Creating Healthy Environments

Practical Tools for Increasing Walking in the Built Environment

2 Evidence and Policy
2.1 Health and Physical Activity

Living Streets is the national charity that stands up for pedestrians. With our supporters we work to create safe, attractive and enjoyable streets, where people want to walk.

2.1 Health and Physical Activity

There is strong evidence that physical activity can play a very positive role in promoting good health and mental well-being and can help to protect against many of the chronic diseases that contribute to Scotlands very poor health record coronary heart disease, obesity, type II diabetes, some cancers, depression, anxiety and hypertension. Adults should accumulate at least 30 minutes of moderate-intensity activity on five days of the week. Children should accumulate at least one hour of moderate-intensity activity daily. People who are considered physically active meet these recommended minimum levels of activity. However, 61% of Scottish adults and 36% of children do not meet these minimum recommended levels. Physical activity, or more precisely, physical inactivity, is one of Scotlands major public health issues. Physical activity is a broad term that incorporates a wide range of activities, including active living (walking or cycling for everyday journeys, housework or gardening); exercise (cycling, jogging, walking, aerobics); sport; play; and dance.

The Benefits of Physical Activity

The health benefits of reducing the level of inactivity in the population in Scotland are immense. Two thirds of adults and one third of children are overweight in Scotland, with over a million adults and over 150,000 children clinically obese. Scotland as a whole has the highest levels of obesity in Europe and one of the highest levels of obesity in OECD countries, behind only the USA and Mexico.1 Physical activity for children and adults helps to prevent weight gain. Obesity may be prevented and treated by making lifestyle changes such as increasing physical activity.2 People who lead an active lifestyle over several years have a reduced risk of suffering symptoms of clinical depression.3 Older people are particularly at risk from poor mental health due to social isolation. Walking provides an opportunity for social contact for people at risk of social isolation.4 Physically active people have a 2030% reduced risk of premature death and can cut the risk of developing a major chronic disease such as coronary heart disease, stroke, type II diabetes and some types of cancer by up to a half. Individuals who are active are 1.9 times less likely to have a heart attack than their inactive contemporaries.5 Promoting physical activity has significant benefits beyond health improvement. It can help to deliver a wide range of other priority outcomes for the nation and there is a strong economic argument in favour of promoting physical activity. Increasing physical activity can help to reduce preventable disease and disability. such as strokes, coronary heart disease, obesity and back pain, a major source of working days lost. It can also contribute to reducing symptoms of depression and anxiety, which impact on levels of sickness and .............................................................................................................
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Preventing Overweight and Obesity in Scotland. A Route Map Towards Healthy Weight, The Scottish Government 2010 http://www.scotland.gov.uk/Publications/2010/02/17140721/0 2 SIGN 115, 2010 Management of Obesity: a national clinical guideline http://www.sign.ac.uk/guidelines/fulltext/115/index.html 3 The Mental Health Foundation, 2005, Up and Running? London http://www.mentalhealth.org.uk/publications/?entryid5=38570&char=U 4 Walking the Way to Health Initiative, 2006, National Evaluation of Health Walk Schemes, WHI www.whi.org.uk/uploads/documents/2335/National%20evaluation%20-%20THE%20FULL%20THING.pdf 5 Blair et al, 1992, How much physical activity is good for health? Annual Review of Public Health, 13, 99-126

absence from work. Environments which are conducive to physical activity can increase the attractiveness of a place and help to attract tourists and visitors who are interested in active leisure.

Walking as part of everyday life: easy, inclusive, cheap Encouraging people to walk or cycle for everyday journeys such as travelling to work, school or trips to shops and other facilities, instead of taking their car reduces congestion on our roads and would make an important contribution to climate change targets. Reducing traffic levels also has added health benefits in that it contributes towards reducing accidents and deaths on roads, lowers noise pollution which has significant mental health benefits and reduces air pollution which exacerbates many diseases such as asthma. Improving health and well-being in target groups and communities reduces health and social inequalities, thereby contributing to the Scottsh Governments Strategic Objectives. The chart below illustrates the disparity in levels of physical activity across social class. This demonstrates the importance of encouraging and facilitating greater levels of physical activity, and thereby contributing to improved health, in areas of deprivation.
No Participation In Any Activity By Scottish Index of Multiple Deprivation 40 35 30 25

% 20
15 10 5 0 1st Most Deprived 2nd 3rd 4th 5th Least deprived

SIMD
Source: Scottish Household Survey 2009
http://www.scotland.gov.uk/Publications/2009/09/01114213/23

Policies for Physical Activity

One of the Scottish Governments five Strategic Objectives, shared by all Scotlands local authorities, is to create a Healthier Scotland: Help people to sustain and improve their health, especially in disadvantaged communities. The contribution that local authorities can make towards health improvement through promoting physical activity, removing the barriers to people being active and creating environments in which people will be encouraged to be physically active is now accepted but not always applied fully. The crucial link between health and physical activity has been recognised in various national policies and strategies which are being translated into action by local authorities and the National Health Service (NHS).

Lets Make Scotland More Active: The National Strategy for Physical Activity
Lets Make Scotland More Active6 set out the National Strategy for Physical Activity to achieve the clear goal: To increase and maintain the proportion of physically active people in Scotland. In order to achieve its goal and to increase levels of physical activity, the national strategy set two national targets, one of which is: To have 50% of all adults and 80% of all children meeting the recommended levels of physical activity in 2022.

Recommended Levels of Physical Activity

ADULTS should accumulate 30 minutes of moderate activity on most days of the week. CHILDREN should accumulate at least one hour of physical activity daily.

The strategy set out four Strategic Objectives to reverse the trend towards reducing levels of activity and to achieve gradual improvements in the overall levels of physical activity across the entire population, including Objective 1: To develop and maintain long-lasting, high quality physical environments to support inactive people to become active. (see Section 2.2 Healthy Environments) Local government was identified as a key partner in delivering the National Strategy for Physical Activity because of the wide range of contributions that could be made by local authority services. For example, transport and planning policies and strategies can improve the built environment to encourage walking and cycling through measures such as reducing speed or volume of traffic, creating paths and links, improving lighting and creating mixed use neighbourhoods. .............................................................................................................
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Lets Make Scotland More Active: A Strategy for Physical Activity, 2003, Scottish Executive, http://www.scotland.gov.uk/Publications/2003/02/16324/17895

The National Strategy was reviewed in 2008 to gather views on what has been successful, what have been the key challenges and what are the future priorities. The Five-year review of Lets Make Scotland More Active7 concluded: The National Strategy remains an essential strategy to influence Scotlands inactive population Interventions that enhance the built environment can impact on large sections of the population. There is good recent evidence8 linking environments to physical activity, therefore the creation and provision of environments that encourage and support physical activity offers the greatest potential to get the nation active Given their responsibility for the key services that directly impact on physical activty (e.g. planing/ environment, transport, education, sports/recreation/ leisure) and as the lead authority in community planning, local authorities should be recognised as the most important local delivery agency for physical activity The commitment to physical activity across a range of government policies has been positive in the first five years of the Strategy. The Government needs to ensure physical activity continues to be a vital component of its public health work and also continues to be integrated into all relevant and related policy, e.g. education, environment, sports, transport.

What Makes A Living Street?

1. Direct walking links to places people want to go. 2. Clean and well maintained. 3. Local shops and services within walking distance. 4. Well-lit and safe, day and night. 5. Attractive and interesting in design. 6. Space to play and relax. 7. Well designed, clutter free pavements. 8. Places for people, not just traffic. 9. Local people involved in decision making. 10. Maps and signs to make it easy to walk.

Healthy Eating, Active Living

Another key national policy behind the drive to increase physical activity is Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008 2011).9 This outlines how the Scottish Government plans to tackle the growing obesity problem by encouraging greater physical activity through targeted interventions. .............................................................................................................
Fiveyear review of Lets Make Scotland More Active, 2009, Scottish Government, http://www.healthscotland.com/documents/3223.aspx 8 Foresight, 2007, Tackling Obesities: Future Choices http://www.foresight.gov.uk/OurWork/ActiveProjects/Obesity/Obesity.asp 9 Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008 2011, 2008, Scottish Government, http://www.scotland.gov.uk/Publications/2008/06/20155902/10
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Healthy Weight Communities

The Scottish Governments Healthy Eating, Active Living action plan set out the intention to establish a handful of Healthy Weight Communities across Scotland. These pathfinder programmes will aim to prevent obesity and associated illnesses, with an emphasis on addressing health inequalities. The objective of the Healthy Weight Communities will be to demonstrate the ways in which gathering together diverse projects, under the shared purpose of tackling obesity, may have a greater impact on health outcomes than dispersed activity. Local communities, families and young people in particular, will be engaged in programmes that embrace healthy eating, physical activity and healthy weight initiatives from a wide range of delivery partners. These programmes will take their lead from the valuable lessons from the EPODE programme in France and the evidence presented by the Foresight report Tackling Obesities. The French model illustrates how important popular promotion and championing by local leaders is to the success of community programmes such as these. Meanwhile the Foresight report is clear that isolated action is futile in our battle against the obesity epidemic. Only close partnership working that supports people to make healthy choices right across their daily routine will make a difference. In May 2009 the Scottish Government and COSLA notified the following successful communities of their inclusion in the programme: Viewpark, North Lanarkshire; Dundee; Dumfries; Priesthill & Househillwood, Glasgow; Armadale & Blackridge, West Lothian; Catrine, East Ayrshire; Barrhead, East Renfrewshire; Stevenston, North Ayrshire.

The Cost of Obesity to Scottish Society

Obesity is a growing and complex problem. It has been estimated that the total cost to Scottish society of obesity in 2007/2008 was over 457 million and this may be an underestimate. It is predicted that by 2030, adult obesity in Scotland could reach over 40% even with current health improvement efforts, an increase of more than 50% over 2008. The costs to NHS Scotland could double and the total cost to Scottish society could range from 0.9 billion to 3 billion. Beyond health costs, obesity can contribute to costs of infrastructure planning. Scottish Government have identified that an increasing number of people with severe obesity may bring about much greater costs, to housing, transport, social support as well as healthcare. The Foresight Report by the UK Government Office for Science, Tackling Obesities (2007) stated that if current trends are to continue across the UK at the present rate then by 2050 it is estimated the cost to the UKs health service will be almost 50 billion at todays prices.8

The Healthy Eating, Active Living Action Plan includes the Scottish Governments commitment to Living Streets work to campaign for environments conducive to physical activity and to take forward a number of key programmes including practical support for implementation of recent NICE guidance on physical activity and the environment, national walkability audits and development of community empowerment tools. The Scottish Government have identified a national indicator to reduce the rate of increase in the proportion of our children with their Body Mass index outwith a healthy range by 2018 and will identify a further outcome to cover the whole population. Walking and active travel have a role to play in delivering this outcome.

Equally Well
Tackling health inequalities is a key priority for the Scottish Government. Equally Well10 the report of the ministerial task force on health inequalities states increased healthy life expectancy is an important part of achieving the Governments overall purpose of creating a more successful country. It must also be achieved in a way that reduces disparities between richer and poorer and narrows the gap between Scotland's best and worst performing regions. Research11 has revealed reasons given by relatively inactive people for their inactivity: lack of time, including family responsibilities, work commitments or generally being too busy health-related issues such as a disability, fear of injury, being too old/frail lack of motivation, including not being bothered, not enjoying it, lack of a partner and fear of embarrassment availability/accessibility of facilities, including financial constraints, lack of information about or transport to facilities. The research also highlighted that those living in the most deprived areas were not as convinced of the benefits of exercise. The Equally Well report makes the point that: Peoples physical environment can have a really positive impact on their health and wellbeing. But poor quality surroundings can have the opposite effect. It states that: There is evidence of links between environmental factors and health inequalities. For example, people living in more deprived communities are at greater risk of many of the chronic health conditions associated with obesity; those who report the highest levels of local environmental bads are also more likely to suffer from anxiety, depression and poor general health. In Scotland, a clear linear pattern of increasing obesity with increasing deprivation is emerging for adult women in Scotland. .............................................................................................................
Equally Well: report of the Ministerial Task Force on Inequalities, 2008, Scottish Government http://www.scotland.gov.uk/Publications/2008/06/09160103/0 11 Sport, Exercise and Physical Activity, Barriers and Attitudes, 2006, Scottish Executive Social Research http://www.scotland.gov.uk/Publications/2006/09/29134901/0
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The Ministerial Task Force on health inequalities made nine recommendations, based on the link between health and physical activity, which are aimed at creating: better opportunities, especially for children and young people, to improve their health through enjoying the benefits of safe green and open spaces. Transport recommendations will make public services more accessible, as well as benefiting health through increasing walking and cycling. One of the eight Equally Well test sites being supported by the Scottish Government to generate examples of what works in reducing health inequalities is Glasgow Citys East End where the City Council and its partners are pioneering an integrated healthy urban planning approach to local development. (see 3.12 Integrating Health into Planning)

Preventing Overweight and Obesity in Scotland

In Preventing Overweight and Obesity in Scotland, A Route Map Towards Healthy Weight, Scottish Government identified a number of actions that it along with partners can take to prevent obesity and people becoming overweight. One commitment is that: We will create environments that make walking and cycling part of everyday life for everyone Critically this recognises that individuals will not change their travel habits without modifications to our physical and cultural environments so: We need to make walking and cycling accessible, safe and appealing enough to be the default means of travel for short and local journeys. The Route map makes it clear that both national and local government must support this shift towards active travel as a mainstream choice by considering how all our policies impact upon built environments so that they represent opportunities rather than barriers to active travel.

For example in practice, this means Scottish Government are committed to addressing obesity prevention
through active travel.1

Living Streets (The Pedestrians Association) is a Registered Charity No. 1108448 (England and Wales) and SC039808 (Scotland), Company Limited by Guarantee (England & Wales), Company Registration No. 5368409. Registered office 4th Floor, Universal House, 88-94 Wentworth Street. E1 7SA