The Healthy Communities Agenda:  How We Can Work Together Dee Merriam, FASLA Community Planner National Center for Environ...
U.S. Health Care Expenditures as Percent of GDP Projections Keehan et al:  Health Affairs March/April 2008 27: 145-155
For every age group from 3 through 33--crashes were the No. 1 cause of death Injury -Vehicle Crashes                      ...
Miles per capita– more than doubled in one generation   <ul><li>Miles per Capita: 1960 to 1995 </li></ul>From 4,000 to 9,2...
Disease in the 21 st  Century   <ul><li>Mental Disorders: Depression, Anxiety, Developmental, Substance Abuse </li></ul><u...
Climate- The European Heat Wave of 2003 Source:  Earth Policy Institute Excess deaths France 14,802 Germany 7,000 Spain 4,...
Climate
Recovery from surgery <ul><li>All cholecystectomies in a Pennsylvania hospital, May-October, 1972-1981  </li></ul><ul><li>...
<ul><li>Results:  The “tree view” patients had </li></ul><ul><li>shorter hospitalizations ( 8.70 days vs 7.96 days ) </li>...
Trees and urban Life <ul><li>Studies in Robert Taylor Homes,Chicago </li></ul><ul><ul><li>28 identical high-rise buildings...
 
 
 
Robert Taylor Homes interview study <ul><li>145 residents </li></ul><ul><li>Asked about social dynamics and aggressive beh...
Strength of Community Positive Interactions Know People on   Floor Know Next Door   Neighbor Unity / Cohesion not at all a...
Strength of Community   Positive Interactions not at all a little quite very somewhat No Trees No Trees No Trees Many Visi...
Strength of Community   Positive Interactions not at all a little quite very somewhat No Trees No Trees Acknowledge Each O...
0 .1 .2 .3 .4 .5 .6 spiteful threatened   to hit threw or smashed threw at partner Proportion Yes Aggressive behavior agai...
0 .1 .2 .3 .4 .5 .6 Hit with something Hit with  fist Beat them up Used gun  or knife Proportion Yes No Trees No Trees No ...
Aggressive and Violent Behavior No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions 0 0.2...
Inactivity, Overweight & Health Evidence links inactivity and overweight with… Inactivity Overweight Increased mortality ...
United States 1990 to 2000
Relationship Between BMI and Risk of Type 2 Diabetes Chan J et al.  Diabetes Care  1994;17:961. Colditz G et al.  Ann Inte...
Percentage of US Adults with Diagnosed Diabetes - 1994 1 state exceeds 6%
Percentage of US Adults with Diagnosed Diabetes - 2001 2 states exceed 9%
Percentage of US Adults with Diagnosed Diabetes - 2007 10 states exceed 9%
 
Sam’s Check Up <ul><ul><li>10 year old boy </li></ul></ul>
“ Problem” List <ul><li>Physical exam unremarkable </li></ul><ul><li>Ht 54”  (50%)  </li></ul><ul><li>Wt 115# (95%) </li><...
Treatment Plan <ul><li>Weight loss program  </li></ul><ul><li>Referral to “overweight” clinic  </li></ul><ul><li>TV out of...
&quot;Outstanding in Its Field&quot;   Hubbard Lake Elementary School, Hubbard Lake, Michigan.
 
Destinations are not connected. PP slide courtesy of Doug Allen Sam’s house Park Joe’s house
Two Months Later… <ul><li>Lost One pound </li></ul><ul><li>Can’t change the food at school </li></ul><ul><li>Day is alread...
2 months later our patient could be taking:   <ul><ul><li>Antihypertensive medication </li></ul></ul><ul><ul><li>Oral  Hyp...
<ul><li>The “environment” is rigged against the patient… </li></ul><ul><li>And the doctor. </li></ul>
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 10%  1985 No D...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1990 Source: Mokdad AH, et a...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 15%  1991 No D...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1992 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1993 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1994 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1995 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1996 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1997 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1998 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1999 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2000 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2001 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2002 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2003 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2004 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2005 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2006 No Data  <10%  10%–14% ...
Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2007 No Data  <10%  10%–14% ...
NHANES --  Measured NHANES –  In person interview-- self-reported BRFSS –  Telephone Interview   BMI US Females  1988-1994
download from CDC at:  www.cdc.gov / nccdphp / dnpa / obesity / trend / maps The data shown in these maps were collected t...
<ul><li>Creating or improving access to places for physical activity can result in a 25% increase in the percent of person...
Walking   good for… Obesity! Heart disease! Cancer! Depression! Diabetes! Gall bladder! Social life!
Higher density and connectivity    Lower obesity  Atlanta study 2004
   Physical activity    Air pollution And by the way…    Infrastructure costs    Social capital    CO 2  emissions  ...
The sidewalk level: The National “ Never Walk”  Campaign 12 Strategies
Strategy #1: Don’t Build Sidewalks
 
 
Strategy #2: Build Repellant Sidewalks
 
Strategy #3: Allow Sidewalks to Disintegrate
 
Strategy #4: Build Treacherous Sidewalks
 
Strategy #5: Obstruct Sidewalks
 
 
Strategy #6: Use creative design.
 
 
Strategy #7: Crosswalks should be dysfunctional, if not silly.
 
 
 
Strategy #8: Combine Multiple Strategies
 
 
Strategy # 9: Never place an interesting or useful destination within walking distance of where anybody lives
 
Strategy #10: Just Say It
 
Strategy # 11: Turn places to park  into architectural icons.
 
Strategy # 12: Make everything car-accessible. Everything !
Pharmacies
Dry Cleaners
Baked goods
Groceries
Booze
Tobacco Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation
Gambling Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation
Auto Service
Fine Food
Coffee
Banking A nice touch… Braille buttons for  blind drivers
Mail Boxes
Utility Bills
Drive-thru sewer payments: Mt. Juliet, Tennessee
Tunnel of Vows Drive-Thru Wedding Chapel Las Vegas, NV
Drive-up wedding windows
Child support payments
Drive-Thru Funerals Gardner Memorial Chapel Davidson, TN Junior Funeral Home Pensacola, FL
Trees…then
Trees…now
The next frontier of drive-thru: Health care?
Parking
?
Resources <ul><li>Healthy Places web Site: </li></ul><ul><li>www.cdc.gov/healthyplaces  </li></ul><ul><li>BRFSS–  data and...
<ul><li>Dee Merriam  </li></ul><ul><li>770-488-3981   </li></ul><ul><li>[email_address]   </li></ul><ul><li>www.cdc.gov/he...
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Embrace the Convergence: Recruiting Allies and Establishing Common Ground for Tough Times- Merriam CNU17 June 13 Denver

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  • You might think, so what’s a little heat. Unfortunately, heat kills. In 2003, a heatwave in Europe killed 35,000 people. The built environment contributes to heat through the heat island effects as well as influencing climate change which leads to an increase in extreme events, like this.
  • Another component of injury has to do with how the built environment affects heat related illness. The more concrete and less green space, the hotter the air will get.
  • U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, 1996. [ii] . NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. NIH Consensus Conference: physical activity and cardiovascular health. JAMA 1996;276:241-246. [iii] . Wannamethee SG, et al. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Arch Internal Med 1998;158(22):2433-40. [iv] . Wannamethee SG et al. Physical activity and the prevention of stroke. J Cardiovasc Risk 1999;6(4):213-6. [v] . Pate RR, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-407. [vi] . Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000;151:293-9. [vii] . Wannamethee SG, et al. Changes in physical activity, mortality and incidence of coronary heart disease in older men. Lancet 1998;351:1603-08. [viii] . Wei M, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999;282:1547-1553. [ix] . Sesso HD, et al. Physical activity and cardiovascular disease risk in middle-aged and older women. Am J Epidemiol 1999;150(4):408-16. [x] . Wei M, et al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men. JAMA 1999;282:1547-1553. [xi] . Blair SN, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205-210.
  • Relationship between BMI and risk of type 2 diabetes The risk of diabetes increases with increasing BMI values in men and women [1,2]. Moreover, the age-adjusted relative risk for diabetes begins to increase at BMI values that are considered normal for men (24 kg/m 2 ) and women (22 kg/m 2 ) based on mortality risk. The marked increase in the prevalence of obesity is an important contributor to the 25% increase in the prevalence of diabetes in the United States over the last 20 years [3]. Increases in abdominal fat mass, weight gain since young adulthood, and a sedentary lifestyle are additional obesity-related risk factors for diabetes [1,4,5]. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481-486. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-969. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998;21:518-524. Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1985;34:1055-1058. Helmrich SP, Ragland DR, Leung RW, Paffenbarger Jr RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147-152.
  • Where does it start – here as kids. Hedley, AA, Ogden, CL, Johnson, CL, Carroll, MD, Curtin, LR, Flegal, KM. Overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291:2847-50. 2004. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288:1728-32. 2002.
  • Hubbard Lake Elementary School is located at the intersection of Hubbard Lake Road and Nicholson Hill Road in Hubbard Lake, Michigan. The school is approximately 7.5 miles west of the town of Ossineke and 20 miles southwest of the city of Alpena.  As you can see from the picture above, Hubbard Lake School certainly lives up to its motto:  &amp;quot;Outstanding In Its Field!&amp;quot; How many children can use the playground after school to play? Schools can be a vital component of the community. They may offer amenities for the community as a whole and everyday, children learn how to travel by traveling to school. What lessons do they learn by driving?
  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • Other areas Alcohol and Drug Addition Building Human Capital End-of-Life Care Health Insurance Coverage Nursing Public Health Leadership Quality Health Care Racial and Ethnic Disparities Tobacco Use Vulnerable Populations
  • On the other hand, we can use a preventive approach: walking or biking to school,…
  • Embrace the Convergence: Recruiting Allies and Establishing Common Ground for Tough Times- Merriam CNU17 June 13 Denver

    1. 1. The Healthy Communities Agenda: How We Can Work Together Dee Merriam, FASLA Community Planner National Center for Environmental Health U.S. Centers for Disease Control and Prevention “ The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.” June 13, 2009 Congress for the New Urbanism
    2. 2. U.S. Health Care Expenditures as Percent of GDP Projections Keehan et al: Health Affairs March/April 2008 27: 145-155
    3. 3. For every age group from 3 through 33--crashes were the No. 1 cause of death Injury -Vehicle Crashes                                                                 
    4. 4. Miles per capita– more than doubled in one generation <ul><li>Miles per Capita: 1960 to 1995 </li></ul>From 4,000 to 9,200 VMT per person
    5. 5. Disease in the 21 st Century <ul><li>Mental Disorders: Depression, Anxiety, Developmental, Substance Abuse </li></ul><ul><li>Macro-environment: Climate, Conflict </li></ul><ul><li>Aging Populations </li></ul><ul><li>Overweight: Chronic Diabetes II, Heart Disease </li></ul>
    6. 6. Climate- The European Heat Wave of 2003 Source: Earth Policy Institute Excess deaths France 14,802 Germany 7,000 Spain 4,230 Italy 4,175 UK 2,045 Netherlands 1,400 Portugal 1,316 Belgium 150 TOTAL 35,118
    7. 7. Climate
    8. 8. Recovery from surgery <ul><li>All cholecystectomies in a Pennsylvania hospital, May-October, 1972-1981 </li></ul><ul><li>Exclusions: age <20 or >69; serious complications; history of psychological problems </li></ul><ul><li>Matched pairs: “tree view” patients with “brick wall view” patients </li></ul>
    9. 9. <ul><li>Results: The “tree view” patients had </li></ul><ul><li>shorter hospitalizations ( 8.70 days vs 7.96 days ) </li></ul><ul><li>less use of analgesic medications </li></ul><ul><li>fewer negative nurse notes ( e.g. “needs much encouragement,” “upset and crying”) </li></ul><ul><li>Ulrich, Science , 1984 </li></ul>Recovery from surgery
    10. 10. Trees and urban Life <ul><li>Studies in Robert Taylor Homes,Chicago </li></ul><ul><ul><li>28 identical high-rise buildings along a 3-mile corridor </li></ul></ul><ul><ul><li>Some have nearby vegetation, others do not </li></ul></ul><ul><ul><li>Residents randomly assigned to apartments </li></ul></ul><ul><ul><li>A “natural experiment” </li></ul></ul>University of Illinois Human-Environment Research Lab William Sullivan, Frances Kuo http://www.herl.uiuc.edu/
    11. 14. Robert Taylor Homes interview study <ul><li>145 residents </li></ul><ul><li>Asked about social dynamics and aggressive behavior </li></ul><ul><li>Compared answers from people living with and without nearby nature </li></ul>
    12. 15. Strength of Community Positive Interactions Know People on Floor Know Next Door Neighbor Unity / Cohesion not at all a little quite very somewhat No Trees No Trees No Trees trees no trees
    13. 16. Strength of Community Positive Interactions not at all a little quite very somewhat No Trees No Trees No Trees Many Visitors Daily Socialize within Bldg. Know People in Bldg. trees no trees
    14. 17. Strength of Community Positive Interactions not at all a little quite very somewhat No Trees No Trees Acknowledge Each Other Help Each Other trees no trees
    15. 18. 0 .1 .2 .3 .4 .5 .6 spiteful threatened to hit threw or smashed threw at partner Proportion Yes Aggressive behavior against partner Negative Interactions No Trees No Trees No Trees No Trees trees no trees
    16. 19. 0 .1 .2 .3 .4 .5 .6 Hit with something Hit with fist Beat them up Used gun or knife Proportion Yes No Trees No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions trees no trees
    17. 20. Aggressive and Violent Behavior No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Psychological Aggression Mild Violence Severe Violence Mean Values trees no trees
    18. 21. Inactivity, Overweight & Health Evidence links inactivity and overweight with… Inactivity Overweight Increased mortality   Cardiovascular disease   Cancers   Depression   Gall bladder disease  Osteoporosis   Dyslipidemias   Hypertension  
    19. 22. United States 1990 to 2000
    20. 23. Relationship Between BMI and Risk of Type 2 Diabetes Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481. Age-Adjusted Relative Risk Body Mass index (kg/m 2 ) Men Women 1.0 2.9 1.0 4.3 1.0 5.0 1.5 8.1 2.2 15.8 4.4 27.6 40.3 54.0 93.2 6.7 11.6 21.3 42.1 <22 <23 23 - 23.9 24 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 31 - 32.9 33 - 34.9 35+
    21. 24. Percentage of US Adults with Diagnosed Diabetes - 1994 1 state exceeds 6%
    22. 25. Percentage of US Adults with Diagnosed Diabetes - 2001 2 states exceed 9%
    23. 26. Percentage of US Adults with Diagnosed Diabetes - 2007 10 states exceed 9%
    24. 28. Sam’s Check Up <ul><ul><li>10 year old boy </li></ul></ul>
    25. 29. “ Problem” List <ul><li>Physical exam unremarkable </li></ul><ul><li>Ht 54” (50%) </li></ul><ul><li>Wt 115# (95%) </li></ul><ul><li>BP 140/90 </li></ul><ul><li>Blood glucose elevated, urine normal </li></ul><ul><li>Cholesterol 220 </li></ul><ul><li>Signs of Depression </li></ul>
    26. 30. Treatment Plan <ul><li>Weight loss program </li></ul><ul><li>Referral to “overweight” clinic </li></ul><ul><li>TV out of the bedroom; no soft drinks in the house </li></ul><ul><li>Exercise program; Encourage sports </li></ul>
    27. 31. &quot;Outstanding in Its Field&quot; Hubbard Lake Elementary School, Hubbard Lake, Michigan.
    28. 33. Destinations are not connected. PP slide courtesy of Doug Allen Sam’s house Park Joe’s house
    29. 34. Two Months Later… <ul><li>Lost One pound </li></ul><ul><li>Can’t change the food at school </li></ul><ul><li>Day is already too full </li></ul><ul><li>No Time for exercise; “not good at sports” </li></ul><ul><li>No place to Walk </li></ul>
    30. 35. 2 months later our patient could be taking: <ul><ul><li>Antihypertensive medication </li></ul></ul><ul><ul><li>Oral Hypoglycemic agent </li></ul></ul><ul><ul><li>Cholesterol lowering agent </li></ul></ul><ul><ul><li>Antidepressant </li></ul></ul><ul><li>Monthly medication costs: $385 </li></ul>
    31. 36. <ul><li>The “environment” is rigged against the patient… </li></ul><ul><li>And the doctor. </li></ul>
    32. 37. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 10% 1985 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 2 001;286:10.
    33. 38. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1990 Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    34. 39. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 15% 1991 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    35. 40. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1992 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    36. 41. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1993 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    37. 42. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1994 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    38. 43. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1995 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    39. 44. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1996 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    40. 45. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1997 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. 3 states over 20%
    41. 46. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1998 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    42. 47. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1999 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    43. 48. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2000 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
    44. 49. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2001 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. Alabama over 25%
    45. 50. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2002 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    46. 51. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2003 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    47. 52. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2004 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    48. 53. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    49. 54. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    50. 55. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Only 1 state under 20%
    51. 56. NHANES -- Measured NHANES – In person interview-- self-reported BRFSS – Telephone Interview BMI US Females 1988-1994
    52. 57. download from CDC at: www.cdc.gov / nccdphp / dnpa / obesity / trend / maps The data shown in these maps were collected through the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) .
    53. 58. <ul><li>Creating or improving access to places for physical activity can result in a 25% increase in the percent of persons who exercise. </li></ul><ul><li>www.thecommunityguide.org </li></ul><ul><li>AmJ Prev Med 2002 </li></ul>
    54. 59. Walking good for… Obesity! Heart disease! Cancer! Depression! Diabetes! Gall bladder! Social life!
    55. 60. Higher density and connectivity  Lower obesity Atlanta study 2004
    56. 61.  Physical activity  Air pollution And by the way…  Infrastructure costs  Social capital  CO 2 emissions  Depression  Injuries  Osteoporosis
    57. 62. The sidewalk level: The National “ Never Walk” Campaign 12 Strategies
    58. 63. Strategy #1: Don’t Build Sidewalks
    59. 66. Strategy #2: Build Repellant Sidewalks
    60. 68. Strategy #3: Allow Sidewalks to Disintegrate
    61. 70. Strategy #4: Build Treacherous Sidewalks
    62. 72. Strategy #5: Obstruct Sidewalks
    63. 75. Strategy #6: Use creative design.
    64. 78. Strategy #7: Crosswalks should be dysfunctional, if not silly.
    65. 82. Strategy #8: Combine Multiple Strategies
    66. 85. Strategy # 9: Never place an interesting or useful destination within walking distance of where anybody lives
    67. 87. Strategy #10: Just Say It
    68. 89. Strategy # 11: Turn places to park into architectural icons.
    69. 91. Strategy # 12: Make everything car-accessible. Everything !
    70. 92. Pharmacies
    71. 93. Dry Cleaners
    72. 94. Baked goods
    73. 95. Groceries
    74. 96. Booze
    75. 97. Tobacco Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation
    76. 98. Gambling Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation
    77. 99. Auto Service
    78. 100. Fine Food
    79. 101. Coffee
    80. 102. Banking A nice touch… Braille buttons for blind drivers
    81. 103. Mail Boxes
    82. 104. Utility Bills
    83. 105. Drive-thru sewer payments: Mt. Juliet, Tennessee
    84. 106. Tunnel of Vows Drive-Thru Wedding Chapel Las Vegas, NV
    85. 107. Drive-up wedding windows
    86. 108. Child support payments
    87. 109. Drive-Thru Funerals Gardner Memorial Chapel Davidson, TN Junior Funeral Home Pensacola, FL
    88. 110. Trees…then
    89. 111. Trees…now
    90. 112. The next frontier of drive-thru: Health care?
    91. 113. Parking
    92. 114. ?
    93. 115. Resources <ul><li>Healthy Places web Site: </li></ul><ul><li>www.cdc.gov/healthyplaces </li></ul><ul><li>BRFSS– data and trends regarding public health: </li></ul><ul><li>http://www.cdc.gov/nccdphp/tracking.htm </li></ul><ul><li>2008 guidelines Physical Activity Guidelines: </li></ul><ul><li>http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html </li></ul>Dee Merriam- 770-488-3981- [email_address]
    94. 116. <ul><li>Dee Merriam </li></ul><ul><li>770-488-3981 </li></ul><ul><li>[email_address] </li></ul><ul><li>www.cdc.gov/healthyplaces </li></ul>

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