Getting Healthy Outdoors

Getting Healthier Outdoors

Lisa A. Cirill, M.S., P.A.P.H.S., ChiefCalifornia Active Communities

California Department of Public Health

78% of children fall short of the recommended minimum dose of active play

Physical Inactivity

Physical Inactivityin Youths

and Adolescents• 1 in 7 youth ages 6–19 is overweight

• Children spend more time watching television in a year

than they do attending school

• 35% of children watch 5+ hours of TV a day

Children don’t walk anymore:

Our Kids Are in Trouble!

• In the 1970s, 70% of youngsters walked or rode bikes to school

• Today, only 14% walk or bike

Unfit Children

Annual California Fitnessgram • Conducted in Grades 5, 7, and 9• Measures 6 major fitness areas

(e.g. aerobic capacity, body composition, flexibility)

• 2008 Results: Who passed all standards?

29% Grade 5

34% Grade 7

38% Grade 9

0

2

4

6

8

10

12

14

16

1963-70

1971-74

1976-80

1988-94

1999-2000

6-11 years12-19 years

Prevalence (%) of overweight among children and adolescents

Average 11 year old boy today is 11 pounds heavier than in 1973

Do Obese Children Become Obese Adults?

• About a third (26-41%) of obese preschool children are obese as adults

• About half (42-63%) of obese school-aged children are obese as adults

If the current trend continues, of those children born in 2000:

• 32.8% of boys and 38.5% of girls will develop diabetes

• Close to 50% of African American and Latino children will develop diabetes

Diabetes Link to Obesity

• 25% of all adults are sedentary

• Most are low-income and people of color

• > 20% get 30 minutes of PA at least 5 days/wk

Physical Inactivity in Adults

Obesity Trends* Among U.S. Adults

BRFSS, 1985

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.


BRFSS, 1986(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14%


BRFSS, 1989




No Data <10% 10%–14%


BRFSS, 1991




No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%


BRFSS, 1994




No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%


BRFSS, 1997




No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%


BRFSS, 2001


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


BRFSS, 2002

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



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



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



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2008

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Impact of Our Legacy?

• 1/3 of all children will be diabetics

• Life span shortened by 15 years

• 1st generation in history

who may not live as long

as their parents

• All adults should perform 30 or more minutes of moderate-intensity physical activity on most, and preferably all days (either in a single session or accumulated in multiple bouts, each lasting at least 10 minutes)

• Children should accumulate at least 60 minutes of physical activity/active play per day

CDC-ACSM, 2007

Physical ActivityGuidelines

Benefits of Physical Activity

• Increases life span by 2 years• Reduces risk of CVD by 40%• Prevents/manages high BP and Diabetes• Decreases risk of breast and colon cancers• Improves mood and mental health• Contributes to weight control• Health care costs for active adults are $300-

$400 less per year U.S. Surgeon General’s Report, 1996

Promoting exercise has not worked

Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System

Trend in Recommended Physical Activity

Contributing Factors

• VERY complex!

• Variety of factors play a role: behavior environment genetic culture socioeconomic status

Environmental Factors

Changes are taking place in a variety of settings

that negatively impact our choices:

home (e.g. too much screen time) school (e.g. lack of physical activity options) work (e.g. poor access to stairs, no locker rooms) community (e.g. parents reluctant to let kids roam free

to play, unsafe streets, urban sprawl)

Walkable neighborhoods encourage trips by bike and foot

56%

33%

0

10

20

30

40

50

60

traditional suburban

Portion of residents walking to shops

People in traditional neighborhoods are more likely

to walk to nearby shops.

Handy, S.L. Transportation Research

Record 1996

Walking for transport and overweight in children

Based on data from the Nationwide Personal Transportation Survey and the Centers for Disease Control and Prevention.

Walking for transport and overweight in adults

Based on data from the Nationwide Personal Transportation Survey and the Centers for Disease Control and Prevention.

Traditional Vs. Suburban Designs

Illustration: Frank, LD “Health & Community Design”

Greenwald, M.J. Transportation Research

Record 2001

The Built Environment = More Risks Than Just Obesity

• Diabetes• Cancers• Heart disease• Injury • Asthma• Bone health• Impotence• Depression, stress

• Air quality• Noise• Climate change• Sense of community • Crime/violence• Economic vitality• Children’s development

Americans Keep Driving More

Over 36 M Served

Taking a step in the right direction

Signs to promote stair use are effective and inexpensive

Pedometer Programs - StepFit Chico a pedometer walking program in which all fifth grade students of the Chico Unified School District participate in a four week walking program

Increasing Physical Activity

Shift people from cars towalking and biking

Trees and Public Health

What do trees have to with public health?

• Nothing

• Something

• Everything

Nothing

• Trees are just pretty

• Trees cause allergies and drop limbs and messy debris

• Funding for greening is funding that could have gone towards health promotion

Something• Trees clean our air

• Trees clean our water

• Trees help prevent flooding

• Trees reduce urban heat islands

• Parks support physical activity and recreation

Everything

• Trees are essential for a healthy human habitat

• Trees enable us to thrive; socially, physically and psychologically

• Funding for greening is funding for health promotion

• Humans evolved in nature – 99.5% of the last 2 million years we have been embedded in the natural environment

• Mobile organisms are drawn toward fit habitats

- Habitat selection theory - Environmental preference as a marker

for fit habitat

Trees Are Essential

What Are Humans Drawn To

Tree Deprivation

• Humans deprived of nature undergo social, physical and psychological breakdown

• How would we tell? Compare humans living in conditions varying in greenness

- Intensity of greenness - Proximity of trees and other green elements

- Exposure to green views and places

Robert Taylor Homes “low green”

Robert Taylor Homes “high green”

Ida B. Wells“low green”

Ida B. Wells“high green”

Social Breakdown

↓ Strength of community↓ Courtesy, mutual support↓ Supervision of children outdoors

↑ Graffiti, noise, litter↑ Loitering, illegal activity↑ Property crime↑ Aggression, violence↑ Violent crime

Aggression, Crime and Violence

• Significantly more total aggression, physical aggression, violence, and severe violence in

“low green” places and buildings

• Aggression is tied to mental fatigue

• Significantly more total crime, property crime, violent crime in “low green” places and buildings

- Explains 7% of variance in crime

Physical Breakdown

↓ Poorer recovery from surgery↓ Self-reported physical health

↑ Obesity in children↑ Mortality rates

Psychological Breakdown

↓ Attention↓ Learning↓ Management of major life issues↓ Impulse control↓ Delay of gratification↓ Well-being (mood, life satisfaction)

↑ Attention Deficit/Hyperactivity Disorder (AD/HD)

symptoms

AD/HD National Survey

• AD/HD symptoms after different activities in different settings

• AD/HD symptoms in general

• “Green Advantage” consistent across age, gender, size of community, part of the country

and diagnosis

Bottom Line

• Humans in less natural environments show all the signs associated with unfit habitats:

- Social breakdown - Physical breakdown - Psychological breakdown

What the Evidence Tells Us

Emergent Findings

• How much greenness? Every bit helps

• In what forms? In almost all forms – but exposure is key

• For whom? Everyone, especially the vulnerable

Trees Are “Vitamin G”

• Integrate nature into the urban fabric

• Greening at many scales and in many forms

• Special attention must be given to children, older adults and underserved populations

What is an Activity-Friendly

Environment?

A place that makes it easy to choose to be physically active, through planned exercise

or routine daily activity

Activity-FriendlyCommunities

Need to design for:

• Active recreation• Active transport

Activity-Friendly Communities

Physical activity is:

• Incidental• Functional• Safe• Accessible • Pleasing• Normal

Complete Streets

Complete Streets

Movement

Pedestrians, bicyclists, motorists and public transit users of all ages and abilities are able to safely move along and across a complete street

Principles of

Healthy StreetsStreets

designed for people -not just cars

Principles of Healthy Streets

Streets designed so drivers feel comfortable at slow speeds:

– 15-25 mph on neighborhood streets

– 25-35 mph on avenues and boulevards

Healthy Streets Need Good Sidewalks• Detached

from curb

• At least 5 feet wide

• Planting strip helps shade streets and sidewalk

Connect Sidewalks and Trails

Access to Transit

We impact the freedom of all residents, especially children and seniors,

when we fail to provide complete streets

Safe Access to Places and Spaces

Greenways, Trailsand Open Space

• Infrastructure• Non-infrastructure

Safe Routes toSchool Movement

Does Design Make a Difference for Kids?

More children walk to school where there are sidewalks

Marin County SR2S – safety, encouragement and street improvements – 64% increase in kids walking

CA SR2S – 15% of kids walked or biked more after physical improvements (vs. 4% w/ no improvements)

Then...

Now…

Schools: Then and Now

From this school district’s website: “ This 38-acre campus is located on Interstate 680 between rolling hills of bean and corn fields in southwest

Iowa.”

School Siting and Design

Placement ofSchools

Well located schools:

• Encourage kids to walk and bike to school

• Discourage car trips that damage environment

• Serve as neighborhood centers that improve the physical and social health of residents

Joint-Use Facilities

www.jointuse.org

Unstructured Play Areas

Other Unstructured Play Areas

Unstructured Play Areas = Active Play

Building Physical Activity Back Into Our Daily Lives

Building on the Initiatives

Partnerships

“Healing the broken bond between our young and nature is in our self-interest.”

Children in Nature Movement

No Child Left Inside!

Yikes…

National Physical Activity Plan

• Public Health• Education• Parks and Recreation, Fitness/Sports• Healthcare• Non-profits, Volunteer Groups• Media• Land Use and Transportation• Business and Industry

-- Safety and Diversity

National PhysicalActivity Practitioners

in Public HealthMission:

• Elevate physical activity as a public health priority• Build a cadre of physical activity specialists at the national, state and local levels• Provide professional development opportunities

- Each state public health department has a PA Lead -- Some states have PA Leads at the local level

American Association of Public Health

Physical Activity Special Primary Interest Group

• Provide physical activity education track at APHA annual conference which welcomes over 15,000 public health professionals• Advance physical activity policy and best practices at the national, state and local levels

A Vision for California: 10 Steps for Healthy Living

1. Californians will understand the importance of physical activity and healthy eating, and they will make healthier choices based on their understanding.

2. Everyday, every child will participate in physical activities.

3. California’s adults will be physically active every day.

4. Schools will only offer healthy foods and beverages to students.

5. Only healthy foods and beverages will be marketed to children ages 12 and under.

6. Produce and other fresh, healthy fooditems will be affordable and available inneighborhoods.

7. Neighborhoods, communities andbuildings will support physical activity,including safe walking, stair climbing,and bicycling.8. Healthy foods and beverages will beaccessible, affordable, and promoted ingrocery stores, restaurants, andentertainment venues.9. Health insurers and health careproviders will promote physical activityand healthy eating.10. Employees will have access tophysical activity and healthy foodoptions.

Governor Endorsed

- California Governor Arnold Schwarzenegger- California Council of YMCAs- California Biodiversity Council- San Mateo County Park District - East Bay Regional Park District- Los Angeles County - California Park and Recreation Society - Pacific Stewardship Council- City of Glendale- California State Park and Rec. Commission - City of Roseville and Roseville PAL- California State Park Rangers Association- San Luis Obispo County

Endorsements

Common Interests

Improving society’s health and well being:

- U.S. HHS and CDC- State Public Health Depts.- Local Public Health Depts.- Non-profits- Universities- Foundations- Health care systems

• Develop, fund and implement policies and programs

• Gather data and conduct research

• Provide educational materials and forums

Partners ….

• Provide direct care and funding for public/patients

• Funds physical activity promotion and programs

• Includes HMOs, hospitals, senior centers, rehab facilities, physicians, nurses and other allied health

• Framework for activities with diverse audiences• Promotes active lifestyles• Involves family and community• Introduces children to outdoor settings

Improving Health

• CDPH Physical Activity Specialists

• California Convergence - Healthy Eating, Active Living (HEAL) - Healthy Eating, Active Communities (HEAC)

- Central Region Obesity Prevention Program

(CROPP) - Communities of Excellence (CX3)

Other Partners

Key Partners•Local Elected Officials•Architects and Urban Designers

•Parks and Recreation•Land Use Planners•Transportation Engineers•Public Health•School Officials•Advocacy Groups•Businesses•Non-Profit Organizations•Law Enforcement•Emergency Services

- Trainings (101, 201, HIA)- Teleconferences- Mini-grants ($5 - $10K)

Increases local public health departments’ skills and abilities to impact community planning and transportation decisions and engage in efforts that reduce vehicle miles traveled

Integrating Public Health into Community Design

Encourage development of sustainable communities, promote equity, public health and safety:

Policies/Strategies

• Health language in General Plans• Complete Streets Policies• SRTS Policies and Programs• Bike and Pedestrian Master Plans• Working relationships with local/regional planning departments or agencies

Policy for Good of the Community

• Can define local government’s role in PA

• Focus on what a community can control

– Physical environment: greening; architecture; geography; roads; sidewalks; public lands, access to community facilities; funding for physical activity

– Social environment: culture; economics; politics

Policy Successes

• Roseville: Joint use agreements between city and schools; hold regular forums with school boards and city council

• Sacramento: Park and Recreation Master Plan address issue of obesity and wellness

• Chino: City council and school board adopted resolution for “Healthy Chino 2005” (America’s Promise Award)

What’s Working: Collaborations

• County-wide P/R initiatives:– Greater San Diego Recreation and Parks Coalition for

Health and Wellness– S.F. P/R Health and Wellness Fights Obesity TF – Los Angeles County “Healthy Parks Initiative”

• iSalud! Salinas Steps to Health:– American Lung Assoc., Monterey Co. Ofc. on Aging,

Office of Education, CSU-Monterey Bay, Stanford, Salinas Ministerial Association, Monterey Co. Insurance Group, Agriculture Growers/Shippers Assoc.

What’s Working: Collaborations

• Tracy: “My Own Marathon” (community and teachers); “Tracy for Teens” collaborative with Sutter Tracy Community Hospital

• Coronado: Parks and Rec staff leads active games/activities during school lunch time

• City of Sacramento: Insurance company, hospital chain, dental firm, and CSUS nursing school created “Healthy Kids Project,” day camp program to teach nutrition and PA to kids and parents

What’s Working:Collaboration

• Fresno: after school fitness program at 53 primary schools; partners with Fresno County Office of Education and Mayor’s Fitness Council

• La Mesa: Community Wellness TF of school districts, adult education, medical personnel, YMCA, community members

• Redwood: City: Distributed free pedometers to public; partnering with Sequoia Hospital to train staff and youth in programs

• Moreno Valley: Fitness 19 (private club now located in community center) and private day care provider available for parents

Parks as Centers of Community

Parks are open for services and activities before, during and after-school, on

weekends and in the summer

Power of Parks

Power of Place • 525 local park and recreation agencies – widely

recognized as a community asset• Thousands of acres of park land and open space• Active infrastructure: swimming pools, gyms,

community centers, senior centers, teen centers, skate parks, trails, bike paths, sports fields, lakes, ice rinks, tennis courts, parks

• Parks provide an opportunity to reach underserved populations

Walkability Audits

More Trees

First Friend

Tree Stewardship

Greenways and Trails

Community Trees

Great Places Bring People Together

Tree Placement Reduces Criminal

Activity• Crime Prevention through Environmental Design Institutes for planners, architects and law enforcement professionals

• Out of four principles, two focus on improving

safety through placement of greenery - maximizes visibility by proper placement and spacing

* street trees for shade and protection * low shrubs along buildings or pathways to

control access points

Infill Projects

Trees: Camouflage and Protection

Trees Are Our Friends

Every city and unincorporated area should have

a tree ordinance establishing the following:

• Existing trees in cities and unincorporated areas be maintained and preserved

• New developments and revitalization projects include a designated number of trees

• Perimeter of school sites and other public facilities are tree-lined and grounds contain sufficient amount of shade trees and edible trees

• Streetscapes include shade trees every 30’ to 50’

• Parks, greenways and open spaces serve as community urban forests

Lisa A. Cirill, M.S., P.A.P.H.S.ChiefCalifornia Active CommunitiesCalifornia Department of Public HealthTel: (916) 552-9943Fax: (916) 552-9912Email: [email protected]

www.CAactivecommunities.org

mailto:[email protected]

Documents

Getting Healthy Outdoors