The public health prescription for walkable communities
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The Public Health Prescription for Walkable Communities. Deb Spicer NYS Department of Health Healthy Heart Program. Impact of Transportation and Land Use Patterns on Health. Physical Activity and Obesity Asthma Injuries Loss of Function in Older Adults Heart Attacks.

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The public health prescription for walkable communities

The Public Health Prescription for Walkable Communities

Deb Spicer

NYS Department of Health

Healthy Heart Program

Impact of transportation and land use patterns on health

Impact of Transportation and Land Use Patterns on Health

  • Physical Activity and Obesity

  • Asthma

  • Injuries

  • Loss of Function in Older Adults

  • Heart Attacks

Underlying causes of death us

Underlying Causes of Death (US)

While most of the preventable causes of death declined, diet and physical inactivity increased 33%.

The public health prescription for walkable communities

Obesity Trends* Among U.S. AdultsBRFSS, 2002

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%–14%15%–19% 20%–24% ≥25%

Source: Behavioral Risk Factor Surveillance System, CDC

The public health prescription for walkable communities




No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS, 1990,1995 and 2001

Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10.

Overweight and obesity among nys adults 2003 brfss

Overweight and Obesity Among NYS Adults (2003 BRFSS)

56% of NY Adults are Overweight or Obese

Obesity among nys adults by ethncity 2003 brfss

Obesity Among NYS Adults, By Ethncity2003, BRFSS




Trends in overweight and obesity among nys adults brfss

Trends in Overweight and Obesity Among NYS Adults, BRFSS



Obesity rates by ethnicity and gender us nhanes 1999 2000

Obesity Rates by Ethnicity and Gender, US, NHANES 1999-2000

  • Based on actual height and weight measurements (BRFSS is self-reported)

  • Rate among AA women predicted to be 57% by 2010.

Estimated medical costs of obesity in nys

Estimated Medical Costs of Obesity in NYS

25% of increase in health care costs due to obesity

Current recommendations for physical activity

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

What s moderate activity

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.)

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

BRFSS Questions on Physical Activity

Physical activity among nys adults brfss 2001

Physical Activity Among NYS Adults, (BRFSS 2001)

Trends in no leisure time physical activity ny

Trends in No Leisure Time Physical Activity, NY

Percent of adults with no leisure time physical activity 2001 brfss

Percent of Adults With No Leisure Time Physical Activity 2001, BRFSS

Cost of physical inactivity in nys

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).

Most frequent leisure time physical activities nys 2000

Most Frequent Leisure Time Physical Activities – NYS, 2000

Health benefits of walking

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)

Health benefits of walking1

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.

Successful long term weight loss

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

Walking trips us 1977 1995

Walking Trips, US, 1977 - 1995

Why don t we walk

Why Don’t We Walk

  • No place to walk

  • Can’t cross the street

  • Too far

  • Unpleasant

  • Dangerous

  • Time

Speed kills

Speed Kills

Average annual hospitalization costs for motor vehicle injuries nys 1994 96

Average Annual Hospitalization Costs for Motor Vehicle Injuries, NYS, 1994-96

Healthy people 2010 objectives

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

Making it easier to be active environmental changes

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

Guide to community preventive services promoting physical activity

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

Guide to community preventive services promoting physical activity1

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



  • 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

Source: Switzerland Federal Office of Sports

Impact of environmental changes stair use 2000

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%.

Impact of environmental changes trail use 2000

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.

Sprawl and health

Sprawl and Health

Ewing, 2003

Impact of environment on physical activity in north carolina 2003

Impact of Environment on Physical Activity in North Carolina (2003)

Huston, AJHP, 2003

Destinations and physical activity in older women in pittsburgh 2003

Destinations and Physical Activity in Older Women in Pittsburgh(2003)

King, AJHP, 2003

Obesity and community design atlanta 2004

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

Asthma and traffic

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

Neighborhood environment and loss of physical function in older adults

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.

Other benefits of walkable communities

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.

The vision

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.

Components of walkable communities

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)

Components of walkable communities cont

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)

The public health prescription for walkable communities

Lewiston, NY - Before and After

The public health prescription for walkable communities

Community Structure and Physical


Growth of the movement

Growth of the Movement

  • Initial focus on transportation

  • Land use may have more effect

  • Health and Built Environment

  • Health Impact Assessments

Role of public health in walkable communities

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

Role of public health cont

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

Walkable community the role of public health

Walkable Community – The Role of Public Health

Long Term Outcomes

Intermediate Outcomes

Short Term Outcomes

Healthy Heart Program

Influential Citizens

  • Walkable Communities Slide

  • Show

  • State Pedestrian Conference

  • Walk to School Week

  • Presentations

  • Walkable Communities

  • Workshops

  • Communication campaign

  • Healthy Heart Contractors

  • Initiative for Healthy Infra.

  • Parks & Trails NY

  • Umbrella for pedestrian

  • groups

Increase Walking

Walkable Communities


Local Decision Makers

Trained Professionals

State Policies

Normalize Walking


BC Walks

Nys doh initiatives to promote walkable communities

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 (

Healthy infrastructure symposium 2005

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


What you can do

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

Walkable communites web sites

Walkable CommunitesWeb Sites

  • NYS Physical Activity Coalition:

  • National Center for Bicycling and Walking:

  • Pedestrian Information Center:

  • NY Parks and Conservation Assoc (trail maps):

  • Walk to School

  • Active Living by Design:

  • America Walks (advocacy groups):



  • 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.

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