Healthy Cities: From Strategy to

Implementation

Susanna Kugelberg PhD MSc Consultant, Nutrition, Obesity and Physical Activity Programme,

Division of Non-Communicable Disease and Lifecourse WHO/Europe

05 April, 2016

Overview

• WHO Global Recommendations on physical

activity

• Obesity and physical inactivity in the European

Region

• WHO’s Physical Activity Strategy for Europe

• Key steps for making cities more physically

active

Physical Activity throughout the Life-course

• Throughout childhood and adolescence

–Basic motor skills and musculoskeletal development

• Throughout adulthood

- Maintain muscle strength, increases cardiovascular fitness and

bone health

• Among older people

- Maintain health, agility, functional independence and enhance

social participation

WHO Global Recommendations on

Physical Activity for Health

• Provide guidance on the dose-response relationship

between the:

– frequency

– duration

– Intensity

– type

– total amount

• The recommendations target three age-groups

Children and adolescents aged 5-17

Min 60 minutes of moderate- to vigorous-intensity of physical

activity daily.

– Physical activity greater than 60 minutes daily will provide

additional health benefits

– Most daily physical activity should be aerobic. Vigorous-intensity

activities should be incorporated, including those that strengthen

muscle and bone, at least 3 times per week

Adults aged 18 — 64

At least 150 minutes of moderate-intensity aerobic physical

activity, or 75 minutes of vigorous-intensity aerobic physical

activity per week

– Aerobic activity should be performed in sessions of at least 10

minutes’ duration

– For additional health benefits, adults should increase their

moderate-intensity aerobic physical activity to 300 minutes per

week, or engage in 150 minutes of vigorous-intensity aerobic

physical activity per week

– Muscle-strengthening activities should be carried out, involving

major muscle groups, on ≥ 2 days per week.

Adults aged 65+

The same goals as for healthy younger adults. Strength training

and balance exercises to prevent falls are of particular importance

for this age group

– When older adults cannot achieve the recommended amounts of

physical activity owing to health conditions, they should be as

physically active as their abilities and conditions allow.

• The case for specific consideration

– Emerging risk factor

– Independent of physical activity level

– Associated with all-cause as well as cardio-vascular disease mortality, type 2 diabetes in prospective studies

– Widespread behaviour (> 60 % awake time)

– Increasing trend

– Need for specific monitoring and surveillance

– Need for action by setting (worksite)

– Need for dedicated research (environment, interventions)

Sedentary Behaviour

What is Physical Activity?

There are many different forms, settings and levels of

physical activity

Gender, Age and Culture influence Physical Activity level

Non-Communicable Diseases

• Worldwide, physical inactivity causes 6–10% NCDs (CHD, diabetes, breast

and colon cancer)*

• Physical inactivity causes 9% premature mortality*

• Known health effects on:

- Mental health, e.g. reducing anxiety, stress, depression and possibly

delaying Alzheimer’s and dementia

- Energy balance and weight control

*Lee IM & al. 2012; **Hallal PC & al. 2012

Physical Activity in the European Region

Low Total Daily Physical Activity

WHO estimates that in in the European region:

• More than half of the population is not active

enough to meet health recommendations.

• One third of European young people aged 11, 13

and 15 years reported enough physical activity to

meet current guidelines.

Physical Inactivity – Adults

Physical inactivity (%) among adults (18+) in the EU

0

10

20

30

40

50

60

70

GRE EST LTU NET SVK CRO HUN BUL POL GER LVA CZH SVN DEN ROM FRA AUT FIN BEL UK SWE LUX SPA POR IRE ITA CYP MAT

Male Female

Global Health Observatory Data Repository. Geneva: World Health Organization (http://apps.who.int/gho/data/view.main.2463ADO?lang=en, accessed 10 April 2016). No data for ALB, AND, AZE, BLR, BIH, CYP, GEO, KAZ, KGZ, MNE, MDA, SMR, SRB, TJK, TKM, UZB

Physical Inactivity – Adolescents

0

10

20

30

40

50

60

70

80

90

100

IRE BUL AUT CZH FIN SPA SVK LUX UK CRO POL LVA SVN HUN ROM NET MAT BEL GER LTU GRE EST SWE POR FRA DEN ITA CYP

Pe

rce

nta

ge

Prevalence of physical inactivity (%) among adolescents (11-17 years) in the EU

Male Female

Global Health Observatory Data Repository. Geneva: World Health Organization (http://apps.who.int/gho/data/view.main.2463ADO?lang=en, accessed 10 April 2016).

Childhood Obesity

50 40 30 20 10 0 10 20 30 40 50

Spain

Italy*

San Marino*

Greece

Malta

Portugal

Bulgaria

Macedonia**

Romania*

Slovenia

Lithuania

Hungary

Turkey

Czech rep.

Latvia

Norway*

Albania*

Ireland

Belgium

Sweden

Overweight - Males

Obesity - Males

Overweight - Females

Obesity - Females

Prevalence of overweight and obesity among children aged 7 years, 2012/13 (2009/10 for CZH, SPA HUN;

2007/08 for SWE). * Children aged 8 years, ** Children aged 6 years

Physical Activity Inequalities

• Some groups are less physically active and

harder to reach for the promotion of physical

activity than other, e.g:

– Adults and older people with low socio-economic

status

– Female adolescents

– Minority ethnic groups

– People with disabilities

Determinants of Physical Inactivity

Some of the determinants of physical inactivity are the result of

systemic and environmental changes, e.g.

- Urban sprawl, i.e. areas with greater distance between homes,

workplaces, shops and places for leisure activities

- Road safety concerns

- Children and adolescents spend more time in school or day-care

settings

- Quality of neighbourhood environments

- Increasingly sedentary forms of entertainment, e.g. screen-based

activities

- More technical aids, such as escalators

Physical Activity Strategy for the

WHO European Region 2016-2025

Global Policy

Frameworks

Landmark

documents on

Intersectoral

collaboration

Guidance on

Best

Practice

Consultation

To inspire governments and

stakeholders to work towards

increasing physical activity for all:

• Promote physical activity

• Enable environment

• Provide equal opportunities

• Remove barriers

Mission

Guiding principles

• Reduce inequities

• Promote a life-course approach

• Use evidence-based strategies

• Empower people and

communities

• Promote integrated, multisectoral,

sustainable and partnership-

based approaches

• Ensure contexuality of physical

activity programmes

5 Priority areas

• Providing leadership and

coordination

• Supporting child and adolescent

development

• Promoting physical activity for all

adults as part of daily life

• Promoting physical activity among

older people

• Monitoring, surveillance, tools,

enabling platforms, evaluation and

research

Priority Area 1 – Providing Leadership and

Coordination for the Promotion of Physical Activity

Ensure leadership to oversee,

guide and integrate PA in policy-

making and coordinate and

promote alliances

– policy learning, dissemination

and sustainability

Priority Area 2 – Supporting the Development of

Children and Adolescents

• Promote PA during pregnancy and for early

childhood

- Training of Health professionals

- Promote physical activity in preschools and schools

- Measures to ensure the nationwide implementation

of quality physical education classes

• Promote recreational physical activity for children

and adolescents

- Out-of- school physical activity programmes

- Innovative approaches to promote physical activity

Priority area 3 – Promoting physical activity

for all adults as part of daily life

• Reduce car traffic and increase walking and

cycling suitability

– establish a mix of accessible walking and cycling

infrastructures

– improve the availability and attractiveness of public

transport

– congestion charges, tax incentives

• Provide opportunities and counselling for

physical activity at the workplace by;

o Regulations or guidelines with regard to cycle racks,

changing rooms and adequate public transport

options

Continuation

• Integrate physical activity into prevention,

treatment and rehabilitation

- Health professionals should promote PA in their

daily activities

• Improve access to physical activity facilities

and offers, particularly for vulnerable groups

- Incentives for providers to offer physical activity

programmes and opportunities for vulnerable

groups

Priority area 4 – Promoting physical activity

among older people

• Improve the quality of advice on physical

activity by health professionals to older people

• Provide infrastructure and appropriate

environments for physical activity among older

people

– flexible working hours and modified work

environments for older people

• Involve older people in social physical activity

– make use of existing social structures to reach older

people, in particular those from socially disadvantaged

backgrounds, in order to encourage them to engage in

physical activity.

Priority Area 5 -Supporting action through monitoring,

surveillance, the provision of tools, enabling platforms,

evaluation and research

• Strengthen and expand surveillance systems

• Deeper understanding of PA-patterns among different social groups,

including by gender, age and socioeconomic status

• Strengthen the evidence base for physical activity

promotion

• approaches to engaging vulnerable population groups across the life-

course in physical activity,

• innovative approaches to promoting physical activity for adolescents, in

particular through the use of technology and peer networks

From Strategy to Implementation

Key findings on Implementation

Physical Activity in Cities • Most member cities viewed physical activity as an important issue

for urban planning.

• Most member cities reported actions targeting the built

environment to promote walking and cycling.

• Many efforts are nested in programmes to prevent obesity

among adults and children

• The health care sector was clearly involve das an arena to identify

and reach sedentary individuals and to initiate disease prevention

Faskunger JT. Active living in healthy cities. Journal of Urban Health (2012)

Barriers and Challenges

• Only a few cities mentioned an integrated framework specific for

active living

• Frequently mentioned barriers included lack of funding and lack of

commitment from decision-makers

• Better evaluation methods are needed to improve the evidence

base for effective action

• Future challenges include establishing integrated policy,

introducing a larger range of actions

Finland- Monitoring Risk Factors

in Adolescents “Move!” A National Monitoring system for physical functional

capacity

“Move!” aims to increase physical activity among Finnish adolescents (aged

11—12 years and 14—15 years) (High Risk group)

It is build around a system that monitors pupils’ physical functional capacity by

measuring endurance, strength, speed, mobility, balance and basic motor skills.

With the help of a “feedback” system, pupils, their guardians, health care

professionals at school, as well as teachers receive information about pupils’

physical functional capacity, its connection to their well-being and advice on

how to improve it.

Austria- Building Strong Partnerships to

Promote Physical Activity for All

The government has build strong partnership with the Austrian Sports for All

organizations — including their network of over 15 000 sports clubs.

The partnership has strengthened the Sports for All organizations’ capacity to provide a

programmes such as:

Move Children Healthy- Austria’s largest intersectoral programme between the sports

and education sectors. The initiative aims to build collaboration between sports clubs,

preschools and primary schools and to promote an active lifestyle by offering a joyful and

fun approach to physical activity for children aged 2–10 years.

By the end of 2014, more than 120 000 interventions have been provided to almost

7000 preschools and primary schools since 2009.

Netherlands- Integrated Programme to

Support Disability Sports

“Active without Boundaries” aims to make sports and physical activity

available to all disabled individuals

The programme has four sections:

1. collaboration at the local level

2. supporting those who provide the opportunities for sports and physical

activity

3. facts and figures (monitoring and dissemination of information)

4. ensuring this population group is represented within other sports policy

programme

From Strategy to

Implementation- Summary • Build commitment

• Form a leadership group

• Create a vision

• Profile the city, neighbourhoods and target population groups

• Consult with residents and stakeholders

• Map opportunities and constraints

• Identify funds and resources

Adopted from A healthy city is an active city: a physical activity

planning guide (2008)

Preparing a plan

• Create a conceptual model that link risk behaviours with

factors in the social and built environment

• Develop key interventions and:

– Set priorities for intervention options in the built environment

– Set priorities for intervention options in the social environment

– Set priorities for intervention options in specific settings

• Strengthen individual intentions

Implementing the plan and measuring

success

• Stage implementation

• Evaluate your progress (effectiveness)

• Share your results

• Review and update your plan

Source: adapted from Community physical activity planning: a resource manual (2006)

Success in

A healthy and active city is one that engages its

citizens and continually assesses and improves

opportunities in the built and social environments,

individual capabilities and motivations to be

physically active in day-to-day life.

Thank You