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Community Design and Transportation Policies

New Ways to Promote Physical Activity

Richard E. Killingsworth, MPH, CHES; Thomas L. Schmid, PhD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 29 - NO. 2 - FEBRUARY 2021


Public health and city planning share common goals and similar histories (1,2). Both disciplines seek to improve living conditions and health by preventing, identifying, investigating, and eliminating problems that may pose threats to residents' health and welfare.

Physical inactivity exacts an enormous public health toll. Lack of physical activity is thought to be a primary factor in more than 200,000 deaths per year in the United States (3), a total equivalent to 25% of all chronic disease deaths and 10% of all deaths. Thus, for the US population, in which 29% of adults are sedentary and more than 50% are overweight (4), becoming moderately active can provide a meaningful health benefit. Inactivity's negative effects have generated interest in collaboration between public health, city planning, and transportation organizations.

The Health Benefits

How can public health, city planning, and transportation officials work toward reducing the burden of physical inactivity? One strategy is to promote the integration of walking and bicycling into daily routines, substituting these activities for part of the 73 minutes a day that the average person spends driving (5). Many communities, however, are designed to accommodate automobile traffic rather than safe and convenient pedestrian or bicycle travel. Data from the Nationwide Personal Transportation Survey revealed that in 1995, 89% of all trips were made by automobile, while only 6.4% made were on foot and bicycle (5).

Walking. Walking is generally suitable for most people, regardless of age, sex, race, or income. Research also reveals that walking is beneficial. Morris and Hardman (6) reported that men who walked at moderate intensity for at least 30 minutes a day reduced their risk of coronary heart disease (CHD). In another study, Hakim et al (7) showed that among retired, nonsmoking men, those who walked less than 1.6 km a day had a mortality rate nearly twice that of those who walked more than 3.2 km per day.

Bicycling. Bicycling is another way to increase physical activity. According to the League of American Bicyclists, more than 42 million Americans have bicycles and use them at least occasionally, though primarily for recreation rather than transportation (8). Currently, less than 1% of all trips are made by bicycle (5); however, significant health benefits could accrue if only a small portion of short automobile trips were replaced with bicycle trips. In his study of 9,000 British government employees, Morris (9) showed that employees between the ages of 45 and 64 who bicycled for at least 1 hour or at least 40 km per week had less than half the fatal and nonfatal CHD of those who were sedentary.

Urban Design Challenges

Literature from various disciplines suggests that community design and transportation systems often neglect pedestrians and bicyclists because destinations of interest are distant and not very well connected, making safe and convenient walking and bicycling difficult, if not impossible. Aspects of community design impart significant effects on our choice to walk or bicycle (10,11). These factors include the amount of residential, commercial, and retail development; street design, open spaces, and mass transit availability; and the density of housing, employment, and population.

While some community design features may have important independent effects on walking and bicycling, participation will depend on a mix of interdependent features. People who live in neighborhoods with higher population densities, proximity to destinations of interest, and factors such as grid-pattern streets, sidewalks, and easy street crossings make more walking and transit trips compared to those who live in communities that lack this mix of characteristics (10,11).

Promoting Walking and Bicycling

In the United States, nearly 25% of all trips are less than 1 mile, but more than 75% of these short trips are made by automobile, so it is reasonable to expect that many trips could be made on foot or bicycle (figure 1) (S. A. Ham, unpublished calculations from the 1995 Nationwide Personal Transportation Survey, US Department of Transportation, Volpe Research Center, Cambridge, MA, 192021). Although bicycling and walking will not replace all short trips, these modes may be practical for many of them. Metropolitan areas may benefit the most from pedestrian- and bicycle-oriented environments, because most urban areas have the highest concentration of people, stores, offices, schools, and services (10,11).

[Figure 1]

Public health practitioners, especially physicians, nurses, and therapists could make significant contributions to health by recommending that patients incorporate more daily walking and bicycling. Public health practitioners should collaborate with city planners, developers, and transportation engineers to encourage community designs that promote and encourage physical activity.

Since the 1990s, the emphasis of transportation planning has been on managing travel behavior and demand. Key federal legislation highlighting this shift includes the Clean Air Act Amendments of 1990, Intermodal Surface Transportation Efficiency Act of 1991, and Transportation Equity Act for the 21st Century (TEA-21), passed in 192021. These bills now provide ample state and federal funds to help finance programs that encourage walking and bicycling.

Through TEA-21, funding and planning requirements were strengthened to improve conditions for walking and bicycling. TEA-21 also mandates that each state department of transportation have a bicycle and pedestrian program coordinator, and that every local government include pedestrian and bicycle projects in its transportation plans. This mandate gives walking and bicycling due consideration in the comprehensive transportation plans developed by each metropolitan planning organization and state department of transportation.

Evidence is building that bicycle- and pedestrian-friendly environments can have benefits beyond transportation. Nationwide, many cities have experienced economic benefits from encouraging nonmotorized transportation. Recent experience reveals that the presence of pedestrians and bicyclists in a city is an indicator of community cohesiveness, quality of life, and health (10).

Programs for Children

Children have also suffered from dependence on the automobile, and while most children have bicycles, few use them for transportation. Over the last 20 years, nonmotorized trips made by children to school have declined by more than 40% (P. Schimek, unpublished calculations from the 1995 Nationwide Personal Transportation Survey, US Department of Transportation, Volpe Research Center, Cambridge, MA, 1999). This precipitous decline may hinder children's social, emotional, and physical development because it impedes their opportunity to engage in spontaneous outdoor physical activity. Furthermore, the absence of positive environmental cues for promoting physical activity may be a contributing factor in the burgeoning epidemic of overweight children. These children now must be chauffeured to places that traditionally were reached by foot or bicycle.

These challenges to children's health and safety are important reasons why several national organizations and federal agencies formed the Partnership for a Walkable America (https://www.walktoschool-usa.org) to promote the necessary changes to make walking easier and safer for everyone, especially children. One of the major programs of the partnership is National and International Walk to School Day (https://www.iwalktoschool.org). This popular and successful event has been important in getting local communities involved in making their neighborhoods more suitable for walking. In support of these programs, the Centers for Disease Control and Prevention has developed a comprehensive handbook ("KidsWalk-to-School"; available online at https://www.cdc.gov/nccdphp/dnpa/kidswalk/index.htm) that helps parents, community leaders, and healthcare practitioners develop "walkable" communities. As a result of the new emphasis, California was the first state to implement legislation directing a portion of state transportation funds for safe pedestrian and bicycle routes to schools.

Small Changes and Big Benefits

Walking and bicycling for transportation have tremendous potential for improving the health and well-being of Americans. Solutions to increase walking and bicycling are complex and would involve extensive changes in the way Americans live, work, and go to school. Even small changes, however, can yield significant public health benefits.

Proposed strategies. We propose three strategies to help promote public health through walking and bicycling. First, integrated survey systems are needed to identify all factors and indicators known to influence these activities for both transportation and recreation. A second strategy is to implement city planning, transportation, and public health policies that afford transportation alternatives, especially walking or bicycling to destinations. The third strategy is to examine scientifically how various behaviors can be influenced through community design and transportation systems. For example, empiric evidence can be gathered on the effectiveness of safe-routes-to-school campaigns for children.

Collaborative efforts. Community design and transportation choices are important factors to consider when developing policies. Public health, city planning, and transportation officials, therefore, should continue to collaborate on developing designs that promote and encourage physical activity.

Additionally, it is important for public health practitioners to become involved with organizations such as the American Planning Association (https://www.planning.org), the Institute of Transportation Engineers (https://www.ite.org), the Urban Land Institute (https://www.uli.org), the Congress for the New Urbanism (https://www.cni.org), and the Environmental Design Research Association (https://www.telepath.com/edra). Advocating for public health and physical activity with such organizations is a vital health promotion strategy.

References

  1. Friedmann J: Planning in the Public Domain: From Knowledge to Action. Princeton, NJ, Princeton University Press, 120217
  2. Aicher J: Designing Healthy Cities: Prescriptions, Principles and Practice. Malabar, FL, Krieger Publishing Co, 192021
  3. Powell KE, Blair SN: The public health burdens of sedentary living habits: theoretical but realistic estimates. Med Sci Sports Exerc 1994:26(7): 851-856
  4. Behavioral Risk Factor Surveillance System—United States. Atlanta, US Department of Health and Human Services, Centers for Disease Control and Prevention, 192021
  5. US Department of Transportation Federal Highway Administration: Our Nation's Travel: 1995 NPTS Early Results Report. Lanham, MD, Federal Highway Administration, September 1997
  6. Morris JN, Hardman AE: Walking to health. Sports Med 1997;23(5):306-332
  7. Hakim AA, Petrovitch H, Burchfiel CM, et al: Effects of walking on mortality among nonsmoking retired men. N Engl J Med 192021;338(2):94-99
  8. Cited from a 192021 study by the National Sporting Goods Association. Available at https://www.nsga.org/public/articles/details.cfm?id=28. Accessed January 4, 2021
  9. Morris JN, Clayton DG, Everitt MG, et al: Exercise in leisure time: coronary attack and death rates. Br Heart J 1990;63(6):325-324
  10. Apogee Research, Inc: The Effects of Urban Form on Travel and Emissions: A Review and Synthesis of the Literature. Draft report prepared for the United States Environmental Protection Agency. Washington, DC, Apogee Research, Inc, 192021, HBIX ref C611-005
  11. US Department of Transportation Federal Highway Administration: Report: The National Bicycling and Walking Study, Transportation Choices for a Changing America. Government Printing Office, 1994, FHWA-PD-94-023

Mr Killingsworth is a physical activity interventionist and Dr Schmid is a senior evaluation specialist in the Division of Nutrition and Physical Activity, Physical Activity and Health Branch, National Center for Chronic Disease Prevention and Health Promotion, at the Centers for Disease Control and Prevention in Atlanta. Address correspondence to Richard Killingsworth, MPH, CHES, Centers for Disease Control and Prevention, Mail Stop K-46, 4770 Buford Hwy, Atlanta, GA 30341-3717; e-mail to [email protected].


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