The Healthy Communities Agenda:
   How We Can Work Together

         Congress for the New Urbanism
                      ...
U.S. Health Care Expenditures
         as Percent of GDP Projections




Keehan et al:
Health Affairs
March/April 2008 27:...
Injury -Vehicle Crashes




           For every age group
           from 3 through 33--
           crashes were the No. ...
Miles per capita– more than
      doubled in one generation




Miles per Capita: 1960 to 1995   From 4,000 to 9,200
     ...
Disease in the 21st Century
• Mental Disorders: Depression,
  Anxiety, Developmental, Substance
  Abuse
• Macro-environmen...
Climate-
The European Heat Wave of 2003
                    Excess deaths
                 France              14,802
    ...
Climate
Recovery from surgery

         • All cholecystectomies in a
           Pennsylvania hospital, May-
           October, 19...
Recovery from surgery

Results: The “tree view” patients had
• shorter hospitalizations (8.70 days vs 7.96 days)
• less us...
Trees and urban Life
Studies in Robert Taylor Homes,Chicago
  • 28 identical high-rise buildings along a 3-mile
    corrid...
Robert Taylor Homes interview study

• 145 residents
• Asked about social
  dynamics and
  aggressive behavior
• Compared ...
Strength of Community
                       Positive Interactions
                                                       ...
Strength of Community
                     Positive Interactions
                                                         ...
Strength of Community
               Positive Interactions
                                                     no trees

...
Aggressive behavior against partner
                          Negative Interactions
             .6
                      ...
Aggressive behavior against partner
                          Negative Interactions
             .6
                      ...
Aggressive behavior against partner
                                    Negative Interactions
                1.6
        ...
Inactivity, Overweight & Health
Evidence links inactivity and overweight with…
                               Inactivity  ...
United States 1990 to 2000
Relationship Between BMI and
                                 Risk of Type 2 Diabetes
                             100    ...
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



  10 year old boy
“Problem” List
•   Physical exam unremarkable
•   Ht 54” (50%)
•   Wt 115# (95%)
•   BP 140/90
•   Blood glucose elevated,...
Treatment Plan

• Weight loss program
• Referral to “overweight” clinic
• TV out of the bedroom; no soft drinks in
  the h...
"Outstanding in Its Field"

                Hubbard Lake Elementary School, Hubbard Lake, Michigan.
Joe’s house




Destinations are not
connected.
                                           Park

                         ...
Two Months Later…
• Lost One pound
• Can’t change the food at school
• Day is already too full
• No Time for exercise; “no...
2 months later our patient could
          be taking:
    – Antihypertensive
      medication
    – Oral Hypoglycemic
    ...
• The “environment” is rigged against
  the patient…
• And the doctor.
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
Obesity Trends* Among U.S. Adults, BRFSS
                 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




       ...
BMI US Females 1988-1994




NHANES -- Measured
NHANES –   In person interview-- self-reported

BRFSS –    Telephone Inter...
download from CDC at:
www.cdc.gov / nccdphp / dnpa / obesity / trend / maps
The data shown in these maps were collected th...
Creating or improving access to places for
physical activity can result in a 25% increase
in the percent of persons who ex...
Walking
  good for…
   Obesity!
Heart disease!
   Cancer!
 Depression!
  Diabetes!
 Gall bladder!
  Social life!
Higher density and connectivity     Lower obesity
               Atlanta study 2004
res sion
                              ↓   Dep


      ↓ CO2                              ↓ Air
     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) Par...
Auto Service
Fine   Food
Coffee
A nice touch…
          Braille buttons for
             blind drivers




Banking
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
Gardner Memorial Chapel         Junior Funeral Home
     Davidson, TN                  Pensacola, FL


                Dri...
Trees…then
Trees…now
The next frontier of drive-thru:
       Health care?
Parking
?
Resources
Healthy Places web Site:
www.cdc.gov/healthyplaces
BRFSS– data and trends regarding public health:
http://www.cd...
Dee Merriam
     770-488-3981
  dmerriam@cdc.gov
www.cdc.gov/healthyplaces
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
The Retail Development Crisis: What Now? - Kelley CNU17
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The Retail Development Crisis: What Now? - Kelley CNU17

  1. 1. The Healthy Communities Agenda: How We Can Work Together Congress for the New Urbanism June 13, 2009 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.”
  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. Injury -Vehicle Crashes For every age group from 3 through 33-- crashes were the No. 1 cause of death
  4. 4. Miles per capita– more than doubled in one generation Miles per Capita: 1960 to 1995 From 4,000 to 9,200 VMT per person
  5. 5. Disease in the 21st Century • Mental Disorders: Depression, Anxiety, Developmental, Substance Abuse • Macro-environment: Climate, Conflict • Aging Populations • Overweight: Chronic Diabetes II, Heart Disease
  6. 6. Climate- The European Heat Wave of 2003 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 Source: Earth Policy Institute
  7. 7. Climate
  8. 8. Recovery from surgery • All cholecystectomies in a Pennsylvania hospital, May- October, 1972-1981 • Exclusions: age <20 or >69; serious complications; history of psychological problems • Matched pairs: “tree view” patients with “brick wall view” patients
  9. 9. Recovery from surgery Results: The “tree view” patients had • shorter hospitalizations (8.70 days vs 7.96 days) • less use of analgesic medications • fewer negative nurse notes (e.g. “needs much encouragement,” “upset and crying”) Ulrich, Science, 1984
  10. 10. Trees and urban Life Studies in Robert Taylor Homes,Chicago • 28 identical high-rise buildings along a 3-mile corridor • Some have nearby vegetation, others do not • Residents randomly assigned to apartments • A “natural experiment” University of Illinois Human-Environment Research Lab William Sullivan, Frances Kuo http://www.herl.uiuc.edu/
  11. 11. Robert Taylor Homes interview study • 145 residents • Asked about social dynamics and aggressive behavior • Compared answers from people living with and without nearby nature
  12. 12. Strength of Community Positive Interactions no trees very trees quite somewhat a little No No No Trees Trees Trees not at all Know People Know Next Unity / Cohesion on Floor Door Neighbor
  13. 13. Strength of Community Positive Interactions no trees very trees quite somewhat a little No No No Trees Trees Trees not at all Many Visitors Socialize Know People Daily within Bldg. in Bldg.
  14. 14. Strength of Community Positive Interactions no trees very trees quite somewhat a little No No Trees Trees not at all Acknowledge Help Each Other Each Other
  15. 15. Aggressive behavior against partner Negative Interactions .6 no trees trees .5 .4 Proportion .3 Yes .2 .1 No No No No Trees Trees Trees Trees 0 spiteful threatened threw or threw at to hit smashed partner
  16. 16. Aggressive behavior against partner Negative Interactions .6 no trees .5 trees .4 Proportion .3 Yes .2 .1 No No No No Trees Trees Trees Trees 0 Hit with Hit with Beat them Used gun something fist up or knife
  17. 17. Aggressive behavior against partner Negative Interactions 1.6 no trees 1.4 1.2 trees Mean Values 1 0.8 0.6 0.4 0.2 No No No Trees Trees Trees 0 Psychological Mild Violence Severe Violence Aggression Aggressive and Violent Behavior
  18. 18. Inactivity, Overweight & Health Evidence links inactivity and overweight with… Inactivity Overweight Increased mortality Cardiovascular disease Cancers Depression Gall bladder disease Osteoporosis Dyslipidemias Hypertension
  19. 19. United States 1990 to 2000
  20. 20. Relationship Between BMI and Risk of Type 2 Diabetes 100 93.2 Age-Adjusted Relative Risk Men 75 Women 54.0 50 40.3 42.1 27.6 21.3 25 8.1 15.8 2.9 4.3 5.0 11.6 2.2 6.7 1.0 1.5 4.4 1.0 1.0 0 <22 <23 23 24 25 27 29 31 33 35+ - - - - - - - 23.9 24.9 26.9 28.9 30.9 32.9 34.9 Body Mass index (kg/m2) Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481.
  21. 21. Percentage of US Adults with Diagnosed Diabetes - 1994 1 state exceeds 6%
  22. 22. Percentage of US Adults with Diagnosed Diabetes - 2001 2 states exceed 9%
  23. 23. Percentage of US Adults with Diagnosed Diabetes - 2007 10 states exceed 9%
  24. 24. Sam’s Check Up 10 year old boy
  25. 25. “Problem” List • Physical exam unremarkable • Ht 54” (50%) • Wt 115# (95%) • BP 140/90 • Blood glucose elevated, urine normal • Cholesterol 220 • Signs of Depression
  26. 26. Treatment Plan • Weight loss program • Referral to “overweight” clinic • TV out of the bedroom; no soft drinks in the house • Exercise program; Encourage sports
  27. 27. "Outstanding in Its Field" Hubbard Lake Elementary School, Hubbard Lake, Michigan.
  28. 28. Joe’s house Destinations are not connected. Park Sam’s house PP slide courtesy of Doug Allen
  29. 29. Two Months Later… • Lost One pound • Can’t change the food at school • Day is already too full • No Time for exercise; “not good at sports” • No place to Walk
  30. 30. 2 months later our patient could be taking: – Antihypertensive medication – Oral Hypoglycemic agent – Cholesterol lowering agent – Antidepressant • Monthly medication costs: $385
  31. 31. • The “environment” is rigged against the patient… • And the doctor.
  32. 32. 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 2001;286:10.
  33. 33. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
  34. 34. 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, 2001;286:10.
  35. 35. 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, 2001;286:10.
  36. 36. 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, 2001;286:10.
  37. 37. 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, 2001;286:10.
  38. 38. 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, 2001;286:10.
  39. 39. 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, 2001;286:10.
  40. 40. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 3 states over 20% 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, 2001;286:10.
  41. 41. 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, 2001;286:10.
  42. 42. 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, 2001;286:10.
  43. 43. 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, 2001;286:10.
  44. 44. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Alabama over 25% 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, 2001;286:10.
  45. 45. 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. 46. 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. 47. 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. 48. 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. 49. 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. 50. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Only 1 state under 20% 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  51. 51. BMI US Females 1988-1994 NHANES -- Measured NHANES – In person interview-- self-reported BRFSS – Telephone Interview
  52. 52. 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. 53. Creating or improving access to places for physical activity can result in a 25% increase in the percent of persons who exercise. •www.thecommunityguide.org •AmJ Prev Med 2002
  54. 54. Walking good for… Obesity! Heart disease! Cancer! Depression! Diabetes! Gall bladder! Social life!
  55. 55. Higher density and connectivity Lower obesity Atlanta study 2004
  56. 56. res sion ↓ Dep ↓ CO2 ↓ Air emissions pollution ↑ Physical activity ↓ Osteoporosis ↓ Injuries And by the way… ↓ Infrastructure costs ↑ Social capital
  57. 57. The sidewalk level: The National “Never Walk” Campaign 12 Strategies
  58. 58. Strategy #1: Don’t Build Sidewalks
  59. 59. Strategy #2: Build Repellant Sidewalks
  60. 60. Strategy #3: Allow Sidewalks to Disintegrate
  61. 61. Strategy #4: Build Treacherous Sidewalks
  62. 62. Strategy #5: Obstruct Sidewalks
  63. 63. Strategy #6: Use creative design.
  64. 64. Strategy #7: Crosswalks should be dysfunctional, if not silly.
  65. 65. Strategy #8: Combine Multiple Strategies
  66. 66. Strategy # 9: Never place an interesting or useful destination within walking distance of where anybody lives
  67. 67. Strategy #10: Just Say It
  68. 68. Strategy # 11: Turn places to park into architectural icons.
  69. 69. Strategy # 12: Make everything car-accessible. Everything!
  70. 70. Pharmacies
  71. 71. Dry Cleaners
  72. 72. Baked goods
  73. 73. Groceries
  74. 74. Booze
  75. 75. Tobacco Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation
  76. 76. Gambling Photo courtesy of Lyle McCoon, Jr., Nicholasville/ Jessamine County (KY) Parks & Recreation
  77. 77. Auto Service
  78. 78. Fine Food
  79. 79. Coffee
  80. 80. A nice touch… Braille buttons for blind drivers Banking
  81. 81. Mail Boxes
  82. 82. Utility Bills
  83. 83. Drive-thru sewer payments: Mt. Juliet, Tennessee
  84. 84. Tunnel of Vows Drive-Thru Wedding Chapel Las Vegas, NV
  85. 85. Drive-up wedding windows
  86. 86. Child support payments
  87. 87. Gardner Memorial Chapel Junior Funeral Home Davidson, TN Pensacola, FL Drive-Thru Funerals
  88. 88. Trees…then
  89. 89. Trees…now
  90. 90. The next frontier of drive-thru: Health care?
  91. 91. Parking
  92. 92. ?
  93. 93. Resources Healthy Places web Site: www.cdc.gov/healthyplaces BRFSS– data and trends regarding public health: http://www.cdc.gov/nccdphp/tracking.htm 2008 guidelines Physical Activity Guidelines: http://www.cdc.gov/physicalactivity/everyone/g uidelines/adults.html Dee Merriam- 770-488-3981- dmerriam@cdc.gov
  94. 94. Dee Merriam 770-488-3981 dmerriam@cdc.gov www.cdc.gov/healthyplaces
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