Planning for Health – Built Environment

Introduction

Physical inactivity is a global concern and is thought to be responsible for responsible for more than 5 million deaths per year [1]. In recent decades, activity has been ‘designed out’ of daily life for many people. For example, there has been a reduction in physically active occupations, an increase in sedentary entertainment, a growing dependence on private motorised transport and the design of our towns and neighbourhoods has been tailored to support car use [2].  Consequently, as a population, we have less and less opportunity to accumulate sufficient physical activity to maintain and improve health through the activities of daily life.

In the UK, America and other (mainly developed) countries, this has led to interest in physical activity promotion that principally focused on individual or group behaviour change interventions (e.g., exercise referral, motivational interviewing) [3].  Although potentially effective with targeted and appropriate delivery, and with the flexibility to tailor to individual need, the ever-increasing need (i.e., continuing rise in prevalence of sedentarism) has resulted in many physical activity researchers embracing models that also consider higher-level determinants.

‘In the 1980s, researchers examined individual cognitions, beliefs, and motivations around diet and exercise. This comprised correlational studies that identified associations between behaviours and a range of theoretical variables derived from social learning theory, the theory of planned behaviour, and motivational readiness to change (self efficacy, behavioural intention, stage of change variables). This resulted in a plethora of cross sectional analytical papers that showed small associations with diet and physical activity, without really ‘‘striking gold’’ in terms of identifying the solve-all correlate(s) that could really improve public health interventions.’ [3] (p.535)

The social ecology model recognises the potential influences at different levels, from the individual (micro) to urban, regional or larger scale (macro); i.e., from the individual level up to broader social determinants of health (considered in previous weeks).  In this sense, environmental physical activity supports are a necessary adjunct to individual behaviour change efforts; without environmental supports for activity at the macro level, targeted individual interventions are unlikely to be successful in effecting sustainable behaviour change [4]. Herein lies the importance of understanding environmental determinants of physical activity. Although we could consider the environment in terms of the home, the workplace, schools and so on, this week focuses on the built (and natural) environment.

Over the past decade the interest and literature related to environmental physical activity determinants has grown enormously. Knowledge of how the environment in which we live and interact can influence our health through physical activity has helped us to understand the types of environments that are conducive to physical activity. Essentially, environmental interventions offer a means to ‘design’ physical activity ‘back in’ to our daily lives.

From a physical activity promotion perspective, creating supportive environments has obvious attractions for public health:

1. The ability to influence the behaviour of large numbers of people, increasing the potential public health impact (compared with individual or group-based programmes)
2. Potential sustainability of modifications to the built environment (compared with short-term programmes)
3. Reduce the need for people to make conscious decisions to be more active.

‘Furthermore, physical activity interventions should be conceptualized on a population basis, because intervening with individuals or small groups is unlikely to bring about population-wide change. Environmental and policy interventions hold particular promise for promoting physical activity because both are designed to influence large groups.’ [5] (p.380)

Much of the recent progress in this field has been in America and, in particular, from the Active Living Research (ALR) group (http://www.activelivingresearch.org/). This website has links to many useful resources, including a Youtube channel (http://www.youtube.com/user/ActiveLivingResearch).  However, there are many other resources and guidance documents relating to environment and physical activity, sometimes within larger texts relating to healthy urban planning; for example:

• Europe
  • World Health Organisation European Healthy Cities project http://www.euro.who.int/en/health-topics/environment-and-health/urban-health/activities/healthy-cities
  • Environment and health for European cities http://eprints.uwe.ac.uk/32227/ (section 3.1.1 Urban design and physical activity in cities)
• USA
  • CDC Healthy Places https://www.cdc.gov/healthyplaces/ https://www.cdc.gov/healthyplaces/healthtopics/physactivity.htm
• England
  • NICE Physical activity and environment https://www.nice.org.uk/guidance/ph8/evidence

Now that we have set the scene, please open the Tasks document for this week and work through the activities.