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

  • Published on
    23-Feb-2016

  • View
    48

  • Download
    0

DESCRIPTION

Bogot. 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 Fernndez. Olga L.Sarmiento . MD, MPH, PhD - PowerPoint PPT Presentation

Transcript

Bogot como ejemplo de una ciudad que promueve la actividad fsica: la Ciclova Recreativa, las CicloRutas, el Transmilenio y los parques

Olga L.Sarmiento. MD, MPH, PhD Adriana Daz del Castillo H. MD, MAEthel Segura Durn. Arq., MG

BogotA City with a Built Environment that Promotes Physical Activity.

Promoting Healthy Living in the Americas: Multisectoral Interventions to reduce health risks factorsWashington, DC, November 18th, 2013

Photo: Diana Fernndez1

Context: physical inactivity and chronic diseasesObjectivesMethodsCase results: Ciclova Recreativa, CicloRutas, TransMilenio & Outdoor gymsLessons learned and recommendationsAgenda

Photo: Ethel Segura2

PrevalenceWen et al. 2012 ; Lee et al. 2012 ; Lobelo 2006Annual deaths (global)5.3MILLIONDeaths attributed to physical inactivity (PI) worldwideDeaths attributed to PI in Colombia11.7%The burden of physical inactivityAll cause mortality attributed to PI in Bogot7.6%Deaths due to NCD attributed to PI in Bogot20.1%3

Ensin 2010 Sarmiento et al Physical activity in Bogot4

objectivesPhoto: Ethel Segura

ObjectivesDescribe the processes and stakeholders that led to the design and implementation of:Ciclova Recreativa, CicloRutas, TransMilenio and Outdor gyms as promising programs or infrastructures to promote physical activity in Bogot.Provide recommendations for the developing of similar policies, programs, and infrastructures in other cities.

methodsPhoto: Olga Sarmiento

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).

Methods

Photo: Ethel Segura8

resultsPhoto: Ethel Segura

Ciclova, CicloRutas, TransMilenio, and Parks Users Average Number of PA Minutes per Week

Ciclova

Week dayCiclova-113 km of streets-~70 events per year-600,000-1,200,000 participants per eventSarmiento et al 2010; Montes et al. 2012; Torres et al 2013Photo: Olga SarmientoParticipantes: 18% poblacin11

Ciclova & Physical ActivityAdults (18-64 yrs)9.8% of the population reported participating in the last month 59.5% of users meet PA recommendations (for leisure) Ciclova 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 costbenefit ratio for health benefit from physical activity was 3.234.26Older Adults (60-98yrs)Access to Ciclova was 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 CicloviaCiclovia users have higher mean minutes of MVPA vs. non Ciclovia users Beta= 3.047 p=0.03

Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013; Gomez 2010Participantes: 18% poblacin12

Ciclova

Week dayCiclova-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 PASarmiento et al 2010; Montes et al. 2012; Torres et al 2013Photo: Olga SarmientoParticipantes: 18% poblacin13

Stakeholders Activists-bike enthusiasts City government mayors Transport Police Ministry Education IDRD Urban planning Health City residents Congress- City Council Private vehicle owners BusinessesTransport prioritiesBusinessesChanged government priorities Favorable contextPolitical willAlignment with government plansCommunity participationMulti-sectoral work Lead entity

BarriersFacilitatorsCiclova

Multi sectorial Network of the Ciclovia

Meisel et al. 2013Comunidades detectadas en la red15

CicloRutasTorres et al 2013; Ricaurte 2010

Photo: Ethel Segura-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

17

CicloRutas70.5% of users meets PA recommendations (for transport)Torres et al 2013; Ricaurte 2010The costbenefit ratio for health benefit from physical activity was 2.8

Photo: Ethel Segura18

CicloRutasStakeholdersBarriersFacilitators City government JICA Urban planning (IDU)Public utility companies: EAAB ETB Codensa IDRD Police Bike activistsNon-integrated interventions Lack of comprehensive policiesLack of a lead entityImbalance of transport prioritiesLow status of bicyclesCircuit interruptionsRoad insecurity and crimeFunding for maintenance Favorable contextVision of the city: sustainable transport Budget allocationChanges to roads that supported the new infrastructure

TransMilenio-30% of the trips in Bogot are made by public transport (9% TransMilenio)

-TransMilenio buses operate in exclusive lanes with fixed stations ~500m

-Average of 1.2million passengers per day

-The fastest mode of transport 28km/hCervero et al. 2009

Photo: Andrea Ramrez20

TransMilenioAdults 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 stationsCervero et al. 2009

Photo: Andrea Ramrez21Physical activity &TransMilenioRelation between moderate and vigorous physical activity (MVPA) minutes per hour and time of day for users and nonusers of TransMilenio (N = 250). >22 minutes daily of MVPA (PR = 1.36, CI = 95% [1.08-1.63]

StakeholdersBarriersFacilitatorsCity governmentUrban planningPublic transport operatorsPrivate concessionaires MediaUrban planning experts and academicsCity residentsProblems in execution and operationReduced user satisfaction Cost of the fareFavorable contextPolitical will Unsuccessful earlier experiencesFixed stations

TransMilenio120 cities280 corridors4,300 Km6,700 stations30,000 buses28 million passengers/day

24BRT around the world

Source: Hidalgo, D., & Gutirrez, L., BRT and BHLS around the world: Explosive growth, large positive impacts and many issues outstanding, Research in Transportation Economics (2012)

Outdoor gymsAmong adults and older adults, park density and frequent use are associated with meeting PA recommendations during leisure timeGmez et al. 2010 (a) (b)

Photo: Olga Sarmiento25

Outdoor gymsStakeholdersBarriersFacilitators Private company City residents IDRD Funding VandalismPublic-private partnerships with benefits for all Community participation

Lessons learnedMulti-sectoral work.Use of existing infrastructure to promote PA to optimize resourcesComprehensive interventions.Health sector needs to build on other sectors initiatives.To promote sustainabilitycommon goals and active interactions among institutions.Community participation & political will: both are necessary but neither is sufficient on its own.

Photo: Diana Fernndez

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.

Recommendations

Photo: Olga Sarmiento

Thank youPhoto: Ethel Segura29

Recommended

View more >