The document discusses the evolution of urban design and public health, highlighting the historical context of infectious diseases in 19th-century New York City and the emergence of chronic diseases today, such as obesity and diabetes. It emphasizes the importance of active design principles in creating environments that encourage physical activity, citing strategies like improving stair accessibility and enhancing neighborhood design. The document also outlines a collaborative framework among health, urban planning, and design professionals to implement effective interventions that promote healthier lifestyles.

1. Active Design –
Creating Opportunities
for Active Living within
Communities
David Burney, Commissioner,
New York City Department of
Design and Construction

2. THE 19th CENTURY: THE 21st CENTURY:
Infectious Diseases
Chronic Diseases,
many of which are
“Diseases of Energy”
The emerging design solutions for health
19th Century codes, planning and infrastructure
parallel sustainable design solutions
as weapons in the battle against contagious

3. 100+ years ago, urban conditions were a breeding ground
for infectious disease epidemics
Over-crowding
in Lower Manhattan
Major epidemics:
1910 density:
114,000 people/ sq. mi.
Air/droplet-borne diseases:
TB
+
2011 density:
67,000 people/ sq. mi.
Water-borne diseases:
Inadequate systems for
Cholera
garbage, water, and sewer,
leading to pervasive filth
Vector-borne diseases:
and polluted water supplies
Yellow-fever

4. The response was through built environment interventions
1842 New York’s water system established – an
aqueduct brings fresh water from Westchester.
1857 NYC creates Central Park, hailed as “ventilation for the
working man’s lungs”, continuing construction through the
height of the Civil War
1881 Dept. of Street-sweeping created, which eventually
becomes the Department of Sanitation
1901 New York State Tenement House Act banned the

5. The Results: Infectious disease rates
BEFORE the wide use
of antibiotics!
57.1% 45.8%
AFTER the wide use
of antibiotics!
11.3% 2.3%
9%
1880 1940 2011

6. The epidemics of today are:
CHRONIC DISEASES
(obesity, diabetes, heart disease
& strokes, cancers)
Top 5 Causes of Death in U.S.:
1.Tobacco, 2. Obesity, 3. High Blood Pressure,
4. High Blood Sugar, 5. Physical Inactivity
Energy in: Energy out:
Food Exercise

7. Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14%
Source: U.S. Centers for Disease Control and Prevention (CDC)

8. Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14%
Source: U.S. Centers for Disease Control and Prevention (CDC)

9. Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14%
Source: U.S. Centers for Disease Control and Prevention (CDC)

10. Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14%
Source: U.S. Centers for Disease Control and Prevention (CDC)

11. Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14%
Source: U.S. Centers for Disease Control and Prevention (CDC)

12. Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14%
Source: U.S. Centers for Disease Control and Prevention (CDC)

13. Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19%
Source: U.S. Centers for Disease Control and Prevention (CDC)

14. Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19%
Source: U.S. Centers for Disease Control and Prevention (CDC)

15. Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19%
Source: U.S. Centers for Disease Control and Prevention (CDC)

16. Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19%
Source: U.S. Centers for Disease Control and Prevention (CDC)

17. Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19%
Source: U.S. Centers for Disease Control and Prevention (CDC)

18. Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19%
Source: U.S. Centers for Disease Control and Prevention (CDC)

19. Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%
Source: U.S. Centers for Disease Control and Prevention (CDC)

20. Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%
Source: U.S. Centers for Disease Control and Prevention (CDC)

21. Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%
Source: U.S. Centers for Disease Control and Prevention (CDC)

22. Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%
Source: U.S. Centers for Disease Control and Prevention (CDC)

23. Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%
Source: U.S. Centers for Disease Control and Prevention (CDC)

24. Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%
Source: U.S. Centers for Disease Control and Prevention (CDC)

25. Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%
Source: U.S. Centers for Disease Control and Prevention (CDC)

26. Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%
Source: U.S. Centers for Disease Control and Prevention (CDC)

27. Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% 30%
Source: U.S. Centers for Disease Control and Prevention (CDC)

28. Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% 30%
Source: U.S. Centers for Disease Control and Prevention (CDC)

29. Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% 30%
Source: U.S. Centers for Disease Control and Prevention (CDC)

30. Obesity Trends* Among U.S. Adults
BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% 30%
Source: U.S. Centers for Disease Control and Prevention (CDC)

31. Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% 30%
Source: U.S. Centers for Disease Control and Prevention (CDC)

32. Diabetes trends among U.S. adults
1994 2000 2009
No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%
Source: CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics

33. Only half of NYC elementary school children are at a healthy weight
Underweight
4%
Obese
24%
Normal
Weight
53%
Overweight
19%
Source: NYC Department of Health and Mental Hygiene, NYC Vital Signs, 2003.

34. World Obesity rates among adults - 2011

35. Obesity and Diabetes have increased rapidly.
Our genetics have not changed in one generation, but
our built environment has!

36. Growing EvidenceResearch Improving Health through Building, Street
Evidence-based Base for shows that we can Increase Physical
and Neighborhood Design Street and Neighborhood Design
Activity through Building,
OOD SCALES
Designing to Point-of-Decision stair prompts
increase stair Signs placed at elevators & escalators encouraging stair use, w/ info on
use benefits of stair use
Median 50% increase in stair use
Design and aesthetic interventions
Music & art in stairwells
Design stairs to be more convenient and visible
Skip-stop elevators
3300% increase in stair use
Designing to
increase active Enhancing access to places for physical activity, such as creating
recreation walking trails or having onsite or nearby parks, playgrounds and
exercise facilities (homes & worksites)
increases leisure-time activity and weight loss
Walking, Bicycling and Transit-oriented development
Designing to Designs to improve street safety and aesthetics (less crime and traffic /
increase active more greening), having sidewalks and bike paths connected to
transportation destinations, mixed land use, high population density
Median increase in physical activity 35% to 161%

37. WE CAN ADDRESS THESE ISSUES AT THE BUILDING,
Growing Evidence Base for Improving Health through Building, Street
STREET AND NEIGHBORHOOD SCALES
and Neighborhood Design
Increased access to healthy foods and beverages within food
Increasing environmentsaccess to healthy foods and beverages within food
Increased
Access to environments
Healthy Food Increased access to premises that provide healthy foods and
and Beverages Increased access to premises that provide healthy foods and
beverages – e.g. supermarkets, farmers markets, drinking water
beverages – e.g. supermarkets, farmers markets, drinking water
facilities
facilities
Decreasing Decreased exposure to unhealthy foods such as trans fats and
Exposure to sugary drinks
Unhealthy
Food and Decreased exposure to unhealthy food premises
Beverages
Point-of- Information at points of selection and purchase of food
Decision
Information

38. Translating Health Evidence into Non-Health Policies Affecting Health
KEY LESSONS LEARNED:
• The Need for Partnerships – Core and Extensive
• Finding Synergies and Co-Benefits
• Complementary Roles of Core Partners
– Health: Presenting the available research-based evidence and the
epidemiology of disease; organized early meetings/conferences to do so
– Design and Construction, Transportation and City Planning: Ideas of what’s
feasible in the current local context; identifying opportunities and
mechanisms, including and especially synergistic efforts
– Health: Playing a supporting role for implementing ideas – presenting the
health evidence; assisting with strategy and planning, undertaking studies
to inform implementation planning and evaluation; providing resources
for coordination of intersectoral meetings, initiatives and follow-up
– Design and Construction, Transportation and City Planning: Leadership and
participation in the efforts
– Researchers: evidence reviews and synthesis, evaluation research
• Garnering Review, Feedback and Inputs from an Extensive Group of Partners
• Using Evidence-Based and Best-Practice Strategies
• Using Annual Conferences as Strategic Milestones to Highlight Successes and
Craft Strategic Next Steps with Extensive Group of Partners
• Key Roles for Peer-to-Peer Partnerships and Mentoring among Cities

39. Fit City Conferences
Fit-City:
Promoting Physical Activity Through Design
Fit-City 3:
Promoting Physical Activity Through Design

40. The Active Design Guidelines
Published in 2010, the Guidelines brought
together a number of best practices for
design professionals.
Chapters
1) Environmental Design and Health:
Past and Present
2) Urban Design:
Creating an Active City
1) Building Design:
Creating Opportunities for
Daily Physical Activity
1) Synergies with Sustainable and
Universal Design
The Guidelines can be downloaded at:
www.centerforactivedesign.org

41. Creation of the Guidelines
Active Design Guidelines Team
New York City Staff* Department of City Planning Editor
Alexandros Washburn, AIA Irene Chang, March, MPhil
Department of Design and Chief Urban Designer Cheng+Snyder
Construction
David Burney, FAIA Skye Duncan, MSAUD, BArch Community, Academic and
Commissioner Associate Urban Designer Private Sector
Michael Bloomberg Mayor’s Office of Management and Ernest Hutton, Hutton Associates,
Margo Woolley, AIA
MAYOR Budget INC.
Assistant Commissioner,
Joyce Lee, AIA, LEED AP Ellen Martin, 1100 Architects
Architecture and Engineering
David Burney Chief Architect Linda Polack Marpillero Pollak,
Division
COMMISSIONER Architects
Department of Design and Vitoria Milne, MID Academic Partners John Pucher, Bloustein School of
Construction Director, Office of Creative Services Planning and Public Policy,
Craig Zimring PhD. Rutgers University
Department of Health and Mental Professor, Georgia Institute of Jessica Spiegel, 1100 Architects
Thomas Farley Technology
Hygiene William Stein, Dattner Architects
COMMISSIONER College of Architecture Shin-Pei Tsay, Transportation
Department of Health and Mental Karen Lee, MD, MHSc, FRCPC Alternatives
Hygiene Director, Built Environment Gayle Nicoll, M.Arch, PhD, OAA
Associate Professor and Chair, Thanks to all the design
Janette Sadik-Khan Sarah Wolf, MPH, RD University of Texas at San Antonio
Built Environment Coordinator practitioners and organizations
COMMISSIONER Department of Architecture who participated in the 2009
Department of Transportation Department of Transportation Design Charrette to help test the
Julie Brand Zook, M.Arch
Wendy Feuer, MA Researcher, Georgia Institute of Guidelines prior to its publication.
Amanda Burden Assistant Commissioner of Urban Technology
COMMISSIONER Design and Art, Division of Planning College of Architecture
Department of City Planning and Sustainability *We also thank the many city
Reid Ewing, PhD agencies that gave input including
Hanna Gustafsson Professor, University of Utah, the Depts of Parks and
Former Urban Fellow, Division of Department of Recreation, Buildings, Housing
Planning and Sustainability City and Metropolitan Planning Preservation and Development,
School Construction Authority,
American Institute of Architects Aging, and Mayor’s Offices of
New York Chapter Long-Term Planning and
Fredric Bell, FAIA Sustainability, and of People with
Executive Director Disabilities.
Sherida Paulsen, FAIA
2009 President

42. IMPLEMENTATION: Inter-Sectoral City Policy Initiatives on
Built Environment
Synergies:
• Health
• Safety
• Environmental
Sustainability
• Universal Accessibility
• Economic Benefits
www.nyc.gov/adg

43. Co-benefits of Active Design: Improve the Environment
Fuel / Electricity Use Air Quality Obesity/Diabetes/
Heart Disease
Biking or walking rather √ √ √
than automotive
transport
Stairs rather than √ √ √
elevators and escalators
Active recreation rather √ √ √
than television
Safe tap water rather √ √ √
than bottled and canned
beverages
Fresh local produce √ √ √
rather than unhealthy
processed foods

44. Co-benefits: Create more accessible places
• Creating safer places to
walk, take transit, & for the
elderly and people with
disabilities.
• Making elevators more
available for those who need
them.

45. Co-benefits: Save money, particularly for low-income people
People in walkable, transit-rich neighborhoods spend only
9 percent of their monthly income on transportation costs; those in
auto-dependent neighborhoods spend 25 percent.
Source: Center for Transit-Oriented Development

46. Building Design Strategies
Site + Building Design
Stairs: promoting easy access
Stairs: accessibility, visibility, convenience
Stair of Prominence Skip Stop Elevators to Enclosed stairs that use
and Visual Interest increase stair use Fire Rated Glass to
Increase Visibility

47. Building Design Strategies
Stairs: aesthetics
Stairs to receive plenty Art in stairs to increase Stairs designed to
of natural daylight visual interest invite users

48. Building Strategies
Stairs: signage and prompts
Motivational Signage placed at points of decision
Promoting stair use at work – Stair Week

49. City Policy + Implementation
Use of LEED Green Building Credits that Promote PA
Development density Public transportation
and community access Bicycle storage and
connectivity changing rooms
LEED Physical Activity

50. Building Design Strategies
Recreational programming
Provide fun and affordable
recreational opportunities

51. City Policy + Implementation
NYC Green Codes
Increasing drinking water access through better tap
water facilities – passed in Plumbing Code

52. City Policy + Implementation
NYC Green Codes
How do we incentivize good stair design and remove
barriers to stair use through Zoning and Building Codes?

53. NYC// Complete Neighborhoods
Walkable

54. NYC: Complete Neighborhoods
JOBS LOCAL RETAIL OPEN SPACE

55. City Policy + Implementation
City Policy + Implementation
Zoning for Bicycle Parking
Zoning for Bicycle Parking:
Increasing active transport by providing
safe and secure parking for bike commuters

56. Site + Building Design
Bicycle parking + storage
Secure Bike Storage with Easy Access

57. City Policy + Implementation
NYC World Class Streets
Remaking NYC’s public realm:
• Street Design Manual
• Plaza Program
• World Class Boulevards
• Complete Streets Projects and
Design Standards, incl. bike lanes
• Public Art Program
• New Streetscape Materials
• Coordinated Street Furniture
Program
• Weekend Pedestrian and
Cycling Streets

58. Urban Design
Pedestrian Environment / Streetscape
Provide places of rest Enliven the sidewalk
Attractive plazas have
to complement with street cafes
mix of trees, lighting, &
active walking movable/ fixed seating
and jogging
Integrate public art
into the streetscape

59. Playstreets
On request of DOT, Playstreets Coordinator hired by Health
Evaluation by Health:
Ages of children attending Playstreets (from surveys): Ages 1-13
Visited Playstreets at least once before: >80%
Average length of time children stayed at the Playstreet (from surveys):
~1.5hours
Most likely activity if children had not come to the Playstreet:
TV or other inside activity: 52%
Outdoor activity: 38%
Indoor or outdoor activity equally likely: 10%

60. owww.nyc.gov/dot
o www.facebook.com/NYCDOT
o #NYC_DOT

61. Transit: Infrastructure
Provide attractive and sheltered seating
areas to encourage use
of transit routes
Bus Rapid Transit systems
for more convenient and
faster travel

62. ty Policy + Implementation
Streetscape Components
Steinway Street Master Plan

63. City Policy + Implementation
City Policy + Implementation
Creation of Additional Active Spaces: Summer Streets
• DOT closes Park Avenue to traffic from
Brooklyn Bridge to Central Park and the
Upper East Side on Saturdays in August
• Evaluation:
– Average amount of physical activity
from distances walked, ran, biked on
route: >40 minutes of vigorous
physical activity, or >70 minutes of
moderate physical activity
– 24% of people were those who didn’t
meet PA Recs
– 87% of participants got to event by
active modes
– High Needs Neighborhoods and
Neighborhoods Outside Manhattan
underrepresented

64. City Policy + Implementation
NYC FRESH Program
FRESH Food Store Areas
FRESH Food Store Program Areas
where zoning and
financial incentives
AdditionalFoodeas owherPreoFRESH efinasancial incentives may be available
FRESH ar St re gram Ar
apply
Additional areas where
Additional areas where FRESH financial incentives may be available
FRESH financial
incentives may be
available
Zoning and tax incentives for providing fresh food options
in the city’s underserved areas with high health needs

65. Impacts
• Won 5 National Awards (Health Policy, Environmental Protection,
Sustainable Buildings, Architecture)
• Distributed >15,000 copies of ADGs nationally & internationally
• Trained >3,000 built environment professionals in NYC and U.S.
• Mentored 14 other U.S. cities and communities
(others now adopting initiatives such as integrating use of ADGs,
“Burn Calories, Not Electricity” Stair Prompts, Playstreets, Fit City)

66. Impacts
To date, NYC has…
•Increased:
- Commuter cycling 262%
- Bus and subway ridership 10%
- Stair use - >40% increase at 9 mos in 10-story low-income
housing
- Places for children’s play - ~40 new Playstreets permitted
• Decreased:
- Traffic fatalities 30%
- Traffic volumes 25%
- Car registrations 5%
• Started Reversing Childhood Obesity (also in San Diego!)

67. Established in New York City in 2012, the Center for
Active Design works to support prevention and
control of obesity and chronic diseases by increasing
opportunities for physical activity through the design
of buildings, streets, and neighborhoods.
The Center for Active Design is a non-profit
organization that has grown out of an inter-
disciplinary partnership among New York
City agencies, the American Institute of
Architects New York City Chapter (AIANY),
private sector architects and developers,
and academic partners. After collaboratively
developing the Active Design Guidelines
published in 2010, the Center for Active
Design was established to foster
widespread implementation of Active
Design strategies among public and private
sector design, planning, policy and real
estate professionals.
www.centerforactivedesign.org

68. Anticipated Programs at the Center for Active Design
 Award and Certification Program: recognizing and providing incentives for individual
and project achievements in Active Design,
 Training: for all design and real estate professions,
 Technical Assistance: ranging from providing resources for implementing strategies for
building managers to research and rollout consulting to other municipalities nationally
and internationally,
 Policy Development:: implementing zoning, code, and other incentives,
 Evaluation and Research: linking to researchers, ongoing data collection and support,
 Communications: using printed material, website and other material for education and
training
 Knowledge Translation and Resource Development: using available research for
updating practice and policy materials,
www.centerforactivedesign.org

69. Fit-City:
Promoting Physical Activity Through Design
Fit-City 3:
Promoting Physical Activity Thro
Fit City conferences have
helped promote Active Design

70. Implementing the Guidelines
Technical assistance and training
Testing the guidelines
through an interactive and
interdisciplinary
Design Charrette
Participants:
Government Agencies/
Developers/
Architects/Landscape
Architects/Engineers

71. Mentoring communities in public healthPartnership environment
Built Environment & Health and the built
Supported by CDC
Communities
Putting Prevention
to Work Mentoring
grant
 Partnership
between NYC
DOHMH, AIANY, and
14 communities
 All communities
are recipients of
CPPW grants
Boston MA ~ Cherokee Nation OK ~ Chicago IL ~ Cook County IL ~
Douglas County NE ~ Jefferson County AL ~ King County WA ~ Louisville KY ~
Miami-Dade County FL ~ Multnomah County OR ~ Nashville TN ~ Philadelphia PA ~
Pima County AZ ~ San Diego CA

72. Creation of Additional Resources:
Active Design Supplements
The Center is now creating 5 nationally applicable Active Design
Appendix Documents
1. Active Design: Shaping the Sidewalk Experience
2. Active Design: Opportunities in Zoning
3. Active Design: Guidelines for a Suburban Context
4. Active Design: Injury Prevention
5. Active Design: Affordable Design in Affordable Housing