Getting Healthy Outdoors

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  • The adult guidelines to accumulate at least 30 minutes per day of moderate intensity physical activity are well known. It is less well known that the guidelines for youth are 60 minutes per day.
  • The benefits of being physically active on a regular basis are documented in thousands of studies. Physical activity can increase the life span while improving quality of life and can help prevent leading physical and psychological disorders. With health care costs continuing steep increases, the lower health care costs of active people is attracting more attention from policy makers.
  • In the exercise capital of the country, it is surprising to see that only about 25% of adult report meeting the guidelines for physical activity. Unfortunately, there is little evidence that leisure time physical activity is increasing in California, or elsewhere in the country. With this flat pattern for active recreation and a decline in active transportation, the need to intervene is clear.
  • The increase in obesity has been accompanied by a decline in walking for transportation.
  • Perhaps we are walking less because we are driving more. Californians drive more than the US average. This graph shows Californians will continue to spend more and more time in their cars. This not only takes time that could be used for physical activity, but a recent study (Larry Frank, Am J Prev Med, July 2004) showed that time spent in a car was a direct risk factor for being overweight.
  • Different terms have been used to describe places that it is easy to choose to be physically active. Two common terms are Activity-friendly environments and Active Community Environments—ACES. This new way of thinking also has expanded our concepts of physical activity. For years health professionals have promoted more leisure time physical activity, but now we are focusing on integrating active living into daily routines, which can be active recreation or active transport.
  • In this second part, I hope to explain why many of us in public health believe it is essential to change the built environment if we are going to have a more active California.
  • Streets are one of the main public spaces in our communities. They need to be designed for people, not just cars and they need to be friendly to all users: cars, cyclists and pedestrians.
  • Neighborhood residential streets need to be designed so that drivers feel comfortable traveling at moderate speeds. We don’t want our neighborhood streets to function as highways or freeways.
  • While 4-foot wide sidewalks meet legal requirements in most cities, ideally we should be building our sidewalks to be five feet wide.
  • Getting Healthy Outdoors

    1. 1. Getting Healthier Outdoors Lisa A. Cirill, M.S., P.A.P.H.S., Chief California Active Communities California Department of Public Health
    2. 2. 78% of children fall short of the recommended minimum dose of active play Physical Inactivity
    3. 3. Physical Inactivity in Youths and Adolescents <ul><li>1 in 7 youth ages </li></ul><ul><li>6 – 19 is overweight </li></ul><ul><li>Children spend </li></ul><ul><li>more time watching </li></ul><ul><li>television in a year than they do attending school </li></ul><ul><li>35% of children watch 5+ hours of TV a day </li></ul>
    4. 4. Children don’t walk anymore : Our Kids Are in Trouble! <ul><li>In the 1970s, 70% </li></ul><ul><li>of youngsters walked </li></ul><ul><li>or rode bikes to school </li></ul><ul><li>Today, only 14% </li></ul><ul><ul><li>walk or bike </li></ul></ul>
    5. 5. Unfit Children <ul><li>Annual California Fitnessgram </li></ul><ul><ul><li>Conducted in Grades 5, 7, and 9 </li></ul></ul><ul><ul><li>Measures 6 major fitness areas </li></ul></ul><ul><ul><li>(e.g. aerobic capacity, body composition, flexibility) </li></ul></ul><ul><ul><li>2008 Results: Who passed all standards? </li></ul></ul><ul><li>29%  Grade 5 </li></ul><ul><li>34%  Grade 7 </li></ul><ul><li>38%  Grade 9 </li></ul>
    6. 6. Prevalence (%) of overweight among children and adolescents Average 11 year old boy today is 11 pounds heavier than in 1973
    7. 7. Do Obese Children Become Obese Adults? <ul><li>About a third (26-41%) of obese preschool </li></ul><ul><li>children are obese as adults </li></ul><ul><li>About half (42-63%) of obese school-aged </li></ul><ul><li>children are obese as adults </li></ul>
    8. 8. <ul><li>If the current trend continues, of those children born in 2000: </li></ul><ul><ul><ul><li>32.8% of boys and 38.5% of girls will </li></ul></ul></ul><ul><ul><ul><li>develop diabetes </li></ul></ul></ul><ul><ul><ul><li>Close to 50% of African </li></ul></ul></ul><ul><ul><ul><li>American and Latino </li></ul></ul></ul><ul><ul><ul><li>children will develop </li></ul></ul></ul><ul><ul><ul><li>diabetes </li></ul></ul></ul>Diabetes Link to Obesity
    9. 9. <ul><ul><li>25% of all adults are sedentary </li></ul></ul><ul><ul><li>Most are low-income and people of color </li></ul></ul><ul><ul><li>> 20% get 30 minutes of PA at least 5 days/wk </li></ul></ul>Physical Inactivity in Adults
    10. 10. Obesity Trends* Among U.S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    11. 11. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
    12. 12. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
    13. 13. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
    14. 14. Obesity Trends* Among U.S. Adults BRFSS, 1989 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    15. 15. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
    16. 16. Obesity Trends* Among U.S. Adults BRFSS, 1991 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    17. 17. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    18. 18. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    19. 19. Obesity Trends* Among U.S. Adults BRFSS, 1994 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    20. 20. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    21. 21. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    22. 22. Obesity Trends* Among U.S. Adults BRFSS, 1997 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    23. 23. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    24. 24. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    25. 25. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    26. 26. Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
    27. 27. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    28. 28. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    29. 29. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    30. 30. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    31. 31. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    32. 32. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    33. 33. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    34. 34. 1999 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI  30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    35. 35. Impact of Our Legacy? <ul><li>1/3 of all children will be diabetics </li></ul><ul><li>Life span shortened by 15 years </li></ul><ul><li>1st generation in history </li></ul><ul><li>who may not live as long </li></ul><ul><li>as their parents </li></ul>
    36. 36. <ul><li>All adults should perform 30 or more minutes of moderate-intensity physical activity on most, and preferably all days (either in a single session or accumulated in multiple bouts, each lasting at least 10 minutes) </li></ul><ul><li>Children should accumulate at least 60 minutes </li></ul><ul><li>of physical activity/active play per day </li></ul><ul><li>CDC-ACSM, 2007 </li></ul>Physical Activity Guidelines
    37. 37. Benefits of Physical Activity <ul><li>Increases life span by 2 years </li></ul><ul><li>Reduces risk of CVD by 40% </li></ul><ul><li>Prevents/manages high BP and Diabetes </li></ul><ul><li>Decreases risk of breast and colon cancers </li></ul><ul><li>Improves mood and mental health </li></ul><ul><li>Contributes to weight control </li></ul><ul><li>Health care costs for active adults are $300-$400 less per year </li></ul><ul><li>U.S. Surgeon General’s Report, 1996 </li></ul>
    38. 38. Promoting exercise has not worked Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System Trend in Recommended Physical Activity
    39. 39. Contributing Factors <ul><li>VERY complex! </li></ul><ul><li>Variety of factors play a role: </li></ul><ul><ul><li>behavior </li></ul></ul><ul><ul><li>environment </li></ul></ul><ul><ul><li>genetic </li></ul></ul><ul><ul><li>culture </li></ul></ul><ul><ul><li>socioeconomic status </li></ul></ul>
    40. 40. Environmental Factors <ul><li>Changes are taking place in a variety of settings </li></ul><ul><li>that negatively impact our choices: </li></ul><ul><ul><li>home (e.g. too much screen time) </li></ul></ul><ul><ul><li>school (e.g. lack of physical activity options) </li></ul></ul><ul><ul><li>work (e.g. poor access to stairs, no locker rooms) </li></ul></ul><ul><ul><li>community (e.g. parents reluctant to let kids roam free to play, unsafe streets, urban sprawl) </li></ul></ul>
    41. 41. Walkable neighborhoods encourage trips by bike and foot People in traditional neighborhoods are more likely to walk to nearby shops. Handy, S.L. Transportation Research Record 1996
    42. 42. Walking for transport and overweight in children Based on data from the Nationwide Personal Transportation Survey and the Centers for Disease Control and Prevention.
    43. 43. Walking for transport and overweight in adults Based on data from the Nationwide Personal Transportation Survey and the Centers for Disease Control and Prevention.
    44. 44. Traditional Vs. Suburban Designs Illustration: Frank, LD “Health & Community Design” Greenwald, M.J. Transportation Research Record 2001
    45. 45. The Built Environment = More Risks Than Just Obesity <ul><li>Diabetes </li></ul><ul><li>Cancers </li></ul><ul><li>Heart disease </li></ul><ul><li>Injury </li></ul><ul><li>Asthma </li></ul><ul><li>Bone health </li></ul><ul><li>Impotence </li></ul><ul><li>Depression, stress </li></ul><ul><li>Air quality </li></ul><ul><li>Noise </li></ul><ul><li>Climate change </li></ul><ul><li>Sense of community </li></ul><ul><li>Crime/violence </li></ul><ul><li>Economic vitality </li></ul><ul><li>Children’s development </li></ul>
    46. 46. Americans Keep Driving More
    47. 47. Over 36 M Served
    48. 48. Taking a step in the right direction Signs to promote stair use are effective and inexpensive
    49. 49. Pedometer Programs - StepFit Chico a pedometer walking program in which all fifth grade students of the Chico Unified School District participate in a four week walking program Increasing Physical Activity
    50. 50. Shift people from cars to walking and biking
    51. 51. Trees and Public Health What do trees have to with public health? <ul><li>Nothing </li></ul><ul><li>Something </li></ul><ul><li>Everything </li></ul>
    52. 52. Nothing <ul><li>Trees are just pretty </li></ul><ul><li>Trees cause allergies </li></ul><ul><li>and drop limbs and </li></ul><ul><li>messy debris </li></ul><ul><li>Funding for greening is </li></ul><ul><li>funding that could have </li></ul><ul><li>gone towards health </li></ul><ul><li>promotion </li></ul>
    53. 53. Something <ul><li>Trees clean our air </li></ul><ul><li>Trees clean our water </li></ul><ul><li>Trees help prevent </li></ul><ul><li>flooding </li></ul><ul><li>Trees reduce urban </li></ul><ul><li>heat islands </li></ul><ul><li>Parks support physical </li></ul><ul><li>activity and recreation </li></ul>
    54. 54. Everything <ul><li>Trees are essential for a </li></ul><ul><li>healthy human habitat </li></ul><ul><li>Trees enable us to thrive; </li></ul><ul><li>socially, physically and </li></ul><ul><li>psychologically </li></ul><ul><li>Funding for greening is </li></ul><ul><li>funding for health </li></ul><ul><li>promotion </li></ul>
    55. 55. <ul><li>Humans evolved in nature – 99.5% of the last 2 million years we have been embedded in the natural environment </li></ul><ul><li>Mobile organisms are drawn toward fit habitats </li></ul><ul><li>- Habitat selection theory </li></ul><ul><li>- Environmental preference as a marker </li></ul><ul><li>for fit habitat </li></ul>Trees Are Essential
    56. 56. What Are Humans Drawn To
    57. 57. Tree Deprivation <ul><li>Humans deprived of nature undergo social, physical and psychological breakdown </li></ul><ul><li>How would we tell? Compare humans living in conditions varying in greenness </li></ul><ul><li>- Intensity of greenness </li></ul><ul><li>- Proximity of trees and other green elements </li></ul><ul><li>- Exposure to green views and places </li></ul>
    58. 58. Robert Taylor Homes “ low green” Robert Taylor Homes “ high green”
    59. 59. Ida B. Wells “ low green” Ida B. Wells “ high green”
    60. 60. Social Breakdown <ul><li>Strength of community </li></ul><ul><li>Courtesy, mutual support </li></ul><ul><li>Supervision of children outdoors </li></ul><ul><li>Graffiti, noise, litter </li></ul><ul><li>Loitering, illegal activity </li></ul><ul><li>Property crime </li></ul><ul><li>Aggression, violence </li></ul><ul><li>Violent crime </li></ul>
    61. 61. Aggression, Crime and Violence <ul><li>Significantly more total aggression, physical aggression, violence, and severe violence in </li></ul><ul><li>“ low green” places and buildings </li></ul><ul><li>Aggression is tied to mental fatigue </li></ul><ul><li>Significantly more total crime, property crime, violent crime in “low green” places and buildings </li></ul><ul><li>- Explains 7% of variance in crime </li></ul>
    62. 62. Physical Breakdown <ul><li>Poorer recovery from surgery </li></ul><ul><li>Self-reported physical health </li></ul><ul><li>Obesity in children </li></ul><ul><li>Mortality rates </li></ul>
    63. 63. Psychological Breakdown <ul><li>Attention </li></ul><ul><li>Learning </li></ul><ul><li>Management of major life issues </li></ul><ul><li>Impulse control </li></ul><ul><li>Delay of gratification </li></ul><ul><li>Well-being (mood, life satisfaction) </li></ul><ul><li>Attention Deficit/Hyperactivity Disorder (AD/HD) </li></ul><ul><li>symptoms </li></ul>
    64. 64. AD/HD National Survey <ul><li>AD/HD symptoms after different activities in different settings </li></ul><ul><li>AD/HD symptoms in general </li></ul><ul><li>“ Green Advantage” consistent across age, gender, size of community, part of the country </li></ul><ul><li>and diagnosis </li></ul>
    65. 65. Bottom Line <ul><li>Humans in less natural environments show all the signs associated with unfit habitats: </li></ul><ul><li>- Social breakdown </li></ul><ul><li>- Physical breakdown </li></ul><ul><li>- Psychological breakdown </li></ul>
    66. 66. What the Evidence Tells Us <ul><li>Emergent Findings </li></ul><ul><li>How much greenness? Every bit helps </li></ul><ul><li>In what forms? In almost all forms – but exposure is key </li></ul><ul><li>For whom? Everyone, especially the vulnerable </li></ul>
    67. 67. Trees Are “Vitamin G” <ul><li>Integrate nature into the </li></ul><ul><li>urban fabric </li></ul><ul><li>Greening at many scales </li></ul><ul><li>and in many forms </li></ul><ul><li>Special attention must be </li></ul><ul><li>given to children, older </li></ul><ul><li>adults and underserved </li></ul><ul><li>populations </li></ul>
    68. 68. What is an Activity-Friendly Environment? <ul><li>A place that makes it easy to choose to be </li></ul><ul><li>physically active, through planned exercise </li></ul><ul><li>or routine daily activity </li></ul>
    69. 69. Activity-Friendly Communities <ul><ul><li>Need to design for : </li></ul></ul><ul><ul><li>Active recreation </li></ul></ul><ul><ul><li>Active transport </li></ul></ul>
    70. 70. Activity-Friendly Communities <ul><li>Physical activity is: </li></ul><ul><li>Incidental </li></ul><ul><li>Functional </li></ul><ul><li>Safe </li></ul><ul><li>Accessible </li></ul><ul><li>Pleasing </li></ul><ul><li>Normal </li></ul>
    71. 73. Complete Streets
    72. 74. Complete Streets Movement <ul><li>Pedestrians, bicyclists, motorists and public transit users of all ages and abilities are able to safely move along and across a complete street </li></ul>
    73. 75. Principles of Healthy Streets <ul><li>Streets designed for people - </li></ul><ul><li>not just cars </li></ul>
    74. 76. Principles of Healthy Streets <ul><li>Streets designed so drivers feel comfortable at slow speeds: </li></ul><ul><ul><li>15-25 mph on neighborhood streets </li></ul></ul><ul><ul><li>25-35 mph on avenues and boulevards </li></ul></ul>
    75. 77. Healthy Streets Need Good Sidewalks <ul><li>Detached from curb </li></ul><ul><li>At least 5 feet wide </li></ul><ul><li>Planting strip helps shade streets and sidewalk </li></ul>
    76. 78. Connect Sidewalks and Trails
    77. 79. Access to Transit
    78. 80. We impact the freedom of all residents, especially children and seniors, when we fail to provide complete streets Safe Access to Places and Spaces
    79. 81. Greenways, Trails and Open Space
    80. 82. <ul><li>Infrastructure </li></ul><ul><li>Non-infrastructure </li></ul>Safe Routes to School Movement
    81. 83. Does Design Make a Difference for Kids? More children walk to school where there are sidewalks Marin County SR2S – safety, encouragement and street improvements – 64% increase in kids walking CA SR2S – 15% of kids walked or biked more after physical improvements (vs. 4% w/ no improvements)
    82. 84. Then... Now… Schools: Then and Now
    83. 85. From this school district’s website: “ This 38-acre campus is located on Interstate 680 between rolling hills of bean and corn fields in southwest Iowa.” School Siting and Design
    84. 86. Placement of Schools <ul><li>Well located schools : </li></ul><ul><li>Encourage kids to walk and bike to school </li></ul><ul><li>Discourage car trips that damage environment </li></ul><ul><li>Serve as neighborhood </li></ul><ul><li>centers that improve the </li></ul><ul><li>physical and social health </li></ul><ul><li>of residents </li></ul>
    85. 87. Joint-Use Facilities www.jointuse.org
    86. 88. Unstructured Play Areas
    87. 89. Other Unstructured Play Areas
    88. 90. Unstructured Play Areas = Active Play
    89. 91. Building Physical Activity Back Into Our Daily Lives
    90. 92. Building on the Initiatives Partnerships
    91. 93. “ Healing the broken bond between our young and nature is in our self-interest.” Children in Nature Movement No Child Left Inside!
    92. 94. Yikes…
    93. 95. National Physical Activity Plan <ul><li>Public Health </li></ul><ul><li>Education </li></ul><ul><li>Parks and Recreation, Fitness/Sports </li></ul><ul><li>Healthcare </li></ul><ul><li>Non-profits, Volunteer Groups </li></ul><ul><li>Media </li></ul><ul><li>Land Use and Transportation </li></ul><ul><li>Business and Industry </li></ul><ul><li>-- Safety and Diversity </li></ul>
    94. 96. National Physical Activity Practitioners in Public Health <ul><li>Mission: </li></ul><ul><li>Elevate physical activity as a public health priority </li></ul><ul><li>Build a cadre of physical activity specialists at the </li></ul><ul><li>national, state and local levels </li></ul><ul><li>Provide professional development opportunities </li></ul><ul><li>- Each state public health department has a PA Lead </li></ul><ul><li>-- Some states have PA Leads at the local level </li></ul>
    95. 97. American Association of Public Health Physical Activity Special Primary Interest Group <ul><li>Provide physical activity education track at APHA </li></ul><ul><li>annual conference which welcomes over 15,000 </li></ul><ul><li>public health professionals </li></ul><ul><li>Advance physical activity policy and best </li></ul><ul><li>practices at the national, state and local levels </li></ul>
    96. 98. A Vision for California: 10 Steps for Healthy Living <ul><li>Californians will understand the importance of physical activity and healthy eating, and they will make healthier choices based on their understanding. </li></ul><ul><li>Everyday, every child will participate in physical activities. </li></ul><ul><li>California’s adults will be physically active every day. </li></ul><ul><li>4. Schools will only offer healthy foods and beverages to students. </li></ul><ul><li>Only healthy foods and beverages will be marketed to children ages 12 and under. </li></ul><ul><li>6. Produce and other fresh, healthy food </li></ul><ul><li>items will be affordable and available in </li></ul><ul><li>neighborhoods. </li></ul>7. Neighborhoods, communities and buildings will support physical activity, including safe walking, stair climbing, and bicycling. 8. Healthy foods and beverages will be accessible, affordable, and promoted in grocery stores, restaurants, and entertainment venues. 9. Health insurers and health care providers will promote physical activity and healthy eating. 10. Employees will have access to physical activity and healthy food options.
    97. 100. Governor Endorsed
    98. 101. - California Governor Arnold Schwarzenegger - California Council of YMCAs - California Biodiversity Council - San Mateo County Park District - East Bay Regional Park District - Los Angeles County - California Park and Recreation Society - Pacific Stewardship Council - City of Glendale - California State Park and Rec. Commission - City of Roseville and Roseville PAL - California State Park Rangers Association - San Luis Obispo County Endorsements
    99. 102. Common Interests Improving society’s health and well being: <ul><li>- U.S. HHS and CDC </li></ul><ul><li>- State Public Health Depts. </li></ul><ul><li>- Local Public Health Depts. </li></ul><ul><li>- Non-profits </li></ul><ul><li>- Universities </li></ul><ul><li>Foundations </li></ul><ul><li>Health care systems </li></ul>
    100. 103. <ul><li>Develop, fund and </li></ul><ul><li>implement policies </li></ul><ul><li>and programs </li></ul><ul><li>Gather data and </li></ul><ul><li>conduct research </li></ul><ul><li>Provide educational </li></ul><ul><li>materials and forums </li></ul>Partners …. <ul><li>Provide direct care and </li></ul><ul><li>funding for public/patients </li></ul><ul><li>Funds physical activity </li></ul><ul><li>promotion and programs </li></ul><ul><li>Includes HMOs, hospitals, </li></ul><ul><li>senior centers, rehab facilities, </li></ul><ul><li>physicians, nurses and other </li></ul><ul><li>allied health </li></ul>
    101. 104. <ul><li>Framework for activities with diverse audiences </li></ul><ul><li>Promotes active lifestyles </li></ul><ul><li>Involves family and community </li></ul><ul><li>Introduces children to outdoor settings </li></ul>Improving Health
    102. 105. <ul><li>CDPH Physical Activity Specialists </li></ul><ul><li>California Convergence </li></ul><ul><li>- Healthy Eating, Active Living (HEAL) </li></ul><ul><li>- Healthy Eating, Active Communities (HEAC) </li></ul><ul><li>- Central Region Obesity Prevention Program </li></ul><ul><li>(CROPP) </li></ul><ul><li>- Communities of Excellence (CX3) </li></ul>Other Partners
    103. 106. Key Partners <ul><li>Local Elected Officials </li></ul><ul><li>Architects and Urban Designers </li></ul><ul><li>Parks and Recreation </li></ul><ul><li>Land Use Planners </li></ul><ul><li>Transportation Engineers </li></ul><ul><li>Public Health </li></ul><ul><li>School Officials </li></ul><ul><li>Advocacy Groups </li></ul><ul><li>Businesses </li></ul><ul><li>Non-Profit Organizations </li></ul><ul><li>Law Enforcement </li></ul><ul><li>Emergency Services </li></ul>
    104. 107. - Trainings (101, 201, HIA) - Teleconferences - Mini-grants ($5 - $10K) Increases local public health departments’ skills and abilities to impact community planning and transportation decisions and engage in efforts that reduce vehicle miles traveled Integrating Public Health into Community Design
    105. 108. Encourage development of sustainable communities, promote equity, public health and safety: Policies/Strategies <ul><li>Health language in General Plans </li></ul><ul><li>Complete Streets Policies </li></ul><ul><li>SRTS Policies and Programs </li></ul><ul><li>Bike and Pedestrian Master Plans </li></ul><ul><li>Working relationships with local/regional </li></ul><ul><li>planning departments or agencies </li></ul>
    106. 109. Policy for Good of the Community <ul><li>Can define local government’s role in PA </li></ul><ul><li>Focus on what a community can control </li></ul><ul><ul><li>Physical environment: greening; architecture; geography; roads; sidewalks; public lands, access to community facilities; funding for physical activity </li></ul></ul><ul><ul><li>Social environment: culture; economics; politics </li></ul></ul>
    107. 110. Policy Successes <ul><li>Roseville : Joint use agreements between city and schools; hold regular forums with school boards and city council </li></ul><ul><li>Sacramento : Park and Recreation Master Plan address issue of obesity and wellness </li></ul><ul><li>Chino : City council and school </li></ul><ul><li>board adopted resolution for </li></ul><ul><li>“ Healthy Chino 2005” </li></ul><ul><li>(America’s Promise Award) </li></ul>
    108. 111. What’s Working: Collaborations <ul><li>County-wide P/R initiatives : </li></ul><ul><ul><li>Greater San Diego Recreation and Parks Coalition for Health and Wellness </li></ul></ul><ul><ul><li>S.F. P/R Health and Wellness Fights Obesity TF </li></ul></ul><ul><ul><li>Los Angeles County “Healthy Parks Initiative” </li></ul></ul><ul><li>iSalud! Salinas Steps to Health : </li></ul><ul><ul><li>American Lung Assoc., Monterey Co. Ofc. on Aging, Office of Education, CSU-Monterey Bay, Stanford, Salinas Ministerial Association, Monterey Co. Insurance Group, Agriculture Growers/Shippers Assoc. </li></ul></ul>
    109. 112. What’s Working: Collaborations <ul><li>Tracy : “My Own Marathon” (community and teachers); “Tracy for Teens” collaborative with Sutter Tracy Community Hospital </li></ul><ul><li>Coronado : Parks and Rec staff leads active games/activities during school lunch time </li></ul><ul><li>City of Sacramento : Insurance company, hospital chain, dental firm, and CSUS nursing school created “Healthy Kids Project,” day camp program to teach nutrition and PA to kids and parents </li></ul>
    110. 113. What’s Working: Collaboration <ul><li>Fresno : after school fitness program at 53 primary schools; partners with Fresno County Office of Education and Mayor’s Fitness Council </li></ul><ul><li>La Mesa : Community Wellness TF of school districts, adult education, medical personnel, YMCA, community members </li></ul><ul><li>Redwood: City : Distributed free pedometers to public; partnering with Sequoia Hospital to train staff and youth in programs </li></ul><ul><li>Moreno Valley : Fitness 19 (private club now located in community center) and private day care provider available for parents </li></ul>
    111. 114. <ul><li>Parks as Centers of Community </li></ul><ul><ul><li>Parks are open for services and activities before, during and after-school, on weekends and in the summer </li></ul></ul>Power of Parks
    112. 115. Power of Place <ul><li>525 local park and recreation agencies – widely recognized as a community asset </li></ul><ul><li>Thousands of acres of park land and open space </li></ul><ul><li>Active infrastructure: swimming pools, gyms, community centers, senior centers, teen centers, skate parks, trails, bike paths, sports fields, lakes, ice rinks, tennis courts, parks </li></ul><ul><li>Parks provide an </li></ul><ul><li>opportunity to reach </li></ul><ul><li>underserved populations </li></ul>
    113. 116. Walkability Audits
    114. 117. More Trees
    115. 118. First Friend
    116. 119. Tree Stewardship
    117. 120. Greenways and Trails
    118. 121. Community Trees
    119. 122. Great Places Bring People Together
    120. 123. Tree Placement Reduces Criminal Activity <ul><li>Crime Prevention through Environmental Design Institutes for planners, architects and law enforcement professionals </li></ul><ul><li>Out of four principles, two focus on improving </li></ul><ul><li>safety through placement of greenery </li></ul><ul><li>- maximizes visibility by proper placement and spacing </li></ul><ul><li>* street trees for shade and protection </li></ul><ul><li> * low shrubs along buildings or pathways to </li></ul><ul><li>control access points </li></ul>
    121. 124. Infill Projects
    122. 125. Trees: Camouflage and Protection
    123. 126. Trees Are Our Friends <ul><li>Every city and unincorporated area should have </li></ul><ul><li>a tree ordinance establishing the following: </li></ul><ul><li>Existing trees in cities and unincorporated areas be maintained and preserved </li></ul><ul><li>New developments and revitalization projects include a designated number of trees </li></ul><ul><li>Perimeter of school sites and other public facilities are tree-lined and grounds contain sufficient amount of shade trees and edible trees </li></ul><ul><li>Streetscapes include shade trees every 30’ to 50’ </li></ul><ul><li>Parks, greenways and open spaces serve as community urban forests </li></ul>
    124. 127. Lisa A. Cirill, M.S., P.A.P.H.S. Chief California Active Communities California Department of Public Health Tel: (916) 552-9943 Fax: (916) 552-9912 Email: [email_address] www.CAactivecommunities.org

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