Transcript Evidence into Action: How to create societies that provide

“Evidence into Action”:
How to create societies that provide ongoing
physical activity support and promotion
The Oxford Health Alliance Summit 2011
Dr Karen Martin
School of Population Health,
The University of Western Australia
Creating active communities requires
a multidimensional approach
Planning and place
Programs
Policies
Partnerships
Planning and place
Basic environmental needs come first
Before focusing on PA supportive environment - infrastructure for
basic needs is priority (WHO Kobe Meeting Healthy Urban Planning)
1. Local economic development
2. Safe, affordable and appropriate shelter
3. Appropriate sanitation and drainage systems
opportunity for redevelopment to
support health including physical
activity…
rather than just redevelopment…..
Developing country example
Rio de Janeiro, Brazil
Govt agreed to substitute the walls  combination of stretches of
• nature paths, including handrails for people with mobility problems
• bicycle and skating paths
• playgrounds
Planning and place
How to plan environments to support PA?
Prioritise infrastructure improvements Hoehner, 2011
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comprehensive sidewalks
medians
crosswalks
street lighting
bike lanes
plantings
Developing country example: focus on planning
Bogotá, Columbia
City of 7 million, of these 3 million live in poverty
Bogota’s former mayor shifted budgets intended for
highways to
 parks
 bike lanes
 mass-rapid public transit
“I was almost impeached for getting cars off
sidewalks which car owning upper classes
had illegally appropriated for parking.”
Enrique Peñalosa, Mayor
Active commuting plus increasing
pedestrian access
 300 km of bicycle lanes, stretch from the slums & suburbs into the capital
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Ongoing project under concurrent development

Since lanes constructed, bicycle use increased by 5 x in the city
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Between 300,000 and 400,000 trips made daily in Bogotá by bike
Bogotá, Columbia
Also some programs…
Ciclovia... Street closures
“I realized that we in the Third World are not going to catch up to the
developed countries for two or three hundred years. If we defined our
success just in terms of income per capita, we would have to accept
ourselves as second- or third-rate societies – as a bunch of losers – which
is not exactly enticing for our young people. So we are forced to find
another measure of success. I think the only real obvious measure of
success is happiness.”
Enrique Peñalosa
Bogotá, Columbia
Programs
What works??
1. Point of decision prompts (Kahn 2002)
strong evidence for effect
 effect sizes net increase from 2.5% to 128.6%
(see U Tube; piano stairs, the fun theory and Fast lane, the slide
2. Mass media campaigns (Leavy 2011)
few studies show effective reduction in PA
when combined with other strategies (such as community involvement)
may be effective
more on mass media programs….
Recent review of mass media PA campaigns
 campaigns reported higher awareness
• women
• tertiary education
• physically active women
• women with active children
(Leavy 2011)
Messages and materials culturally adapted to specific populations
improves intervention effectiveness (Müller-Riemenschneider 2008)
Mass-media interventions create awareness but not good investment
for changing behavior when used alone (Müller-Riemenschneider 2008)
Do mass media programs preach to the converted???
Programs
3. Community-wide programs/campaigns
Mass media plus social support
 strong evidence for effect
4. School based programs
↑ PE class (number/length),↑ MVPA, mandating PE
 strong evidence for effect
 barriers: school or system based
5. Social support in community settings
Support groups outside family, e.g. walking groups
 strong evidence for effect
 barriers: costly, target fewer people
6. Individually adapted health behaviour change programs
Teach participants specific skills relevant to their situation
 strong evidence for effect
 barriers: costly, target fewer people
(Kahn 2002)
Isolated city example: focus on programs
PA promotion in Perth, Western Australia
Western Australia, 2.3 mill, Perth city 1.7 mill, temperate climate
• Various government and not-for-profit programs to promote PA
 Find 30 everyday (adult- encourage 30 minutes each day)
 Be active (Physical activity taskforce, beactive.wa.gov.au)
 Travelsmart (encourage active transport transport.wa.gov.au/14890.asp)
• 61% respondents in recent adult survey were aware that 30 minutes of
moderate-intensity PA is required on most days for good health.
s
PA trends in Perth, Western Australia
Adults; proportion participating in sufficient activity
70%
Proportion of adults sufficiently active in Western
Australia btw 1999 and 2009

60%

50%
1999
2002
2006
2009
 significant difference p< 0.05
PA trends in Perth, Western Australia
Children’s physical activity remained stable between 2003 and 2008
Primary school boys
met guidelines
didn’t meet guidelines
Primary school girls
met guidelines
41%
59%
27%
73%
Secondary school boys
met guidelines
didn’t meet guidelines
didn’t meet guidelines
Secondary school girls
met guidelines
didn’t meet guidelines
10%
38%
62%
90%
Opportunities in Perth….
Planning and
infrastructure
Take advantage of climate
and place: Eg programs,
Nature Play
natureplaywa.org.au
Congested city example: focus on programs
PA promotion in London
likeridingabike.org
Partnerships
Promising strategies and partnerships
 Parks and recreation agencies (Bruton 2011)
 Partnerships with schools e.g. sharing facilities,
access to oval out of hours (Bruton 2011)
co-locating: with parks? community hub?
1. Maryland (co-location program)
2. Rosa Parks School, Oregon
edfacilities.org/rl/community_use.cfm
 Community participation (Bruton 2011)
Developed country example: focus on partnerships
San Diego County Childhood Obesity Initiative (COI)
Public/private partnership
 advocacy
 policy development
 environmental change
 government, healthcare, school and after school,
early childhood, community, media and business.
Early policy change success
(school, workplace policies, planning policies etc)
Childhood Obesity Initiative
recommendations
 Find a common agenda and shared solutions effectively engages
partners from different sectors. e.g. climate change
 Leadership and political will on multiple levels is critical
(Linton 2011)
(San Diego County COI)
Developed country example: multifaceted
West Virginia University Department of Community Medicine
Programs
•mass media
•involved local physician –prescription for walking
•walking clinic
Place
•Upgrading and connecting local trails
• Adding rest rooms and telephones
•Improving overall safety & aesthetics
•planning for an urban state park
•University engineering team to develop walkable community plan
(Reger-Nash 2005)
Partnerships:
• On-going Walkable Wheeling Task Force (initiated by mayor)
• Local schools to expand youth physical activity
• Local clubs to develop walking opportunities
• Engaged city agencies—mayor, streets, highways, parks, law
enforcement, planning, local clubs, government,
• Schools, press, businesses, medical society, other stakeholders
• Community advisory committee helped plan campaign
Wheeling Walks, West Virginia
Results of intervention
Evaluation measures
Media exposure
Self reported walking
Outcome
30% of Wheeling's sedentary residents increased their walking to the
recommended level compared to a 16% increase in a control
community (14% net increase in Wheeling)
The cost pp to change sedentary to regular walker
=$26.32 pp/per month.
Wheeling Walks, West Virginia
Developed country example: multifaceted
Blue Zones Vitality Project,
Albert Lea
Habitat
Community
Inner-self
Social Networks
http://www.bluezones.com/programs/vitality-cities/
Changes to the community
City of 18 000 people
25% participated in program
component
Initial program cost =
approx $750 000
Partnerships:
• AARP and the United Health Foundation funding
• Local government
• 60% city’s local restaurants, 51% largest employers, every school
• Social, commercial, communal and professional networks
Albert Lea
Changes to the community
Place
• Workplace modifications
• Space for community gardens
• Bike and walking paths connected
Policies
• Amended school and workplace wellness
policies
Programs
• Walking school bus and adult walking
teams
• Standing or walking meetings
Albert Lea
Results of intervention
Project longevity:
3.2 yrs
PA and weight:
•Engaged in more PA
•lost average 1.5 kg (every member of the community)
Other health benefits:
•20% reduction in absenteeism for key employers
•49% decrease in health care costs of city employees
Successful interventions are run by people who know the
community and recommendations are specific and appropriate
(bespoke!)
Albert Lea
Example in developed country: multifaceted
Agita São Paulo, Brazil
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37 mill State of Sao Paulo, started in 1996
WHO praised program as model for developing countries
Scientific board and executive board
Outcomes
 Reach: 60%
 Recall and knowledge: well distributed different socioeconomic groups
 The prevalence of people reaching the PA recommendation was 54.8%
 Risk of being sedentary was smaller
amongst those who knew the Agita
message (7.1%) compared with
those who did not know (13.1%).
Key elements for program success
Simple message: “At least 30 min of PA per day”
Participants choose enjoyable
activities
Linking existing policies
Inclusion principle
Cultural links
Specific messages relevant
to intrapersonal factors
Stakeholders
Political and technical support
Appropriateness of PA interventions
Qualitative and quantitative evaluation
Scientific based information
(university research centre)
Agita São Paulo, Brazil
(Matsudo 2004)
Agita Galera Day (Active Community Day)
• every year since 1997
• Every public schools and hundreds of
private schools
• students participate in sports events
and a neighborhood walk
Agita São Paulo, Brazil
Adult physical activity correlates
SES
program access
education level
overweight/obese (-)
age (-)
healthy diet
race (white)
physician
influence
sex (male)
social support
psychosocial (e.g.
enjoyment, expected
benefit)
physical activity
equipment
recreational facilities:
• availability
• accessibility
• convenience
having a companion
Climate/season
(Sallis 2002,
Wendel-Vos 2007)
Child physical activity correlates
program access
sex (male)
previous physical
activity
healthy diet
perceived
physical activity
activity
preferences
competence
perceived
intention to be
barriers (-)
active
parental
overweight
status (-)
transport infrastructure
(sidewalks/controlled
intersections/ destination access /
public transportation
time spent
outdoors
recreational
infrastructure (access
to recreational
facilities and schools).
local conditions (crime,
area deprivation) (-)
transport infrastructure (N roads to
cross/traffic density&speed) (-)
(Sallis 2000,
Davidson 2007)
Adolescent physical activity correlates
direct help
from parent &
parent support
age (-)
previous
physical activity
ethnicity (white)
sex (male)
physical activity
preferences
intentions
sibling physical
activity
sensation
seeking
sedentary after
school and on
weekends (-)
recreational
infrastructure (access
to recreational
facilities and schools).
community
sports
support from
others
depression (-)
opportunities to
exercise
transport infrastructure
(sidewalks/controlled
intersections/ destination access /
public transportation
local conditions
(crime, area
deprivation) (-)
transport infrastructure (N roads to
cross/traffic density&speed) (-)
(Sallis 2000, Davidson 2007)
LOCAL COMMUNITY SPECIFICITY….
Be locally specific with…..
1. identifying health promotion priorities
health issue/behaviour/target group
Example (low SES suburb, WA)
1. overweight & obesity rates/physical
activity/low SES adolescents
2. identifying strategy (i.e. program,
planning and place/partnerships/policy)
2. place and partnerships
3. identifying priority target
3. improving perceptions of safety,
increased maintenance of skate parks
(local council), working with schools
to promote sport
EFFECTIVE LOCAL STRATEGIES
1. Lobbying/partnerships with policy
makers
2. Brief brochures summarising research
findings to stakeholders/policy makers
(plus journal publications)
3. Partnerships to help identify priorities
Take home messages…..
1.
2.
3.
4.
5.
6.
Opportunities within developing countries to plan for PA
Remove barriers to physical activity
Programs alone are not enough
Identify and target correlates
Community wide approaches with community ‘buy-in’
Ask how can we create sustainable changes in the local
community?
How can
programs be
developed in
times of
economic
downturn?
Challenges for researchers....
“Over the past 80 years we have been building cities
for cars much more than for people.
If only children had as much public space as cars,
most cities in the world would become marvelous.”
Enrique Peñalosa
References
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Bruton 2011 Active Living Research Annual Conference 2011
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Hoehner 2011 Active Living Research Annual Conference 2011
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Kahn 2002 Am J Prev Med 2002 22 (4s) 73-107
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Linton 2011 Active Living Research Annual Conference 2011
•
Leavy 2011 Physical activity mass media campaigns and their evaluation: a systematic review of
the literature 2003-2010 Health Education Research Accepted March 2011
•
Matsudo 2004 J Phys Act Health 2004; 81-97
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Matsudo 2010 Med Sci Sports Exerc 2010; 45 (12); 2231
•
Reger-Nash 2005 Fam Community Health 2005;28:64-78
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Sallis 2000 Med Sc Sports Exerc 2000; 32(5):963-975
•
Sallis 2002 Med Sc Sports Exerc 2002 34(12) 1996–2001
•
Wendel-Vos 2007 Obesity reviews 2007 8 (5) 425
Enrique Peñalosa http://www.pps.org/articles/epenalosa-2/
[email protected]