Physical Activity Policy Interventions: The Big Opportunities In Our Cities Enrique Jacoby PAHO/WHO

LEADING RISK FACTORS FOR GLOBAL MORTALITY High blood pressure13% Tobacco use 9% High blood glucose 6% Physical inactivity 6% Overweight & obesity 5%

LEADING RISK FACTORS FOR GLOBAL MORTALITY High blood pressure13% Tobacco use 9% High blood glucose 6% Physical inactivity 6% Overweight & obesity 5%

RECREATION WORK DOMESTIC TRANSPORT

RECREATION WORK DOMESTIC TRANSPORT

Adults should do at least 150’ of moderate- intensity aerobic p.a. throughout the week OR at least 75’ of vigorous-intensity a.p.a. throughout the week WHO, Global Recommendations on Physical Activity for Health, 2010

1999

Exercise is good for your health

Physically Active Adults Overweight Exercise is good for your health

Participation Adherence

Education and Communication approaches School and Workplace interventions/policies WHO, Interventions on diet and physical activity: What Works, 2009 Urban policies: Transport & Land Use and Recreation

Health 1 LAND USE POLICIES: PROXIMITY & CONNECTIVITY TRANSPORT OPTIONS 2

Enrique Jacoby, OPS Walk / Bike to work 3-7 Km per day (3-5 d/wk) Improve CR fitness (Hendriksen, 2000; P. Oja, Vuori I, et.al. 1998) Weight Control (Vuori I, 94; Boyd, 98; Bell et.al, 02; Wen&Rissel, 08) ↓ CVD risk (SR: Cavill&Davis, 2007; Meta-A N=18: Hamer & Chida, 2008) Health Impact

In 8-year: Kg

Enrique Jacoby, OPS 40% reduction in mortality (Anderson et. al., 2000) 40% reduction in mortality DBT and CV (Matthews, 2007) All-cause mortality (n=18): (Meta-A N=18 Hamer and Chida, 2008) Mortality Walk / bike to work 7-10 Km per day

Health LAND USE POLICIES: PROXIMITY & CONNECTIVITY TRANSPORT OPTIONS 2

Where do you live?

Enrique Jacoby, OPS Active Transportation and Obesity Rates (Basset y col, 2008)

Transportation options and urban development: Cuasi-exp Portland, Oregon Ohland 2006

FACTOREFFECTSTUDIES Density and Diversity + Walking, Biking - Polution + Quality of Life 95/3 Street Connectivity + Walking, Biking 29/1 Active Transportation + Walking, Biking - Polution 58/4 Hosking J et.al WHO Report, unpublished

55% of Bogotanos are physically active LF Gomez y col., 2004

37% 55% of Bogotanos are physically active LF Gomez y col., 2004

37% 3% 15% 55% of Bogotanos are physically active LF Gomez y col., 2004

Enrique Jacoby, OPS +200 km of bikepaths 2.5 to 4.12 m 2 Green Areas m2 100 km de Ciclovia +120 km TransMilenio

3 Bogota A TransMilenio user, compared to a non user, is 70% more likely to be “physically active”

Health 2 LAND USE POLICIES: PROXIMITY & CONNECTIVITY TRANSPORT OPTIONS: MOBILITY

Health 2 COMPACT DEVELOPMENT MASS PUBLIC TRANSPORTATION

Spillover benefits

Spill over

Enrique Jacoby, OPS IV Congreso de Transporte Sustentable Ciudad de Mexico, octubre Liters of gas per person / year

Annual miles in mass transportation Road deaths and mass public transport use Deaths /100,000

Physical activity and health Pollution reduction Road safety Mental health Affordability Mobility

Annual miles per capita Mileage Change SuburbanGood Transit TOD Automobile base-case Transit travel base-case Walking base-case Cycling base-case2139 T Litman, Evaluating public transportation health benefits, June 2010

Annual health benefits when 1-m residents move TOD BENEFITSFrom 10% to 20%From 10% to 40% ROAD SAFETY55 m151 m ↓ EMISSIONS3.3 m9 m WALKING11.5 m52.6 m CYCLING0.8 m2.9 m TOTAL BENEFITS 71 m216 m T Litman, Evaluating public transportation health benefits, June 2010

Ciclovias

Enrique Jacoby, OPS Bogota

Guadalajara

Mexico City

41% of Ciclovia’s participants in Bogota participate 3 hours: Cycling (49%), running or walking (36%) and roller-skeating (38%) If Ciclovia were not in operation 60% would pursue sedentary activities

Average cost per user per year (USD) of different physical activity programs Montes F et.al. Cost-benefit of Ciclovias, unpublished

Cost-Benefit ratio of Bogotá’s Ciclovía for every Dollar invested: 5-year simulation using different values for the Direct Health Benefit Montes F et.al. Cost-benefit of Ciclovias, unpublished