jonathan Long, Jayne Caudwell, John Spink, and Kevin Hylton. London: LSA. Publication No. 88. pp. 141-155.

The Determinants of Health--Evans and Stoddart Framework

Social Environment Physical Environment Genetic Endowment

Individual Response -Behaviour -Biology

Health and Function

Disease

Health Care

Well-Being

Glace Bay Neighborhood Study (Unpublished GIS Study)

Mental Health, Physical Activity and Neighbourhood

Safety, Physical Activity and Neighbourhood

Robert Pitter, Glyn Bissix; Acadia University; Konrad Dramowicz, Nova Scotia Community College, Centre of Geographic Science; and Peter MacIntyre, Cape Breton University. Neighbourhood as a determinant of leisure, physical activity and health: the Glace Bay experience.

Wolfville Postal Code Study (In Progress)

• Glyn Bissix (2009) Active Lifestyles, Active Transportation and Neighborhood Influences in Wolfville.

Wolfville Interactive Mapping Project

• Will information on ecological footprint & Active Transportation Calorie Counter motivate more Physical Activity?

The Role of Education• Is it a case of build it and they will

come?• If not, then what is the role of

education?• Who do we educate and who does it?• Who has most influence about health

issues?• Do MOHs have to have absolutely

bomb proof evidence before acting?• If no harm in investing in AT

infrastructure but possible population benefits, is that good enough?

• The CFLRI seems to think so: http://www.cflri.ca/eng/active_transportation/index.php