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Olga L.Sarmiento . MD, MPH, PhD Adriana Díaz del Castillo H. MD, MA

Bogotá. A City with a Built Environment that Promotes Physical Activity. Promoting Healthy Living in the Americas: Multisectoral Interventions to reduce health risks factors Washington, DC, November 18th, 2013. Photo : Diana Fernández. Olga L.Sarmiento . MD, MPH, PhD

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Olga L.Sarmiento . MD, MPH, PhD Adriana Díaz del Castillo H. MD, MA

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  1. Bogotá A City with a Built Environment that Promotes Physical Activity. Promoting Healthy Living in the Americas: Multisectoral Interventions to reduce health risks factors Washington, DC, November 18th, 2013 Photo: Diana Fernández • Olga L.Sarmiento. MD, MPH, PhD • Adriana Díaz del Castillo H. MD, MA • Ethel Segura Durán. Arq., MG

  2. Agenda • Context: physicalinactivity and chronicdiseases • Objectives • Methods • Case results: Ciclovía Recreativa, CicloRutas, TransMilenio & Outdoorgyms • Lessonslearned and recommendations Photo: Ethel Segura

  3. The burden of physical inactivity 5.3 MILLION Deaths attributed to physical inactivity (PI) worldwide Wen et al. 2012 ; Lee et al. 2012 ; Lobelo 2006 11.7% Deaths attributed to PI in Colombia Prevalence Annual deaths (global) 7.6% All cause mortality attributed to PI in Bogotá 20.1% Deaths due to NCD attributed to PI in Bogotá

  4. Physical activity in Bogotá Ensin 2010 Sarmiento et al

  5. objectives Photo: Ethel Segura

  6. Objectives • Describe the processes and stakeholders that led to the design and implementation of: • CiclovíaRecreativa, CicloRutas,TransMilenio and Outdor gyms as promising programs or infrastructures to promote physical activity in Bogotá. • Provide recommendations for the developing of similar policies, programs, and infrastructures in other cities.

  7. methods Photo: Olga Sarmiento

  8. Methods • Literature review of the policy processes. • Document analysis of policies, regulations, legislative acts, and district development plans. • Semi-structure interviews. • Secondary analysis of population surveys (2005, 2010, 2011). Photo: Ethel Segura

  9. results Photo: Ethel Segura

  10. Ciclovía, CicloRutas, TransMilenio, and Parks Users’ Average Number of PA Minutes per Week

  11. Ciclovía Photo: Olga Sarmiento • -113 km of streets • -~70 events per year • -600,000-1,200,000 participants per event Weekday Ciclovía Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013

  12. Ciclovía & Physical Activity • Adults (18-64 yrs) • 9.8% of the population reported participating in the last month • 59.5% of users meet PA recommendations (for leisure) • Ciclovía participants vs. no participants are more likely to meet PA recommendations (POR:1.7; 95% CI 1.1-2.4); (POR: 7.4; 95% CI 4.0-13.8). • Ciclovia participants are more likely to bike for transportation OR 2.28 (1.32-3.94) • The cost–benefit ratio for health benefit from physical activity was 3.23–4.26 • Older Adults (60-98yrs) • Access to Ciclovíawas associated with having walked at least 150 minutes in a usual week (POR:1.29, 95% CI1.0, 1.7). • Children (9-10 yrs) • 31.8% of the children reported participating at least once a month in the Ciclovia • Cicloviausers have higher mean minutes of MVPA vs. non Cicloviausers Beta= 3.047 p=0.03 Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013; Gomez 2010

  13. Ciclovía • -1974, started promoted by activists • -1995, District Institute of Recreation and Sports • -Program to reduce NCD in National Public Health Plan • - Law on Obesity (1355) as a strategy to promote PA Photo: Olga Sarmiento Weekday Ciclovía Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013

  14. Ciclovía • Facilitators Barriers Stakeholders • Activists-bike enthusiasts • City government– mayors • Transport • Police • Ministry Education • IDRD • Urban planning • Health • City residents • Congress- City Council • Private vehicle owners • Businesses • Favorable context • Political will • Alignment with government plans • Community participation • Multi-sectoral work • Lead entity • Transport priorities • Businesses • Changed government priorities

  15. Multi sectorial Network of theCiclovia Meisel et al. 2013

  16. CicloRutas • -Bike paths • -344km in the network • -Longest network in Latin America • -83,436 users per day • -Law on Obesity (1355) as a strategy to promote PA Photo: Ethel Segura Torres et al 2013; Ricaurte 2010

  17. CicloRutas • 70.5%of users meets PA recommendations (fortransport) • The cost–benefit ratio for health benefit from physical activity was 2.8 Photo: Ethel Segura Torres et al 2013; Ricaurte 2010

  18. CicloRutas Stakeholders • Facilitators Barriers • City government • JICA • Urban planning (IDU) • Public utility companies: EAAB – ETB – Codensa • IDRD • Police • Bike activists • Favorable context • Vision of the city: sustainable transport • Budget allocation • Changes to roads that supported the new infrastructure • Non-integrated interventions • Lack of comprehensive policies • Lack of a lead entity • Imbalance of transport priorities • Low status of bicycles • Circuit interruptions • Road insecurity and crime • Funding for maintenance

  19. TransMilenio Photo: Andrea Ramírez -30% of the trips in Bogotá are made by public transport (9% TransMilenio) -TransMileniobuses operate in exclusive lanes with fixed stations ~500m -Average of 1.2million passengers per day -The fastest mode of transport 28km/h Cervero et al. 2009

  20. TransMilenio Photo: Andrea Ramírez Adults living in a neighborhood with 1 or 2 TM stations are more likely to walk for transport and meet PA recommendations than those who live in neighborhoods without TM stations Cervero et al. 2009

  21. Physical activity &TransMilenio >22 minutes daily of MVPA (PR = 1.36, CI = 95% [1.08-1.63] Relation between moderate and vigorous physical activity (MVPA) minutes per hour and time of day for users and nonusers of TransMilenio (N = 250).

  22. TransMilenio Stakeholders • Facilitators Barriers • City government • Urban planning • Public transport operators • Private concessionaires • Media • Urban planning experts and academics • City residents • Favorable context • Political will • Unsuccessful earlier experiences • Fixed stations • Problems in execution and operation • Reduced user satisfaction • Cost of the fare

  23. BRT around the world • 120 cities • 280 corridors • 4,300 Km • 6,700 stations • 30,000 buses • 28 millionpassengers/day Source: Hidalgo, D., & Gutiérrez, L., BRT and BHLS around the world: Explosive growth, large positive impacts and many issues outstanding, Research in Transportation Economics (2012)

  24. Outdoor gyms Photo: Olga Sarmiento Amongadults and olderadults, parkdensity and frequent use are associatedwithmeeting PA recommendationsduringleisuretime Gómez et al. 2010 (a) (b)

  25. Outdoor gyms Stakeholders • Facilitators Barriers • Private company • City residents • IDRD • Public-private partnerships with benefits for all • Community participation • Funding • Vandalism

  26. Lessons learned • Multi-sectoralwork. • Use of existinginfrastructuretopromote PA tooptimizeresources • Comprehensiveinterventions. • Health sector needstobuildonothersectorsinitiatives. • Topromotesustainability—commongoals and active interactionsamonginstitutions. • Communityparticipation & politicalwill: both are necessary but neither is sufficient on its own. Photo: Diana Fernández

  27. Recommendations • Include the health sector in urban planning processes. • Include health indicators in the design, evaluation and monitoring of urban development programs. • Promote different dimensions of PA through comprehensive approaches. Photo: Olga Sarmiento

  28. Thank you Photo: Ethel Segura

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